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1529010 110 _ POST THIS CARD NEAR FRONT OF BUILDING' CITY OF CUPERTINO152J INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS �Q �7 /Vl� - V[S'T/d- Aver UNIT# _LOT# OWNER Z_jCONTRACTOR PERMIT NUMBER' QO PERMIT EXPIRATION PERMIT EXPIRES*IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- OR 180 DAYS FROM . LAST CALLED INSPECTION., INSPECTION DATE I INSRECTOR INSPECTION RECORD FOUNDATION'ANCE -� NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED' COMPLY WITH THE APPROVED PLANS AND SIN OF CU CUPERTINO STANDARDS: - - UFER PREGUNITE PERMIT VALIDATION %-»-- %' r ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING - ELECTRICAL MECHANICALy,Ij�06 P ELECT. kJrv-i PLG. MECR ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w` U`` fl DING PERMIT INFORMATION WOOD FLOOR VA N pQ SIFT. PLUMBING - - MECHANICAL ELECTRICAL ,• - �{�� PERMIT TO 4000"//0',/�7Ce"% FRAMING, INSULATION Lo "r- e \week STORIES TYPE CONSTR HES - DCC GROUP UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN IGNED ROOF ' ' NOTE: NO FINAL INSP. SHALL$O BE'MADE BEFORE THE CONSTRUCTION fAX IS PAID •, FT FLOOR PPEN A TOTAL CREAGE � DIAPHRAGM ROOF SHEATHING �" BUILDINGUSE RES IND CON Pa on... ❑ ❑ ❑ ❑ ` ❑ APPLY NO ROOFING UNTIL ABOVE HAS B EN SIGNED FINALS DATE INSP. - ROUGH.- SAN.# ASSESSORS PARCEL NO I PLUMBING ELECT. ENERGY TUBS & SHOWER PAN - PLUMBING ENERGY TRACT No, PARCEL NO , ! MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC. DATE ACC FILE NO., FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE N0. , GAS TEST - GAS - MECHANICAL FIRE SPRINK Y ❑ "❑ ENERGY T.44 ° ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE„ Y ❑ N❑ A,c UC. Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. - SHEETROCK - GRADE FEESUMMARY EXTERIOR LATH- N i BUILDING L h INTERIOR LATH MPORARY APPROVALS SCRATCH COATELECTRIC - PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE -HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' .. 7 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F-oF ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT!. PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL�Q /:, OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - - BUILDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 1 [ (] O - I J J BDILDING _ ADDRESS OWNER'S NAME " N.II -ell t:e, TV ELECTRIC PERMIT FEE PLAN CHECK VALIDATION AERACTDRsNM UTLETS- SWITCHES -RECEP 117X'"0 LIC. NO. 7 LIGHTING FIXTURES 10.00/1.00 AUGHEs5T0R's APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 , PHONE DATE OF APPLICATION- ARCHITECT. OR n D �• PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO, ENGIN EK h j I LIC. NO. 1,1 .. SIGNS TRANS. 3.00 ARCH. OR ENG pp ��11 ADDRESS [��0 Va,.SU 1n U2ryS eJ-V�1' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS, 20.00 ZI /�L•.�-,�O+r-�'�. APPLICANT'S - ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 7 0 LICENSED CONTRACTORS DECLARATION I hereby ufDrm that I am licensed u ndc,pH.viamCS.fChapter9 (commencing with Section 7000) of Division 3 nllhe Business and Professions Code, and my license is in full force and effect. License Class Lic. Number ISSUANCE DATE ELECT. PLG. MECH. ❑ ❑ - Date Contractor 2 ILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason, (Sec. 7031,5, Business.nd Professions Code: Ally city or county which requires a permit to construct, alter, MISC. - REFER TO ORD ti - PERMIT ISSUANCE +11DIDD VALUATION /� 5/FT. ELEC. CONTE. LIC. NO. ELEC. TOTAL improve, demolish, of repair any structure, prior to its issuance, also requites the applicant for such permit to file a signed statement that re u licensed pursuant to the provisions of the Contractor's License ct Law (Chapter 9 (commencing with Section 7000) of Division 3 of Business and Professions Code) or that he is exempt therefrom and v w PERMIT TO �� t A � � �� T1 ({• QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant boacivil penalty of not more than five hundred dollars ($500).): ' ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, Or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale -(Sec. 7044, Business and Professions Code Tire Contractor's License Law does not apply to an owner of - FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintended or offered for sale. If, however, the building GAS - EA. SYSTEM -11 NC. 4 OUTLETS 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 im- proV for purpose of sale.). I.as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 ' BUILDING USE RES IND CON PB Other 11 El1:3 1:1Ii INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. sed contractors to construct the project (Sec. 7044, Business and ro fessions 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. contractor(s) licensed pursuant to the Contractors License Law. SEWER -SAN V -STORM EA. 200ft/10.00 _ TRACT NO. PARCEL NO. ❑ lam exemptundurSec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Ow" att - WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO, WATER TREATING EQUIP, 5.00 WORAERS'COMPENSA1ION DECLARATION 1 hereby affirm That I have a certificate of consent to self-insum. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereat (See, 3800, Lab.C.). " Policy No. Company ❑ Certified copy ishereby furnished. .❑ Certified copy is fled with the city inspection division. Applicant FIRE SPRINK V ❑ IN ENERGY T-24 Y ❑ N❑ MISC. REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ IN C] Y ❑ N❑ hundred dollars (8100) ar leas.) I certify that in the performance of the work for which This per- Out is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING /.2 6 become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after muking this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should became Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 1QOODCF.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE 7 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 3097. Civ C.j00e of me work for which this permit is issued fSec. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.UJ9.50 - ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER -COMP (3 H.P. Or 100,000 B.T.U.1 6.00 BOILER -COMP (Over 100,000BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives.of this city to enter Upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify slid keep harmless the City of upertino against liabilities, judgments, costs and expenses which ay in any way accrue agaim said City in consequence of the mCIA of this permit \ Q I 1/ CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL 10,1 Sgnatureof Applicant/Contractor Date / OFFICE COPY