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18170• POST THIS. CARD NEAR FRONT OF BUILDING CITY OF CUPERTINg ' INSPECTION DIVISION JOB INSPECTION RECORD IL_ V� / r( JOB ADDRESS I Dq��.�a /'UNIT# _LOT# OWNER CONTRACTOR �% tI� a PERMIT NUMBERaw . 18170 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED .TO COMPLY WITH THE APPRIWOS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERMIT VAuoATION J, A V,.i C� N V C L ISSUANCE LATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED •'• un Ir 7 1989 UNDERGROUND /SLAB PLUMBING' ELECTRICAL MECHANICAL BLDG ❑ EL[Ci Fxy 1'LG. MF.CH ❑ El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL ELECTRICAL veHn+n ro e .1+ems FRAMING INSULATION sroRlE rvPE colvsrR OCC 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 50 Fl FLOOR PHf< LOLAL FCRf AGF DIAPHRAGM --CU usE RES IND CONON Pe ou.., ElEL ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT. ENERGY rHACI NO PARCEL NO TUBS &SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC, ELLE NO , ELECTRICAL BUILDING ENERGY FRAMING ELECT. FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE $PRINK YO N❑ ENERGY i 24 r ❑ NO MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD LONE E] N[] ALUC. L• NE] EXTERIOR SHEAR ELECTRICAL RELEASE' INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRICPLAN CHECK FEE GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ISEISMIC OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDINGINSPECTOR. MICROFILM. ARRANGE FOR INSPECTION BY PHONING 252-4505, Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - ELECTRIC OD PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL p(J OFFICE COPY FINAL�Tm File No. Date Location Subject' i Notes Approve/_ D e Inspector, I �— o ¢ z FOO Q V V �6o z oma 2m A F H s E a Q V H�.oa ce0 co a w mU. f i o H a 3 O Z_z F - cc y ao z Uo LL U 0 U } V1 F 2 • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON,PERMIT APP4_WAi90N & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL NUMBER '- 18170 , Go LOING GoV OWYER'S NAME OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION PLAN CHECK FEE P; C. NO, CONTRACTORS NAME UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 rorvTRAcaoms AooREss 6oQ PHONPsz V,49 -r," ARCHITECT OR ENGINEER LIc. No. APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 PANELS (OVER 200 AMP) 20.00 SIGNS TRANS. 3.00 ARCH, OR ENG. ADDRESS ZIP '.S.00 SPECIAL CIRCUIT] PERMIT VALIDATION �� Z b -v / l� J..21 vKUC(_1 11' TEMP. METER OR POLE INS. 20.00 PA APPLICANTS ADDRESS MOTORSEE SCH. _ SERVICE CHANGE 20.00 LICENSI:D CONTRACTORS DECLARATION ` 9 1 hereby aldrin that 1 am licensed under provisions of Chapter 9 (commencing will, Section 7000) of Division 3 of the Business andyw Professions Code, :cod my license is in full force and effect License Class Lic. Number ISSUANCE DATE BLDG. ELECT. ❑ PLG. MECH, El❑ Date Contractor ' BUILDING PERMIT OWNRR-BUILDIiR DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law lot tire tiro following reason.IScc. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior m 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 7000) Of Division 3 of the Business and Professions Code) or that he is exempt therefrom and thebasis for the alleged exemption. Any violation of Section 7031.5 INFORMATION MISC. - REFER TO ORD VALUATION S/FT. PER MIT ISSUANCE 10.00 ELEC. CONTR. LIC. NQ FLEG . TOTAL v2),• Q O PERMIT TO Z C OTY. PLUMBING PERMIT FEE BTORIE TYPE CONSTR. ALTER-DRAIN&VENT-WATERMAJ 5.00 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars (5500).1: BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ❑ 1:.S owner of tire property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of Property who holds or Improve, thereon, and who docs such work provided that such improve- menet are of Intended or empltl ee sale. vi ed that s the building hem, re through into de ownemployees,or FIXTURES - PER TRAP 5.00 50, FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, tine owner- builder will have the burden of proving that he did not build or im- Prove for purpose of sale.). ❑ I, as owner of the property, an, exclusively contracting with licensed contractors to construct tine project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON Pe Omer INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'I he Cunt ecun's License Law docs not apply to an owner of property who builds or improves thereon. and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for suit, projects with a contractor(,) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 O lam<•xcmpIRRmrSec. ,B.&PC.6v ruts reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK ERS'COMPENSA'I'[ON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofcoment to self insure. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof ISee. 3800, fab.CJ. Policy No. Company ❑ tied copy is hereby furnished. Cerrife copy with the city inzpeaion division. nnpbcnnt- IA�/--�� FIRE SPRINK Y E] NE] ENERGY T 24 Y 0 N[] MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOODZONE A. L.UF. CER'I'IFICATI:OI' EXEMPTION FROM WORKERS' PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE 1'f his Reaction need net be completed if the pennit is fill ono v� N� Y� N❑ OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the perfonnunce of the work for which this Per- mil is issued, I shall not employ any person in any manner so as 10 become subject 10 the Workers' Compenwtion Laws ul'California. Date Applicant NOTICE '10 APPLICANT'. It, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith uunply with such provisions or this permit shall be deemed revoked. BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10MOOF.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONST RUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm that there is a construction landing agency for rhe perfonnunce of the work for which this permit is issued (Sec. 3097, CivCJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC , 0� Lender's Name Lender's Address I certify that l have read this application and stile that the above information is correct. I agree to comply with all city and county ordinances and stare laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -ODMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorw representatives of this city to enter upon the above mentioned property for inspection purposes (We) agree to save, indmpnify and keep hmmless the City of ino against liabilities, judgments, Costs and expenses which any way ueerue against said City in consequence of the MISC.- REFER TO ORD. TAX pERM1T ISSUANCE 10.00CONST. CONT. LIC. NO. MECH. TOTAL TOTAL a�46 of thi'pcnniLMECH. a e I'Applica ontractor Date OFFICE COPY