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9363 rvol I mIJ I.AHU INtAH FRONT OF BUILDING CITY OF CUPERTINO PERA,ITNUMBER INSPECTION DIVISION Q �� JOB INSPECTION RECORD JOB ADDRESS l99a5 E_{74n S Creek _814 UNIT# LOT# PERMIT EXPIRATION OWNER V PERMIT EXPIRES IF WORK CONTRACTOR r INSPECTION, - �� 1 NOT STARTED WITHIN DATE INSPECTOR INSPECTION ECORD 180 DAYS OF PERMIT ISSU- FOUNDATION a�fl N►- - - ,I A CE OR 180 DAYS FROM UFER O �--(.l ASTCALLED INSPECTION. PREGUNITE ��/ �/y/ �� PERMIT I((�LIpgTION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB , PLUMBING _ ELECTRICAL ' MECHANIC AL I SUAN DATE BLDG. ELECT. PLG. MECH, DO NOT POU 'FLOOR UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ 1:1BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION E/FT. MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TV CONSTR, OCC.OROUP RES.UNITS PLACE NO SUBFLOOp UNTIL ABOVE HAS BEEN SIGNED DIAPHRAGM ROOF SQ FT,FLOOR AREA TOTAL ACREAGE BUILDING USE APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED RES IND CDN PB olne, ❑ El ED ❑ ROUGH I ASSESSORS PARCEL NO. PLUMBING ��. GAS TEST MECHANICAL TRACT N0. PARCEL NO n F ELECTRICAL. FE« FIN LS: DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ v ❑ N❑ LATH—INTERIOR ELECTRICAL FLOOD ZONE A,L.U.C. LATH—EXTERIOR SHEETROCK FIRE DEPT. I v❑ rv❑ v ❑ N❑ SHEAR INTERIOR GRADE FEE SUMMARY BUILDING SHEAR EXTERIOR FIREWALLS TEMPORARY APPROVALS BUILDING ELECTRIC PLAN CHECK GAS IFEE NO TAPE OR PLASTER UNTIL ABOVE III BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM WARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC F-� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY r-sl-r L.Ix,ally ( IV r-ILL Ilv mir-Ug1MAI IUN VVI IHIN HED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I IDENTIFICATION aUItoRDING APPLICATION & PERMIT OWNE PERMIT NUMBER Es `cx ZS 5TO&OS Cr-afl K ILDING—ELECTRICAL—PLUMBING—MECHANIC L 9363 LAN CHECK VALIDATION 15LECTRIC.PERMIT_-. p PEI IJ M-^{{{-'�',-atiY 'I ^ CONTRACTORS ' x NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 1. LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS ARCHrtECT 10'00 GATE OF APPLICATION ENGINEER x PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE NO. LIC.No. G- SnS SIGNS TRANS. 3.00 ADDRESSRCH OR ENG. �._.�.// (� ADDRESS ID Iti�IE7-�•/ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLEAPPLIC ADDRESS Ts MOTORS SEE FEE SCH, v/ 4(TR.(.`� SERVICE CHANGE 20.00 D ¢ Z PUG i . 02 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30 �� < u I hereby affirm that I am licensed under provisions of Chapter 9 v, a et (commencing with Section 70001 of Division 3 of the Business and ISS WITE r y z Professions Code,and my license is in full force and effect. PLG. I MECH. Oz 0 w W License Class Lis.Number Date Contractor. ¢ y 3 J ¢ ¢ w OWNER.B UILDF.R DECLARATIONBUIL'OI O.P RMIT.&' L X y I hereby affvm that I am exempt from the Contractor's License MISC.— REFER TO ORD INQORMATION,'W�<T h. H w o ¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE VALUATION g/FT, Ewi� Code:Any city or county which requiresapermit toconstrucLalter, 10.00 MO. ¢ ¢ ¢ 2 improve,demolish,or repair any structure prior to its issuance,also ELEC.CONTR. LIC.NO., ELEC. Vs/ n 0 LL requires the applicant for such permit to file a signed statement that I/1/ TOTAL n w m u he is licensed pursuant to the provisions of the Contractor S License PERMIT TO HzQ Law(Chapter 9(commencing with Section 7000)o(Division 3 cfthe _f,;',' - y�* •/ Business and Professions Code)or that he is exempt therefrom and CITY- SE `' - 'PLUMBINO'PERMIT'.JBvvh'rt aFEI ¢r 0 the basis for the alleged exemption.Any violation of Section 7031 5 !ER ,y �.' i ; by any applicant for A permit Subjects the applicant Ica civil penal( ''- STORIES TYPE CONSTR. of not more than five hundred dollars($500).1: y ALTER-DRAIN&VENT-WATER (EA.) 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 DCC.GROUP RES.UNITS intended or offered for sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00 Code: The Contractor's License Law does not apply to an owner of Property who builds or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00 himself or through his own employees,provided that such Improve. 4Q FT.FLOOR Afl EA TOTAL ACOEAGE menta are not intended or offered for Sale.If.however,lhebuilding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 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- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE prove 1,as ownerose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND PB oma ❑ I,as owner of the property,am exclusively contracting with Cl El C3 13licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. and Professions Code:The Contractor's License Law does not apply 6.00 ASSESSOR PARCEL NO. to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractorts)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C.for this naso WATER HEATER W/VENT 6.00 Gwne Date WATER SYSTEM 5'00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5,00 ' 1 hereby affirm that I have a certificate cf consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy Ihereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Certified copy is hereby furnished. Z O Applicant❑ ertified copy is fled with the city inspection division. FIRE SPRINK ENERGY T-24 MISC.- _ REFER TO ORD. N y N� v N� CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 W COMPENSATION INSURANCE FLOOD ZONE A.L.U.C. 1 a PLO.CONTR. LIC.NO. PLG (This section need not be completed if the permit u for one TOTAL Y 0 NC] Y ❑ No O hundred dollars(SI00)or less.) _ certify that in the performance of the work for which this r y _rvt, t 12s STM�' 4,S' t al LL 1= mit is issued,1 shall not employ an y per. OTY - ,yU e K MECNANICALrPERMIT{.1.,tz� " pE,E,L�i L'r A P.EESUMMARK p y y parson m an manner so i s to O LU become subject to the Wurkeri Cumpemalion Laws of Califomie. w %= , x ': t a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate sa ion ? emvision you should become subject to the Workers'Compensation with APPLIANCE Provisions of the Labor Code, you muss d revo is comply with 5.00 PLAN CHECK / U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that them is a construction lending agency for EXHAUST HOOD WITH DUCT) 5.00 the performance of the work for which Ihu permit is issued(Sec. 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address HEATINGUNIT(OVER 100,000B.T.U.)9.50 ELECTRIC I certify that I have read this application and state(hal the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING udinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 sereby authorize representatives of this city to enter upon the above.mentioned property for inspection purposes. BOILER-COMP 10w1 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may any way accrue ag i at said City in consequence of the PERMIT ISSUANCE i0 CONST.TAX g +g oft per MECH.CONT. LIC.NO. MECH. (o TOTAL ? TOTAL /LQ T Ignature of plicant/Contractor Data OFFICE COPY