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16960-:. POST THIS CARD NEAR FRONT'OF BUILDING ' CITY OF, CUPERTINO - INSPECTION DIVISION JOB INSPECTION RECORD • / �M qy. - ^y�d-('p -•�[ ` V� # -LOT# JOB ADDRESS _ - UNIT owrvER ii SQ ��. d -h corvrRncrory---.--- PERMIT NUMBER A.� PEFIMIITz prpfRATION Y PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN,. 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM-- LAST CALLEDINSPECTION. INSPECTION DATE INSPECTOR 'INSPECTION RECORD FOUNDATION NOTE:- - ALL GRADING AND DRAINAGE'SHAEL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. _ ' UFER PREGUNITE PERMIT VALIDA ON �( Z �Ui,-�• 4 GARAGE SLABS . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - n igag DEC 0q,L„ UNDERGROUND / SLAB' . PLUMBING � � r Wry Or Cupertino'.ISSUANCE DATE ELECTRICAL MECHANICAL - j•�ja (jN[`, or'Tvcs1fl S G E a k-84 �� BLDG XZj• ELECT. PLG, .MECR �tg ❑ . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING slEr. MECHANICAL ELECTRICAL - PBRMIT To, FRAMING. - INSULATION. STORIES TYPE CONSTR, . OCC. GROUP RES UNITS PLACE NO SUBFLOOR'UNTIL ABOVE HAS BEEN SIGNED ROOF _ NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - So FT FLOOR AREA TOT.AL ACREAGE DIAPHRAGM - ROOF SHEATHING BUILDING USE RES IND ' CDN PB am•, 11 ❑ El 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SANA ASSESSORS PARCEL NO . 4+OW PLUMBING -Z � ELECT. ENERGY TUBS &SHOWER PAN, � PLUMBINGENERGY�� .• ._ TRACT No. ' r ARCE.L NO MECHANICAL . MECH.ENERGY ELECTRICAL - 7f+ BUILDING ENERGY - ACC, DATE '- ACC. FICE-No FRAMING Z ELECT:. FINAL TEST INSULATION PLUMBING ZONRJG ENG. SITE NO. GAS TEST GAS - - MEG HANCAL FIRE SPRINK Y N E ENERGY T-24 v,L "�' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - EXTERIOR SHEAR . ELECTRICAL RELEASE FLOOD ZONE YE] N aL uc. Y L N❑• INTERIOR SHEAR FIRE DEPT.. SHEETROCK GRADE FEEPSUMMARY EXTERIOR LATH .BUILDING -lo.tq- BUILDING INTERIOR LATH TEMPORARYAPPROVALS SCRATCH COAT ELECTRIC- - PLAN CHECK cFEE ,.- - '• GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE {^/, I, V OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC Ib, UO PLUMBING: OO MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE . CALLING FOR FINAL INSPECTION. 'TOTAL j -w'SID' OFFICE COPY O Z F O CC W - ao 7z UQ LL U Ow F- 5 U 01 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING -MECHANICAL .PERMITNUMBER ^ n �,0 69 BD, - ADDRESS ZZ 6 8 S HEss ,S I in OWNER'S NNME 5 f` PHONE Z Z5 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S NAME OUTLETS - SWITCHES -RECEP 10.00/1.00210 LIC. NO. I LIGHTING FIXTURES 10.00/1.00 100 ADDESSroR's APPLIANCES - RESIDENTIAL - 4.00 PANELS 10.00 !� PHONE DATE OF APPLICATION ARCHITECT aR -PLAN PANELS (OVER 200 AMP) 20.00 CHECK FEE P.C. NO. - SIGNS TRANS. 3.00 uC. NO. ARCH. OR ENG. ApoREss 37q-o5o4 ZIP, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION I ••L�iy�1,L� EMP. METER OR POLE INS. 20.00 ADDA Ss rr AMP � O i ^ MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION C1 ^ t n I hereby affirm that I am licensed under provisions of CLupter'J (commencing with Section 7000) of Division 3 of the Businese and Professions Code, and my license Is In full force and effect. License Class Lis. Number ISSUANCE DATE' BLDG. ELECT. PLG- MECH. IL ❑ Date Conlruetor PERMIT INFORMATION OWNER-BUILDERBUILDING DECLARATION License I hereby affirm that I i m exempt from the Contram Pr Law for the following reasom(Sec. 703 L5, Business and Professions Code: Any city or county which requirespermit Loco issnLal¢q MISC. - REFER O ORD PERMIT ISSUANCE 10.00 �.Z OF VACUA TIONOv $/FT. ELEC. CONTR. LIC. NO. ELEC. ��qq TOTAL t D V improve, demolish, or repair any structure, prior to its issuance, also tnr such permit In filo a signed ac tor's Lll that requires the dp pursuant he is licensed pursuant the provisions of the Contractor's License V PERMIT TO - Law (Chapter 9 (co en of Division 3 of the Secthan Code) , sions Business and Profession" Code) or Ihn[ he is exempt Therefrom and or ie is exempt QTY. PLUMBING PERMIT FEE thebasisthea or. exit SLAbees the violation fSection 7031.5 by any applicant fora permit sdojems S500).licunlloacivil penalty of nal more than five hundred dollar" (55001 J: STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.)5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do file work, and the structure is not BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 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 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -11 NC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. Rents are not intended or offered for sale. If, however, the building SO. FT. FLOOR AREA , TOTALACREAGE or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or ice. prove 1, aso nee of sale.). for ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 IEA.) . 2.00 BUILDING USE RES IND CON PB '• Other ❑ ❑ 0 ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who builds or improves thereo, and who LAWN SPRINKLERS- 1 INC'5 V.B. 6.00 ' ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a conlraclnrts) licensed pursuaht In the Contractor's License Law. ❑ lam exempt under Sec. ,B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft%10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT - 6.00 Owner Date WATER SYSTEM 5.00 -L-I)T ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSnf ION UECLARA'PION 1 hereby affirm that I have a certificate ofconsent to self -insure, AJJO ZONING ENG. SITE NO. or a certificate of Workers' Com pmuation Insunutee, nr a mi-lified - k •S copy thereof (Sec. 3800, Lab.C.). Policy No:- Company ❑ Certified copy isfiled furnish tJ. ❑ Certified copy is filed with the city inspection division. ApplicantMISC - REFER. TO ORD. FIRESPRINK Y[] NE] ENERGY T 24 Y[] NC] CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if lite permit is for one • PERMIT ISSUANCE 10.00 2, 4 D FLOOD ZONE Y ❑ N A.L.U.C.' Y [3 NC] PLG. CONTR.. LIC. NO. pl-G. / TOTAL (�' 0 hundred dollars ($100) or less, ) I certify that in the performance of the work for which this per- mit is issued,.) shall not employ any person in any marinerso as to OTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING qDs OI 1 becom^s b eWork nrs'CtC�Wp",I�so5r{ sas•�ofCIfyr if,� Date/ Applicant-Z-C4�X--O.rR1CAttSL NOT C: T APPLICANT: If, after -making his Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.1 4.00 PLAN CHECK FEE emplion, you should become subject In the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)OODC.EM.) 6.00 SEISMIC FEE I S Q EXHAUST HOOD (WITH DUCT) 5.00 I hereby affirm that'there is a construction lending agency for - DIe-performance of the work for which this permit is issued (Sec. 3097, Civ.C.). ,MICROFILM ^ HEATING UNIT (TO 100,000 B.T.U.) 8.00' Lender's Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC ) 0 100 VENTILATION FAN (SINGLE) 4.00 I certify that 1 have read this application and stale that the above information is correct. I agree to comply with.all city and county ordinances and stale laws relating to building construction, and BOILER- COMP(3 H.P. or 100,0008.T.U.) 8.00 PLUMBING 0 e hereby hereby authorize representatives forms of This city to soler upon )lieabove ned property for inspection ofpurposes. to. BOILER -COMP (Over 100,000 BTU) SEE FEE$CH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD, gainst liabilities, judgments, costs and expenses which way accrue against said City in consequence of the srantgoit' iL I PERMIT ISSUANCE- 10.00 CONST. TAX ' ECH. CONT. ,LIC. NO. ' MECH. /2 / Applic ontractor Date TOTAL TOTAL 20,S- OFFICE COPY