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17655 POST TA CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER CITY Y CUPERTINO 1765 INSPECTION DIVISION' JOB INSPECTION RECORD o$Z6 Btr oo fKWe& br PERMIT EXPIRATION JOB ADDRESS UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER C-o� .efQ CONTRACTOR d. perc zIS NOT STARTED WITHIN • INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - API D.OR 180 DAYS FROM NOTE: UFEfl � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.- PREGUNITE TO COMPLY WITH THE APPROVEQP�ibAND CITU OF PERMIT vnLmnnoN GARAGE SLABS CUPERTINO STANDARDS. j,) S, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED APR 2 0.1989 UNDERGROUND /SLAB ' IA ve i PLUMBING CI6q.Of CUpBIGDD ELECTRICAL ISSUANCE DATE MECHANICAL BLOC ELECT PLG MECH, F3os9 uJS ❑ ❑ ❑;. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING" VALUATION u $SFT. MECHANICAL - � ELECTRICAL - - \PPERm,'k0 FRAMING /� -oaor ,INSULATION sraRlEs TWE CONSTR. - • OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O.FT'.FLOOR AHE'A TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING.' RES IND CON PR Dm.• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSOHS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY. TUBS 8 SHOWER PAN - 'PLUMBING ENERGY TRACT NO. PARCEL NO. MECHANICAL . MECH.ENERGY ELECTRICAL - BUILDING ENERGY - ACC DATE ACG FILE NO FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T�24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEArwc Y ❑ "❑ ❑ "❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLDODZONE aLuc. INTERIOR SHEAR FIRE DEPT. Y❑ "❑ Y L_ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH jt3UILDING FELECTRIC 3- � 3t do INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - GAS `J 7 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY FEE ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE.GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL JT.*)' CALLING FOR FINAL INSPECTION. OFFICE COPY 1 A2PJ.ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LOING PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT !' ADORESs Q BUILDING -ELECTRICAL-PLUMBING-MECHANICAL i,. 17655 V PLAN CHECK VALIDATION NA U OTY. ELECTRIC PERMIT FEE SII r� PHONE a� Nqo'/ Ha9TOR's ,Jfes� .LZpy ZZ�� -OUTLETS-SWITCHES-RECEP 10.0011.00 r QleA) !� OI' uc.No. /�f LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S Q(S aDDRE55 PPLIANCES-RESIDENTIAL 4.00 GLLC/IU PHON�[ r3Z PANELS 10.00 DATE OF APPLICATION' A CHITECT OR - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEE I&OZW, LIC.NO.r Q SIGNS TRANS. 3.00 ARCH ADORES ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION SQ ZIP ITEMP.METER OR POLE INS. 20.00 y/y� APPLICANTS 7P aooREss �C/_ eI�I�QL�?.. MOTORS SEE FEE SCH. ((` •SEC l�etJ tc+r` Q, SERVICE CHANGE _ '} 20.00e w o g LICENSED CONTRACTORS DECLARATION - y D C Azp kV u,l < u I hereby affirm that I um licensed undet provisions of Chapter 9 ISSUANCE DATE vHi a n (commencing with Section 7000)of Division 3 of the Business and F M.-, Lied ions Cod a d y license is in full fnfff��CCC d efj4t ct. BLDG. ELECT. PLG. MECH. Z o m - License Cla C..Numbe /TE/q}^�yT �'� o`�uEl 0 1 El B T t_ Dale Contractor t 1 Cupertino m CE a OWNER-BUILDER DECLARATION BUILDING PERMIT w- o a ° - INFORMATION 3: N I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u O¢ Law for the following reason.(See.703 LPERMIT ISSUANCE 5,Business and Professions 1000 V LUATION $/FT. r - Code:Any city or county which requiresapermlr to construct,alter, ^� �� re 4 o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIQ NO. ELEC. 5 DLL requires licehe nsed puna[for such permit to file t a signed statement that TOTAL PERM n. w m re is licensed pursuant to the provisions of the Coed statement License (7L� x HZQ Law(Chapter 9(corniumcingwith Section 7000)of Division 3 of the 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TWE CONSTR. a- by any applicant for a Permit subjects the applicant foa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner the property,or my employees with wagesBACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will the work,and the structure is notet intended or offered For sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of prophimself or th build,hhirwn employees, oes such improve. work FIXTURES-PER TRAP SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- memsarenotintended,oroffered for sale.If,however,the building GAS-EA.SYSTEM-IINC.40UTLETS 6.00 or Improvement is sold within one year of completion,the owner. GAS EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that h •e did not build or ins- BUILDING USE prove for purpose of Sale.). RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 ❑ 11 1:1 1:1licensed contractors to construct the project(Sec. 7144,Business LAWN SPRINKLERS-i INC 5 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply V.B. to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such Projects with a contracted s)licensed Pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,L&P.C,for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK Ii RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 _ I hereby affirm that I have it certificate of consent to self-insure, ar a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. ropy thnreof(Sec.3800 Lab.C.}e,�. 67-,,1/� 8? Poleccr. Company 7 Z Pl Ce iilie copy Is hereby furnished. Z Z ❑ Celt py rs filed 'flf`tl FIRE SPRINK ENERGY R24 pectiol division. H p Applicalrt L MISC- REFER TO ORD. v❑ rv❑ v❑ N❑ CC CER FICATE OF EXEMPTION FRO MW KERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W COMPENSATION(NSU RA NC PLG.CONTR. LIC.N0. TOTAL Y❑ N❑ Y ❑ N❑ d (This section need not be completed if til Penntl s for one _ - 0 Z hundred dollars 18100)or IcssJ U O I certify-that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mil is issued,I shall not employ any person in any mminer so as to O become subject to the Workers'Compensation Laws of California. - y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3 3 t! >_ W NOTICE,TO APPLICANT: If,alter making this Certificate of Ex- / ? emption,YOU should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE / 3 V such provisions or this permit Shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.BM.) 6.00 SEISMIC FEE r 7 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM. 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read Ills application and stale that fill above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county BOILER-COMPI3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and ,✓; hereby authorize representatives foriins of this city to enter upon the s. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above hereby authored property for inspection puity to (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.11 upenino against liabilities,judg M costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay, 'n 'Iny way accr c against Clty in consequence of the ngofthispernf. MECH.CONT. LIC.NO. MECH. ,e.D� TOTAL TOTAL S-0V u eOf Applicant cor Date OFFICE COPY