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17855POST THIS CARD NEAR FRONT OF BUILDING a CITY Of.- CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' JOB ADDRESS 6Y Y� UNIT#_-LOT# V.. -�_}_ / OWNER O ._` c�.�-�. LU.t-e- l e- CONTRACTOR GU VA_ PERMIT NUMBER 17855 PERMIT EXPIRATION - PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN IOU DAYS OF PERMIT ISSU. ' ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR - INSPECTION RECORD FOUNDATION - NOTE:. ALL GRADING�AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. UFER - PREGUNITE PERMIT VALIDATION T^-•-y,. V1VL'l, ISSUANCE DATE GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED gay S jqAq '- UNDERGROUNDIISLAB PLUMBING' ELECTRICAL MECHANICAL BLDG. ELECT PLG. MecRt DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING .. MECHANICAL ELECTRICAL PER&I TTO FRAMING INSULATION - STORIES TYPE CONSTR. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .. OCC GROUP, -RES. UNITS ROOF' NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - _ so. ET ELooR AREA ,TOTAL ACREAGE DIAPHRAGM ROOF.SHEATHING BUILDING USE RES IND CON. PB OII„•, El ❑ ❑ 1-1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ASSESSORS PARCEL NO. PLUMBING ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO ' MECHANICAL - MECH. ENERGY' S/ ELECTRICAL BUILDING ENERGY .Acc DATE ACC FILE No. FRAMING ELECT.FINALTEST INSULATION PLUMBING ZONING - 'ENG. SITE NO, GAS TEST GAS - S _ ' MECHANICAL FIRE SPRINK- V ❑ N❑ ENERGY T24 ` ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING S;�S�, EXTERIOR SHEAR ELECTRICAL RELEASE PL000 ZONE r ❑ N❑ AL.V c. Y1 -1 N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEESUMMARY EXTERIOR LATH - BUILDING BUILDING. INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS 'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, H ONE WORKING DAY BEFORE REQUIRED INSPECTION. o PLEASE GIVE-JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL 23,03 CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE •CALLING FOR FINAL INSPECTION. TOTAL. 3�' 'A 00) OFFICE COPY • ZZ F N Lu j Q_ _ a.o Uo APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY' DENTIFICATIONPERMIT BUILDING PROJECTIDENTIFICATION , APPLICATION & PERMITaADDRESS -, ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBE 178 55 a 1 1OqQWBUILDING N�G`E\` OWNERS NAME PHONE o[ QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S NAVE OUTLETS - SWITCHES - RECEP_ 10.00/1.00 Lr7 5V__' 5c. No. 6W_L �-,��,, C up ' DATE OF APPLICATION LIGHTING FIXTURES 10.00/1.00, ADOREss rolls D PkI"{. LN)CPHONE CA -C31 PPLIANCES- RESIDENTIAL 4.00 PANELS .10.00 OARCHITECT ENGINEER LID. NO. PANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AARCH. OR DO REar ErvG. ZIP SPECIALCIRCUIT 5.00 PERMIT VALIDATION -S T-�r/ •l r TEMP. METER OR POLE INS. 20.00 Ar'r oREss ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20:00 LICENSED CONTRACTORS DECLARATION ` t 6� I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profess Cod a license is in full forth' L I License LIC. Number "CM Dale Contractor �Q n+ ,� OWNER -BUILDER DECLARATION I hereby art that I am exempt from the Contractor's License Law forthefollowing reason, (Sec.7W1.a Businessand tocontProfessions Code; Any city or county which requires e permit to construct, ISSUANCE DATE BLDG. ELECT. PLG. MECH. O ❑ ❑ QlWMYt ape1tino BUILDING PERMIT INFORMATIONirm MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC.- TOTAL improve, demolish, or repair any structure, prior to its issuance, also also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License PERMIT TO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ezempt therefrom and QTY. PLUMBING PERMIT FEE - eL the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant ton civil penalty of not mom than five hundred dollars (8500).): STORIES TYPE CONSTR. _ ALTER -DRAIN (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and lire structure is not BACKFLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of - FIXTURES - PER TRAP 5.00 - GAS -EA. SYSTEM INC. OUTLETS 6.00 property who builds or improves thereon, and who does such work improve- himself re,or ugh intends ownemployees,Carrs provided 1.ho evhat r, the ments are not intended Or offered' for sale. If• however, the building s2 FT. FLOOR AREA - TOTAL ACREAGE or improvement is sold within one year of completion, Ole owner.GAS builder will have tire be uNen of proving that he did not build or im. of sale.). prove 1, as owner ❑ as owner of the est property, y, am exclusively contracting wills - . EA. SYSTEM - OVER 4 (EA) 2.00 - BUILDING USE RES IND CON Pe Other C1 ❑ .❑ ❑ ❑ INDUSTRIAL WASTE INTER.. 30.00. ^ d ns licensed contractors to construct the project (Sec. 7044, Business Contractor's License s H does not apply and Professions Code: The who to owner of property who builds of improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS =OVER 5 (EA.) - 1.00 ASSESSORS PARCEL NO. tr contracts for such projects with a coniractor(s) licensed pursuant to the Contractor's License Law. � ❑ lam ezempt under Sea ,B.&P.C. fur this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL N0. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate .tem sent to self -insure. ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy Ihereot'(Sec. 3800, Lab.C.). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is tiled with the city inspection division. Applicant _ .FIRE SPRINK Y [] N[] ENERGY T 24 Y [3 NE] MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need net be completed if the permit is for one PERMIT ISSUANCE' 10.00 FLOOD ZONE • Y ❑ No A.L.U.C. Y ❑ NE] PLG. CONTR. LIC. NO. PLG , EA TOTAL hundred dollars IS 100) or less. I certify that in 16C performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE. FEE SUMMARY - BUILDING become bj�•.ct he Workers'�y6pen�Itiyn �'yypq��{ornia. Date �= @ Applicant s? vCSS�fu S71S.__ ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Fx- APPLIANCE 5.00 PLAN CHECK FEE ' emotion, you should become subject to lite Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10ADC.F.M.) 4.00 , AIR HANDLING UNIT (OVER IO,000C.RM.16.00 SEISMICFEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.0 O o I hereby affirm that there is a construction lending agency for the performance of The work for which this permit is issued (Sec. 3097, Civ.C.), MICROFILM Lender's Name Lender's Address HEATI NG UNIT(OV ER 100,000 B.T.U.) 9.50 ELECTRIC . I certify that I have read this application and state that the abo4 VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction• and PLUMBING BOILER -COMP (3 H. P. or 100,000 B,T.U.) 6.00 , L9 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL O�QV Hereby authorize representatives hf Othis city enter upon the above-mentioned property for inspection purposeses , - (We) all to Save• indemnify and keep harmless the City of MISC. - REFER TO ORD. uper. firm against I bilities, judgments, costs and expenses which aY i any Say cme ag nor said City in consequence of the old of this Pe iL - (Date PERMIT ISSUANCE 10.00 .L:, CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL - TOTAL 30-D'D Sin O Applicant/Contractor U OFFICE COPY- M