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16976 I - OST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO = DIVISION X6976 INSPECTION ' JOB INSPECTIOI4 RECORD ? Y�PERMIT EXPIRATION • JOB ADDRESS—�D V Z' C"ke UNIT# _LOT# ' `mac J r/�+ L...�� PERMIT EXPIRES IF WORK OWNER .C�V L U is _�i d, CONTRACTOR r C.. // IS NOT STARTED WITHIN INSPECTION V DATE I INSPECTOR - INSPECTION RECORD ' 180 DAYS OF PERMIT ISSU, FOUNDATIONANCE OR 180 DAYS FROM NOTE: - LASTCALLED INSPECTION. LIFER ALL GRAOING AND DRAINAGE SHALL BE INSTALLED PR EG UNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDAT17 CUPERTINO STANDARDS. _ GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - �� 2 6'. PLUMBING CRY Of Cuve- A vLf'P_ Lir ELECTRICAL - - nD ISSUANCE DATE MECHANICAL 7 ELECT. PLG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION s/FT. PLUMBING ' MECHANICAL 1 . ,ODO .o'Q _ ELECTRICAL ERMTT " FRAMING. SY✓1l W11(['1 a INSULATION sroRlEs rYPE CONSTR. OCC GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE SO.IT aaoR AReA rorAi ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ew LOI usE ROOF SHEATHING Res IND cONory Pa o"", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ❑ 0 NO. E-1ASSESSORS PARCEL ROUGH SAN.N PLUMBING - - - ELECT,ENERGY ' TUBS&SHOWER PAN PLUMBING ENERGY ' TRACT NO, PARCELNO MECHANICAL - - MECH.ENERGY ELECTRICAL ACC DATE ACC FILE NO BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST - GAS FIRE SPRINK ENERGY L]G MECHANICAL Y NY [3 NE3 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FL000 zoNE AL uc. INTERIOR SHEAR - - FIRE DEPT. N❑ Y Q No SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING rEE ING � IOO INTERIOR LATH TE SCRATCH COAT ELECTRIC CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN'SIGNED OCCUPANCY IC FEE 1 or OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. FILM ARRANGE FOR INSPECTION PHONING 252.4505, RIC (jQ Lu 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 CALLING FOR FINAL INSPECTION. r' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION ' I .PERMIT NUMBER BUILDING APPLICATION & PERMIT 97 6 1 C ADDRESS zo � cBUILDING r I UJ ( o Iz -i �2 EC - OWNER'S 4� PLAN CHECK VALIDATION NAME �� /. ( I\ , `O ,z - QTY ELECTRIC PERMIT FEE n p • V 'E V '�'�PNONI: LA I V CONTRACTOR'S . NAME � ^ UTLETSr SWITCHES-RECEP 10.00/1.00 W )S UL��O�cs`s/ LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S PPLIAN CES-RESIDENTIAL 4.00 ADDRESS ' 1 �1 �` 135'1) r \'STs PHONELIS-7165 PANELS 10.00 GATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) ' 20.00 "PLAN CHECK FEE P.C.,NO. OP I� - 1 - SIGNS TRANS. - 3.00 ' ARCH.OR ENG. - PERMIT VALIDATION ADDRESS SS SPECIAL CIRCUIT 5.00 '53 L-1 S -n '"P i'L TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE'SCH. t �� ADDRESS // 535'/J -7sr SERVICE CH NGE 20.00 00 LICENSED CONTRACTORS DECLARATION O D �•0 L �I 1r`-' -( a U I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE yea (commencing with Section 7000)of Division 3 of the Business and JAN 2 G 1984 BLDG. ELECT. PLG. MECH. r wo Z Professions ColiIII&LM license is in full forCey j if ❑ License 71-16 c.Number_ 1 L w Date_(_Z=/�(_ Contractor ��,I �y�,�,� a x a-1 `' BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION X ; U MISC.- REFER TO ORD A N I hereby affirm that 1 sm exempt from the mess Contractor's License - .VALUATION 5/FT. u o<- Law for the following reason.(Sec.703 t,5,Business and Professions PERMIT ISSUANCE 10.00 i Ob y� 3wCode:Any city or county which requiresapermil to construct,alter, ¢ ¢Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. QQ n O 0 requires the applicant for such Permit to file a signed statement that - TOTAL 3�OD PERMIT TO w $m he is licensed pursuant to the provisions of the Contractor's License I_ Law(Chapter 9(commencing with Section 7000).f Division 3 ofthe 4""-'�• Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE IMM If,� ¢ r Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTfl, c ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ` of not more than five hundred dollars(4500)): Cl ,1,as owner of the property,or my mnployees with wages as BACK FLOW PROTECT. DEVICE 4.00 CCC.GROUP RES.UNITS their Sale compensation,will do the work,and the structure is not. intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Commcmr s License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himsementa are not hrough ownemployees,orSle.IL ed that however. the improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 mems are nor intended of offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS:EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im. RES IND CON PB Other prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to Construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contmctorts)licensed Pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. T,B.&P.C.for thisWATER HEATER W/VENT 6.00 .0 reason _T Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. . WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to sell'-insure. ZONING ENG.SITE NO. ' or a certificate of Workers'Compensation Insurance,or a certified copy there (Sec.3801 Lab.C). Policy NIrA 10. 1lPany_pa_b"1x/A L._tivi-blirmi oI _ - O k ❑ Cerlitied copy is hereby fu nished. FIRE SPRINK ENERGY T 24 Z Z opy i lh the city inspection division. MISC.- REFER TO ORD. O -- Y N❑. Y❑ N❑ iry CERTIFICATE Or FX17MPTION FROM WORKERS' PERMIT ISSUANCE 10.00/2-,o FLGOO ZONE A.L.U.C. LU COMPENSATION COMPENSATION INSURANCE PLG.CONTR. LIC.NO. - PLG. CL O (This section need mol be completed if the permit is for one TOTAL iV Y❑ N❑ Y ❑ N❑ Z) Z hundred dollars IS 1001 or less.) - L) O 1 certify That in the performance of the work for which this per. GTY. MECHANICAL PERMIT FEE FEE SUMMARY. LL F , air is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. Dy Dmc Applicart ALTER OR ADD TO MECH. 5.00 BUILDING 16�IVO } W NOTICE TO APPLICANT: If,after making this Certificate ofEx- H ? mnplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000GF.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE F Qf I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT). '5.00 the performance of the work I'or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C). _ ' Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC n Lenders Address F Of I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and County - PLUMBING - Ordinances and slate laws relating to building Construction, and BOILER-COMP(3 H.P.Or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU(SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree in save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE. " _ 10.00 CONST.TAX ay in any way accrue against .Said City in consequence of the ratting of this pe It. - MECH.CONT. LIC.NO. MECH. TOTAL TOTAL gnature of Applicant/Contractor Date OFFICE COPY