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12863• i POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOBADDRESS' UNIT' _LOT# . OWNER CONTRACTOR PFRMIT NUMHER 12863 • PERMIT EXPIRATION PERMIT EXPIRES IF WORK. IS NOT STARTED WITHIN 188 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPEC ION TE I INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE PER ON FEB % & 1987 City of Cupertino ISSUANCE DATE BLDG. ELECT, PLJ ME H. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . • - UNDERGROUND/SLAB PLUMBING - _ , ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT/ INFORMATION WOOD FLOOR PLUMBING VALUATION S/FT. MECHANICAL ELECTRICAL j PPEERMM,ITTTTOO�,, 1 1•���1/'!' 13!•�'L`I-�1'.t FRAMING INSULATION - IE TYPE c NSTR. ', G I R NITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - - sa. TT. rwoR ARE o ', DIAPHRAGM BUILDING USE RES IND CON PB ❑ - 1:1 1:1 ❑ I�rr ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO, TRACT NO, PARCEL NQD PLUMBING d' ropaiir GAS TEST - MECHANICAL ELECTRICAL 3— L -b' FINALS DATE INSP. ACC DATE ACC. FILE NO. FRAMING SAN # ' INSULATION PLUMBING zorvlNc ENG. SITE No. GAS MECHANICAL rFIRE SPRINK Y ❑ "0 ENERGY T24 Y ❑ "E] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD ZONE Y ❑ AL.0 C, Y ❑ N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK' GRADE '• FEESUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE, OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, 0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE — 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 BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 12863 BUILDING ADpss�sp�i-s OwNE/R'�S.'// NAME V. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ,EW -elLPHDNE Zs7 -z?O OTRArHsNMEC��Bs-¢S� UTLETS - SWITCHES -RECEP 10.00!1.00 LIGHTING FIXTURES 10.00/1.00 o. CONTRACTOR DR's ADDRESS AD0C APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 j� 5 " HONE > DATE OF APPLICATION OARCHITECT ENGINEER LII. No, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH OR E a. - ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP D APPLICANT'$ ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 n U 'i A 1987 ( •7 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under 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. License Class Lic. Number NCE DATE B T. P H Dale Contractor OWNER-BUILUIiR DECLARATION affirm that I Inn exempt from the Contrimetra dvr License I herebythe Law forAnycountyng whichccJ0res apemit tocnstruct, Sher, Code: Any city or county which requirese permit to construct alter, improve, demolish. 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 althe Contractor's License BUILDIN PERMIT INFORMATION/ MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEC. CONTR. LIC. NQ TOTAL TOTAL p TO QTY. PLUMBING PERMIT FEE Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt themtrom and ' PIA IES TYPE NSTIl. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).1: ALTER -DRAIN -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 400 . ❑ 1, as owner of the property, or my employees with wages as sole compensation, will do the work, and the structure Is not ac UP 5 UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 intended or offered for sale (Sec. 7044, ELI and Professions Code: The Contractor's License Law does not apply to an owner of - FIXTURES - PE TRAP 5.00 GAS - EA. SYSTEM -11NC.40UTLETS 6.00 50. FT PLDDR AR A rq a PER GE l/� property who builds or improves thereon. and who does such work himself or through his own employees, provided that such improve- mems arc not intended or offered for sale IL however, the building or improvement is sold within one year of completion, the owner- builder will have the burden ofproving that he did not build or int- prove for purpose of sae.). ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB mar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sce. 7044, Business and professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves diction, and who LAWN SPRINKLERS -I INC 5 V.B. . 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 - teem tracts for such projects with a contractors) licensed pursuant to tile ContractorsLicense Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL No. ❑ l am exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE AOC. FILE NO. TER TREATING EQUIP, 5.00 WORKERS'COMPENSATION DECLARATION I �re�y u 1 lificate of consent to selfinsure' or e7jeli� c �(t"K'brk 4i C0 pensatmo lnsunnce. or rifled ZONING ENG. SITE N0. Policy No. acpch; iY�_ ❑ - titled cr - hcrchyhv shed. Cc led opy I. I'I wits city Ilion I cion. pelican RE SPRINK Y ❑ N ❑ ENERGYT-24 Y ❑ N❑ MISC. - REFER TO ORD. : RTIFICATIi OF E. 17MPTION PROM CRS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.G. CoM PIIS ION INSURANC ('Phis section need not be completed if it permit is fol one PLG. CONTR. LIC. NO. PLG. TOTAL Y ❑ N ❑ Y ❑ N ❑ hundred deltars(5100) or IIsi.) 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 OTY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO AI'1'LICAN'1': 11, after making Ihis Certificate .1 E.- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE empliom, you should become subject to the Workers'Connpeasation Provisions of the Labor Code. you must forthwith to nn ply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE ' CONSTRUCTION LENDING AGENCY I 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 (Sec. 3097, Civ.C.L MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address H EATI NG UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC I certify Thai I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER- OOMP(3 H.P. or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon a above-mentioned property for inspection purpous. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree save, indemnify and keep ha less the .j of MISC. - REFER TO ORD., - Cupertino ' just liabilities, judgments, costs ' d expo � hich y way accrue against said City corse of the gra this per it. / Z CONST. TAX PERMIT ISSUANCE 10.00 U, .MECH. CONT. LIC. NO. MECH. TOTA TOTAL r Dale v OFFICE COPY -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 0 orei Foo QVU y2w a y= / o 0se H aBE BE J ¢ ¢ w U X ;: Hwoa i'A>F BE BE O V ca dm¢ A w vs BE a d 3 s O Z ZIL F' -O 2 LU _ 0- C1 Z) z UO LL I- 00 d } N � Z A e BUI LDI NG PROJECT 1 DENTI FICATION APPLICATION & PERMIT UILDING- ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 1244 BUILDING ADOREss / c� OWNER'S NAM y ( :257 8'034 TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACT R'S /�OS/ NA E UTLETS-SWITCHES-RECEP 10.00/1.00 /11 LIGHTING FIXTURES 10.00/1.00 A-oNTRACTOR's ./ ADDRE- sS Oki., {CJC' � APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 BONE DATE OF APPLICATION AORRCHITECT I ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AARCH. 08 DDRESS ENG. ' ZIP SPECIAL CIRCUIT, 5.00 PERMIT VALIDATION 0 TEMP. METER OR POLE INS. 20,00 A ADDDRESSDRESS - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSEDCONTRACTORS DECLARATION �f// (/ I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Sectio 7000) of Division 3 of the Business an Professions Code dyyfimasl i isN full fof/� yW 1W L License Class_ Lic. Nu Der_ J `/ ! Date//1/Contr.(rl' OW R -BUILDER DECLARATI iyI � I hereby affirm that I .0 exempt from the Contractor's License Lawlor Any he following unty which Code: Any city or county which requires a permit to construct ager, to construct, improve, demolish, or repair any permit 1. ei prior ID its issuance, also req isles the applicant for such permit Io ole u signed actor's nl that he is licensed pursuant en the provisions of 00 ) ofD¢isave License of Division 3 of the Law (Chapter 9 (commencing with Section is exempt Business arid Professions Code) or that he is cxcmpl therefrom and ISSUANC DATE P1�16 BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ IS MH O BUILDING PERMIT INFORMATION MISC.- C1 E TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEC. DONTR, LIC. NO. EOTA p W TOTAL V J PERMIT TO r CLE G7 DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant (or a permit subjects the applicant tea civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of the properly, or my employees with wages as the it sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE . 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 in or offered for sale (Scc. 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. It however, tire buildingGAS FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or int - prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting will GAS EASYSTEM -OVER 4 IEA.) 2.00 - . BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors m construct the project (Sri, 7044, Business and Professions Code: The Contractor '.% License Law does 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 projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I um cxcmpl under Sec ,B.hl'.C. iia this reason ' WATER HEATER W/VENT 6.00 sone, Date _ WATER SYSTEM 5.00 ACQDATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION I hereby affir a certificate of consent m scl Ginsure, ora¢¢¢is��9 t rke om pellsxHon surance, or a cer' icJ WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. Pol o.- Company 7� 1'.] f , c Oo Company ' FIRE SPRINK Y ❑ N❑ ENERGY T-24 Y ❑ N❑ ❑ CCrtifiC Iereby flVn(Shed. O Certif copy w' I lh •inspec" division. Applicant- _ MISC. - REFER TO ORD. CER'I'IFICA'[I:OF IiXEMP1'I ON 1' , WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.u.C. COMPENSATION' NSU NCE ('Phis section need nol be completed if me permit is for one PLG. CONTR. LIC. NO. PLG. TOTAL Y ❑ N ❑ Y ❑ No Hundred dollar.(5100) 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 m DTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become suhjecl to the Workers' Compalsalion Lows of Culifornu. Date -Applicant NOTICE TO APPLICANT: It after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should hecomesubjecl to the Workers'Compensat ion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10=11F.NL) 4.00 FEE AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I 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 (Scc. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenders Name Lender's Address HEATING UN IT ER 100,000 B.T.U.)9.50 CTR C ELECTRIC a I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating IO building construction, and PLUMBING BOILER- COMP (3 H.P. of 100,000 B.T.U.) 6.00 gQILER-COMP (Over 1011.000 BTUI SEE FEE SCH. I MECHANICAL hereby authorize representatives of this city to enter on the above-mentioned properly for inspection purposes. IWrl Bur to save, indemnify and k p hannl-., e City of MISC. - REFER TO ORD. Cupertino gains( liabilities, judgments 'osis an uses which' y way accrue, against ai 'ity in uence of the his unit. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIQ N0. MECH. TOTAL TOTAL naNrc o' t/Com or ac OFFICE COPY