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9021 POST THIS RD NEAR FRONT OF BUILDING ERraIr NUNi6[R CIlwF OF CUPERTINO i 2 9�• INSPECTION DIVISION ' JOB INSPECTION RECORD •PERMIT.EXPI RATION JOBA RESS UNIT# _LOT PERMIT EXPIRES IF'WORK OWNER CONTRACTOR IS NOT STARTED WITHIN S ECTION DATE INSPECTOR INSPECTION RECORD0DAYSOFPERMITISSU- FOUN ATION _ ,-p' m ANCE OR 180 DAYS FROM .. LAST CALLED INSPECTION: UFER _ /tiT/, i R,1' T Gvt22 PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB / PLUMBING 4 ELECTRICALISSUANCEOATE MECHANICAL, BLDG. ELECT. PLG. nn ECR: 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT INFORMATION WOOD FLOOR - VION , ALUATSIFT. PLUMBING , MECHANICAL ' 7 •sl t „Vi ELECTRICAL o PRMIr To FRAMING —Z -�{ STORI TVP CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF _♦ .• SO.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM I . BUILDING USE. HES IND CON P9 0"" APPLY NO ROOFING UNTIL ABOVE HAS BEVVStZNED ❑ ❑ ❑ ❑ ❑' ASSESSORS PARCEL NO. ROUGH PLUMBING _ aoLd TRACT No PARCEL No. GAS TEST 107i7�-b -(--v(,sZrO MECHANICAL -- - . . • ELECTRICAL FINALS DATE INSP. ACCDATE ACCFILE NO. FRAMING. I Lit ytrALL ItSAN # 11,f`-D ZONING ENG.SITE NO. INSULATION �� PLUMBING ,f GAS zt� FIRE SPRINK ENERGYT 24 MECHANICAL v ❑ N❑ r ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICALFLOOD ZONE A.L.U.C. LATH—EXTERIOR ,/ FIRE DEPT. Y❑ N❑ r ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR.INTERIOR BUILDING a 3-& BUILDING SHEAR EXTERIOR �,d TEMPORA Y APPROVALS FIREWALLS ELECTRIC / 6 PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUIL DING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ; �\ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o� y Z PLEASE GIVE JOB.ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL �• IMPORTANT! CONST.TAX' PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. _ OFFICE COPY �'' - FINAL GRADE ROUTE SLIP File No. < ti D .e / Location R Subject Notes 7r-- Approved -.-Date.--.-.- - — --.....Inspector- - --- "- } ELECTRIC SERVICE NOTICE OFFICE COPY TBUILDING INSPECTOR'S NOTICE PP CITY OF CUPERTINO i You are hereby autprized to Connect electrical service for , 'Owner or Tenant r—X� No.of Wires —� nSize of/Wires Size o4 Switch O Motor Load' I pp Vole Phase Hemin1�(lyptoarl�\s ^ F .K.W. Voltage N1Mpr¢rs (1 Light 110_New Service Reconnect \ ( Hear 120 Three W,e More Service No,of Ad M¢rers 1 Power � i ree Phase Move Maer a ELECTRICAL INSPECTOR 1 1 ,00 �n BUILDING INSPECTOR'S OFFICE `�oermosooiro,y 0 CITY OF CUPERTINO Disidcr Copy I ❑ Backflow Device Sanitary Permit No. � e D[L Sewer Connection ru Plumbing Permit No. Jq Plumbing Final Lot No. 6 Owner or Tenant—zo// © At Tract Date Connected 19--Date Final `J 19�/f � PLU G INSPECTOR ca -- rn CERTIFICATE OF COMPLETION C77 BUILDING INSPECTOR'S OFFICE a CITY OF CUPERTINO e DATE_ S — 1 9/ BLDG./PERMIT NO.. E < THE BLDG. LOCATED AT_2 2I 3 9 o I L1 a OWNED BY k-0 lA St froY MPLE , HAS BEEN EREDI FOR USE AS__S �l o� � Y J O• BUILDING INSPECTOR CERTIFICATE OF COMPLETION ' cy" BUILDING INSPECTOR'S OFFICE �71 CITY OF CUPERTINO - 3 DATE S' – �� - 9 / BLDG. PERMIT NO. 9 Z�• I a • THE BLDG, LOCATED AT-2 Z / 3c OWNED BY R–O k Ir c1 _ f mJa HAS BEEN lIC MPL D1 FOR USE AS `r b Lt/ '(ALTERED) Ohm o� 1 I BUILDING INSPECTOR APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FI N ERMIT NUMBER ap,LR /J 'D,NG. APPLICATION & P IT � . � -_/ ? .,0- AGGBUILDING - ELECTRICAL-PLUMBING-MECHANICAL 9021 OWNEfl' v N E PLAN CHECK VALIDATION QTY. ELECTRIC PERMIT{ ,.; - FEE- PHONE NAMERacroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 r^- LIC NO, > LIGHTING FIXTURES 10.00/1.00 /IJ CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDS Ess PHONE PANELS 10.00 0 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.0 PLAN CHECK FEE P.C.NO. R /V G L LIc.rva. /DY SIGNS TRANS. 3.00 i ADDREss ARCH.OR eNc. SCOZ Wt 1_e,r SPECIALCIRCUIT 5.00 PERMIT VALIDATION O Sco7T5 R IL) ZIv EMP.METER OR POLE INS. 20.00 Zo� J APPLICANTS - MOTORS SEE FEE SCH. AODREss S 7 L G SERVICE CHANGE 20.00 Doo LICENSED CONTRACTORS DECLARATION - TEMP.POLE 30.00 ( (• Icw < u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE maw (commencing with Section 7000)of Division 3 of the Rusiness and B D ELECT. PLG. MECH. H w z Professions Code,and my license is in full force and effect. o z m W License Class Liu Number Dale Contractor Q , E J Ix 2 w u _ OWNER-BUILDER DECLARATION BUILDING PERMIT ` E: 3 ,�a I hereby affirm that I am exempt from Ilse Contractor's License MISC.- REFER TO ORD - INFORMATION:} w0a Low forthe followingreason.(Sec.7031.5.Business and Profession' PERMIT ISSUANCE 10.00 _ VALUA ION $/FT. L i40J Code:Anycity orcounty whichrequiresupermilloconstruct,alter, Q a Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. )F Q .req nl licensed the dp u sua Ter Snell permit t0 full'a Signed act rl's Li that TOTAL ��U P TQ e oi,10 wm ha is licensed pursuant to the provisions DI the Contractor's License r z i Low(Chapter 9(commencing with Section 7000)of Division 30fth, - 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE It H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant Far aperunit subjects the applicant foe civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500).): ❑ I,as owner of the property,or.my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 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 FIXTURES-PER TRAP 5.D6 SO.FT.FLOOR AREA TOTAL ACREAGE • himself'or through his own employees,provided that such improve ments are not intended or of for sale.l f,however,the building GAS-EA.SYSTEM-11 NC.40 UTLETS 6.00 or improvement is sold within one year of completion,the owner- I ail Ile will have the burden ofproving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE po for purIOSC ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB OIL., L as owner of the property,am exclusively contracting with � � I] ❑ ❑ li sed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO. Professions Code:The Contmetor's License Law does not apply Air owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 Qthe Contractor's License Law, TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&PC.fo,this / WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENS ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cerfificate of consent to self-insure, or a certificate of Workers'Compensation Insumnw,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). p' Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z ZCICertified copy is fled with tire city inspection division. F O Applicant MISC.- REFER TO ORD. Y E] N Q Y ❑ NE) CC CERTIFICATF.OPEXEMPTION PROM WORKERS' PERMIT ISSUANCE 10001/0- FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTH, LIC.No, PLG, CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N[3Y N hundred dollars(S 100)or less,) U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL f mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. U 0- Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING X? CA) } m NOTICE TO APPLICANT: If,after making this Certificate of Ex Z_ emption,you should become subject to the Workers'Compensation APPLIANCE F- provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SWIC-F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .F.M.) 6.00 SEISMIC FEE �3 1 hereby affirm that there is a construction lending igoney for EXHAUST HOOD(WITH DUCT) 5.00 S the performance of the work ]or which this permit is issued(Sec. MICROFILM 3097,CN.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00/6 - Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)9.50 ,,p� Lender's Address ELECTRIC 170 I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 • information is Correct.1 agree to comply with all city and county - PLUMBING ++" ordinances and slate laws relating to building construction, and 1301LER-COMP(3H.P.Or100,000B.T.U.) 6.00 hereby authorize representatives ins of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL /Wu above-mentioned property tativsp of purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX y 0' may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 Qr �( gra of this permit MECH.CONT. LIC.NO. MECH. S TOTAL (p /-� TOTAL Signature Of Applicant/C nlracl Date OFFICE COPY