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17955• --v POST THIS CARD NEAR FRONT OF BUILDING : CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS _C�"� J UNIT# LOT# • � �O� OWNER C' -(C/, C.ACTOR /T'�" �- PERMIT NUMBER 17955 ` PERMIT EXPIR ATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLEDINSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UPER PREGUNITE PERMIT VAUDAnUN i I ISSUANCE DATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f l—/ I/ UNDERGROUND /SLAB PLUMBING /%- 171 ^'^/(. / 31ca L u ,.., /.- !� L' L•l ELECTRICAL MECHANICAL BLDG ELECT I PLG. sIECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION O PEReur TO S/FT_ PLUMBING _ MECHANICAL�� ELECTRICAL FRAMING INSULATION _ /"L -I 'F'R o! `✓1cS ... .� Lo'�j� STORIES TYPE CONST.. me d.'Y7 °t 11'/`F -`y OCC GROUP " RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HASBEEN SIGNED ROOF NOTE: NO FINAL INSP. SHA BE rE THE CONSTRUCTION TAXI PA 50 ET FLOOR AREA - `BUILDING TOTAL ACREAGE DIAPHRAGM USE Res IND CON Pe 0"', ❑ ❑ ❑ ❑ ❑ ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH FINALSINSP. SAN.N ASSESSORS PARCEL NO PLUMBING ELECT.ENERGY TRACT NO PARCEL NO. TUBS d SHOWER PAN PLUMBIN N MECHANICAL MECH.E ER ELECTRICAL BUILDIN EN ACC DATE ACG FILE NO FRAMING ELECT. FI AL zoNlNc ENG. SITE NO, INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ° ❑ N ❑ ENERGY T 24 E] NO MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING \ FLOOD ZONE `' ❑ Np A.L. 1 L, N❑ EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVAL SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE 6A ct NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL c� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ", BUI VDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 17955 BUILDING, ADoorss„ N1 OWNER'5 NAME '1 0 y VHONE CITY. ELECTRIC PERMIT FEE PLAN CHECK VALIQAIr Onil SIJ ' / / � �+13A Ivyl/Y/L'il J �.011y �' _I � - -Bti GATE OF APPLICATION CONTRACTOR'$ NAME 6� uc. No. '�j7j OUTLETS -SWITCHES- 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 AcrDR's ADORE &0'7 L4Xj ADDREss I05 PHONE APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER HI^.9 LIC NO, ColO-Nol PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS 4 �L/{(fllt 2� zm SPECIAL CIRCUIT S.QQ PERMIT VALIDATION GSL'!'✓"'"iLd'U �� EMP. METER OR POLE INS. 20.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION - 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force agit ef�fffee License Class �) Lic. Number Y ISSUANCE DATE ,r BLDG. ELECT. �,.r PLG. MECH. I�[I i v , Date 9V Contractor ��^- (D--Cv'I BUILDING PERMIT OWNER-BUILDER DECLARATION I hereby million that I ran exempt Bunt the Cons rncl errs' License (See. 7031.5. a.Bmit toI.dProfessions on.which Law for At,, city ... county At,,cityttr my whiny Structurep riot 0.1ts issuance. also improve, demolish, or repair any structure, prior n its issuance, also improve. Pastures the applicant for such permit to file a signed statement that he is licensed pursuanten the provisions of the Contractor's 3i fthe. of Division 3 of the Law (Chapter 9 (commencing with Section 7s exempt therefrom0 and Business and Code) or that he is exemptSection INFORMATION MISC. - VALUATION $/FT. PERMIT ISSUANCE 10.00Code ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO y ' CITY. PLUMBING PERMIT FEE STORIES r �1 TYPE CONSTR. he alleged the basis for the alleged exemption. Any violation alto action malty by any aonetha fora permit subjects thu0).): anttoocivil penalty LIC not more than five hundred dollars (3500).): ALTER-DRAINStVENT-WATER ❑ 1, as owner (it the properly, or my employees will' wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 DCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law docs flat apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 se- FT. FLOOR AREA TOTAL ACREAGE hlmsulf or through his awn employcus, provided that such improve - merits are not intended or offered for sale. If, however, the building m �V GAS - EA. SYSTEM - 1 1 NC. 4 OUTLETS 6.00 or Impnrvemmd is sold within one year of c(mpletion, the owner- builder will have the burden of proving that he did not build or im prove for purpose of talc). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB OHe, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. licensed contractors to Construct file project (Sec. 7044, Business and Professions Code: Tire Contractor's Licen.m Lew docs not apply to an owner of property who holds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant tla the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I all, exempt Imdur Sec. ,BAILC. fur His WATER HEATER W/VENT 6.00 ,ease, Owner Date WATER SYSTEM 5.00 ACC. GATE ACC. FILE NO. � WORK BRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate Df consent It, sLfivure, or a certificate of Workers' Compensation Insurance or a certified - ZONING ENG. SITE NO. copy thercof(Sec. 3800. Lab.CJ. Policy No. Company FIRE BPRINK ENERGY T-24 ❑ Cutlil'wd copy is lu,pby l umished. Certified copy is filed with the city inspection division. Ap lica of Y ❑ N❑ Y ❑ N❑ MISC. - REFER TO ORD. Cl: RTI E OP EXE M PTION FROM WORK 17RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMP17NSATION INSURANCE n ['Phis Lcf,i, ,red not be completed if the penin is nix one V [:] N❑ V C] N❑ CITY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or ILVS) 1 crHity that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner aD as to beeme, subject to the Workers Compensation Laws of California. Dale Appliciud NOTICE TO APPLICANT: If, after making this Certil'iceu• of Ex. BUILDING pn VVVUU ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE _ emption,you should become subject m the Workers Compmnsation provisions of the Labor Code you must forthwith mmply.,vith stroll provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE r ori EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm that there is a Construction lending agency lit the peHbriance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATI NG UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I certify that I hove read this application and state that the abuse information is correct. I agree to comply with all city and county . ordinances and since laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING 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 property for inspection purposes. misc.- REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which 'ny we- accrue against sold City in consequence of llm PERMIT ISSUANCE 10.00 MECH. CONT, LIC. NO. MECH. ntingo Ibis c iL Coe-_ 3U TOTAL TOTAL Signator lA licant 'ontractor Date OFFICE COPY