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139940 0 • POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ��.T'� I In, JOB ADDRESS o�/�911//1�i /��V�zr '� cr�, 61"' UNIIITT I#^v�-�Iy,, /I L�IOAT{Ir1#)fin- OWNER eA dl( l CONTRACTOR !/Vb �I-IW''Vv/4' RMIT NUMBER 13994 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECT ON DATE' INSPECTOR INSPECTION RECORD FOUNDATION ' UFER PREGUNITE PERMIT VALIDATION F. J .i If}TLI'ILL-�` Q+ p 11SSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDP�D UNDERGROUND/SLAB PLUMBING .AUG 198 ELECTRICAL MECHANICAL - - City of CUpe y. BLDG, 'n® `ELECT, ❑ Pte/ ED ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT 'INFORMATION WOOD FLOOR vALunnoN I s/FT. PLUMBING _ MECHANICAL ELECTRICAL PERM To FRAMING INSULATION - STORIES TYPE CONSTR. - OCO.GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SO. FT, FLOOR ARTA TOTAL ACREAGE DIAPHRAGM BUILDING USE .RES IND CON PB 00 - ❑ 11 ❑ 0 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH - . ASSESSORS PARCEL NO. PLUMBING GAS TEST - TRACT NO, PARCEL NO. MECHANICAL - ELECTRICAL FINALS- Acc, UnrE ACC. FILE No, FRAMING SAN # - INSULATION PLUMBING 2GNWG ENG, SITE NO. rDAtINSP. GAS FIRE SPRINK '.'COVER ENERGY T 2G ❑ "C:] MECHANICAL NO WORK.UNTIL ABOVE HAS BEEN SIGNED �'" HEATING '� LATH -INTERIOR - ELECTRICAL PL000 zorvE aL.u,c. ❑ N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY 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 OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE.FOR'INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION, o� Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING ��= MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL (ILXJ OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT PERMIT NUMBER Im LOING a°ORE aa 2D3 _5rrs/� ILDING-ELECTRICAL-PLUMBING-MECHANICAL 13 9 9 4 OWNER'S PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE PHONE L� rva BRACT Rjs� O e:3t5 UTLETS- SWITCHES -RECEP 10,00/1.00 LIGHTING FIXTURES 10.00/1.00 c. NoM 4/ lQu� DATE OF APPLICATION ADDRESS 6'02 ADDRESS IrW .4 41AgI APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCH I ET- OR ENGINEER uc. ND. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG.- ADDRESS SPECIAL CIRCUIT S,QQ PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP APPLICANTS aooREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �L LICENSED CONTRACTORS DECLARATION I hereby affnm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Cod an license is in lull fore a f c -as � Number Con o Ualc Contractor BLDG. ELECT. El El PLG. MECH. E]License D BUILDING PERMIT OWNER -BUILDER DEC RATION I hereby affirm that I am exempt from the Contractor's License Law forthe following mason. (Sec. 7031.5, Business and Professions Code: Any city Dr County which requires a perm, to construct, alter, improve, demolish, or repair any structure, prix to its issuance, also INFORMATION MISC.- REFE R PERMIT ISSUANCE 10.0 VALUATION $/FT. ELEC. CONTR. LIC. NO, �A�sr.'a�.I.I s .{ Ri UI CUpo1E!U requires the applicant for such permit t° file a Igned statement that he is licensed pursuant to the provisions of I • Contractor's License L PERMIT TO '}� F, w OTY- PLUMBING PERMIT FEE Law (Chapter 9(commencing with Section 00)ofiivision3oftlic Business and Professions Code) or that h Is exempt therefrom and �I1`1 STORIES TYPE CONSTR. the basis for the alleged exemption. Any olation of Section 7031.5 by any applicant for a'psonI subjects; applicannoacivilpenalty of not more than five hundred dollars ( 500).1: ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, or y employees with wages as their sole compensation, will do the ark, 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. 044, Business and Professions Code: The Contractor's License L does not apply to an owner of property who builds or Improves wrcon, and who does such work himself or through his own amp yees, provided that such improve- mentsamnorintendedorofferdl'or sale. If, however, the building FIXTURES - PER TRAP 5.66 SO. FT. FLOOR AREA TOTAL ACREAGE - GAS-EA.SVSTEM-;INC. 40UTLETS or improvement is sold with; ne year of completion, rho owner- builder will have the burden f proving that he did not build or im- prove for purpose of sale.). ❑ 1, as owner of the p perry, am exclusively contracting with GAS - EA. SYSTEM •OVER 4 IEA.) 2.00 - BUILDING USE RES IND CON PB Omar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE ENTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1,00 ASSESSORS PARCEL NO. licensed contractors to c struct the project (Sec. 7044, Business and Professions Code: T Contractor's License Law does not apply to an owner of propert who builds or improves thereon, and who contracts for such proj cis with a contractors) licensed Pursuant to the Contractors Lice Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. 0 lamexemptu der Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner IF Dam WATER SYSTEM 5.00 ACC.OATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKF-RS'COMPF-NSA'I'[ON DECLARATION 1 hereby affirm that 1 have a certificate of Consent to sell' -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. copy therep(jS .3800, Lab.CJ.A PolicyN Company O!Ffc. _ FIRE SPRINK Y ❑ N❑ FLOOD ZONE ENERGY T44 Y ❑ N❑ A.L. u.c. ❑ Certified copy is her furnished. A:K�Certified py i d with tl� city inspection division. p an" (�• MISC. - - REFER TO ORD. CE FICATE OPf EMPI'ION I'ROM WORKERS' PERMIT ISSUANCE PLG. CONTR. LIC. NO. PLG. �J TOTAL COMPENSATION INS RANCE (This section need not be complei d if the permit is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars (S 100) or IC9a.) I certify that in the performance f the work for which this per- mit is issued, 1 shall not employ y person in any mannerso as to CITY. MECHANICAL PERMIT FEE , FEE SUMMARY BUILDING become subject to the Wo'rkersmpensation Laws of California. Date' Apple ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: f, after making this Certificate of Ex- emption, you should beco a subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labo Code, you must forthwith comply with such provisions or this omit shall be deemed revoked. AIR HANDLING UNIT (TO IOPWC.F.M.) 4,00 FEE AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE CONS' UCPION LENDING AGENCY I hereby affirm hat there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance IF the work for which this permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.0.50 ELECTRIC ' Lender's Name Lender's Address I Certify that I have read rhisapplication and stare that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city an8c°unty ordinances and state laws relating to building construction, and PLUMBING BOILER•COMP(3H.P.or 100,000B.T.U.) 6.00 BOI LER-COMP (Ove, 100,000 BTU) SEE 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 granting of thisp it. �� MECH. CONT. LIC. NO. MECH. TOTAL TOTAL JALD I reo ppli I/Contractor• Date V I OFFICE COPY