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18244POSTTHISCARD NEAR FRONT OF BUILDING _ PERMIT NUMBER-, CITY OF CUPERTINO" ' 1$244 ;INSPECTION DIVISION. -JOB INSPECTION RECORD � ', 1 �� . ' .. � - PERMI�EXPIRA�TION iii'' JOB ADDRESS ` L ��i` UNIT#' 'LOT# r, fI : �, ,1 //yy �•1 ✓I '-3 PERMIT•EXPIPES IF.WORK SNOT OWNER S. L YN coNTRAc.oR l70(J pV� L-eJ1/� IS STARTED WITHIN 180 DAYS OF,PERMIT ISSU- ANCE OR 180 DAVS.FROM INSPECTION DATE I INSPECTOR INSPECTION RECORD- FOUNDATION . i s NOTE: - �' "' - '�LASTCALLEDINSPECTION. ALL GRADING ANDDRAINAGE SHALL'BE INSTALLED' TO COMPLY WITH THE APPROVED PLANS AND CITY OF UFER, - PFRnu tryryrynLmnnoN ITE • CUPERTINO STANDARDS.. - -- GARAGE GARAGE SLABS; POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -' UNDERGROUND/ SLAB. PLUMBING - - 'r,. - ISSUANCE DAJE ELECTRICAL .MECHANICAL - - - PAIrl BLOG!,4 ELEc+. � LG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'AI .; f� iE�« I .L �LI� - ,.�1 BUILDING PERMIT .INFORMATION ' WOOD FLOOR', -. ALUA, 10N �y �TT7•�� SIFT. PLUMBING bwOex- /i/l�ufG /h vJT S• MECHANICAL .. 'ELECTRICAL HAM To FRAMING INSULATION � - � � I STORIL - TYPE CONSTR. - • - OCC,GROLIP RES,UNITS• PLACE NO^SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /l - - - ROOF NOTE: NO FINAL INSP. SHALL E DE.BEFORE THE CONSTRUCTION TAXIS PAID sn FT. noon AncA TOTAL AcaencE . DIAPHRAGM - - •-- ROOF, SH EATH ING `��• UIL CON USE RFs o CON Pe om•,Y ❑ ❑ ❑ ❑ APPLY`ND ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS.:' DATEINSP.1 -ROUGH' SANA ' nssessnRs PARceI: No.. - PLUMBING. - ELECT, ENERGY' TUBSB SHOWER PAN - PLUMB ING ENERGY. - .TRACT No. 'PARCEL No MECHANICAL MECH. ENERGY ' ELECTRICAL '• - I •. -' BUILDING ENERGY, ACC oATE - ' ACC PILE No . FRAMING'. ,- - - - • ELECT. FINAL TEST ,INSULATION PLUMBING ZONING - - ,FIRE ENC, SITE NO - GAS TEST -- - - - — - GAS - MECHANICAL SPRINK EN E RGY L]a ° ❑ "❑❑"❑ ,COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR _ ELECTRICAL RELEASE - - FL000 ZONE v ❑ , 'N❑ aL.0 c. Y ❑ - N❑ INTERIOR'SHEA R� 'FIRE DEPT: - ti SHEETROCK'- ;GRADE - + FEE SUMMARY EXTERIOR'CATH' ••BUILDING- '; +. --. . BUILDING INTERIOR .LATH TEMPORARY APPROVALS SCRATCH COAT ItLLUTRIC PLAN CHECK FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY.. SEISMIC FEE i Q OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. v1 MICROFILM ARRANGE FOR INSPECTION'BY-PHONING M-4505; ELECTRIC,UJ ?S ONE WORKING DAY BEFORE REQUIRED INSPECTION. F PLEASE GIVE JOBADDRESSWHEN PHONING. PLUMBING Q„D MECHANICALSp - SEE PERMIT FOR EXPIRATION DATES- , ,,,CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE.BEFORE CALLING, FOR *FINAL INSPECTION. TOTAL �'� G OFFICE COPY W -APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY '. BUILDING PROJECT IDENTI FICATION APPLICATION & PERMIT - BUILDING — ELECTRICAL— PLUMBING — MECHANICAL .PERMIT NUMBER w 1 ,S LJ 4 T RUILGNG I appREss ?761/ • �' L� OWNER'S "a E O�`7 •l �, K� bet ,.� 6� o DTV. ELECTRIC PERMIT FEE, PLAN C E K VALIDATION CONTRACTOR'S NAME OUTLETS - SWITCHES -RECEP '10.00/1.00 LIC. NO �� I IfLIGHTING FIXTURES 70.00/1.00 3• ADDRESSroRs APPLIANCES - RESIDENTIAL -' 4.00 t PANELS 10,00 - ' PHONE DATE OF APPLICATION ' ARCHITECT - OR• ENGINEER '^.- M xYI 1f/Vt' ,• 1 LIC. N0. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR OR ESS ENG.' /V ADDRESS V i�Yfl Ir • ZIP - SPECIAL CIRCUIT 5:00 PERM VALIDATION j,�.,►�/� '`ff _s vvx',\ EMP. METER OR POLE INS. 20.00 ADDRESS ' aooREss ' MOTORS SEE FEE SCH. 1 �'IN�I SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 7 I hereby arinn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bmsimesl end' 1'rofessions Code,' nd my license is in full force' ndr[Tec Lic. Numberq �f 10� Date Nntmclor *� " h tr . ISSUANCE DATE LDG. LECT. PLG. MECH. . El El w o OWNER-BUILDIiR DECLARATION 1 hereby affirm that I am exempt Iron the COntruclor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: Any city or county which requires a 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 of the Contractor's License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and BUILDING PERMIT INFORMATION MISC.— EFER TO ORD -11 VALUATION S/FT. PERMIT ISSUANCE `"— — - )J. 00 ELEC. CONTR. LIC. NO. ELEC. TOTAL3j. G O PE MIT TO 1 •'1 I DTV. PLUMBING PERMIT FEE STORIES I TYPE CONSTR. ` the basis for the alleged exemption. Any violation ul Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty, of not mora than five hundred dollars ($500j): ALTER-DRAIN&VENT•WATER (EA.) 5.00 .msfl ❑ I, as owner of the properly, or my employees with wages as their Sole compensation, will do the work, and (be,structure is not BACK FLOW PROTECT. DEVICE 4.00 O I • l% OCC, GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions - Code: The Contractor's License Law does not apply town owner of - - - FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA n TOTAL ACREAGE , property who holds or improves thereon, and who does such work himself or through his own mnployees, provided that such improve- meats am of intended or ofl'cred for sale. If, however, the building GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner - builder will have life burden of proving that he did not build or no. prove tar purpose of,alc). ..- ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE• RES IND CON PB Oth m �E, ❑ Q INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construes the project (Sec. 7044, Business and Professions Code IT, Contractor's 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 will, a cmumctor(s) licensed pursuant to the Cnntmctor's License Law, _ SEWER -SAN EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ l um exempt under Sec.—, B &P.C. for this reason - WATER HEATER W/VENT 6.00 Owner _ umgt WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP: 5.00 WORKERS'COMPENSA'HON DFCIARATION ' I hereby affirm that'I have a cer il'ieatcofconsenl fuself-insure, ora certificate of Workers' Con ensetion Insurance:or a -certified co �f1SQ�(VpQ z r� Poli Y o, nmpunYg3iYtrMa,yme- - ZONING - ENG. SITE'NID FIRE SPRINKENERGV Y[:] N� T24 . ,r❑ NQ ❑ Ccrlil'ied cupY is hereby li rnish' ❑ Cerlifiet��gpy is filed whit thd e Ity inspec'm.ivisi Applicant— LM MISC.- REFER TO ORD. CERTIPICATG'OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10 CIO FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE - ' (This section need not be completed it the permit is I'or one PLG. CONTR. LIC. NO. PLG. TOTAL ,$• - Y.❑ 'NE] .-Y ❑ NC] hundred dollars 1 E 100) or less.) - ' I'certify that in the, performance of the work for which this per- mi[ is issued, I 'hall not employ any person in any Tanner so as m QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING r •J� `✓ become subject to the Workers' Compensation Laws of Califsirow.. Date Applicant NOTICE'TO APPLICANT: If, after making this Certificate of E x- ALTER OR ADD TO MECH500 . . APPLIANCE 5.00 I AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 !� PLAN CHECK FEE anption, you should become subject to the Workers C'onpensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked, • COrvSTRUCTIONLENDINGAGHNCY AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE Ga. agency for 1 hereby aflinn that [here is a constructionnit EXHAUST HOOD (WITH DUCT) 5.00 is the performance of the work for which this permit Is issuul ,Sec.MICROFILM 3097, .C.1. HEATING UNIT (TO 100,000 B.T.U.) -8.00 Lender's Name Gender's Address - HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 'Gd I certify that l have read this application and stale that the above information is correct. I agree to Comply will( all city and county ordiwneco,and state laws,relating to building construclimt, and VENTILATION FAN (SINGLE) 4.00 BOILER -COMPO H.P,or 100,000B.T.U.1. 6.00 PLUMBING .00 8 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL , 'O hereby authorize representatives ins of this city to enter upon. the above-mentioned property forinsp of ion purposes. . (We)',agree to savc, indemnify cod keep harmless filo City oP MISC. - -- - REFER TO ORD. uperlino against liabilities, judgments, casts and expenses which may in any way accrue against said City in .consequence of the ranting of this permit! - PERMIT ISSUANCE 10.00 �'„QG CONST. TAX' ' ' MECH. CONT, , v LIC. NO. MECH. - )��•,��_ 1 II b�Cals. TOTAL2� TOTAL /�• / $ngneture of Applicant/Contractor D.—Tc OFFICE COPY