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17220+ti POST THIS CARD NEAR'FRONT OF BUILDING - +1 CITY OF CUPERTINO. INSPECTION DIVISION JOB INSPECTION RaECORyD.} - OVA V% JOB ADDRESS Yl ,1'11`i'•'ll '� UNIT# _ LOT# OWNER 'CJS' (� CONTRACTOR �.. 5 1 Y"'U�� , PERMIT NUMBER ' 17220. PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATIONANCE - NOTE: ALL GRADING .AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE. APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERMIT VALIDATION .sy�}�, 01. ISSOANc4: unrF. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND / SLAB PLUMBING ELECTRICAL MECHANICAL' BLDG, EI.EC4.1 PLC, MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. l'� PLUMBING � � � MECHANICAL.L ELECTRICAL FRAMING INSULATION - STORIES TYPE: CONSTR OOO.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 FLooH nRCA roTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE HE Irv0 CON Pa OP ­ L El 0 E` APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED .FINALS DATE INSP. ROUGH SAN.a ASSESSORS PARCEL NO � .PLUMBING O :2- ELECT. ENERGY FEB s I;,1.-;'„ TUBS &SHOWER PAN � - PLUMBING ENERGY � TRACT No PARCEL CEL NO MECHANICAL/.- MECH.'ENERGY 01 ELECTRICAL � BUILDING•ENERGY ACC DATE ACC FILE NO. FRAMING - ELECT. FINAL TEST. ' INSULATION - _1— L rfrL PLUMBING ,'l —SKI -4ZONING ENG.SITE.NO. GASTEST- GAS ' MECHANICAL ^n� / A r FIRESPRINK Y L N( ENERGY T-24 Y ❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE -?. FLOOD ZONE f'Y ❑ N❑ A.L U C v L N❑ INTERIOR SHEAR. FIRE DEPT. SHEETROCK G ' 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' OCCUPANCY - SEISMIC FEE ' OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR.INSPECTION BY PHONING 252-4505, Iw-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN -PHONING. - SEE PERMIT FOR EXPIRATI'ON'DATE -' IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ELECTRIC PLUMBING v' MECHANICAL CONST. TAX TOTAL OFFICE COPY ' 40 O ZZ P 0 CC W _ ao 7 z UO LL I- 0 Ow F Z ME APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY EUH-DIMG PROJECT IDENTIFICATION, APPLICATION & PERMIT BUILDING - ELECTRICAL -PLUMBING - MECHANICAL _ PERMIT NUMBER , 17220 17 2 Z O nUILDING aOORESs y2999 'VIAMWgl ' o4% q'; OWNERS /�f • .. NAME "r Q�La.1c1 Q ' PHONE QTY. ELECTRICPERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION ' CONTRACTORS - .�,,,,► //��S�a.�.7r (/.0! 6• Ic. NO. 10 1*7 OUTLETS-SWITCHES-RECEP 10.00/1.00 0 ij LIGHTING FIXTURES10.00/1.00. CONTRACTOR 5�,wE ^ PHONE APPLIANCES - RESIDENTIAL 4.00 PANELS' 10.00 ORCHRECT4O� OR ENGINEER uc. No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ' 1 ' SIGNS TRANS. 3.00 ARCR Ess ENG. - ZIP SPECIALCIRCUIT S.00 PERMIT VALIDATION ATION �iR �' }} �J]� 1 -_q 1 a J EMP. METER OR POLE INS. 20.00 AAPPODDRESSTa /� R' /, �'7�t App AeovlO AhlPik . C4 • 9¢sT'f MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON'T'RACTORS DECLARATION 1 hmehy affirm that 1 am licensed under provisions of Chapter `J (commencing with Section 7000) of Division 3 oothe Business and Professions Cody and n license is in full for d of Licenst�j')yssa.Q_ Lic.N nI �Z _O �.�L(2� ISSUANCE DATE BLDG. ELECT. PLG. ME H. Date (A-'71 Con ractor BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Low for the following reason. (Sec.uiresa ermitt sondtruct,Professions Code: Any city Or county whiny requires MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 YALUATION`�T �,c'�V $/FT, ELEC. CONTR. - LIC. NO. EOTA ��`` 1P� TOTAL�•Ol VO QTV. PLUMBING PERMIT FEE structure, to its issuance, alser,o prior also improve, demolish, or repair any structure, prior t. its statement requires theapplicantpuisua for suchPermit to file oxContlacror's i that he is licensed pursuant en the provisions of the Contractor's License Law(ChapterI'Dicosions Cog with Section is7000) n3 of the Code) or that he is exempt therefrom and exempt business and ire PERMIT TO L o I `'--�' 1 = QFV0Dii �-- alleged the basis for the aor ad exemption. Any violation Of Section malty by any applicant fora permit subjects ilia applicant too civil penalty of not more shun five hundred dollars (4500).): STORIES TYPE CONSTR. ALTER -DRAIN 5.00 !7 � l� ❑ 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 FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, 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 property who builds or improves thereon, and who does such work himself or through his ownemployees, provided that such improve- CentsarenotiNendedoroffered for sale. If, however, the building ' FIXTURES - PER TRAP 5.00 LDL GAS-EA.SVSTEM-11NC.40UTLETS 6.00 SQ FT FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the'osper- builder will have the burden oC przwing that he did not build nr int- prove for purpose of sale.). C,. 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Omar ' ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER3000 . licensed contract., to construct the project (Sec. 7044, Business and Professions Code: Tire Contractor's License Law docs not apply to an owner of property who builds or improves thereon, 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 contracloos) licensed pursocan to Ilse Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-, B &P.C. for this reason - WATER HEATER W/VENT 6.00 Owner 'Dale WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORKERS•COMPENSATION DECLARATION 1 herebyaffirm that I have a certificate of consent to self -insure, or a certifcale of Workers' Compensation Insurance, or a certified nth r FED ZONING ENG. SITE N0. copy thereof (Sec. MOO Lab ,CJ.- I'olicy�� Company >'�� __ FIRE SPRINK Y ❑ N ENERGY T-24 y ❑ No El�l;Crtlled copy is hereby furnished. ❑ Certified copy is fled with the city inspection division.MISC Applicant - REF CERTIFICA11:017 EXEMPT [ON FROM WORKERS' PERMIT ISSUANCE 10.00 I L FLOOD ZONE A.L.U. C. ' ' COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N❑ PLG.CONTR.- LIC. NO. PLG, - D TOTAL •(, 91 hundred dollars is 100) or It,, ) 1 cattily that in the performance of the work for which this per- ant is issued, I shall not employ any person in any manner so as 10 OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING 1,Jra - become subject to the Workers' Compensation Laws of California. Date ApplicantALTER OR ADD TO MECH. 5.00 x0 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 CO b AIR HANDLING UNIT (TO 10=C.F,M.) 4.00 PLAN CHECK FEE emption, you should to coma subject 10 the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10MC.F.M.) 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 Permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT ITO 100,000 B.T.U.) -8,00 Lender's Name Lendeer's Address HEATING UNIT 100,000 B.T.U.)0.50 ELECTRIC I C . Jsl 60 1certify that l have read this application and slate that t he above t VENTILATION FAN(SINGLE) 4,00 rXL� information is correct I agree to comply with all city and comdy ordinances and state laws relating to building conshuclion, and PLUMBING H, P, Dr 100,000 B.T.U.) 6.00 IL BOILER -COMP IOver 100000 BTU) SEE FEE SCH, MECHANICAL c 7 hereby hereby authorize representatives of this airy to eater upon the ah-ve-men Honed property for inspection plupoself'. (We) agree to save, indemnify uad keep harmless the City of MISC. - REFER TO ORD. upertino against liabilities, judgments, costs and expenses which may in any way accrue akainst said City In consequence of the ra gof this per PERMIT ISSUANCE 10.00 Y CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL IT TOTAL-�'�"I��� ignatnrc .fA plicant/Contractor � U e OFFICE COPY.