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15540 Af�PLIC ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 1 BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER BUILDINGp uT- �4_ APPLICATION & PERMIT a 15540 AODRO Sj S+9N �U C! BUIL PLUMBING v. OWNER'S ./ PLAN CHECK VALI ATION NAME LO(/LJ L QTY. ELECTRIC PERMIT FEE 'J 0.5 vnorvE CONTRA ORS OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME / LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR S ADDRESS PPLIANCES-RESIDENTIAL 4.00 1 / ? / PANELS 10.00 DATE OF APPLICATION ' ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0, DR NlgG &4s I /%0C, ENGINEER ` ♦/� /%0- LIC.rvo. SIGNS TRANS. 3.00 T ADDREES ENG. .�a�/y SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 1 A Y zm EMP. METER OR POLE INS. 20.00 (� ASNT'$ MOTORS SEE FEE SCH. H. ADDRESS '�1 'As &My"i SERVICE CHANGE 20.00 Ila- per/ woo LICENSED CONTRACTORS DECLARATION / Is - Fz W I hereby aflinn that I am licensed under provisions of Chapter 1) SSUANCE DATE - a (commencing with Section 70001 of Division 3 of the Business and G EkEqT. PLG. MECH. I­ y Professions Code,anq my license is in full force a d effect ,�.x• n o i w o License Class Lic.Number yF Data Contr ctor. / BUI PERMIT I Is: ¢o i OW Ii R- UILDER DECL A'I'ION MATION w ; u_r 1 hereby affirm that I am exempt from the Contractor's License M15C.- REFER TO ORD w d. DATION S/FT. H u0J Law mi-the following reason.(Sec.703 L5,Bminessand Professions PERMIT ISSUANCE } - / w'^ Code:Any city or county whichrequiresa permit to construct,alter, ¢.¢¢SO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. i x m u requires lire applicant for such permit to file a signed statement that TOTAL 7 PERMIT TO he is licensed pursuant to the provisions of the Contractor's License _ _ �r Fii Law(Charter 9(commencing with Section 7000)OfDivislon3ofthe SFd a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE M H the basis for the alleged exemption.Any violation o(Section 7031.5 STORIES TYPE CONSTRY by any applicant for u permit subjects the applicant to it civil penally DRAIN& VENT-WATER (EA.) 5.00 of not more titan ALTER- an five hundred dollars(4500).): N ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OC .GROUP RES.uNrtS/ (heir sole compensation,will do the work,and the structure is not / Intended or offered for sale (Sea..7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -3 Code,The Contractor's License Law does not apply to an Owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 50.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are oat Intended proffered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 ! (Q or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM.OVER 4 (EA.) 2.00 BUILDING OSE builder will have the burden of proving that Inc did not build or im- NO CDN PB Other I'or purpose 01 Shce.). INDUSTRIAL WASTE INTER. 30,00 O I,as owner of the property,am exclusively contracting with ❑ ❑ '❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 1 ASSESSORS PARCEL NO. and Professions Code.The Contractor's License Law docs not apply p to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 6 �0 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. I SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO ❑ Inm exempt under Sea ,B.&PC.for this WATER HEATER W/VENT 6.00 \ o"Vin Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.,, WORKERS'COMPENSA]'ION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have a certificate ofconsenl to seffinsure. ZONING ENG.SITE NO. or o certificate of Workers'Compensation Insurance, r u cerlil iad Dopy th4reoff Sec.3800 Lab.CJ.i Policy No. Company rjy ❑ Ca'IGed k Acre by I 'nnshcd. FIRESPRINK ENERGY T-24 Z Z �[ Certified Bled Ow <'ty inspcctlon division. MISC.- REFER TO ORD. Appncunt- V ❑ N❑ V ❑ N❑ CC O �o- PERMIT ISSUANCE 4A.06 /oZ � CIiRT A'1'Ii OP iXEMI'TIO FROM WORKERS' FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. 4 /,t V❑ N❑ Y ❑ N❑ IL CI This section need not he completed if the permit is for one TOTAL D Z Imodral dollars IS 100)or less.) U Q 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY . IL F mil is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. BUILDING M. num npphc"nl - ALTER OR ADD TO MECH. 5.00 I1W1 } b NOTICE TO APPLICANT': If,after making this Certificate of lis- L.. Z emption,you should become subject to the Workers'COmpensalion - - APPLIANCE -- - _ 5.00 PLAN CHECK provisions of the Labor Code, you most I'orhwith comply with FEE U such provisions or this permit strait be deemed revoked. AIR HANDLING UNIT(TO 10=171F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE I hereby affirm that there if a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1 certify that I have real this application and state that the above VENTILATION FAN (SINGLE) 4.00 (J /S information is correct I agree to comply with all city and county BOILER-CCNVIP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 71 , ' ordinances and slate laws relating m building construction, and hereby authorize representatives of this city to enter upon,the - BOILER-COMP (Over 100,000 BTUI SEE FEESCH. MECHANICAL i above-mentir p petty for inspection purposes. (We) a c to s e, indemnify and keep harmless the City of MISC.- REFER TO ORD. _ Cupertino against abilities,judgments, costs and expenses which - PERMIT ISSUANCE ,yp,QB q CONST.TAX may in any w accrue agai t Yid City in consequence f the Ix �' mn�ng f f r nit a MECH.CONT. LIC.NO. -JiMECH. �./ ':n TOTAL p� �s� TOTAL Signa Applican or Date / '� OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER - CITY OF CUPERTINO 15540 , I t INSPECTION D VISION JOB INSPECTION RECORD' . PERMIT EXPIRATION JOB ADDRESS IU•S 0 p� J�N7F}'.(,V G/9- �.L�. UNIT# _.LOT#- . PERMIT EXPIRES IF WORK OWNER ` -LO VS ,9 /A/Ver7/k;,;,r-,7 CONTRACTOR / IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION NOTE: ANCE OR 180 DAYS FROM, UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF' PPRMn VALIDATION CUPERTINO STANDARDS. •• GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �% j ' UNDERGROUND /SLAB PLUMBING - - - - ELECTRICAL r D ISSUANCE DATE6• MECHANICAL - nLo' ELECT. PLD. MECH AUG "D a o DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - CUQ F ING,PE ONT WOOD FLOOR RMATVALUATION SIFT, PLUMBING o-�$-- / MECHANICAL ELECTRICAL PE�R\M" TO FRAMING /0-2`d' 9 �tl-�, - ' • INSULATION srovues rove comsrR.,., �• . ,` Occ CROUP RES UNITS IPL>AC.E NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED / $O FT'FLOOR ARLA TOTAL ACREAGE `ROOF NOTE:NO'FINAL INSP.SHALL BE MADE BEFORE Jv ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING . - RES IND ILDCON usePe 00- °;APPCY NO ROOFING UNTIL ABOVE IIAS BEEN SIGNED FINALS DATE INSP. Z ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.0144 PLUMBING ELECT. NERGY ' - j "j TRACT NO, PARCEL NO TUBS 8SHOWER N[ , �=_�f-/j=�j'CJ a PLUMBING ENERGY s= MECHANICAL - - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO. I FRAMING . ELECT.FINAL TEST - V- INSULATION PLUMBING - 2ONIAD ENG,SITE NO. GAS TEST - /-]y- ,jay GAS' Z a,X_ MECHANICAL E FIRE SPRINK ENERGY'T.za COVER NO ORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ • �- _ v ❑ N❑ ° ❑ NO —y' FLOOD ZONE 4LOC. . EXTERIOR SHEAR ELECTRICAL RELEASE ./!T INTERIOR SHEAR FIRE DEPT, v❑ "❑ v ❑ No SHEETROCK _Z .- ° GRADE FEE SUMMARY EXTERIOR LATH _ - BUILDING U-C` ' L INTERIOR LATH TEMPORARY APPROVALS - BUILDING SCRATCH COAT - ELECTRIC PLAN CHECK GAS - FEE ,INO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 7 ° I OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE,FOR INSPECTION BY PHONING 252-4505, ELECTRIC e H. ONE WORKING DAY BEFORE. REQUIRED•INSPECTION. PLUMBING q/ � — kkO PLEASE GIVE JOB ADDRESS WHEN PHONING. Cz — SEE PERMIT FOR EXPIRATION DATE ME,,cNANICAL IMPORTANT! CONST.`TAX i•: PLEASE READ REVERSE•SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBER - CITY OF CUPERTINO 15540 , I t INSPECTION D VISION JOB INSPECTION RECORD' . PERMIT EXPIRATION JOB ADDRESS IU•S 0 p� J�N7F}'.(,V G/9- �.L�. UNIT# _.LOT#- . PERMIT EXPIRES IF WORK OWNER ` -LO VS ,9 /A/Ver7/k;,;,r-,7 CONTRACTOR / IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION NOTE: ANCE OR 180 DAYS FROM, UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF' PPRMn VALIDATION CUPERTINO STANDARDS. •• GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �% j ' UNDERGROUND /SLAB PLUMBING - - - - ELECTRICAL r D ISSUANCE DATE6• MECHANICAL - nLo' ELECT. PLD. MECH AUG "D a o DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - CUQ F ING,PE ONT WOOD FLOOR RMATVALUATION SIFT, PLUMBING o-�$-- / MECHANICAL ELECTRICAL PE�R\M" TO FRAMING /0-2`d' 9 �tl-�, - ' • INSULATION srovues rove comsrR.,., �• . ,` Occ CROUP RES UNITS IPL>AC.E NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED / $O FT'FLOOR ARLA TOTAL ACREAGE `ROOF NOTE:NO'FINAL INSP.SHALL BE MADE BEFORE Jv ' DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING . - RES IND ILDCON usePe 00- °;APPCY NO ROOFING UNTIL ABOVE IIAS BEEN SIGNED FINALS DATE INSP. Z ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.0144 PLUMBING ELECT. NERGY ' - j "j TRACT NO, PARCEL NO TUBS 8SHOWER N[ , �=_�f-/j=�j'CJ a PLUMBING ENERGY s= MECHANICAL - - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO. I FRAMING . ELECT.FINAL TEST - V- INSULATION PLUMBING - 2ONIAD ENG,SITE NO. GAS TEST - /-]y- ,jay GAS' Z a,X_ MECHANICAL E FIRE SPRINK ENERGY'T.za COVER NO ORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ • �- _ v ❑ N❑ ° ❑ NO —y' FLOOD ZONE 4LOC. . EXTERIOR SHEAR ELECTRICAL RELEASE ./!T INTERIOR SHEAR FIRE DEPT, v❑ "❑ v ❑ No SHEETROCK _Z .- ° GRADE FEE SUMMARY EXTERIOR LATH _ - BUILDING U-C` ' L INTERIOR LATH TEMPORARY APPROVALS - BUILDING SCRATCH COAT - ELECTRIC PLAN CHECK GAS - FEE ,INO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 7 ° I OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE,FOR INSPECTION BY PHONING 252-4505, ELECTRIC e H. ONE WORKING DAY BEFORE. REQUIRED•INSPECTION. PLUMBING q/ � — kkO PLEASE GIVE JOB ADDRESS WHEN PHONING. Cz — SEE PERMIT FOR EXPIRATION DATE ME,,cNANICAL IMPORTANT! CONST.`TAX i•: PLEASE READ REVERSE•SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY V 'F 1 FINAL GRADE 6 ROUTE SLIR'' ;^ ,. .i F'. ._. File No. Date I II Location • 1 • I Subject Notes C/ r Approve ��'� Y to Inspector � Xf 19z, 3 , /_ // BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO Offg. Dp,, ❑ Backflow Device Sanitary Permit No./ ❑ Sewer Connection Plumbing Permit No. G.� P�bing Final Lot No. � i 1r Lwner or tenant— /a n r S A7 �c�/rfca �Li n iJ�/77) Tract p f Date Connected 19&Date Final S`3 I r Pry/ / G I/ R