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11174• • POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO DIVISION JOB INSPECTION RECORD JOB ADDRESS UNIT# LOT# OWNERCONTRACTOR PFRnffT NU118EI' '174INSPECTION PERMIT EXPIRATION PERMIT ET(PIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSP.ECTION,:y<;;`:--=;;',DATE;: '.INSPECTOR INSPECTION RECORD FOUNDATION 41 d,� L LIFER PR EGUNITE o K 7 PERMIT VALIDATION % ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL RLoc, ELECT. El PLG. MEw. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION z / l SIFT. PLUMBING MECHANICAL ELECTRICAL PER FT T ' O IES TYPE STR. FRAMING INSULATION OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO, FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM euILDI USE RES IND CONPB Oinn ❑ ❑' EDASSESSORSP APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIONEOt RCEL NO. ROUGH PLUMBING TRACT NO, PARCEL NO GAS TEST MECHANICAL ELECTRICAL 1 . 4� '5M - a I,- - Sz;,.,;FINALS'h,-'�"_ �DATEY, •: INSP"' ACC . DATE ACG FILE NO. FRAMING _ SAN it ZONING ENO. SITE N0. INSULATION PLUMBING GAS FIRE SPRINK YE) N[j ENERGY T?A v [D NF] MECHANICAL .,COVERNOIWORKIUNTIL"ABOVEIHAS?BEEN;SIONED.--Jl HEATING a000 ZONE v N� A.L. u.c. v 0 N❑ LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. viFEE SUMMARY SHEETROCK 71T GRADE SHEAR INTERIOR BUILDING BUILDING ' SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE'HAS'BEEN SIGNED' OCCUPANCY OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, HONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY a M z Foo Q U V Nzwzo ¢ c Z w Q Y i J a 0¢u W 3 N H u 04 g A, > ] 6600 $u CA t z a 3i0 Aa i • O Z_ z 0 CC - LU a0 7 z U_0 LL Ow } N F � AE • APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 1'74 1 ING noo.ESS�(7�5Gx9 GcG� OWNER'S NAME 41 0TY. ELECTRIC PERMIT.' 'FE: / PLGAN HALIOATION f 3 CGNTRACTOR$ NAME UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. NO, CONTRACTOR'S ADDRESS APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECTPANELS OR ENGINEER uc. No. (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 AR Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 0/}!/ EMP. METER OR POLE INS. 20.00 -ZIP ADDRESS 1d Ll ADDRESS LeJS Q 0I'11S `IZkIJx!�S fJv MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie. Number BdWI ELECT. ❑ PLG. t MECH. El❑ Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License perBusmness itProfessions to Code: Any city or county which requirese permit to Construct, alter, Code:Law Any citylowingrey which improve, demolish, or repair any structure, prior to its issuance, also INFORMATION MISC.- REFER TO O RD V LUATION S/FT. PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT "- F!+ -" GTY,: u�`-� •,'';'PLUMBING PERMIT ti ' y ° FEE', LAW (Chapter 9(commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703 L5 STORIES TYPE by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars (55000.): fNSTR. 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, AREA, 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 FIXTURES - PER TRAP 5.00 So. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered 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, am exclusively contracting with GAS- EA. SYSTEM - OV ER 4 IEA.) 2.00 SUILOING USE RES IN ON PB Omar ❑ [1❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B, 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSOR CELNO. licensed contractors to Construct the project (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 contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO/ PARCEL NO. ❑ l Am exempt under Sec. , B.&P.C. for this reason WATER HEATER Vil 6.00 Owner Dale WATER SYSTEM 5.00 ZCC. ­OATE ACC. FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self -insure, or a certificate of Workers Compensation Insurance, or a grtified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab C.). Policy No. Company FIRE SPRINK ENERGY T 24 ❑ Certified Copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant y❑ q❑ y❑ N[] MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTE. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one v C] N ❑ Y ❑ N ❑ _: - *�"- ' `� �' ' ti+/,-7��°ti`'.""".,1-"''`" ':,w„r'nT•r%iv " GTY. =. P- ,MECHANICAL-PERMIT.".p., l'?,FEE%° ,4, �. -- ae"�''' "' ^ V,LL� -( is . _ '' ' ' ' -'-' FEE SUMMARY hundred dollars IS 100) or less.) I certifythat in the performance of the work for which this per- v p mit is issued, I shall not employ any person in any manner so as to become sobject to the Worons' Compi nration Laws of California. Date Applicant BUILDING My ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex - emption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10=11F.li 4.00 AIR HANDLING UNIT (OVER 10=CF.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 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.), 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 Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING I Certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county .rdinances and state laws relating to building construction, and BOILER -COMP 13 H. P, or 100,000 B.T.U.) 6.00 BOILER -COMP Ove, 100,000 BTU) BEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL` / granting of this permit. Signature of Applicant/Contractor Date OFFICE COPY BUILDING I, :POST.THIS CARD,NEAR FRONT OF ,FRF,ITN . 'CITY, OF CUPERTINO MBEI I INSPECTION•DIVISION ".• ' I JOB INSPECTION RECORD: `PERMIT EXPIRATION. _ 'JOB ADDRESS 'UNIT# LOT#k - - - _ PERMIT: ET(PIRESlIF WORK OWNER `'. 'CONTRACTOR IS.,NOT ,STARTED WITHIN 180DaYSOFPERMIT ISSU-* ANCE OR 180 DAYS FROM LAST CALL E D I NSPECT,I ON. PERMIT VALIDATION INSPECTION DATE INSPECTOR • INSPECTION RECORD FOUNDATION s(�C'V .'—+�• UFER' PREGUNITE - - ',. J. •A,, • .•. ,. _ i ` ' POUR NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED UNDERGROUND / SL'AB ' PLUMBING ELECTRICAL'ISSUANCeuATE MECHANICAL ..• - . BLDG/'I ELECT. PLG. MECro DO NOT POUR,FLOOR UNTIL ABOVE HAS BEEN SIGNED ' - euILDING PERMIT INFORMATION WOOD FLOOR 'P .� VALUATION • $/FT. ..' . 'PLUMBING MECHANICAL TT ELECTRICAL � --. PERF I li FRAMING ,INSULATION 0 IES TYPE STR. r • .. - OCC.GROUP RES. UNITS - SO. FT. FLOOD AREA ' TOTAL ACREAGE! " PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF . DIAPHRAGM ,BUILDING USE,• ^ �' •-' < 4' •" r •. RES IND , CON PB Om«r ❑ ❑ 1140 EDASSESSORSp APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH - ;'. .. RCEL NO. �. i/ , PLUMBING GAS TEST • � - � " ' I •. TRACT NO. PARCEL N0. .. MECHANICAL ELECTRICAL- FINALS ACC. DATE ACC.FILENO. ' SAN.#`ZONMG. -- - PLUMBING -GAS ENG.SITE NO.INSULATION UDATEINSP.FRAMING MECHANICAL FIRE SPRINK ❑"�°NE]LATH—INTERIOR ENERGY T 2A COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING',. t' ELECTRICAL FLoao zoNE v � N� n.L.u.c. v I] NQ LATH—EXTERIOR FIRE.DEPT. SHEETROCK GRADE. FEE SUMMARY - SHEAR INTERIOR .' BUILDING BUILDING v • ,� 1 SHEAR EXTERIOR ",; w... - ,.'TEMPORARY APPROVALS FIREWALLS•, ELECTRIC; PLAN CHECK' FEE • - GAS, NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' .' ' SEISMIC FEE ". p OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING'FINAUISSIGNEO BY BUILDING INSPECTOR. A MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'.' ONE WORKING DAY BEFORE' REQUIRED INSPECTION. •' PLUMB iNG. ' C�•� PLEASE.GIVE JOB ADDRESS WHEN PHONING.': _ - :-'SEE'PERMIT.FOR'EXPIRATION. DATE - MECHANICAL 4 CONST: TAX,' IMPORTANT! PLEASE READ REVERSE SIDE BEFORE", TOTAL CALL NG FOR FINAL INSPECTION..' " OFFICE COPY