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15104POSTTHISCARD NEAR FRONTOF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS -�3 `/`9 SV"-'e ,X 9/ V:E UNIT# _ LOT# OWNER e, CONTRACTOR PERMIT NUMBER 51 04 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU-' ANCE OR :80 DAYS FROM . LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERAVT VAUDArION P ' ISSUANCE uAre GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL RLDe ELECT ❑ PLG. MEcR p ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MPS BUILDING PERMIT • 004FORMATION WOOD FLOOR PLUMBING, ALUATIDN �� C ti S/ .MECHANICAL ELECTRICAL vERMn ro _ .4— FRAMING INSULATION - STORIES TYPE CONSTR , _ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' OCC GROUP RES UNITS 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 I+es IND CON vE ou.., 1:1 El ElROUGH APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.1:11:1 SAN.q AssessoRS PARCEL n,o ' PLUMBING —ELECT. ENERGY TUBS &SHOWER PAN PLUMBING ENERGY Taact NO PARCEL No MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST _ GAS MECHANICAL FIRE SPRINK Y ❑ N'❑ ENERGY T-]G I ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD CONE Y ❑ N •n.L UC. , ❑ N❑ .INTERIOR SHEAR FIRE DEPT. - SHEETROCK _ 6 GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY AP 0 qL SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDtNG FINAL ISSIGNED BV BUILDING INSPECTOR. " sEISMIc"Fee MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING Mec HANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL ; OFFICE COPY s4 eyEC i 00 amu Nzw Q a 0 v z o m ozr� �ecI ca sA Fw0< ire > 0 Q6p0 6 W m LL r z a F1o U. tL 3 O Z Z F O UJ IL CL 0 D 2 00 LL I- 0 U } Z H _ fI APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL .PERMIT NUMBER' 1510 4 ADDRESS f�DDRE55'/t�/, SOR •'YI ({}N �..1[ON l�.tt�.# 1 *�Y! rvP OwrvLER SS NAM J/'i✓•"z, J7 _RN KC) 3c-3"gg7,5 PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION NAME AcroRs uc. NO. UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRAS ADDADDRESS R's PHONE PPLIANCES- RESIDENTIAL 4.00 PANELS 10,00 ARCHITECT OR ENGINEER uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. -, SIGNS TRANS. 3.00 ARCH. eo Ess ENG. ZIP SPECIALCIRCUIT S.00 PERMIT VALIDATION (\(JJ/J�j{-t� // ( "" ISSUANCE DATE BLDG. ELECT. PLG. MECH. EMP. METER OR POLE INS. 20.00 APvucarvrs ADDRESS MOTORS - SEE FEE SCH. SERVICE CHANGE - 20.00 LICENSBU CONTRACTORS D17CLARATION 1 hereby alliin that I am licensed under provisions of Chapter 9 (commencing will, Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contactor P OWNFR-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason. (Sec. 7031.5. Businessand ProfessionsPERMIT Code: Any city or county which require'a permit m construct, u Req improve, demolish, or re pal r an y sl ract u re, prior to its issuance, a[So n,q Wfes the applicant for Such permit to file a Signed Statement that he is licensed pursuant eo the provisions of Ole Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of Dlc Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation ofSection 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500)): ❑ I, as owner of the property, or my employees with wales as their sole compensation, will do the work, and the structure is not in ended or offered for sale (Sec. 7044, Business and Professions Code: The Cuntmctor'S License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. 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 in, pfor purpose ofsale.). X trI, as owner of the property, am evclusieely contracting with li ed conactors to construct the and Professions Code The Contractor'sproject (Sec. 7044, Business License Law docs not apply to an owner alproperty who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ lame t funder Se ,B.&P.C. for this reused BUILDING PERMIT INFORMATION ATION S/FT. ` PERMIT TO "Jf�-%/� /��/o•1 d,�G�L O MISC. — REFER TO ORD ISSUANCE 10.0 ELEC. CONT R. LIC. NO. ELEC. TOTAL �. QTY. PLUMBING PERMIT FEE ALTER -DRAIN -WATER (EA.) 5.00 STORIES TYPE CONSTR. BACK FLOW PROTECT. DEVICE 4,00 oCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA,CON D. 5.00 FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB other ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 _ Ower Date WATER SYSTEM 5.00 woRKElis'co '1iNSAlION DECLARATION 1 hereby anti... that 1 Imw a certificate of consent to Self-insur, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sce. 3800, Lab.C.), Policy No.—Company-- o. Company❑ ACC. DATE ACG FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE N0. MISC.. REFER TO ORD. ClCeRiliud copy is hereby furnished. Cl Certified copy is flet) with the city inspection division. Applicant FIRE SPRINK Y[:) N[:] ENERGY T 24 vF NE] CERTIFICA FE OF EXEMPT ION FROM WORKERS' COMPENSATION INSURANCE 1"fhis action need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify That h the perf lfloy an of the wink 1'or which this per- mit is issued, I tooth not employ any person in a w manner so is to become subject to the glean ts' Comperootion Laws of Calil'omia. Dao PERMIT ISSUANCE 40-60 4a (N FLOOD ZONE YE N � A1.U.C. Y � ry� PLG CONTR. LIC. NO. PLG. TOTAL (� �+ QTY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ` ALTER OR ADD TO MECH. 5.00 ICAN1:lD 11, eject making ork Cicrs' Compefi,aw of Ex- NOTICE prion, TO APPLshould become emption, you the L become e, You to 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 I hereby affirm that there is a construction lending agency for the pmfnnm once of the work for which this permit is issued (See 3097, Civ.C.), Lender's Name Lcmlcrs Address 1 certify that 1 have read Misapplication and state that the above information is state . 1 agree to comply with all city and county henna au end State laws relating m building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cuper'm against Ilaiies, judg�maents, costs and expenses which may m an way acagai 'fid City in consequence of the of his penni /v 1 � APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=0C.F.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT (OVER 10,ODOQEM.) 6.00 SEISMIC FEE !T V " 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 VENTILATION FAN (SINGLE) 4.00 BOILER-CUMP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00gen CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTALSignature ofApplinontractor Date OFFICE COPY