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17217POST THIS CARD NEAR FRONT OF,BUILDING CITY OF CUPERTINO -:" INSPECTION DIVISION JOB INSPECTION RECORD i•- JOB ADDRESS [.U�S (� OCV�Z-(L UNIT# LOT *f ., /� �p .. OWNER �� C -O A CONTRACTOR PERMIT NUMBER 17217 PIP uER ITjPIRA�TION, �G�F _EX`3 JJ PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 160 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM ti LAST CALLED INSPECTION.-+ . INSPE ON DATEI INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. UFER 'PR EGUNITE PERMIT' VALIDATION :'' „�'•7�. 'ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 14AR '_f? UNDERGROUND / SLAB PLUMBING ELECTRICAL MECHANICAL 9LDG ELECT PLG, MECH 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR L T SIFT. , PLUMBING fayp� s;��a T�� C6 17L I�E21+�%T- C-�LTk+/+ MECHANICAL, ELECTRICAL •Cb R. G�•nb.b:•,,.__ 1 .. PERniIT 'il1JY1 TU 1 4-1L ` EY. FRAMING' - INSULATION - STORIES TYPE CONSTR „ OCC GROUP .RES. UMTS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED+ . ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID • $p. FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE AES IND CONPB Q'I'_ , APPLY NO ROOFING UNTIL ABOVE HAS.BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING - ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. ' PARCEL NO MECHANICAL MECH. ENERGY t ACC, LATE ACC. FILE NO ELECTRICAL BUILDING ENERGY FRAMING - ELECT. FINAL TEST ZONING END SITE NO. INSULATION IPLUMBING GAS TEST - GAS , FIRE SPR INK Y[] No ENERGY T 2 Y;❑ N❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FL000 ZONE ° N❑ A.Luc. ❑ 71:1 EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. - SHEETROCK GRADE FEESUMMARY EXTERIOR LATH G BUILDING �G_•. �� BUILDING PLAN CHECK -FEE : ('� INTERIOR LATH ' TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - ' GAS SEISMIC FEE E, NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDI NG F•INALISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252450 Iw_ ONE WORKING'DAY'BEFORE REQUIRED O� IRED INSPEC PLEASE GIVE ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE= MICROFILM ELECTRIC ELECTRIC PLUMBING MECHANICAL coNST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY O ZZ F y i - LU CL. 0 Z UO LL U Ow } H H z u APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY "4DI TLDING PROJECT I DENTI FICATION ' -APPLICATION &PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 41 0, 17217 an,LD,NG ((��((''��//''\��\ ADDRESS J �r r./� �'/Y�`,%/-��y✓,�/ /AI1 Y_ 2 �. OW ER'e - NAME �j r 1Ti(�( ONE QTY. ELECTRIC PERMIT FEE PLANCHECKVALIDAT�N- 'rF�� q' L �i J DATE OF APPLICATION CONTTORS NAm v/��c, rwKNo UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 coN ACroR's aDD Ess PHONE PPLIANCES- RESIDENTIAL 4.00 PANELS 1.0.00 ARCHITECT - on L�-nit/GfIZLJ- ENGINEER ICJj uc. No. PANELS (OV ER.200 AMP) 20.00 PLAN CHECK FEE -P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG ADDR s a/ ,yam ]� GJ' LA�OWV CA Gni x,P SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ISSUANCE DATE EMP. METER OR POLE INS. 20.00 ADD,ReNrS a01 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON "TRACTORS DECLARATION I hereby affirm that I am licensed undOr provisions Of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and� Professions Code, and my license is in full force and effect.MAR License Class Lic. Number Date' Contractor OWNER -BUILDER DECLARATION I hereby affirm that 1 so exempt from the Contractor's License Law: Any city eternallyng Professions Code: Any city or county which requirese permit to construct, alter, whichequire .a permit to improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement (hut he is licensed pursuant to the provisions of the 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 for the alleged exemptimt. Any violation of$ection 7031.5 by any applicant for o permit subjects the applicant ton civil penalty of not more than five hundred delta,, ($500).1: ❑ I, asowner of the property, .r my.employees with wages as sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contract.,', 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 (hut such improve- ments are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, (lie owner- builder will have the burden of proving that he did not build or it, -- prove prove for purpose.1 the.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractoris) licensed pursuant to the Contract is License Law. ❑ lam temp under Sec. ,B.&P.C. lot (his reason s Z BLDG ELECT. PLG. MECH. ❑ ❑ BUILDING PERMIT INFORMATION MISC. - REFER TO ORD A UATI. ON / SIFT. , PERMIT ISSUANCE 10.00 ELEC. CONTR. - LIC. NO. ELEC. TOTAL 1 A IT TD M- Ne) ,I Mf'--�/1 111 I MF{2/\ , OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP REB. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - Z INC. 4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2,00 BUILDING USE e RES IND CON PB Omer, ❑ ❑ �_ INDUSTRIALWASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.8. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO.. WATER HEATER W/VENT 6.00 Owner _ Date WATER SYSTEM 5.00 ALL. DATE ACC. FILE NO. ' OR F:R' CO PIiNSATION UGCLARATIO 1 hereh off m i t I I've a certifieme of consent to self -insure, 0 icate f o urs Compensation Insurance, or a certified copy thereof(Sec.3B0 , b.C.). Policy No. Company WATER TREATING EQUIP. 5.00 ( ZONING - ENG. SITE NO. ' ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 .. Y ❑ No MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per-OTV. mit is issued, 1 shall not employ any person in any mannerso as to become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00 - FLOODxONE I N❑ A.L.II.O. Y❑ N❑ PLG.CONTR. LIC. NO. PLG. TOTAL MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ' 99. �O ALTEfl OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation Provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for e work for Much this permit is issued (Sec. the performance of tire hi 3097, Civ.C.). Lender's Name APPLIANCE 5,00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 AIR HANDLING UNIT(OVER I0=C.F.M.) 6.00 SEISMIC FEE t'LQ EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9,50 ELECTRIC Lender's Address 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 authorize representatives of This city to enter upon the ubuve-mentioned property for inspection purposes. (We) agree to save, in lemnify.and kccp'harmless the City of Cripelump against liabilities, judgments, costs and expenses which ay in ny way true ug nsI said City in consequen a of the feNi f(his per ti VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000BTU) SEE FEE SCH. MECHANICAL - MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO, MECH. TOTAL TOTAL 2-6 0Q U nota, of Ap cn / nt tier . Du . v v OFFICE COPY