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12131 POST THIS CAEAR FRONT OF BUILDING PERMIT NUMBER CITY.RD CUPERTINO 12131 INSPECTION DIVISION ----- JOB-INSPECTION RECORD--- - — > 1 h PERMIT EXPIRATION JOB ADDRUNIT# OT# " PERMIT EXPIRES IF WORK OWNER TRACTOR IS NOT STARTED WITHIN INS'PECTIONr DATE INSPE R INSPECTIONRECORD 180 DAYS OF PERMIT ISSU- ANCE OR 160 DAYS FROM LASTCALLED INSPECTION: UFER / g PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING Y ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG, MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION .WOOD FLOOR VALUATION $SFT. PLUMBING. MECHANICAL 1 ELECTRICAL vsPE MIF"�.9���� FRAMING IZITT STORIES TYPE CONSTR. INSULATION ' OCC.GROUP RES,UNITS IP,LFACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT,FLO)OIR,AREA TOTAL ACREAGE 1J iIDIAPH RAGM - 0 BUILDING use RES IND CON PIT Omw 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ®• ASSESSORS PARCEL NO. ROUGH 3 /,(- —n ; PLUMBING 0 /O OUr / TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL - p- FINALS DATE INSP. FRAMING INSULATION Q,J- PLUMBING - ZONING ENG.SITE NO. GAS FIRE SPRINK ENERGY T 24 MECHANICAL Y [] NE] Y C-] No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. LATH-INTERIOR �ffioewfl .-M_17 10ELECTRICAL LATH-EXTERIOR - —I V FIRE DEPT. Yo N� Yo N[3 SHEETROCK GRADE _ FEE SUMMARY SHEAR INTERIOR _( .+g BUILDING SHEAR EXTERIOR 0—k7 TEMPORARY APPRO ALS BUILnINc �_ ' ` FIREWALLS ELECTRIC• PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE / + OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDI NG F INAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, 'EL crR1C / r iIW—�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 7 j was Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE —' MECHANICAL r IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ? TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - - Fn,- FINAL GRADE t ROUTE SLIP R 's File No. Da e ; Location -` s Subject - Notes _ t nspector 1. . . �_j .. r ',fit,-<,1:} 1�• , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY s tU1LD1NG PROJECT 1 DENTIFICATION PERMIT NUMBER Tu-D, C G /, �r APPLICATION & PERMI 12131 AoREss /4'�`�o [L ry C t! 1 1?,- /N T O �R., BUILDING -ELECTRICAL-PLUMBING-MECHANICAL DINNER'S _ PLAN CHECK VALIDATION •� NAME �_syy OTY. ELECTRIC PERMIT FEE +� p ( 2JCC [• SCN/Z6l t/rPHONE 3�] JOSS/z n CONTRACTOR S' NAME OOUTLETS-SWITCHES-RECEP 10.00/1.00 O ' (/ SCHIg0ee' (r' COAATI UC.ND.a590 Ql 30 LIGHTING FIXTURES 10.00/1.00 3O - ADD Ess tun'(s� CSC A9P.BCCG 4.9f00 APPLIANCES-RESIDENTIAL 4,00 �6e .moi /Ip3 JTC/IU a-;. R1/, 'PHONE 3 PS-9 PANELS 10.00 G DATE OF APPLICATION OOPRCHIrecr I LCVzu I?• I_I Il.L / C; PANELS (OVER 200 AMN 20.00 PLAN CHECK FEE P,c.No. ENGINEER uc.NO 11-704 ISIGNS TRANS. 3.00 ARCH.OR ENG. W/O A,'CA1 ,TOLL S SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADD RESS CLIWLLL. C'L2 r' ZIP EMP.METER OR POLE INS. edLO noo ESS 11f3 n p.O• T C i f✓ !!la-1/ /f V 2p MOTORS C7GC C- Com. ` "e_ SERVICECHANGE 2 00 LICENSED CONTRACTORS DECLARATION f /L v I hereby affirm that I am licensed under provisions of Chapter 9 If SSU NC �n0 N a w (commencing with Section 7000)of Division 3 of the Business and BLDG. EL P MECH. H z Professions Code, d my license is in full force and effect. / Z 0 L W License lass Lic.Number o m Da[c Contractor st y f a BUILDING PERMIT M ¢ ¢ , OWNER-BUILDER DECLARATION o d U INFORMATION K ; w w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL o tauz .Qi Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit to construct,alter, U O •f Q Q ¢ D Improve,demolish,Or repairany stroctore,prior to Its Issuance,also ENTLIC. LEC.CGR. / NO. ELEC. p V OC• / ai o u requires the applicant for such pennif[o file a signed statement[hal S�'h/.O 60 TOTAL/�O PERMITTO n w m as he is licensed pursuant to the provisions of the Contractor's License �J F i>• Law(Chapter 9(commencing with Section 7000)of Dlvislon 3 ofthe a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE I Oo the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. i ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 7 of not more than five hundred dollars(5500).), s� ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP HIS.UNITS their sole compensation,will do the work,and the structure is not ,ry intended or offered for sale(Sec. 7044, Business and Profession, DRAINS-FLOOR,ROOF,AREA,COND. 5.00 /t_3 Code:The Contractor's License Law does not apply to an owner of who builds or Improves thereon,and who does such work 2 F IXTURES-PER TRAP 5.00 4 = SQ- property .FT.F�LLIIOOR AREA TOTAL ACREAGE himself or through his own employees,provided that suet(improve- 6 3vg/ ments are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or .-improvemenl is sold within one year of Completion,the ownerGAS EASYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of-proving that he did not build or int- BUILgING USE RES IND CON PB OMe. prove for pupas,of sale.). - IN USTRIAL WASTEI TER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKL C 5 V.B. 6.0) ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply �p I. an owner OF property who builds or improves thereon,and who LAWN SPRINKL RS-OV A.) 1,00 J�p a 3 .�0 contracts for such projects with a Contractot(s)licensed pursuant to SEWEfl-SANITA -$ A.200ft/10.00 A the Comtrac(oi s License Law. 0 '- - TRACT NO. PARCEL NO. ❑ Tum exempt under Sec.-,B.&I'.C.1'ur this WATER HEA )VENT \(� 6.00 �p reason Owner Date - WATER SYSTEM 5.00 {��' pCC.DATE ACC.FILE NO. WORKERS'COMPBNSATION DECLARATION WgTER TREATI QUIP. 5,00 1 hereby affirm that I have a cert i ficoC of consent to self.insure, or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO. copy Nemofu _&Lab.Q). �./ (1 Policyenc Ympany 4.1G CO A'��" O O etlified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z m erti ie cop Ia filed wit th city insp••coon division. O Applicant��fs�st-c-r�L-+- MISC.- REFER TO ORD. Y ❑ N❑ Y N❑ ~ w PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU CIiRTI PICCOM E EXEMPTION FROM WORKERS' C7 W COMPENSATION INSURANCE PLG.CONTR. - ! qu�g.N0. PLG. Qts CL Z (This section need not be completed if the permit is for one G ) r0 �-O Pim rnU OCJ TOTAL Y❑ N❑ Y❑ N❑ hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per- GTy. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued, I shall nal employ any person in any manner so as In O w become subject to the Workers'Compensation Laws of California. a Dale Applicant ALTER OR ADD TO MECH., 5.00 BUILDING r7� >_ Do NOTICI7 TO APPLICANT: If,after making this CcOiticate of Ex- - F Z emPtion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code,.you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(T C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLINGGIN ( 10 .1 6.00 SEISMIC FEE ' I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH U 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT( ,000 B.T. %VA.00 Lender's Name a,C II r, GI yn t L' V 24 4) Lender's Add.«�rLE.'-C_JL'I ^J HEATING UNIT(OVER 10 .U.)9.50 ELECTRIC & Q rypp I certify that I have read(Itis application and state that the above 'V ENTI LAT ION FAN ( LEI 4.00 Q`a information is correct. 1 agree to comply with all city and county PLUMBING 7 .' ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 � hereby authorize representatives h i of this city es purposes. above-mentioned property for insp ofenter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL .�. �� (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against-liabilities,judgments, costs and expenses which PERMIT ISSUANCE ORD. ,0 - CONST.TAX b may in any way accNC against said City 1n consequence of tM1e granting of this permit. MECH.CONT. LIC.N0. MECH. • I c/� TOTAL "1 J TOTAL X Signature of jean[/Contractor Date Ch's C,Q(jf `15gD0/ �l / 36� _ OFFICE COPY - / ' OFFICE ACITY OF CUPERTINO " I Copy GAS-SERVICE NOTICE: 19 'M / iTO . , �• , . o .. ,E ( �u are hereby outhori,ied to connect the GAS service for ' Owner or Tenant �� At `r, 2 til /4 sl �A _ New Service— No. ervice No. of Meters, Recorinect' ' . .r . No. of Add. Meters Move Service Move Meter , .. . PLUMBING INSPECTOR ��1 ./�{� t'�l 'l�.lil:%�•wXnJ'•F=ry(�. pp M BUILDING INSPECTOR'S OFFICE Bldg.Dept , CITY Of CUPERTINO, "Office copy' I Ct � ❑ Backflow Device ',SanitaryPermit No. _ ? ❑ Sewer Connection ,Plumbing Permit No f �'•�-� M -.Plumbing Final - • - Lot No. Owner or Tenant r Tract - Date Connected 19_Date Final ©M PLUN(BING INSPECTOR CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE , CITY OF CUPERTINO DATE I�_`_ P9 � BLDG. PERMIT NO. .3 THE BLDG. LOCATED AT— �Z ,� > HAS JSEEN MPLETED) FOR USE AS_ n (ALTERED) — f� i � I UILDING INSPECTOR OM