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17253POST THIS CARD NEAR FRONT OF BUILDING - CITY SOF. CUPERTINO INSPECTION. DIVISION 'JOB INSPECTION RECORD ' 2240:► 'Si��eM 'Ave JOB ADDRESS /'j'� �♦ � U{/N{IT#_LOT# OWNER lel 1-\ CONTRACTOR I' .,�'/ ��- PERMIT NUMBER 17253 PERMIT EXPIRATION pERM1T. EXPIRES IF WORK IS NOT STARTED WITHIN 100 DAYS OF PERMIT ISSU- ANCE OR, 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORb FOUNDATION- _ NOTE:. ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PR EGUNITE PERnm vnLmnnoN- ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/,SLAB PLUMBING - c r' �^ ELECTRICAL MECHANICAL f'�l 1\ N eLuc, ❑ eLEcr. ❑ PLP. mccR ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Vitt Of cupe BUILDING PERMIT INFORMATION - WOOD FLOOR VALUATION SIFT, PLUMBING MECHANICAL ELECTRICAL PERMIT T0. FRAMING INSULATION - STORIES TYPE CONSTR. „ Ox -L: OCC. CROUP - RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE: NO FINAL INSP. SHALL BE MADE FORE.sU. THE CONSTRUCTION TAX IS PAID Fr rLooR Arn;A TOTALnca encE DIAPHRAGM - - ROOF SHEATHING BUILDING USE RES IND CONPB Om., �E:l ❑' ❑ ,1 "1-] APPLY NO ROOFINGUNTILABOVE HAS BEEN SIGNED •FINALS DATE INSP. • ROUGH SAN.# Il n55EB50R5PnRCEL NO PLUMBING ELECT. ENERGY TUBS &SHOWER PAN- PLUMBING ENERGY THACT NO. PARCEL, NO. MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC, FILE NO FRAMING - ELECT. FINAL TEST - INSULATION - PLUMBING ' = /j' ZONING ENG. SITE NO. GAS TEST. - GAS MECHANICAL, FIRE SPR INK Y ❑ N❑ ENERGY T ZC v N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FL00DZ0NE VEI 'NO A.L.0 C." Y0 NE] ' INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT• ELECTRIC PLAN CHECK FEE -. GAS, ' ., NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR•EXPI RATION DATE — ELECTRIC PLUMBING Q'J MECHANICAL CONST, TAx, "IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION:,' TOTAL W OFFICE COPY 0 a z Foo QUU :HihGy o vii ¢ E f o Q W U w3Avc Fuoa E Y E �¢pO 6,N„m u H z f x o rc r a 3 m O Z z F, O' Ir y LU a o. :) Z. UO LL U Ow } N H � 111 s APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT'PEN ONLY BUILDING PROJECT I DENTI FICATION'. - - •,; APPLICATION & PERMIT - •. BUILDING-ELECTRICAL- PLUMBING'- MECHANICAL PERMITNUMBER 7 7 J BmLmNG AODnE55 A ✓l �j A16) ll S OW ER'S PLAN CHECK VALIDATION NAME - ��jJqq OTY. ELECTRIC PERMIT - FEE - DATE OF APPLICATION d CONTRACTORR NAME OUTLETS - SWITCHES -RECEP .10.00/1.00 LIGHTING,FIXTURES 10.00/1.00' CONTRACTOR'S - ADDRESS n �j A j� y e I� S $HONE / 7! (/ - APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITEDTPLAN OR ENGINEER LIC. NO PANELS (OVER 200AMP) 20.00 CHECK FEE P.C. NO. „ , - SIGNS TRANS. 3.00 ADDRESSs ENG. SPECIAL CIRCUIT ' 5.00 PERMIT VALIDATION ' TEMP. METER OR POLE INS. 20.00 ' ZIP 1 /�,1�p`` J • All CItAW-C, (� -6 - APPLICANTS - ADDRESS . MOTORS SEE FEE SCH. SERVICE CHANGE - 2000. LICENSED CONTRACTORS DECLARATION LICENSED _ �Qj I hereby affirm that•I am licensed under provisions of Chapter 9J. (commencing with Section 7000) of Division 3 of the Business and Professions Cod' an license Is in full foreMa P o Liiense Class _�=_. Lia Number G DateContractor ISSUANCE DATE BLDG-- ELECT. ❑ PLG. MECH. `-'� of Upp� 1110 : f"' BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATI uctor's License I helnhy:aC(irmantthat I mexempt from the Contractor's Law for the following reason, (Sec. 7031.5, Business and Professions Code: Any city or county which reunites u permit to construct, ahcr, improve, demolish, or repair any. stricture, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant t0 the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and -. MISC. REFER TO ORD . VALUATION b/FT. ' PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC -NO. ELEC. ' TOTAL PERMIT TO ml,. FF�� _ CITY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permitsubjects the applicant tea civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER (EA.) 5.00 - ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 Oce. GROUP RES. UNITS DRAINS -FLOOR, ROOF; AREA, GOND.5.00 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 thercon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale, If, however, the building ' FIXTURES - PER TRAP 5.00 SO, FT. FLO.OR AREA TOTAL ACREAGE or improvement is said within one year of completion, the owner- builder will havetheburden of proving that he did not build or im- prove for purpose Of sale.). ❑ 1, as owner of the properly, am exclusively contracting with GAS - EA. SYSTEM -OWER 4 (EA.) 2.00 _ ' - BUILDING USE RES IND CON RB Other ❑ ❑ ❑ ❑ , ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to 'construct the project (See. 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 LAWN SPRINKLERS +1 INC 5 V.B. 6.00- ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contacts for such projects with a contractors) licensed pursuant to the Contractors License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO.. PARCEL NO. ❑ lam exempt under Sec. ,BAP.C. for this reason WATER HEATER W/VENT 6.00 .tJO Owner Uate WATER SYSTEM 5.00 ACC. DATE ACG FILE NO. WATER TREATING EQUIP:' 5.00 WORK ERS'COMPFNSA'FION DECLARATION I hereby affirm that I have a certificate of consent to set Finsure, or a c_ertifcate of Worker' Compens t n Insure 08r ZONING ENG, SITE N0. co L' .CCuliislie�❑ FIRE SPRINK Y❑ -N❑ ENERGY T 24 Y rv❑ etlI is hereb fur fished. Zopp", Certif file with the city inspection division. cant MISC.-' - REFER TO ORD. -CER'fl - ATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 tlJ FLOOD zarvE 'A.L. u.c. COMPENSATION INSURANCE ,;I o (This section need not be completed if the permit is for are PLG. CONTE. LIC. NO. PEG . TOTAL tdd V ❑ N ❑ Y ❑ N ❑ hundred. dollars ($100) or less.) - - I certify that in the performance of the, work for which this per- mit is issued, 1 shall not employ any person in any manner so as to _ DTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING' become subject to the Workers' Compensation Laws of California Date Applicant- NOTICE TO APPLICANT: If, after making this Certificate of rix-' - ALTER OR ADD TO MECH- 500 . . _ .APPLIANCE 5.00 PLAN CHECK emptlon, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked', FEE ' AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE • CONSTRUCTION LENDING AGENCY I hereby mfirnf that there is a construction lending agency for EXHAUST HOOD'(WITH DUCT) 5.00 - the performance of tire work for which this permit is Issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.)'.8.00' Lender's Name HEATING UNIT 100,000 B.T.U.) 9,50 ELECTRIC Lender's Address - I certify that l have read this applicationand'stute that,the above. VENTI LATION FAN (SINGLE) 4.00 information is correct, 1 agree to comply with all city and county ordilunres and state laws relating to building construction, and PLUMBING " (� BOILER.COMP(3H.P.or IO0,000B.T.U.) 6.00 s BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL hereby authorize representatives of this city, to enter upon the above-mentioned property for inspection purposes. MISC. - _ REFER TO ORD. • •. CONST. TAX (We)' agree save, indemnify and keep harmless the City of Cupertino again liabilities, judgments, coats and expenses which iq any way accrue against said City in consequence of the - t PERMIT ISSUANCE 10.00 loch of Ibis pe it,I 'MECH. CONT. LIC. NO. MECH. Z 'e- y .. TOTAL A TOTAL � Si at a of Applicant Contractor Date V OFFICE COPY