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111551 • POST THIS RD NEAR FRONT OF BUILDING • CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD / I - �ym HE UNIT# LOT# JOB ADDRESS /0a�Tn� C.Q- OWNER Z4WA Ill CONTRACTOR T:�6Yr 'ra `Pf RA1IT NDN,BEH 11155 PERMIT, EXPIRATION - I X .1 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPf CTOR INSPECTION RECORD FOUNDATION 7 -f o- 6 'J-3o-�6 I' O UFER PREGUNITE + PERMIT VALIDATION ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED y, _ UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - BLDG_ ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION E/FT. PLUMBING MECHANICAL - ELECTRICAL PERMIT TO FRAMING "%'I - jj INSULATION 7-17- j + STORIES TYPE CONSTR. - OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SQFT.FLOORAREA TOTAL ACREAGE DIAPHRAGM - ' BUILDING USE RES WO CON PB Olner 1:1 ❑ D 1:1 1:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ' ELECTRICAL FINALS DATE INSP. ACC.OATE ACC. FILE NO, FRAMING -. D SAN # INSULATION PLUMBING ZONING ENG. SITE No. GAS MECHANICAL O- a' F IRE SPRINK "O ENE ROY T 24 NEI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . � - ELECTRICAL -/0-$ FLOODZONE Y EI NEI A.L.UA, Y 0 N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE _ FEE SUMMARY SHEAR INTERIOR BUILDING3-(0- BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS IELECTAIC PLAN CHECK FEE - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOBADDRESS WHEN PHONING. z -SEE PERMIT FOR EXPIRATION DATE - IF' �E�,'y ELECTRIC PLUMBwG MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL } I 0FFICE COPY E C E T CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE 3 �191 /� BLDG, PERMIT NO. THE BLDG. LOCATED AT 10 2" ' vin 1REE LN OWNED BY HAS BEEN IALTERE� FOR USE AS 5 �� APPLICANT TO FILL IN INFC•ATION WITHIN RED LINES - USE Pft01POINT PEN°ONLY BU I LDING PROJECT I DENTIFICATI ON APPLICATION & PER IT UILDING- ELECTRICAL- PLUMBING - MECHANICAL ±Iv PERMIT NUMBER 1.1-155` BUILDING ADDRE ss u i� LLM Tir�_C% OWNER'S AME J �'o(� ELECTRIC PERMIT FEE PLAN CHECK VALIDATION �G , r • DATE OF APPLICATION CONTRACTOR'S NAy�E �, 1////n� [��% �, P/-LAL` P&_f- •'L taP^L�IC. ND. q 7 01 S2-, Q UTLETS-SWITCHES-PIECED 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADORE`ir7� AODRE55 Q��, pp (L'�2 a'L p /J ,/ L.1A(/u rip_ PHONE a19-4711 PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 - ARCHITECT ((�'1 / e°R E R �ulf"L- f>%["A �h PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. C SIGNS TRANS. 3.00 ARCH. OR ENG.- 9DDREss n` n. �} Eb� i / r- I�ln� DL r3 e9sl 4 SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION,, ^` . 'b I U E O TEMP. METER OR POLE INS. 20.00 APPLICANT - DRE55 ADDRESS MOTORSPPI FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm Thal 1 um licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pra fessions Cod it cen lise is in full far {Lgj�S� �J License Class Lic. Numher e ..Ki__J� Date_LQ- Contractor Ino BLDG. CT. POW, MECH. �'c' , B IMEHNIIWAMIT INFORMATION p; Vat V 1 OWNIiR-BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Lawfurthe following reason. (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to construct, alter, 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 Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 critic Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500).1: ❑ I, as owner of the property, or my employees with wages as Oleir sole compensation, will do the work, and the structure is not intended or offered for sale (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 does such work himself or through his own employees, provided that such improve. mentsarenotintendedorofferedforsale. ll, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or an- pruveforpurposeofsaleJ.INDUSTRIAL V, 1, as owner of the property, am 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 improvesthereon, and who contracts for such projects with a contrachms) licensed pursuant to the Contractor's License Law. ❑ I:une empl hder Sec. ,B.&I'.C.l rthis MISC.- REFER TO ORD VALUATION ' s..•f.-w V ✓ S/FT. PERMIT ISSUANCE 10.00 1P.0q,' ELEC. CONTR. UC. NO. ELEC. n oL TOTAL ,/J PERMIT TO " / �' /� /'/ d N �1 QTY. i`r� PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 F IXTUR ES - PER TRAP ' 5.00 SO. FT. FLOOR AREA TOTAbACREAIIE - GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ . . WASTE INTER3000 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5IEA.) 1.00 ASSESSORS PARCEL NO. SEWER-SANITAR V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00reason Owner Owner Uate WATER SYSTEM 5.00 �qe % ACC.DATE ACC. FILE NO. WORKERS'COMPENSIRION DECLARATION I hereby affirm that I have a certificate ofconsent to sell -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.CJ. Policy No. Company WATER TREATING EOUIP. -5.00 ZONING ENG. SITE NO. ❑ Certified copy is hereby furnished. ❑ Certified copy is fled with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ REFER TO ORD. . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) 1 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. Date Applicant. NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. N•A•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, Cie.C.). Lender's Name PERMIT ISSUANCE 10.00 FLOOOZONE Y ❑ N❑ A.L.U.C. I Y ❑ N❑ PLG, CONTR. LIC. NO. PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING / ALTER OR ADD TO MECH. Ismd'UJ APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.EM.)6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT . 1 5.00 HEATING UNIT (TO 100,10CV01PM 6.00 MICROFILM HEATINGUNIT (OVER 100,00 .T. ELECTRIC Leader's Address I certify that I have read this application and slate that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building constnmlion, and hereby autlmrize representatives of this city to enter upon the above-menlioned property for inspection purposes, ONO agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, Costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. VENTILATION FAN (SI ) 4.00 PLUMBING BOILER-CONM(3H.P.or100,000B.TUDIM I BOILER -COMP IOver 100,00 ESCH. MECHANICAL o, MISC. • REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10,00 170 -_-Ga MECH. CONT. LIC. NO. MECH. TOTALTOTAL Signature of Applicant/Contractor Data OFFICE COPY