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17140 POST THIS CARD-NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO � 71 � INSPECTION DIVISION � JOB INSPECTION RECORD JOB ADDRESS f �.5 ]- lC 5 PERMIT EXPIRATION Q l UNIT# _LOT# rt'I PERMIT EXPIRES IF WORK OWNER F, LT o.0 !` S CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - _ANCE OR 180 DAYS FROM NOTE: UFER ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.' PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMITVALIDATION CUPERTINO STANDARDS. GARAGE SLABS - ��. E• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB =JAN 25 1989 PLUMBING J!i E- / ` f/( VC V d: ELECTRICAL - City Ot cugerfiflo SSUANCE DATE MECHANICAL eLuc ELECT: v(�Lpc1. MecR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION' Sl FT. , MECHANICAL i ELECTRICAL p� PERM'I TO FRAMING - Up O INSULATION _ STORIES YPE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF 'NOTE:NO FINAL INSP.SHALL MADE BEFORE SO FT FLOORAREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING USE RES IND COry PB om.l APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS .DATE INSP. El El ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO SAN.# PLUMBING - ELECT.ENERGY . • TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO. FRAMING - - ELECT. FINAL TEST INSULATION FM :z7 ZONING ENG.SITE NO. GAS TEST FIRE SPRINK ENERGY T.1a COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ° ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELEASE FLOOD ZONE A.L Uc. INTERIOR SHEAR kin SHEETROCK EXTERIOR LATH INTERIOR LATH .TEMPORARY APPROVALS SCRATCH COAT ELECTRIC NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. • MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �p Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATON DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL a� cv0 CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATI ON .PERMIT NUMBER BUILDING APPLICATION & PERMIT O ADOREss BUILDING—ELECTRICAL—PLUMBING—MECHANICAL C . E7-,q�s R • - OWNERS NAME �f,," 1 2 PLAN CHECK VALIDATION '• ICLl E7N '&C)WV&AJ Jk2r DTV ELECTRIC PERMIT FEE l r CONTRACTOR'S NAmE /x;�c�i OUTLETS-SWITCHES-RECEP 10.00/1.00 a �• LIC.No. LIGHTING FIXTURES 10.00/1.00 ADORRess TORS L_- APPLIANCES-RESIDENTIAL 4.00 - PHONE PANELS 10.00 DATE OF APPLICATION ` OPCRItECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. NGINEER IC NO, SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP-METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. SERVIICE CHANGE 20.00 o ¢ i �0'e. 0VLV(.G H 0 o LICENSED CONTRACTORS DECLARATION uw I hereby affirm that I ani licensed under provisions of Chapter 9 ISSUANCE DATE H 3 w (commencing with Section 7000)of Divl.siou 3 of the Business:md BLDG. ELECT. PLG. MECH. F N z Professions Code,and my license is in full force and effect. Z,i e o License Class Lia Number oo �:_ ❑ E] t,^4 ,A ❑ H j Uate Convector My at q.,, f111 IS ¢w a OWNER-BUILDER DECLARATION D ia BUILDING PERMIT AINFORMATION w ; I I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD u O j Law for the lollowing reason.(Sec.7031.5,busboy..nd Professions VALUATION $/FT. - PERMIT ISSUANCE 10.00 a, Code.Any city or county which structur e p riot to consuaRc ,also ¢ E ¢ o improve,dnnolish,or raptor any svuaturc,prior to its issuanw,also ELEC.CONTE. LIC.NO. ELEC. 5 m4mres the applicant for such permit to file u signed statement that 0 a. TOTAL 6 W w he is licensed pursuant to the provisions of the Contractors LicensePERMIT TO H z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the P/ /}/� 4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I V ¢ H m the basis for the alleged exanpvon.Any violation of Section 7031.5 STORIES PE CONSTR. III by any applicant lot a permit subjects the applicant ton civil penally ALTER-DRAIN -WATER IEA.( 5.00 of not mon than five hundred dollars(5500).1: ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECTDEVICE 400 their sole compensation,will do the work,and the structure is not . . OCC.GR0 UP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cade:The Contractors License Law does not apply to an owner of property who builds ur improves thereon,told who does such work FIXTURES-PER TRAP 5.00 SO.FT FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If.however,the building GAS.EA.SYSTEM-11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the ownee GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove 1,asor of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Other ❑ I,as owner of the property,am exclusively contractor, - . ng with 0 licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not up,ly to an owner of Properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractorls)licensed pursuant to tire�ontmctor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. �y I sem exempt under Sec: e.&P.C.for cis WATER HEATER W/VENT 6.00 D D reason Owner -f?-r-- WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK IIRS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG SITE NO. copy thereof(Sec.3800,Lab.C,). Policy N..—Company O ❑ Certified copy is hereby furnished. Z Z O Cetlified copy k tiled with the city inspection division. FIRE SPRINK ENERGY T-24 � O Applicant MISC.- .REFER TO ORD. YE] ry[] YC3 NQ DL y CE;RTIFICA'ri,Oil;EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10,00 U LU J COMPENSATION IN'SURANC17 PLG.CMMECHANICAL .NO. PLG "fir /� V FLOOD ZONE A.L.U.L. O' O (This section need not he completed if the permit is for oneTOTAL (`fir 0" Y rv� v ry� � Z hundred dollars IS 100)or less,) U O I certify that in the performance or the work for which this per- OTVAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any mannersoastoO W become subject to the Workers'Cumpunsalion Lows of Calikoria.a Duct ICAN1:nt MECH. 5,00 BUILDING } Z NO IDate CF? TO AI'I'LICAN,: IL after making this Ccrtil icuce ul'Ex- I— emption,you should become subject to the Workers'Compensation 5.00 PLAN CHECK provisions of the Labor Code, you nest forthwith comply with suh provisions or this permit shall be deaned revoked. TO 10MC.F.M) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 tin performance of the work for which this permil is issued(Sec. MICROFILM 3097,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read this'opplicaticn and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct, I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00 r d� hereby authorim representatives of this city to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keel)'harmless the City of MISC.- REFER TO D. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX RmY in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 Nin,alibis permit MECH.CONT, LIC.NO. MECH. 9N cLf T)—,(f Cao � 0-4-1 /Z �laS TOTAL TOTAL U 0 Slgnatur"I Apphcanhi-ontractor Date OFFICE COPY