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17531POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION. DIVISION JOB INSPECTION RECORD /i•1VX3 / i• �•�� ¢� £� JOB ADDR ESS '•VV D /.,.7 Ltl L UNIT# _LOT# ' OWNER - CONTRACTOR PERMITNUMeEH 17531 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS. NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU ANCE OR 180 DAYS FROM CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE:LAST ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERMIT VALIDATION {D .755unNCEDATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED pj UNDERGROUND / SLAB - PLUMBING MAY 1 ELECTRICAL(� MECHANICALbIDG City of i [CECT PLG. MECH �' 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDwc''iPERMIT INFORMATION WOOD FLOOR - PLUMBING � - VALUATION S/FT. MECHANICAL ELECTRICAL plvc. PERMIT TO, t% FRAMING INSULATION �• Y STORIES Tn'E CONSTH. .�'GIaC%iA./L �•G DCC, 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 ' sa. v*.pLoou An EA TOTAL ACRLACL DIAPHRAGM ROOF SHEATHING buIL CON CON use HES IND P8 Omer ❑ ❑ - ❑ ❑ ❑ • APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGHSAN.k ASSESSOHS PARCEL NO. - PLUMBING . ELECT. ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT NG. PARCEL. -NO. ' MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ncc DATE ncc EILE No FRAMING ELECT. FINAL TEST 7 —✓� INSULATION PLUMBING 7_ ZONING ENsITENO a . GAS TEST GAS MECHANICAL FIRE SPRINK Y [:]N❑ EN ERGY r.)a v ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE PLOoo solve v ❑ N❑ 4.L u,c. v ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATHBUILDING BUILDING 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 IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, � -ONE 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. rax TOTAL /! It OFFICE COPY APPLICANT TOEILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT ILDING -ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 17531 13wLDrNG AODREss(des l is l O.NER S U NAME S ONE �a5?_3QTY.l ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OFAPPLICATION' CONTRACTORS NAE,gJk�Q Q No. () / OUTLETS-SWITCHES-RECEP 10.00!1.00 LIGHTING FIXTURES 10.00/1.00 ADDRESS DRs /J S.JO. J PHONE40 Q PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT oR ENGINEER ' uC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDDRESS ENG' Zip SPECIAL CIRCUIT 5,06 PERMIT VALIDATION y- ` J. Ahl �OI�(L�'C�I•• ISSUANCE DATE TEMP. METER OR POLE INS. 20.00 ADDRESSTs ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 - - LICENSED CON TRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (man ncncmg with Section 7000) of Division 3 of the Business and Professions Code, a y license is in full foo t [+/ Licata Class Lia Number �--77 Date Contractor OWNERI am exempt t from RATI N I hereby ull'inn that I am exempt !sato the Contractor's License Law for the following reason. (See. 7031.5. Business and ProfessionsVALUATION Code: Any city orcountyswhichrequn iresapenittoconstrL reallef, improve, demolish, or repair any structureprior to its issuance, also requires the applicant for such permit to file a signed statement that rs be is licensed pursuant to the provisions of lite Contractors License Law (Chapter 9 (commencing with Section 7000) o' Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged examption. Any v i.Irlio,, o f Section 7031.5 by any applicant bor a permit subjects the applicant to a civil penalty Of Got more than free hundred dollars (SSOO).): ❑ I, as owner of the property, or my cmployees with wages as sole compensation, will do tire e work, and the structure is not intended or offered for sale (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- mentsarenotintendedorotfcrcd for salelf, however, the building or improvement is sold within one year of completion, the owner- builder will have tire e burden of proving that he did not build or im- prose for purpose of Sale.). ❑ I, as owner of the property, am exclusively contracting with licensed cummmors to construct the project (Sec. 7044, Business and Professia ns Cade: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who contracts for suet, projects with a conhoctorts) licensed pursuant Or the Contractors License Law. ❑ lam exempt under See ,B.&P.C. for this reason � +J BLDG. ❑ ELECT. ❑ PLG. MECH. ❑ MAY BUILDING PERMIT INFORMATION S/FT. MISC. - a REFER T Ca Bftl .PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO OTY. PLUMBING PERMIT FEE ALTER -DRAIN -WATER (EA.) 5.00 STORIES TYPE CONSTR. BACK FLOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS -EA. SYSTEM -1 INC.4 OUTLETS 6.00 - GAS EA. SYSTEM -OVER 4 IEA.) 2.00 so. vT. FLOOR AREA TOTAL ACREAGE BUILDING USE RES IND CON PB ORR,, 11 ❑ El El ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS1 INC 5 6.00 - V.B. ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 WATER HEATER W/VENT fy00 r TRACT NO. PARCEL NO. Owner Date WORKERS'COMPENSATION DIECLARAT ION 1 hereby affirm that 1 have a certificate of consent to self -insure, mpensa m Insurance , a certified or a certificate of Wo5:., copy J. h,, at _y}'c' ❑ Cer rf !Ted cop furnished. with the 1 ins cry pection div QA WATER SYSTEM 5.00 ACC. DATE ACC, FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE N0. FIRE SPRINK Y [3 N ENERGY Tcopy Z4 Y F] NEI MISC. - REFER TO ORD. c CE I JCAI'1' 01' EXIiMPI 'ION FROM WORKERS' COhIPF.NSATION INSURANCEPLG. (This section need not be completed if the permit is for one hundred dollars ($100) or Tess.) 1. certify that h the performance of t¢ work for which this per- mit is issued, I shall not employ any person in any Inanner so is to become subject to the Workers' Contpensution Lawsof California. Date Applicant NOT..,, ye APPLICANT: If, after making this ,s' Corn R• of on emptioo, you should become subject m ten Workers' Ccomply with provisions of the Labor Code, you muss forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm thin there is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ.CA Lender's Name Lender's Address I eerily that I have read this application and sone that tre above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to so e, indemnify and keep harmless the City of Cupertino against iia ililies, judgments, Lust, and expenses which ay m ny way icC a against said City in consequence of the ra ing this eons!. PERMIT ISSUANCE .00 'f D0 FLOOD ZONE Y -E] N ❑ A. L. U.C. Y ID N ❑ CONTR. LIC. Na.PLG. TOTAL for) QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 ' AIR HANDLING UNIT (TO 10,0W CF.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT 10=C.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM ELECTRIC HEATING UNIT 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.19.50 VENTILATION FAN (SINGLE) 4.00 BOILER-OOMP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING G(j 801 LER-COMP (OMo 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 - CONST. TAX MECH. CONT, LIG NO, MECH. TOTAL TOTAL aignatur PfApplican t/ Contractor are OFFICE COPY