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18056::. POST THIS CARD N,EAR.FRONT OF BUILDING , " - CITY- OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS _aC x-2__9 '`P�-ire UNIT# # LOT. OWNER G- CONT ACTOR a PERMIT NUMBER ' 18056 PERMIT EXPIRATION PERMIT EXPIRES IF WORK . IS NOT STARTED WITHIN i 180 DAYS OF PERMIT ISSU- , ANCE OR 180 DAYS FROM• LAST CALLED INSPECTION. • INSPECtid DATE I INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED' TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS.. ry LIFER PREGUNITE W H:HMIT VALIDA 'ON 7. 2 -o - +.� f`pfAI.P. Lt ISSUANCE LATE I GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 4 6 UNDERGROUND/SLAB PLUMBING' n: tl ELECTRICAL MECHANICAL BLDG -❑ ELECT ❑ P MBCH. 1'Tl _ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - PLUMBING ., VALUATION ' SIFT. MECHANICAL ELECTRICAL FRAMING INSULATION - - sT IEs TYPE CONSTR, - . ._ OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF I NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID _ � S0'IT FLOpR ARFA IOTAL ACRLACE DIAPHRAGM - ROOF SHEATHING � BUILDING USE RE5 IND CON ,PB Ow.. ❑ ❑ ❑ D APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH sAN.k ASSESSORS PAHCEI. NO. ' PLUMBING - ELECT. ENERGY TUBS &SHOWER PAN PLUMBING ENERGY TRACI NO. PARCEL NO MECHANICAL. MECH.ENERGY ELECTRICALBUILDING ENERGY ACC DATE ACC. FILE NO. FRAMING ELECT. FINAL TEST INSULATION ' - PLUMBING ZONING ENG. SITE NO. GAS TEST GAS MECHANICALFIRE SPRINK ° "0 ENERGY T 24 ° N[-] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD /,ONE ❑ N❑ A L UC. v L-1 : NEI INTERIOR SHEAR FIRE DEPT.Y SHEETROCK. GRADE FEE SUMMARY ,EXTERIOR LATH - BUILDING' BUILDING INTERIOR LATH. o TEMPORARY APPROVALS SCRATCHCOAT ELECTRIC 'PLAN CHECK FEE '• GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE. OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING 252-4505, F-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. o PLEASE GIVE JOB ADDRESS WHEN PHONING,. z - SEE PERMIT F -OR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL 3LUC) CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL (Q.' L OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER qp • 1 0 5 BUILDING ADDRESS 6 5 s a(R.m �I'Va- • OWNER'S _- " E �' OV. .ELECTRIC PERMIT FEE'' PLAN CHECK VALIDATION ll-'� VNONE • 1�I� CONTRACTOR'S NAME TLETS-SWITCHES-RECEP 10.00/1.00 TING FIXTURES 10.00/1.00 la uc. NU. - ADDRESS oRs ADDRESS (1 air /\'nom LIA CES -RESIDENTIAL 4.00 I•U� JRUNE1/✓YJ/fl ('L�' NELS 10.00 [PANELS DATE OF APPLICATION RCHITEC OR (OV 200 AMP) 20.00 PLAN CHECK FEE P.c.No. ENGINEER NS TRANS. 3.00AD�REgS ENG ZIP ECIAL CIRCUIT - • 5.00 ' •PERMIT VALIDATION % ZV 1 EMP. METER OR POL INS. 20.00 ADDRESS MOTORS SEE FEE SCH. VL SERVICE CHANGE 20.00 V�VE LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisionsof Chapier9 (commencing with Section 7000) of Division 3 of the Business and Professions Co an ice nse is in full force . Class Lic. Number ISSUANCE DATE BLDG. ELECT. PLG. MECH. ❑ E]License Date Contractor OWNER -BUILDER DECLARATION I hereby collo that I am exempt from the Contractor's License Law for the city or co ntywPeastun.(Sec.7ireta perIlLomit essandtrct, alter, Code: Any city nr county wh ich requirese permit mconstruct,otleq p'. Gill at BUILDING PERMIT INFORMATION DISC.— - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. ELEC. CONTE. LIC. NO. ELTA - TOTAL TV. PLUMBING PERMIT FEE improve, demolish.apicant repair h y resit structure, prior n its issuance, also hequires the applicant for such permit In file a signed statement that he Is licensed pursuant to the provisions of the )ol Divmrs License Law (essa and de) or Section 70001 n1'Divisiml3 of the Business and Professions Code) or that he is exempt therefrom and PERMIT TO y Q M he alleged the Basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.)5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not CK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DR INS LOOP, ROOF, AREA, COND. 5.00 Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does riot apply to an owner of ' FIXT ES - PER TRAP 5.00 - GAS -EASYSTEM-1 INC.4 OUTLETS 6.00 property who builds or Improves thereon, and who does such work himself or through his own employees, provided that such inlprovo- mentsare Rotintended oroffered for sale. If, however, the building GO. FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner- builder will have the burden of moving that he did not build or im- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with - . -.. GAS EASTEM OVER 4 IEA) 200 BUILDING USE RES IND CON PB Omer 1 1:1 ID E E] INDUSTRIAL ASTEINTER. 30.00 LAWN SPRINKL S - 1 INC 5 V.B. 6.00 LAWN SPRINKLER - OVER 5 (EA.) .1,00 licensed contractors to construct the project (Sec. 7144, 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 contructosts) licensed pursuant to the Contractor's License Law. Cl I am exempt under Sec.,B.&P.C. for this reason SEWER -SANITARY -S RM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER WIVE - 6.00 Owner [)ate WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO. WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a eerNNLate of enllscalt ro Self -Insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insuranm, or u ce11�ipp� copy liq 8 LAC). Policy N posy ❑ Certified copy is hereby furnished. Certified cop is Filed with Ie [ inspection division. Applcar 2 FIRE SPRINK Yo No ENERGY T-24 v� N� MISC.- REFERTOORD. CERTIFICAT�EXEMPTION FROM W( KERS' COMPENSATION INSURANCE (Phis section need not be completed if the pernd is for one PERMIT ISSUANCE 10.00 FLOOD ZONE. Y [—]' N A.L.U.C. Y ❑ NE) PLG, CONTE, LIC. NO.PLG.' TOTAL hundred dollars ($100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any nanner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY - become subject to the Workers'. Compensation Laws of California. ALTER OR ADD TO MECH. 5.00 Uam Applicant BUILDING NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Worknrs' Compensation Provisions of the Labor Cade, you most forthwith comply with such Provisions or this permit Shall he deemed revoked. AIR HANDLING UNIT (OVER 10=1C.F.M.) 6.00 SEISMIC FEE CONSTRUCT' ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Perforriance of the work for which this permit is issued (Sec, 3097, Civ.C.). EXHAUST HOOD,(WITH DUCT) 5.00 - MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 ' I certify that I have read this application and state that 0m above information is correct I agree to comply with all city and county ordinances and state laws relating m building construction, and PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.0 • hereby hereby authorize representatives ec this city to enter upon the above-mentioned property 1'orirsp ofpurposes. BOILER -COMP (Over 100.000 BTUI SEE FEE SCH. ' MECHANICAL � • V� (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses which may in y way accrue against said City in conseyu nee of the PERMIT ISSUANCE :' zr9 • db CONST. TAX gr n[i t�h'iys pyermit ^ _ i 1/�/� Qvr1p� P — / Slsyn(a[u a of Applicant/Contractor U e MECH. CONT. LIC. NO. MECH. ' �j%� / TOTAL,,,. p6 /"I�as � ' t `,r 1 TOTAL °b ��• OFFICE COPY