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18169POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO • INSPECTION DIVfSION JOB INSPECTION RECORD q c ',,may\' l ��,,��?16 JOB ADDRESS _%y Y ` & ia �l �" XIT# _LOT# I 7 1 OWNER ��{-e t/l ,P J` CONTRACTOR CI eK. PERMIT NUMBER 18169 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST ,,CALLED INSPECTION. .a INSPECTION DATE I INSPECTOR INSPECTION RECORD ' NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPRQy��NS AND CITY OF CUPERTINO STANDARDS. lr� UFER PREGUNITE •• PERMIT VALIDATION L (_ V - ) ^ `- y `� " ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED „Op! 90, 1989 UNDERGROUND/SLAB PLUMBING f,� cify Of Ci1p rtIDO ELECTRICAL MECHANICAL- BLDG ❑ [CECT PL(i. MECH x. ❑ o DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL' ELECTRICAL veRMn TO ' 1i/f1 er, FRAMING INSULATION SIORIEV TYPECONSTH 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 SU EL (IOUH AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE TIES IND CON PeOR,— L L L L L ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT ,ENERGY- TRACT N0. PARCEL NO TUBS & SHOWER PAN PLUMBING ENERGY MECHANICAL MECH. ENERGY ACC DATE ACC, FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT, FINAL TEST - ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK � ❑ NL ENERGY L]J L NL MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD zorve vl NL a -1 vL NE] EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, I" ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC Da, PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY rl O ZZ F O LU - W > tl Q Z UO LL U Owet } N H Z L011 10 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BJA LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT ILDING--E•LBCPRICAL- PLUMBING - MECHANICAL PERMIT NUMBER �(] S81�7 i` 0 r•.ILDING V I DDRESS _ S DWNER'$ PLAN CHECK VALIDATION NAME 1r r� �'{ Vi, CO11( �' DTV. ELECTRIC PERMIT FEE CONTRACTOR S NAME e KtJ UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONT ACTOR s ADDRESS APPLIANCES - RESIDENTIAL 4.00 PANELS 0,00 PANELS (OVER 200 AMP) 20.00 F6A 4 HON QQ ARCHITECT DATE OF APPLICATION PLAN CHECK FEE P.C. NO. OR ENGINEER uc. No. ISIGNS TRANS. 3.00 ARCH, OR END.SPECIAL ADDRESS ZIP CIRCUIT S,OB PERMIT VALIDATION � _ •T d_ L l� 0'� I TEMP. METER OR POLE INS. 20.00 1# _0 p APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE .00T ` 1. Y`V C` LICENSED CON 'IRACPORS DECLARATIONIp I hereby affirm that I am licensed under provisions of Chapter 9�� ISSUANCE DATE (commencing will, Section 7000) of Division 3 of the Business sntl Professions Code, and my license Is In full force and effect. Class Lic. Number - RLDG. ❑ ELECT. 119-1 PLG. MECH. ❑ 1:1License Date Cnmmmor Ci},� of C� ertin BUILDING PERMIT ' `'-- - p-- - OWNER -BUILDER DECLARATION I herebyaffirm that 1 run exempt from the Contractor's License ' p Law fortheowingrcaeon.Bea703L5,Busittoa.d Professions Code: Any city or county which requirese permit towns, anc. also 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 Contractors License/ Late(Chapter 9(commencing with Section 7000) of Division 3oftha Business and Professions Code) or that he is exempt therefrom and the basis for lire alleged exemption. Any violation of Section 7031.5 INFORMATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 - 00 ELEC. CONTR. LIC. NO. ELEC. TOTAL . PERMIT TO -�� l Q� QTY. PLUMBING PERMIT FEE STORIE7 TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5,00 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars (S500).). ❑ 1, as owner of the property, or my employers with wages as their sole compunsation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 Code 'rhe Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 50. FT. FLOOR AREA TOTALACREAGE himself or through his own employees, provided that such Improve- mentsamhot intended oroffered lot Sale. If, however, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or iin- prove for purpose ofsale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer El Cl 1:1 ID Cl INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's License Law does nut apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OV ER 5 (EA.) 1.00 contracts fur such projects with a contractous) licensed Pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200tt/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. , B.&I'.C. fix oris reason WATER HEATER W/V ENT 6.00 Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO. WORK 1iRS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of camem to self -insure. ,r a eerlil'ica[e of Workers' Compeni.tion Insuanee, or a certified ZONING ENG. SITE NO. copy therrof(Ste. 3800, Lab.C.). Policy No. Company FIRE SPRINK V ElNE] ENERGY T-24 Y ❑ N[]CER ❑ Certified copy is hereby furnished r1<rRif,lof Is del With the city inspection division. Applicant= -/-/ _ MISC.- REFER TO ORD. TI FICA'I' E of FXEMI' ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.UC. PLG.CONTR. LIC. NO.PLO. TOTAL COMPENSATION INSURANCE (('his section need not be completed if lire Permit is for one V❑ N❑ V❑ N❑ OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S I W) or Ica.) I Certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. nam Applicant BUILDING ALTER OR ADD TO MECH. 5.00 NOTICE rO APPLICANT: If, after making this Certificate of Ex- mnphon, you should become subject m the Workers'Compensation APPLIANCE 5.00 - PLAN CHECK of 0m Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 CONSTRUCIIONLENDINGAGENCY EXHAUST HOOD (WITH DUCT) 5.00the I hereby affirm that there is a Construction lending agency for performance of the work for which this ermit is issued (Sec. Co,.G).Lender's HEATING UNIT (TO 100,000 B.T.LL) 8.003097. HEATING UN IT(OVER 100,000 B.T.U.)9.50 Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING I certify that I have read this upph"lion and state that lire above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned prnPetty for inspection purPOWS, MISC. - REFER TO ORD. CONST. TAX (We) agree to Save, indemnify and keep harmless flee City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Pd _,0 O runtingoflhispernit. C --2e-^ 5ignalum 6f ApplicantVatractor Date OFFICE COPY