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15025!= 0 POST THI RD NEAR FRONT OF BUILDING • ' CIT ..0F CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOBADDRESS 10060 Pasadena Avenue UNIT# _LOT# Ow'ER James H. Sisk CONTRACTOR Pf KNIT NUMBER 15025 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180E OR OF PERMIT ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. ' 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. LIFER PREGUNITE PERMIT VAUDAnuN ._ '-- DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNE G ® !/.-orf UNDERGROUND/SLAB PLUMBING aj9/F'T- I=vKISSUANCE ELECTRICAL BG ELECT PLG MEC. MECHANICAL s�'u �] ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED all RV BUILDING PERMIT Y INFORMATION ` WOODFLOOR VALUATION SIFT. PLUMBING �{ Pf MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR INSULATION c� � �D dO �C� 1'LG OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O.ki !LOOK ARRA TOTALACREAGE ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID DIAPHRAGM auaomc USE 0'. HES IND Co. Pe El E-1 ❑ ❑ ❑ ROOF SHEATHING ROOF NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING �- ELECT. ENERGY TRACT N0 PARCEL NO TUBS 8 SHOWER AN PLUMBING ENERGY MECHANICAL .9- f MECH. ENERGY ACC DATE ACC FILE No ELECTRICAL _)`3- b_S_ BUILDING ENERGY FRAMING ELECT. FINAL TEST ZONING ENG SITE NO. INSULATION PLUMBING W GAS TEST GAS -.i-ir�K FIRE SPRINK Y ❑ NEI ENERGI 1.19 I [-] NEl MECHANICAL '-A% COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,j , / fLOOU ZONE v N� A,L UC. L N� EXTERIOR SHEAR ELECTRICAL RELEASE ,p, INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS PLAN CHECK FEE SCRATCH COAT ELECTRIC GAS S, SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED' BY BUILDING INSPECTOR. MICROFILM ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z PERMIT FOR EXPIRATION DATE — PLUMBING MECHANICAL CONST.TAX CONST. IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY c• O Z_ 2 F ¢N - LU > 0-0 :DZ UO LL U W } Z Lt is APPLICANT TO FILL IN INEMMATION WITHIN RED LINES - US"LL POINT PEN ONLY . BUI LDI NG PROJECT I DENTI FIC ION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER t 15025 BUILDING ,DOR0PA0410 ADENA AVE OWNER'S NAME AME 11 /• ll -7 5 �vHorvE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NOERACTOR's M II IOUTLETS-SWITCHES-RECEP bke$ �, Sl$K LIC. NorjbZ-5-S!5 10.00/1.00 'Z LIGHTING FIXTURES 10.00/1.00 7L2CONTRACTORS ADDRESS L 004.,�(( GQN{G 7 IJE D pgprypS•J .ice ,/ / PPLIANCES- RESIDENTIAL 4.00 Uv 3 PANELS IO.OD S ARCHITECT OR ENGINEER Lie. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR END SS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 IIP -PI 9ir G ADDREANT'S/�P� J N�G VrJ" MOTORS ESCH. -- SERVICE CHANGE PW 20.00 C. r�2� w Z J D / LICENSED CONTRACTORS DECLARATION I '�/ I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Cod^ nd my license is in full fo nd c e L.. ens[llass Lie Nu Z lit m/byeL/ SLOG. J ELECT. LJJ• PLG. MECH. Ili L/ Dale --fig Contract D BUILDING PERMIT OWNER -BUILDER DLRATION I hereby affirm that I am exempt from the Contractor's License Law (o t itfollowing reason, (e.703L 5. Business and Professions Code: Any Or county which requirespermit to construct alter, city mol re improve, demolish, or repair any structu, priorto its issuance, also requires the applicant for such permit to file SlFned $tJlCmfnt that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthr Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7011.5 INFORMATION MISC. - REFER TO ORD VALUATION SIFT. PERMIT ISSUANCE -1$00 �-'• ELEC. CONTR. LIC. NO. ELEC. 0 TOTAL /9 PERMIT TO LC^G7 DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 b) any applicant for a permit subjects the applicant ton civil penally of not more than five hundred dollars (S500).): ❑ I, as owner of the 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 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS 2- DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who does such work' SO. FT. FLOOR AREA TOTAL ACREAGE FIXTURES -PER TRAP 5.0 �� himself or through his own employees, provided that such improve ments are not intended or offered for sale. I f, however, the building I GAS - EA. SYSTEM - I INC.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 int " prove for purpose of sale.). ❑ I, as owner of the Property, on exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who GAS - EASYSTEM -OVER 4 (EA.) 2.00 . BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 30.00 (LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors sl licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STD Ott/10.00 [ V TRACT NO. PARCEL NO. D 1 am exempt under Sec. .B.&P.C. for thisWATER HEATER W/VENT6.00 reason Owner Date W A 1NSYSTEMA. Ar Y615%.00 - ACC.DATE ACC. FILE NO. WORK ERS'COM PENSATION DECLARATION WATER TREATING VmMfp. 5.00 1 herebv affirm stmt I have a certificate of consent to self-inwre. or a certificate of Workers' Compensation Insurance, or a certified CupQ ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab C. Policy'No.CompanY' FIRE SPRINK ENERGY T 24 ❑ Certified copy is hereby furnishN. ,IP e d copy is fled ith th i�>' in pe^lion division.rPLG. V N � V N � E) MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE �� .� PLOOD ZONE A.L.U.C. ' ONTR. LIC. NO. TO .At Q'O COMPENSATION INSURANCE section need riot be completed if the• permit is for Ont'hundreddollars1S1001Orless.) Y N ❑ V(Tills MECHANICAL PERMIT FEE FEE SUMMARY I certify that in the performance of the work for which mis per mit is issued. 1 shall not employ' any person in any manner sit as to BUILDING become subject to the Workeri Compmua Hon Laws of California. Dale Applicant NOTICE TO APPLICANT': If, He, making this CrHihrc c of Ei -- emplion, you should become subject to the WorkersCompensation ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cod,, you must forthwith comply with such provisions or this permit shall he deemed revoked. FEE AIR HANDLING UNIT (TO 10A00CF.M.) 4.00 AIR HANDLING UNIT IO R10,000 C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ.0 ). Lender's Name EXHAUST HO DUCT1 5.00 ,� MICROFILM CC HEATING UNIT (TO 100 T.U.) B.00 J HEATING U I Q7 ,000B.T.U.)9.50 ELECTRIC a7C) Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city' and county ordinances and state laws relating to building construction, and hereby aUdmT17C representatives of this city to enter upon the above mentioned properly for inspection purposes. V ENTI LAT( AN (SIN Q 4.00 PLUMBING, BOILER -COMP( ,000 B.T.U.1 6.00 BOILER -COMP (&., 100.000BTU)SEE FEESCH. MECHANICAL MISC. - REFER TO ORD. CONST. TAX (We) agree to are. indemnify and keep harmless th, City Ot Cupertino against liabilities. judgments, costs and expenses which may in any way accrue against said City' in consequence of the PERMIT ISSUANCE ?Be6B�, MECH. CONT. LIC. NO. MECH. TOTAL Cl��j TOTAL ng n! this permit. S • 3 g$ Signature of Applicant/Contractor Date OFFICE COPY