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15228POST THIS CARD NEAR FRONT OF BUILDING .. CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS 1198 Elmsford Drive UNIT# _LOT# OwrvEH Rayma and R.J. Mann corvTRacroR PERMIT NUMBER 15228 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ' INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND -DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE ,. PCRNIT VALIDATION ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL Pi R G .ELECT I ❑ PLG MECH ❑ ❑ R F DO NOT POULOOR UNTIL ABOVE HAS BEEN SIGNED �11N LDING PERMIT I FOR "TION WOOD FLOOR PLUMBING CIV CUpB�IROj VALUATION SIFT. MECHANICAL - ELECTRICAL - Peamn ro ` FRAMING INSULATION STORIES TYPECONSTR OCC GROUP HES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID, SO. ET FLOORA[IEA TOTALACREAGE DIAPHRAGM ROOF SHEATHING BUILDING. use HEIS IND CON P9 Open ❑ 11 El E ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.N ASSESSORS PARCEI. NO PLUMBING ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY acc ogre ACC FILE No FRAMING ELECT, FINAL TEST INSULATION PLUMBING zON1NG ENc. SITE No. GAS TEST GAS MECHANICAL PINE SPH Irvrc Y ❑ N❑ ENERcv r.Za ` ❑ N❑' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE .�p, PLooD -ZONE v ❑ N❑ AL_uC Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH - BUILDING BUILDING / INTERIOR LATH TEMPORARY APPROVALS . SCRATCH COAT ELECTRIC PLAN CHECK FEE �- T GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, 0-0ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL OFFICE wry APPI (CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .J • BU I LDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 'PERMIT NUMBER 15228 BUILDING ADDRESS 8 � OwN .2 \I I 1 V PHONE LzJ�S QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION.' COONTRACTORs LIC. No. UTLETS-SWITCHES -RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 ADDRESS DR's PHONE APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ORRCHIi ELT ENGINEER LIC ND. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ciao zIP SPECIAL CIRCUIT 5.0Q PERMIT VALIDATION 0 ISSUANCE DATE -91-DG, ELECT, PLG. MECH. TEMP. METER OR POLE INS. 20.00 APPLICANT'S AGOG ESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON'I'RACTURS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and illy license is in full force and effect. License ClassLie. Number Data Contractor OWNER -BUILDER DECLARATION I hereby arrant that am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5.Ousincssend l'roRuioos Code: Any city .,County which rcquiresa permit toconstrucL alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to flle'a Signed Statement that he is licensed pursuant to the provisions of the Contractors 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 exemption. Any violation of Section 7031.5 by any applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars(8500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered for of, (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 does such work himself or through his own employees, provided that such improve- mentsarenotintended or off'ered for sale. IL however, tie building Or improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or im- prove for purpose ofsale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to comtrun the projrel (Sec. 7044, BusinessLAWN and Professions Code: The Contractor's License Law does not apply to un owner of property who builds or improves thereon. and who contracts for such projects with a conlractm(s) licensed pursuant to the Contractors License Law. ❑ lam,xe 9t under Sec. ,B.&P.C: Ibrthis reason Q__ UN u BUILDING PERMIT FORMATION DATION $/FT. (J/ MISC.- REFER TO ORD PERMIT ISSUANCE ELEC. CONTR. LIC. NO. ,�A_ ELEC. / Ci u 6 TOTAL ( L PERMIT TO _ S�/L �] QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,CON D. 5.00 FIXTURES - PER TRAP 5.00 So. FT FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 - GAS EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 30.00 . SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PagcEt. No. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT No. PARCEL NO. WATER HEATER W/VENT 6.00 Owner t dr-"-- WATER SYSTEM 5.00 ' / �i� WORKP S'COMPIiNSAT1UN Dec LA RATION ad I hereby affirm 1hal I have a cortitic,le of consent to sell insure, or a certificate of Workers' Compensation Insurance, or a certified Copy thereef(S,c. 3800, Lab.C-). Policy No. Company ACC. DATE ACC. FILE N0, WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. MISC. - REFER TO ORD. ❑ Certified copy is hereby furnished. ❑ Certified copy is Filed wish the city inspection division. Applicant FIRESPRINK Y E) N� ENERGY T-24 Y N[3 CERTIFICATE OF IiXEMPTION FROM WORKERS" COMPENSATION INSURANCE, (This doll:.n sed not be completed it the pcnnit is for one 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 sir as of become subject to the Workers' Compensation Laws .(California. Dat` PERMIT ISSUANCE 10.00 FLOODZONE Y ❑ N aL.U.C. Y OUN 1 PLG. CONTR. LIC. NO. PLG. TOTAL OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING �/�� Almbc°m NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should hecome subject m the Workers' Compensulmr, Provisions of the Labor Code, you must forthwith comply wilh such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, Civ.C.). Lender; Name Lender's Address ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=0C.F.M.) 4.00 AIR HANDLING UNITIOVER 10=1C.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OVER 100,000 B.T.U.)9.50 ELECTRIC rte, 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 stale laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of upertino against liabilities, judgments, costs and expenses which may in any way acaoe against said City in consequence of the •ton i this pcnnit. �a VENTILATION FAN (SINGLE) 4.00 BOILER- ODMIP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISQ - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL 137 _ Ig alar (Applicant/Contractor Date OFFICE COPY