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17943POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD • r G JOB ADDRESS -1rp l_ V 2_5_ UNIT# _ LOT# OWNER 0 (r a �� _ l% CONTRACTOR CL UMBER PERMIT 7943 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPEdTION I DATE IINSPECTOR I INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. �•� u1 UFER PREGUNITE PERMIT VALIDATION T V, I ' ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - PAY `I, B 198 UNDERGROUND /SLAB PLUMBINGn. �{r,'� citz of idN ELECTRICAL MECHANICAL BLDG ELECT PLG. MEC. El❑ ❑ OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL _ PERnuT ro r o�C✓ FRAMING INSULATION SIORI! 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 TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE TIES IND ('ON PB LT,.1 - ❑ ❑ - ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH $AN.p ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT No PARCEL NO MECHANICAL MECH.ENERGY - ELECTRICAL BUILDING ENERGY - ACC DATE ACC FILE NO FRAMING ELECT. FINAL TEST - INSULATION PLUMBING ZON'NG ENS SITE NO GASTEST GAS MECHANICAL .FIRESPRINII Y ❑ N❑ ENERGY T.1a Y ❑ NO COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE 'LOUD ZONE '-Y❑ N❑ A.LU C. v 1 N❑ 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 occuPgNcv sElsMlc FEE 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 PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL -^� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT I IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 794 ?'+ BUIRUI G Ao fl s r P7 4 0 11 OwNE 'sPLAN NAME %%J✓/ L9YG'G/ PHON fli QTY. ELECTRIC PERMIT FEE CHECK VALIDATION ` DATE OF APPLICATION NA�M+eA °nsY GJ C+ I Llc.no.�� OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADD ESS rolls asp HONE O O APPLIANCES - RESIDENTIAL 4.00 -. PANELS 10.00 CMITE OR ENGINEER uc.No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. - SIGNS TRANS. 3.00 nooAess sea. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP D / ISSUANCE DATE BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ EMP. METER O POLE INS. 20.00Q,/3 APPLICANTS AQOBEss ®n ily9' MOTORS SEE FEE SCH. SERVICE CHANGE - 'x'-20.00 LICENSED CONTRACTORS Df;CLAR ION I hereby affirm that I am licensed under provisions of Chapter 9I m (comencing with Section 7000) of Division 3 of the Business and Professions Cod" d my license is in full furcy,lln p License Class Con Number O O Date Contractor �� P .I p F �.{' city Oy COppyjl BUILDING PERMIT INFORMATION OWNIi R -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License MISC. - - REFER TO ORD Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which req vires a pcvnit to Construct, alter PERMIT ISSUANCE 0.00 VALUATION S/FT. E EC CONTR. LIC. NO. ELEC. �� TOTAL QTV. PLUMBING PERMIT FEE ALTER-DRAIN&VENT-WATER(EA.)5.00 in prove, demolish, nr repair any structure, prior to its issuance, also requires the applicant for such revisit to file v signet statement that pursuant n the provisions of the Contractor's License he is (Chapter of Division 3 of the Busi (ess and 9 (commencing with Section is exempt Business and Professions Code) or that he is coI therefrom and thebasisthe a or adexemrObw Any violation ppct 1. a.,it malty subjects tire applicant lnuCivil penalty by any applicant fora hundred Ili not more than (of hundred dollars (my PERMIT TO e STORIES!TYPE CONSTR. em): with wagesas ❑ Las owner at the property, or my, and the their sole compensation, will (S the work, and the structure is not et offered for sale (Sec. 7044, not apps and Professions Code: The Code: The Conhaaor's License Law does not apply to an owner of BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- mentsarenotintendedcrnRered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or im- prove for purpose of sale.). ❑ I, as owner of the property, alis exclusively contracting with licensed contractors to convruct the project (Sec 7044, BusinessLgWN and Professions Code: The Contractors License Law does not apply SO. PT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON 'PB Omer' INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. to un owner of properly who builds or improves thereon, and who contracts for such projects with a contmerar(s) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sec.., B.&P.C. for tllia rc.,on LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dat° WATER SYSTEM 5.00 WON KE1iS' WMPI:NSAI'ION rntCLnenTloN ACC. DATE ACG FILE NO. WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent in self -insure. or a certificate of Workers' Compensation Insurance, or a certifiedZONING copy thereof (Sec. 3800, Luh.CJ ✓� Policy No. Compan - ENG. SITE NO. e W thel city un' of Un IVIfl011. ❑ CerVIFATI': Applican CEOF IiXEMPTION FROM WORKERS' COhIPIiN'SATION INSURANCEPLG. I (his section need not be rump crud if Ihl; permit is for one hundred dollars ($100) or Iess.l FIRE SPgINK Y N ENERGYTCer24 v N� MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOODZONE V N A. L. U. C. Y NF] CONTR. LIC. NO. PLG TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY wormk for which this per I certify that tire performance of person mit is issued, I shall not employ any pcon in any annerso as to become subject to the Worker: Compensation Laws nl California. Date ApplicaALTER NOTICE TO APPLICANT: If, after making this Cerl :Ciente of Cx- BUILDING OR ADD TO MECH. 5.00 cmpfir,you should become subject to the Workers'Compensation provisions of tire Labor Code, you most (atlhwith comply with such provisions or this permit shall be deemed revoked. APPLIANCE 500 . AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). Lender's Name EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM ' HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lenders Address - VENTILATION FAN (SINGLE) 4.00 BOILER- COMPQ H.P. or 100,000 B. T. U.) 6.00 I certify that l have read this application mid stat, that the above information is correct. I agree to comply with all city and county ordircuces and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mmntioned property for inspection purposes. (We) agree to s3 indemnify and keep harmless the City of Cupertino against I' ie ies, judgments, Costs and expenses which aY in any way accrue aguins lid City in consequ •nee of file rantin f t 's rmi U PLUMBING BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ofp� Sign• re0 Applicant/Confmcfor Dale OFFICE COPY