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09994u POST'THIS J&D NEAR FRONT OF BUILDING ... . f ' CIT7%F CU PERTINO994 INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS /.�e�L '(,'/ lffltt' 'a UNIT# -1! _LOT# OWNER 1 CONTRACTOR �. PERMIT NUMBER PERMIT EXPIRATION , PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS'OF PERMIT ISSU-' ANCE OR'180 DAYS FROM LASTCALL'EDINSPECTION. [' f - INSPECTION DATE . INSPECTOR INSPECTION RECORD FOUNDATION - b � � UFER _ PREGUNITE, - PERMIT VALIDATION PAID (JAN 2 , POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - •. - UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL - eLDc. .ECT. MECR. DO NOT POUR FLOOR UNTIL ABOVEHASBEEN SIGNED BUILDING PERMIT INFORMATION - WOOD FLOOR PLUMBING a.- -JV&t VALUATION' 'tl '. r S/FT. MECHANICAL . )L.)— ELECTRICAL' - PERMIT TO PE INSULATION Z G -,/ STORIES ll TYPE CONSTR. ri 2 OCC. GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL A OV HAS BE ROOF $O FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM _ .. ' - E ' BUILDING USE IND CON PB O,hm ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ' /. ASSESS ORS PARCEL NO, ' f l' PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL" _ .T,� FINALS DATE INSP. ^cc. DATE - L Acc. FILE NO. FRAMING '7J.u.I�., sa6 SAN # - INSULATION - !�. (r PLUMBING ZONING ENG. SITE NO. GAS • MEC A I AL FIRE SPRINK V El'N❑ ENERGY T-24COVER ❑ ' N❑ NO WORK UNTIL ABOVE HAS BEEN SIGNED HE TIN LATH -INTERIOR EL CTRICA ^3`y FLOOD ZONE " Y❑ N❑.; A.L.U.C. Y ❑ N❑ LATH -EXTERIOR - - _� FIR DEP . SHEETROCK GRAD FEE SUMMARY SHEAR INTERIOR jr BUILDING BUILDING SHEAR EXTERIOR _( TEMPORARY APPROVALS FIREWALLS = - ELECTRIC PLAN CHECK FEE .. �,,..-..� GAS. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE r OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDINGINSPECTOR . MICROFILM ARRANGE FOR INSPECTION BY PHONING 252=4505, ~� ONE WORKING`DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS.WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE =' ELECTRIC°' PLUMBING f t ' J MECHANicAL+ la CONST. TAX. - •�� - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FORTINALANSPECTION:`• TOTAL: .I. • .'� OFFICE COPY APPLICANT TO FILL IN INFORI&TION WITHIN RED LINES - USE BPj'j. POINT PEN ONLY BUILDING PROJECT IDENTIFICA APPLICATION &PER BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 09994 BUILDING ALS` -7Z OWNER'S NAME PAW, QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Q,yE'/I�/ ` PHONE y� CONT ACTORS yem. No. 3 UTLETS-SWITCHES-RECEP 10.00/1.00 -1LEVF1'E/ LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S_ _ sonlyy/1'Lf^+0I 10/ c°�1*O PPLIANCES- RESIDENTIAL 4.00 , PANELS 10.00 AW HONE x.12, Q� DATE OF APPLICATION OR p l�tl;6wG4. ENGINEER NGINEER LIC. ND.3 PANELS (OVER 200 AMM 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS, 3,00 ARCH. OR ENG. aooREss s'�0}/,D(I P�-SUNNI✓/�'LEI0 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION PAID (JAN 2 7 1986 , (�I pp �p city,.lilsllCE'GYE� EMP. METER OR POLE INS. 20.00 APPUCANTBIoilI "Al11XV rJ LN'C•.L ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 TEMP. POLE - 30.00 (commencing with Section 7000) of Division 3 of the Business and Professions Co> d my license is in full for afjw r� Cl� License�ClP...��fssss Lic. Number BLDG. LECT. PLG. ECR. Ln' Uate Contractor BUILDING PERMIT - INFORMATION 16� OWNER -BUILDER DECLARATION /Q"�" I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION SIFT. ELEC. CONTR. LIC. NO. ELEC. TOTAL / improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such penal t0 file a signed statement that License he is licensed pursuant to the provisions of the ) of Law (Chapter (commencing) Section of Division 3 of the /7a7O PERMIT TO r Business and Professions Code) or that he is exempt therefrom and or is exempt DTV. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section malty by any applicant foto permit subjects l500).)cant ton civil penalty of not more than five hundred dollars ($500)J: STORIES TYPE CONSTR. a(/ 'fir ALTER -DRAIN 5.00 ❑ I, as owner of the property, or my employees with wages us their sole compensation, will do lite work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 Occ. GROUP RES. UNITS ROOF, AREA, COND. 5.00 intended or offered for sale (Sce, 7044, Business and ProfessionsDRAINS-FLOOR, Code: The Contractor's License Law does not apply to all Owner of - / FIXTURES - PER TRAP 5.00 GAS-EA.SVSTEM-i IN0,40UTLETS 6.00 SO. FT. FLOOR AREA 264-0 TOTAL ACREAGE property who builds or improves thereon, and who does such work himscll' or through his own employees, provided Iltat such im,'eGoorv mems are not intended or offered for sale. If, 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 im- prove for purpose of sale.). O 1, as owner of the property, am eaClusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE R IND CON PB Other ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B, 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 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 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to tine Contractors License Law. l am exempt under Sec. .& BP.C. for Olin re , a SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT fi.00 Owner r_��jj Uat--e�� •' OMPIiiV TRA�IONWATER WATER SYSTEM 5.00 - ACC.DATE ACC. FILENO. TREATING EQUIP. 5.00 7R1rjR I heat 1 have a certifcate ofconsent to self -insure, rkers' Compensation Insurance, or a certified ZONING ENG. SITE ND. copyt00,Lab.C.).Poli y-e.Company_ MISC.- REFER TO ORD. FIRE SPRINK V N� ENERGY T -2a V N� Cc rt d Copy is hereby furnished GJ a C Cerli ied copQy'yis Fled with tile�citay��alspectim division. Applicant ��/At PERMIT ISSUANCE 10.00 {HT1- R/RT]FICA'TE OYFF FAEMPTION FROM WORKERS' _ COMPHNSATION INSURANCE (This section need not he completed if the permit is for one FLOOD ZONE V ❑ N� A1.U.C. V N� PLG. CONTR. LIC. NO. PLG. TOTAL hundred milms(S 100), or less.) I certify thab in the perfonaxnce of the work for which this per- mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL`PERMIT FEE - , FEE SUMMARY BUILDING. become subject to the Workers' Compensation Laws of California. Date -Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of fix emption, you should become subject in the Workers' CompensationIr provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. APPLIANCE .00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10p000.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 C.). �Nrf�p O� I.endcr's Name /+7'�1� Lender's Address EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 / HEATING UNIT 100,000B.T.U.)B.50 ELECTRIC / / 1 certify that I have read tlliYagynceli M1a f se rs( shove information is correct. I agree to omply with all city an county ,minances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 ` PLUMBING / A- '1 BOILER-OOMP(3 H.P. or 100,000 B.T.U.) 6.00 hereby authorize representatives oecf this tpurposes. s city to enter upon tile above-mentioned property for inspection BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to .Eve, indemnify and keep harmless the City of Cupertino ugains ecru ties, judgments, costs and expenses which cosy in any wt accrue yp'' said City in conscpuenceaa'O..��f11 �'the granting of thi pe tit. / �C. • REFER TO ORD. ERMIT ISSUANCE 10.00 I CONST. TAX MECH CONT. LIC. NO. TOTAL ✓ TOTAL Qw Big ontraclor Dale OFFICE COPY