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17940u r� POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION,RECORD'. - JOB ADDRESS -be %4'14_Z^�_ -�V UNIT# =LOT# • OWNER p—, CONTRACTORIS PERMir NUMBER 17940 PERMIT EXPIRATION PERMITEXPIRESIF WORK NOT STARTED WITHIN ` 16o DAYS OF PERMIT ISSU- ANCE,OR 180 DAYS FROM -LASTCALLED INSPECTION., INSPECTION DATE INSPECTOR INSPECT -RECORD IO FOUNDATION.- - NOTE: ALL GRADING AND DRAINAGE•SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. y" _�.D LIFER' PREGUNITE- ' PERMIT VAuoATION ;1 t�,ccf: ` _fA���� ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Y 2.51989pp UNDERGROUND/SLAB PLUMBING ,�,.. Giij ot I uRd we�� w ELECTRICAL MECHANICAL - BL c ELECT., El . PLO.MECR. t ❑. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - - BUILDING PERMIT INFORMATION •" -' WOOD FLOOR - VALUATION S/FT, PLUMBING MECHANICAL ELECTRICAL - PERI I TOO ' ` FRAMING INSULATION STORIED TYPE CONSTR. - OCC GROUP - RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SO.11 rLDOR ARIA L Ta TAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON• PB Other ❑ ❑ 0 ❑ ❑ ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP., ROUGH SANA ' ASSESSORS PARCEL NO PLUMBING - ELECT. ENERGY, TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO. MECHANICAL MECH,ENERGY ELECTRICAL BUILDING ENERGY - ACC. DATE Acc. FILE No FRAMING - S ELECT. FINAL TEST INSULATION' PLUMBING IZONINc r ENG. SITE No. GAS TEST - - - GAS FRE SPRINK Y I] N❑ ENERGY T 24 v ❑ N❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FmOD ZONE N[] -A.L uC: Y L NE] INTERIOR SHEAR FIRE DEPT. - SHEETROCK S c GRADE FEE SUMMARY EXTERIOR LATH BUILDING '— —g BUILDING 4 (fi—oo 7( 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 ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252 4505; ONE WORKING DAY BEFORE REQUIRED•INSPECTION. zo � PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE- MICROFILM ELECTRIC 1.)b PLUMBING MECHANICAL CONST. TAX' ' IMPORTANT! `" PLEASE -READ REVERSE SIDE BEFORE, CALLING FOR FINAL INSPECTION. TOTAL .� OFFICECOPY • • O Z Z PN CC Lo LU - 0. 0 7)z 00 u 110 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY . BUILDING PROJECT IDENTIFICATION APPLICATION &PERMITnRs UILDING-ELECTRICAL-PLUMBING-MECHANICAL PERMIT NUMBER _ A ,- O ol+i�Lss-� IVA C/ OWNER'S NAM ,d `- /J���� e PHONE��(� QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATIONr ' DATE OF APPLICATION CONTRACTOR (.lnl,Q4✓C/L't/ddgKeC �/ OUTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADDTRACrofls DRESS 7.-Y "1 PHONEri VWO PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCRrtECT /�C �� OR C'.5 ENGINEER ilc. 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 / \ y� V CC i EMP. METER OR POLE INS. 20.00 ADDfl E55 21DRESIS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 2-40 I hereby affirm that I am licensed under provisionsof Chapferl) ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Cp� m .§cCn,C is in full foypay)1 �jeCI. License Class Sl7 Lie. Number✓ - JI - BLDG. ELECT. W M PLG.' MECH., ❑. ❑ . Dale Contracto MAY 2 519,$ BUILDING PERMIT WNER-BUILDER DECLARATION I hereby affirm that I so exempt from IAC Contractors License Law fornycit ll or wuntason.(hrequi3Lres a permit ess and Professions it to construct, Alan alter, Any city or coo my whiny structure, improCodeve. toFC, pd sign its statement also prior ImprOVs, he applic. Or repay h permit requires the applicant for Such permit m file a signed statement that 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 be is exempt therefrom and the basis for the alleged exemption. Any violation of SccuoR7031S INFORMATION MISC.- REFER TO ORD VALUATION SIFT. O D 0 PERMIT ISSUANCECit U. ELEC. CONTR. LIC. NO. ELEC. � TOTAL I� I V V .. PER IT O ' 11-- rl OTY. PLUMBING PERMIT FEE I STORIES TYPE CONSTR. by any applicant for a Demur subjects the applicant to a civil penalty of not more than five hundred dollars 135001.): ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS , DRAINS -FLOOR, ROOF, AR EA, CON D. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors 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- menu are not intended or offered for sale. If, however, the building - .. FIXTURES - PER TRAP 5.00 50. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of Completion, tse owner- builder will have the burden of proving that h e did not build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM -OVER 4 (EA.) 200 BUILDING USE RES IND CON PB Other El ❑ ❑' ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 _ LAWN SPRINKLERS -OVER 5 (EA.) - 1.00 ASSESSORS PARCELNO. - - licensed contractors to construct the project (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 contracts Icor such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 __YR ACT _NO. PARCEL NO. ❑ I am exempt under Sec.-, BAP.C. for this reason 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 1 hereby affirm that I have a certificate of consent to self-insuro, or a certificate of Workers' Compensation Insurunce, or a eerlificd ZONING ENG. SITE N0. Copy Ihereo(lS5 3800. Lab.CJ. / I Poll Company_` Certified copy is h creby furnished. Certif d co y_is EI w h the city aspect' Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-74 Y ❑ ry❑ MISC. - REFER TO ORD. CIiRTIFICATIi OF EXEMPTION FR WO ; S' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N❑ I Y ❑ IN C] OTY. MECHANICAL PERMIT FEE - FEE SUMMARY hundred dollars IS 100) or less,) I certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to BUILDING f + becomesubjecttodieWorkers'Compensation Laws of Calil'onam. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex. eruption, you should become subject to the Workers'Compensation ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO I0=C.F.IV0 4.00 'AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE , CONSTRUCTION L17NDING AGENCY 1 hereby affirm that there is a construction lending agency for the 3097, Cw C.j"ce of the work for which this permit is issued (See. EXHAUST HOOD (WITH DUCT) 5.00 ' MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATING UN IT (OVER 100,000 B.T.U.)9.50 ELECTRIC a* �O Lender's Name N Lender's Name SS 1 certify filar I have read this application and Slate that the above information is correct. 1 agree to comply with all city and county ordinances Slid state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING , BOILER -cGMP (3 H.P. or 100,0008.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. - (we) agree to Save, indemnify and keep harmless the City of uperdno against liabilities, judgments, costs and expenses which my in any way accrue agail t sai .C' y tG`of-the ' ranting this permit. - u CONST. TAX - - PERMIT ISSUANCE 10.00 MECH.CONT. LIC. NO. MECH. TOTAL - TOTAL 00 Si ureofA m nl/Co actor Date OFFICE COPY