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17630POST THIS CARD NEAR FRONT OF BUILDING CITY OFCUPERTINO INSPECTION ,,,11 ;JOB INSPECTION RECORD OR 2 0 198 pSrl JOB ADDRESS _Z .Z(L\J 14 IT# `—SUG A-Av'f GH ! %V� ✓♦T OWNER Bltd I CONTRACTOR PERMITNUMBER 17630 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1Bo.DAYS OF PERMIT ISSU-ANCE OR 180 DAYS FROM - LAST CALLED INSPECTION. INSPECTION DATEINSPECTOR INSPECTION RECORD FOUNDATION NOTE: - ALL GRADING AND DRAINAGE SHALL BE INSTALLED COMPLY WITH THE APPROVED PLANS AND CITY OF 'CUPERTINO STANDARDS. UFER PREGUNITETO - PLAIMO VALIUAr!ON - S�j /� ) ISSUANCE DATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED! UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL RI.Dc ❑ ELECT PLG. MELD ❑ - ❑ • DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR VALUATION $/FT. ' - PLUMBING � - _ � � � MECHANICAL ELECTRICAL - ' PERMn To r ,. FRAMING INSULATION - Si(NIF.S TVYEC N$TR 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 ' $0 FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING RUILDINC, USE HES IND cON PREl cl Dni ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. ROUGH SANS ASSESSORS PARCEL NO PLUMBING - ELECT. ENERGY TUBS B SHOWER PAN PLUMBING ENERGY IHACT On 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 N V � � ENERGY T 2 v � N . � COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - EXTERIOR SHEAR ELECTRICAL RELEASE FL000 ZONE Y ❑ N❑ A.L. U C. ❑ No INTERIOR SHEAR FIRE DEPT. - SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH IBUILDING - 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 IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPE CTION BY PHONING 252-4505, Iw—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC E♦ j PLUMBING MECHANICAL CONST, TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY i O Z_ z N CC W - aD Z) z 00 LL U OW C Q,PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FI CATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 17630_ BUIL ING A°DQRESS �!%9.�Lf5 G� "�LUD OWNER'S NAME P T 914 ELECTRIC PERMIT FEE PLAN Gf CK ALIOATION `' •'��U OK/AL Y'L PRONE Z) - APR 2 U 1989 CONTRACTp/+q NAME �J'D� r�G io,80*0 UTLETS-SWITCHES-RECEP 10.00/1.00 )O.CaO 011W1 JXWdd AL LIC, No. City of Cupertino .. LIGHTING FIXTURES 10,00/1.00 0.01 CONTRACTOR'S C/p.3'7�1. DORBss APPLIANCES -RESIDENTIAL 4.00 Qbz-APHONE - DATE OF APPLICATION I PANELS 10.00 ;(.Sv ARCHITEC�3o� OR �! ENGINEER c. NO. Lie.SPECIAL PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AARCH. OR ENG. � / 7/�e:. 9f�e 5ej ZIP CIRCUIT 5.00 PERMIT VALIDATION (/T[/ - .2D �c _ EMP. METER OR POLE INS. 20.00 ADDRESSTS MOTORS SEE FEE SCH. ?,_Pp SERVICE CHANGE 20.00 l l LICENSED CONTRACTORS DECLARA'fION I hereb,,iffurn that I :em licensed under provisions of Clmpter 9 (commencing with Section 7000) of Division 3 of the Business III Professions Code vh}Iyynmy licenxe ie in full force anfl License Class Lia N wnber�J � ISSUANCE DATE ISSUANCE ELECT. PLG. MECH. ❑ ❑ Dalc__�7� Contraclo�_�� - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law I'or the Holum ngruuson.(See 703 L5, Businessand PodyssionsPERMIT Code: Any city interiorly which requires a permit to construct, alter, - BUILDING PERMITINFORMATION MISC. - REFER TO ORD ISSUANCE 10.00 �sQ VALUATION $/FT. ELEC. CONTE. LIC. NO. - _ ELEC. r/\ TOTAL �) (/ improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License PERMIT TO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or the he Is exempt therefrom'untl OTV. PLUMBING PERMIT FEE a L1 the basis for the alleged exemption.. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to u civil penalty of not more than five hundred dollars ($500).1: ST IES TYPE COPxSTR. 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 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 FIXTURES - PER TRAP 5.00 - GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 property who builds or improves thereon, and who VOCs such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. IL however, the building SO, FT, FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the ownur- builder. will have the burden of proving that lie did not build or iin- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 IEA.).- 2.00 BUILDING USE RES IND CON PB Duo, C3 El El 1:1 11licensed INDUSTRIAL WASTE INTER. 30.00 contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors License Law does not apply to :in owner of property who builds or improves thereon, ,sed who LAWN SPRINKLERS- 1 INC 5 V.B. 600 . ASSESSORS PARCEL NO. LAWN SPRINKLERS - OV ER 5 (EA.) 1.00 contracts for such projects with a conlractor(s) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sec. ,1i.&BC �1'or thin reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.OATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sel6iesure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, o a eerlifi copy they f('#,3800, Lab.C.) I'olicY No._ -- Company l/_�27i_9 d. ❑ Certific I opy is Fiilthe -city 'nspec ti n divlslo ❑ Certified copy ishere�;SIPTION Applicant-yr„G.�1r� FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. CERTIFICATE. OP IFROM WORKERS' COMPENSATION INSURANCE (I [,is section need not be completed if the pernit is ]or ane PERMIT ISSUANCE 10.00 FLOOD ZONE Y E]N ❑ A.L.U.C. V [:]N ❑ PLC. CONTR.LIC. NO. PLG. TOTAL hundred dollars (S 100) or less.) I certify that in the perl'omence of the work for which this Per. mil is issued, I shall not employ any person in tory manner so as In QTY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensation Laws of Calit'orma. ALTER OR ADD TO MECH. 5.00 Dam Applicam - NOTICE TO APPLICANT: If, alley making This Certificate of Ex- BUILDING APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to 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 - CONS'fRUCI[ON 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 (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC ST 1 certify that 1 have read this application and stale that rte above VENTILATION FAN (SINGLE) 4.00 agree to comply with all city and county information is style laws ordinances and state lows relating to building ronslrucl ion, and BOILER - COMP (3 H.P. or 100,000 B.T.U:) 6.00 PLUMBING hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. - BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL, (We) agree to save, indemni' and keep harmless the City of Cupertino against liabilities, bymeats, Costs and expenses which in any way accrue ag sl said City in consequence. f tm ra ting of thispermit ' MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE • a 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Ignature of Applican ontraclor ate OFFICE COPY