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187514,1 .POST THIS CARD NEAR FRONT OF BUILDING - CITY OF CUPERTINO.. INSPECTION DIVISION ¢� JOB INSPECTION RECORD •I pf�jlJ. / I .vAr 7 - • JOB ADDR Ess _"t ` Y�V UNIT# _LOT#, OWNER ;Lv,_� CONTRACTOR •C_, PERMIT NUMBER 18751 PERMIT EXPIRATION MIT EXPIR SIF WORK IS NOT STARTED WITHIN 160 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. I PECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION _ NOTE: ALL GRADWG AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPER71N0 STANDARDS. PAZ) LEER PR EGUNITE PERMIT VALIOAnoN F ! -. �A t ( L ISSUANCE LATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED JAIL! - - UNDERGROUND /SLAB PLUMBING� Cli'T rf ^,Era1�I[It♦ ELECTRICAL MECHANICAL - BLuc FLEcr PLC.. MECH. ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED( BUILDING PERMIT WOOD FLOOR PLUMBING ^ , 1 V�\ UATINFORMATION VALION ' oa lfU,' !/ SIFT. MECHANICAL ELECTRICAL Q,c PERMn TO S'T' uiji�C.'V I %r-ji.0 FRAMING INSULATION ` \ sroRIES T PE CONSTR - OCL GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - .ROOF NOTE' NO FINAL INSR SH DE BEFORE THE CONSTRUCTION TA I - so T. aoov oven TOTAL acve.aue DIAPHRAGM ROOF SHEATHING- BUILDING USE ' RES IND CON PR 0"", . ❑ ❑ ❑ ❑ ❑ ^111110.1 PARCEL NO , APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ATE $ ROUGHSgN.q . PLUMBING - - ELECT.ENER TUBS & SHOWER PAN PLUMBING E ERGY THncr No PARCEL No MECHANICAL MECH.ENER ELECTRICAL BUILDIN ACC oATF ACC FJLE NO FRAMING ELECT. INAL TEST INSULATION - -. PLUMB NG ZONI ENG. SITE NO. GAS TEST GAS ' MECH ICAL EIRE SPR,NK Y ❑ N ENERGY T 2 Y [—]N❑ ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATI G EXTERIOR SHEAR ELECTR AL RELEASE PLOoo Y ❑ aLu.c Y ❑ N❑ INTERIOR SHEARFIRE - DEP - SHEETROCK GRADE FEES MARY EXTERIOR'LATH" ! BUILDING ! 3330 INTERIOR LATH TEMPO ARY APPROVABu1LDwG` SCRATCH COAT ELECTRIC, PLAN CHECK FEE SEISMICfFEE MICROFILM _ GAS - ,- a49 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE. FOR INSPECTION BY PHONING 252-4505, I— . ONE WOR KING - DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. coNs7. TAx TOTAL 1.3 S`� OFFICE COPY - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT - BUILDING -'ELECTRICAL- PLUMBING - MECHANICALI PERMIT NUMBER !;> 18751 11ILDING noDRess�aµ .8S8� OWNER'S NAME PHONE QTY. ELECTRIC PERMITFEE PLAN CHECK VALIDATION 6 D2 WkS DATE OF APPLICATION CONTRACTOR'S NAME - uc.NO. L OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES' '. 10.00/1.00 CONTRACTORS ADDRE n%N V �PHOxEe , `j APPLIANCES -RESIDENTIAL ' 4.00 . PANELS 10.00 ARCHITECT OR G ItSSoG ENGINEER PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. , ' SIGNS TRANS. 3.00 �QLIC.N�O. `, ARCH. OR ErvG.'O8�! Q ��I �� . ADDRESS 144-110 PAjej< 34922a SPECIAL CIRCUIT 5.00 PERMIT VALIDATION D ISSUANCE DATE BLDG. -ELECT. PLG. MECH. ElDate EMP. METER OR,POLE INS. 20.00 APPLICAN s ,S• •� • ADDRESS MOTORS SEE -FEE SCH. SERVICE CHANGE r; n prp 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I oat licensed under provisions of Chap[er9 (commencing with Section 7000) of Division 3 of the Business and Professions Codc, and nay license is in full for a License CW Lie. Number _ Contractor DEkDECLA T1 , 7iI%%'� P hereby affirm that I am exempt from the Contmctor's License nC°` Law for the followingon. (Sec. 7031.5, Business and Professions Code. e, dem y demolish, countypair any requires astructure p prior i[ to construct,ue, also improve, demolish, of repair any permit toff prior to its Issuance, also requires the applicant for such revisit to file a signed statement that he is licensed pursuant to ing provisions of the Contractor's License of Division 3 of the Law (Chapter 9 (commencing with Sectionie is exempt Business and ProfessionsCode)xempt or that he is exempt Iden- 70 and thebasisfor thealora exemption. Any applicaofSection7nally by of inorlicha fora permit subjects theapplicanl toecivil penally of not more than five hundred dollars (55001.1: ❑ 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 lar sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve mints are not intended or offered for sale. If, however. the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or lm-- prove for purpose of sale.). ❑ 1, as owner of the property, an, Exclusively contracting with licensed contractors to construct the project (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 contracts for Such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. ,B.&P.C. I'or this reason ' t A NI O 9 '�� - r� .•, r. •� - - Litt{ r1F opli,na in BUILDINGPERMIT MISC. - - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION pfl �<f 0)/0 00 �t 00/000 " $/FT. ELEC. CONTR. LIC. NO. - _ ELEC. TOTAL PERMIT TO SP -IS « I) P QTY. PLUMBING PERMIT FEE STORIES PPECONSTR, ALTER-DRAIN-WATER(EA.) 5.00 BACK F LOW PROTECT. DEVICE 4.00 OCC. GROUP _ RES. UNITS DRAINS -FLOOR, ROOF, AREA, GOND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -11 NC. 4 OUTLETS 6.00 so. Fr. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PS Omer ❑ 0 ❑ 11 ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 ASSESSORS PARCELND- LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SAN ITARV-STORM EA. 200ft/10.00 TRACT NO. PARCELNO. WATER HEATER W/VENT 6.00 Cane, Date - WORKERS'COMPENSATION DECLA RATION 1 hereby affirm that I have a certificate of consent to sell -insure, or a certificate of Workers' Compensation Insurance, or u certified copy thereof(S,,. 3800, Lub.C.L Policy No. Company WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 - - ZONING ENG. SITE NO. MISC.- REFER TO ORD. ❑ Certified ropy is hereby furnished. - Certified o y is filed with the it city insP�'lion division: Ap,unt�{..i�� CF-RTIFICA 1F EMPTION FROM WORKERS' COMPENSATION INSURANCE _ IThis section need not be complcicd if the permit is for on, hundred dollars lS100) or less.) I certify that In the performance of the work for which this per- mil is issued, 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of Cali Cornia. Date Applicant NOTICE TO APPLICANT. If, alto making this Ccrtificah:ol fix- emption, you should become subject to the Workr,, Compensalnm provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, 0v.C.). - Lender's Nam, FIRE SHRINK YEj NE ENERGY T 24 YE] NE] PERMIT ISSUANCE 10.00 FLOOD ZONE V NEI A.L.U.C. v N� PLG. CONTR. LIC, NO. PLG. TOTAL OTV MECHANICAL PERMIT FEE ' FEE SUMMARY BUILDING I' ALTER OR ADD TO MECH: 5.0 _ APPLIANCE 00 AIR HANDL. HANDLING UNIT (TO 1Q000C-F.M.) 0 PLAN CHECK FEE AIR HANDLING UNIT(OVER 10=C.EM.) 6.0 SEISMI f PD EXHAUST HOOD (WITH DUCT) 5.0 MICROFILM HEATINGUNIT(T 10 OOOB.T.U.) 0 Leadtr,Addres's - I certify that l have read this application and state that the above Information is correct.1 ogres with all city and county ordinances and state Ines relatingto [o b building construction, and hereby authorize representatives ins of this city to enter upon the above-merilioned p}operty for inspection purposes (We) agree to save, indemnify and keep harmless the City of upertino galnst liabilities, judgments, costs and expenses which may in wayaccrue against said Cit g yin consequcnc- of lh ra this permit / HEATINGUNIT(O E 1 ,00 T. .50 ELECTRIC - _ VENTILATION FA (SI E) .00 PLUMBING BOILER -COMP (3 H. ,or 100,000 B.T.U.) .00 BOILER -COMP (Over 100,000 BTU) SEE F SCH. MECHANICAL MISC. - REFER PERMIT ISSUANCE T ORD. 10,00 CONST. TAX ECM. CONT. LIC. NO. - ME TOT A TOTAL Sig arc oC Apphcent/Contractor Da OFFICE COPY