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17584POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO INSPECTION: DIVISION JOB INSPECTION RECORD JOB ADDRESS I•V V_�'_'_E'_�{'Uttl1T# '' _LOT#,� ` -,. • owNER\Ah@comrRAcroR D 2 PERMIT NUMBER 175$4 PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN . 180 DAYS OF PERMIT ISSU- OR 180 DAYS FROM LASTCALIED INSPECTION.. INSPECTION DAT ,INSPECTOR INSPECTION RECORD FOUNDATIONANCE NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER - PR EGUNITE ul 777 P-7 77 nON tJ ISSUANCE DATE. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PR,lU 1% UNDERGROUND/SLAB PLUMBING "+ ' O ELECTRICAL MECHANICAL - B� ELECTS PLG. N CH Lam/](` DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - PLUMBING � � . . VALUATION SIFT., MECHANICAL -• ELECTRICAL - - - _ PERK TO FRAMING - INSULATION � - - STOHIE TYPE CONSTR PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - OCC GHOUL ' 'RES UNITS ' �• ROOF 'NOTE: NO FINAL INSP. SHALL BE MADE BEFORE', THE CONSTRUCTION TAX IS PAID -. t $O FT, FLOOR AREA ' TOTAL ACREAGE bIAPHRAGM - ROOF SHEATHING Res ' IBUILDING USE NO CON PB OR", ❑ ❑ "❑ ❑ ❑ - APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED. FINALS DATE INSP. •, ROUGH SANA - ASSESSORS PARCEL NO PLUMBING - ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY. LRACI NI,), PARCEL NO . - MECHANICAL - MECH.ENERGY ELECTRICALBUILDING ` ENERGY E ACC.DAT ACC. FILE NO FRAMING ELECT.FINALTEST INSULATION PLUMBING - ZONING . ENG, SITE NO. GAS TEST, - GAS - - - - MECHANICAL ��2•�j FIRE SPRINK Y❑ NE]v ENERGY T.)E ❑ N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE VLOODZL�NE. . ° ❑ N❑ AL.UC. - • Y ❑ N INTERIOR SHEAR FIRE DEPT. SHEETROCK _ GRADE FEE SUMMARY EXTERIOR LATH - BUILDING BUILDING INTERIOR LATH "- TEMPORARY APPROVALS '. SCRATCH COATELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTILBUILDING FINALISSIGNED By BUILDING INSPECTOR. MICROFILM LU 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 PLUMBING MECHANICAL CONST. TAX ,QQ IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL "OFFICE COPY XPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN.ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING.— ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER + .. 758 4 BUILDING - ADDRESS ��Q n /1 i�J/ OWNER' - , 'NAME OTY. ELECTRIC PERMIT "FEE PLAN CHECK VALIDATION S4en 45 PHONE 7, ^p Ory N OUTLETS - SWITCHES -RECEP 10.00/1.00 FcaoRs 1nnA''M11E ►x"� n IC. NO, AJJ LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS APPLIANCES- RESIDENTIAL 4.00' PANELS 10.00 5+ PHONE DATE OF APPLICATION .� ARCHITECT OR ENGINEER ' LIC. NO. IPANELS (OVER 200 AMP) 20.00 PLANCHECKFEE _ SIGNS TRANS. 3.00 ARCHEaR ENG. SPECIAL CIRCUIT 5,00 i0'D PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP C� aPPucarvrs . ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �1/�(��//�� J V -p— ff-To LICENSED CONTRACTORS DECLARATION _ - � APR 1 I hereby affirm that 1 am licensed under provincuS cf Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cq�1 ugd my 11y'y-pse ¢ in full force anA f c' License Class'7�'1_C=)Of]A�N.ic. 6.3 _ ISSUANCE DATE BLDG. ELECT. PLG.. MECH. ❑ ❑ ' Date Contractorractor - OWNER -BUILDER DECLARATION I hereby affran that I am exempl from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code Any city orcounly which rv,ui,,sapern it to, 0 ... Iuct,alter, CI BUILDING PERMIT INFORMATION MISC.— REFER TO ORD PERMIT ISSUANCE ,10.00 - 9 vnLuanoN, $/FT. ELEC. CONTR. -' LIC. NO. ELEC. T TOTAL IJ improve, demolish, or repair any structure, prior to its issuance, also requiref the applicant for such permit to file a signed statement that he is licensed pursuant to lire provisions of the Contractor's License - PER O Law (Chapter 9(commencingwith Section 700(l)of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE pp ,po Ilio basis for the allege. exemption. Any violation of tied ion 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollar., 0500).: STORIES TYPE CONSTR. ' ALTER -DRAIN -WATER IEA.) 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 BACK F LOW 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 -1 INC.4 OUTLETS 6,00or property who builds or improves thereon, and who does such work himself or through his own employees, provided that Such improve- memsare not intended or offered for sale. If, however, the building SD. FT. FLOOR AREA - TOTAL ACREAGE improvement is sold within one year of completion, the owner - builder will have the harden of proving that he did not build or ire- prove for purpose of sale.). ❑ 1, as owner Of the property, in exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IN0" CON Pa Other ❑ ❑ v❑4.T,p, ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Pro fissions Code: The Contractor's License Law docs not apply to un owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1700 ASSESSORS PARCEL NO. 'p,.Ig,;11,I contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. - SEWER -SANITARY, -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under See.—, B,&P.C. for this reason WATER HEATER W/VENT - 6.00 Owner Date. WATER SYSTEM 5.00 ACC. DATE ACC. FILE No. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSA'fION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a Certificate of Workers' Compensation Insurance, or a certified - ZONING ENO. SITE N0. copy thereof (Sec. 3800, Lab C.). Pofc Company , - FIRE SPRINK Y❑ N❑ ENERGY 24 Y❑ Is Certified copx Is�hereb furnisheJ. - Cl ant- ed l ed—w1i11 specliun Aivisioa Applicant) MISC.- REFER TO ORD. C IS RTI F ICAT E O F f:X EM PT ION FROM WO R K 1: RS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. COMI'FNSATION INSURANCE (This section need not be completed if the permil is for one Y N ❑ ❑ V N ❑ ❑ PLG. CONTR. LIC. NO. TOTAL hundred dollar, IS 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 manner so as to OTV 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 Ex- ALTER OR ADD TO MECH. 5.0 CDU APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) '4.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Codr, you must forthwith comply with .such provisions or this pernit shall be derined revoked. AIR HANDLING UNIT (OVER 10= C. EM.) 6.00 SEISMIC FEE ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 _ the performance of the work for which this permil is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenders Nair, lender's Address - HEATING UN IT (OVER 100,000 B.T.U.)9.50 ELECTRIC l ,OD VENTILATION FAN (SINGLE) 4.00 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER- COMP (3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP lover 100.000 BTU) SEE FEE SCH. MECHANICAL ob herebyriz properly tatfor vespL`f this hereby. authorize representatives of this city es enter upon the on city to ' 01 agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. upertiuO againsLliabilities, judgments, costs and expenms which ru ay in any way ac e agai st said City in Consequence of the. E PERMIT ISSUANCE .10.00 TDd CONST. TAX renlin V/0_" MECH. CONT, LIC. NO. MECH. TOTAL TOTAL 3 UO Signa ure pplicant/Contractor Date OFFICE COPY