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18749POSTTHIS.CARD NEAR FRONT.OF BUILDING CITY OF CUPERTINO' INSPECTION DIVISION JOB INSPECTION RECORD .S `T J �/' JOB ADDRESS _7 �y��v• //"� �• UNIT# _LOT#' S I Q 4-o- f/w owNEa C; RAcroR PERMIT NUMBER 18749 PERMIT EXPIRATION" ' PERMIT EXPIRES I WORK Ib NOg STA�7�ED WITHIN .. . /l80 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 COMPLY WITH THE APPROVED PLANS AND CITY. OF CURERTINO STANDARDS. ' UFER. _ - PREGUTO ITE - PERMIT VALIDATION "ISSUANCE LATE GARAGE ". GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/ -SLAB. PLUMBING' - ^J\ .. ELECTRICAL MECHANICAL "- BLDG. ELECT PLG.- MecR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDINFORMATION -^ BUILDING PERMIT " WOOD FLOOR VALUATION S/FT. PLUMBING -V, i MECHANICAL ELECTRICAL _ pPERMIT TO 7^/ tj•aL/�� I _ Jl?lTl, FRAMING .. INSULATION". - - OCT 51989 STORIES. TYPECONSTR, Cit" Of CBnarfina occ.GRODPs REB UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAXIS PAID - so. Fr. FLOOR ABPA TOTAL ACRFncF DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB 01m., ❑ ❑ Ell ❑ - ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGHSAN.M ASSESSORS PARCEL NO. ' PLUMBING" '- � ELECT. ENERGY TUBS & SHOWER'PAN�y . /O- / PLUMBING ENERGY TRACT NO. 'PARCEL NO. MECHANICAL MECH.ENERGY ELECTRICAL .. BUILDING ENERGY ACCDATE . ACG FLLE NO. - FRAMING 16 Min ELECT, FINAL TEST INSULATION PLUMBING - ZONING ENG SITE N0. GAS TEST GAS ' MECHANICAL `FIRE SPRINK Y ❑ N❑ ENERGY T 2 Y Q N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR.SH EAR- ELECTRICAL RELEASE FE000 ZONE YQ N A,L. U.C. YL. N❑ INTERIOR SHEAR FIRE DEPT.-' SHEETROCK - GRADE ' - FEE SUMMARY EXTERIOR LATH .BUILDING - '. BUILDING .'"'i9 .INTERIOR LATH , , �- 'TEMPORARY,'APPROVALS- SCRATCH COAT ELECTRIC.' PLAN CHECK FEE .. - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY '• SEISMIC FEE /"U OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.: MICROFILM ' ARRANGE'FOR INSPECTION BY PHONING 252-4505, F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. 'SEE FOR EXPIRATION DATE — " ' °` A?` ELECTRIC PLUMBING MECHANICAL ` coNST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL, '- .! OFFICE COPY '/ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY' BUI-LDI NG PROJECT.I DENTI FICATION - APPLICATION&PERMIT .- BUILDING - ELECTRICAL- PLUMBING - MECHANICAL . PERMIT NUMBER 18749 aD"°"° /OS9/ CAsT/NB E . AOOREss / OLu riN 7 OWNER'S NAME ' � � p PHONE 7 OTY. ELECTRIC PERMIT FEE- PLAN CHECK VALIDATION , , ��^ DATE OF APPLICATION NAMERAcr s - ' LIC. NO. OUTLETS - SWITCHES: RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS - ADDRESS. _ PHONE PPLIANCES- RESIDENTIAL 4.00'- '. PANELS 10.00 ARCHITECT- - - ENGINEER _ LIC. NO. PANELS (OVER 200 AMP)' 20.00 PLAN CHECK FEE P.C. No. SIGNS TRANS. 3.00 ' ADDRESS ENG' ZIP SPECIALCIRCUIT _ 5.00 - PERMIT VALIDATION. , ISSUANCE DATE TEMP. METER OR POLE INS. ,20,00 APPLICANT *�s MOTORS SEE FEE SCH. .. SERVICE CHANGE 20.00 - LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 commuting with Section 7000) Of Division 3 of the Business And Professions Code, and my license Is In full force and effect, License Class Lic. Number Data Contractor. a - - - BLOO. ELECT. PLG. MECH. OWNER -BUILDER DECLARATION I hereby Affirm that I am exempt fm.5 the Contractor's License Law forS Businessland tr ct,alons followingreason. ch e. requires Any city Code: Any city or county which reyuiresapermit townstrucNalter, improve, domolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a Signed statement that. he is licensed pursuant to the provisions of tile o Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and Professions Code) or that he is exempt therefrom and the basis far the alleged exemption. Any violation ofSection 703 t,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ' ❑ I, as Owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for all (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or am- pr�for purpose of sale.). _ 1, as owner of the property, am exclusively contracting with tic used contractors to construct the project (Sec 7044, Business and Profesaiona Code:'The Conlmetor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed Annan. to the 1amcexe License Law. ❑. I,am exempt under ,B.&P.C. nUli' reason BUILDING PERMIT INFORMATION MISC.- leffy Of CUM TO ORD '- PERMIT ISSUANCE 10.00 VALUATION jy. $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL -TO �/ c1MggaL GTY. PLUMBING PERMIT FEE ALTER -DRAIN & VENT -WATER (EA.) 5,00 - 1 STORIES TYPE CONSTR. BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,CON D. 5.00 - F IXTUR ES - PER TRAP - 5.00 GAS - EA. SYSTEM -I INC.4 OUTLETS 6.00 ,• GAS EASYSTEM (EA.) 2.00 - . -OVER 4 50. FT. FLOOR AREA TOTAL ACREAGE BUILDING USE RES IND CON PB. other �'�, ❑ El INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. r, WATER HEATER W/VENT 6.00 Owner Dat WORK. S'COMPE-NSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificateofWorkers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.CJ. Policy No: Company WATER SYSTEM 5.00 Acc. DATE ' ACC, FILE N0, ' WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. ., MISC.- REFER TO ORD. D Certified copy is hereby furnished. ❑ Certified copy is, Ned with the city inspection division. Applicant FIRE SPRINK YC3 NE] I ENERGY TYO Y,0 "NE] CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION INSURANCE (This section aced not be Completed if the permit is for one hundred dollars ($100) or ICS6J 1 certify that in the performance of the work for which this per, mit is issued, 1 shall not employ any person in any manner So as to become subject,to the Workers' Compensation Laws of Calil orma. Date - -Applicant NOTICE TO APPLICANT: If, alter making this Certificate of Ex- emption, you should_ become Subject to the Wekers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sea 3097, Civ.C.L - Lender's Name PERMIT ISSUANCE 10.00 FLOODZONE Y [:] N [JY A.L.U.C. N ❑ PLG.CONTR. LIC. NO. l PLG. . TOTAL - DTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING O✓ ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHEC K-.'. FEE AIR HANDLING UNIT (TO 10� OC.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=1.F,M.) 6.00 SEISMIC FEE' EXHAUST HOOD (WITH DUCT) 5.00 - HEATING UNIT (TO 100,000 B.T.U.) 8.00 - MICROFILM Lender's Address HEATI NG UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby autioanedp representatives ec this city to enter upon the hereby authored property forinsp ofpurposes. (We) agree to save, Indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in �aanny/��way accrue against said City in couse�q/uuence ppf the m;+-'r�•s per V / -Y- / Signature o pplicant/Comminctor V Out _ VENTILATION FAN (SINGLE) 4.00 BOILER H.P. Or 100,000 B.T.U.) 6.00 PLUMBING ' BOILER -COMP (Over 100,000 BTU) SEE FEE SCH, MECHANICAL MISC. - REFER TO ORD: PERMIT ISSUANCE - 10.00 e CONST. TAX ' MECH. CONT. .LIC. NO. MECH. TOTAL TOTAL !/ OFFICE COPY