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17887' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO17887 INSPECTION DIVISION JOB INSPECTION RECORD. PERMIT EXPIRATION �^ s7, — InQD Y -N Q�NIT# JOB ADDRESS _L V .] _LOT# -o _ PERMIT EXPIRES IF WORK owNER S Sk v coNTRAcroR ',G IS NOT STARTED WITHIN 180 Dnvs of PERMIT Issu- ANCE'OR 180 DAYS FROM INSPECTION - DATE INSPECTOR I SPECTION RECO FOUNDATION - NOTE: - ALL GRADING AND DRAINAGE SHALL BE 'INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. UFER PREGUNITE Pf,WAIT VALIDATION CUPERTINO STANDARDS. SSI GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID UNDERGROUND/SLAB PLUMBING uAIE ELECTRICALISSUANCI. BLD: ELECT. PLG. MECR MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING - PERMIT INFORMATION ' WOOD FLOOR VALUATIONp ZU 1) SIFT. ' PLUMBING - - - . � - � MECHANICAL - ELECTRICAL PERn D fy FRAMING - 'L INSULATION - srOla Bs rvPE comsrR. - OCC. GROUP - RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFNOTE: NO FINAL INSP, SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so. , r. FLooR ARCA _IorAL ACREAee DIAPHRAGM - BUILDING USE ROOF SHEATHING ITS IND CON PB OIm., ❑ ❑ - ❑ ❑ ❑ 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 ELECTRICAL BUILDING ENERGY ACG DATE ACG, FILE No. FRAMING — ELECT. FINAL TEST INSULATION PLUMBING ZONING LNG. SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ❑ I[] ENF.IIGV T -]G v. ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD 70NE Y❑ `N❑ 4l UA NOL, INTERIOR SHEARFIRE DEPT. _❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING BUILDING QO' INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT- ELECTRIC - PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEEOCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. —"� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING MECHANICAL Z —SEE PERMIT FOR EXPIRATION DATE — CONST. rnx IMPORTANT! TOTAL ] (J PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT PERMIT NUMBER ' 1J 1 7 /87 EDILDING ADDRESS 5 fA R BUILDING - ELECTRICAL- PLUMBING -MECHANICAL (' 11 V 1 OWNER'S � ' 0 SE or,/ PHONE8'.25 OTY ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS NAME 5k CrCJ+ OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CODNTRATOR's ADDRESS c PPLIANCES- RESIDENTIAL 4.00 ,RC`` PNONEt,550 DATE OF APPLICATION \ PANELS 10.00 ARCHITECT OR ENGINEER ' uc. NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ENa SPECIAL CIRCUIT 5,00 PERMIT VALIDATION Z" TEMP. METER OR POLE INS. 20.00 A ADDDRESSDRESS MOTORS SEE FEE SCH. ' SERVICECHANGE PAID 20.00 LICENSED CONFRAM OHS DIECLARA'1' ION - I hereby affirm that 1 an licensed under provisions of Chapler IMAY (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lwrosc Chess _n-1 Lic.Nunibcr 31A0(r3 Data Contractor ISSUANCE DATE BLD ELECT. PLG. MECH. "`111"'CCC ❑ ❑ City .{pEl - Cly of Cuperino BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby vl firm 1he1 ant uSec.7 from the Contmaois License Law for the following ntyreason. which requires a,emit tocodProfessi°ns Code Any city or county which requirese permit rot, MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. D ELEC.CONTR. LIC. NO. ELEC. TOTAL i... ancager, improve, demolish, or repair any sl acture, Prior to its ixsuana, also "quires the applicant for such pennit to file a signal 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 he is exempt therefrom and PERMI TO S r QTY. PLUMBING PERMIT FEE the basisfill tileallcged exen;ption. Any v iolalio, ofSectiun 7031.5 STORIES YPE 00 STR. by any applicant l'or a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN -WATER (EA.) 5.00 O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, a11d the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 tended or offered for sale (Sec. 7044. Business and Professions Code: T'he Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 $0. FT. FLOOR AREA TOTALACREAGE properly who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- ment, are not intended or offered for sale 11, however. the building GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that lie- insC did not build or - prove for purpose ofsde.). ❑ I, as owner of the property, um exclusively contracting with . -. GAS EASYSTEM OVER 4 (EA) 2.00 BUILDING USE RES IND CON .Pe Orae, ❑ ID 1:1 El ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construe, the project (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ' ASSESSORS PARCEL NO. ' contracts for such prolccls with a enntract00%) licensed Pursuant to lire C'omuctor's License Law. . SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ l um exempt under Sec.-, BAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Dale WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMP ENSA'I'ION DECLARATION I hereby affirm tlmt l have a cenip,me of convent to gulf -insure. c Or a urlificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thaeof (Sec. 3800. Lab.C.). ' Policy No. Company _ FIRE SPRINK Y 0 N ENERGY T -2d v ❑ N� ❑ Certified copy is hereby furnished. 1T Certified Y is filed with 0 IY 'nspecn inn division. Applicant n'~L 1�=-� cdn=- 1If MISC. - REFER TO ORD. CBR'IfPICA I E OP EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AL.UF. COMPENSATION INSURANCE (Tills section need net be cOtllp Ctl'd If the Pettit It is for one PLG. CONTE. - LIC. NO. PLG. ' TOTAL YE] NE] Y F] NE] hundred dollars(S100) or leso I certify that in the perfonmeev of the work for which this pee- 11111 is issued, 1 ,shall not employ any person in any manner so as to OTV. MECHANICAL PERMIT .FEE FEE SUMMARY BUILDING become subject 10 the Workers' Compensation Laws o(California. Irate Applmam NOT'IC17 '1'O AITLICANI': If, after making this Certificale W Iix- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE entption, you should become subject m the Workeri Compensmioo Provisions of the Labor Code, you must forthwith comply with such provisions or this permil shall be deemed revoked, CONS'I'RUCI'ION LENDINGAGENCY AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLINGUNIT(OVER 10p000EM.) 6.00 SEISMIC FEE F �� 1 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 Isco. 3097. Civ.0 f MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name ELECTRIC Lender's nddreaa - HEATING UNIT (O V ER 100,000 B.T.U.)9.50 I certify that I have read this application and state that ate abuse I VENTILATION FAN (SINGLE) 4.00 information is correct I agree to comply with all city and county ordinances and slate laws relating to building Gans¢tion, anJ u PLUMBING �1 BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 Bene- me l.tioncd properly for inspectionor this hereby l.thentinriee roperty natives of this city 10 enter Open the purposes. BOILER-COMP(Over 100,000 BTU) SEE FEE SCH, MECHANICAL - (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses which aY in any way aeeNC against Said City In consequence of the ranting of this pcnnit, PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. [� Q4 a D _ SI ISI S 1 TOTAL TOTAL a Sigwturc of Applicant/Con meter ate OFFICE COPY