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14061t POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD - - 'JOB ADDRESS x..9333 'VALLCO PARK uN1T4*' Lor# OWNER TANDEM CONTRACTOR PERMIT NUMBER 14061 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE f INSPECTOR INSPECTION RECORD FOUNDATION AMX ;, UFER PREGUNITE � - � � PERMIT VALIDATION P ' Inrrr�'f' ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING � � ELECTRICAL MECHANICAL BLDG. El ELECT. C5 gLG. MECH.. ❑ Q ' 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT, - INFORMATION I WOOD FLOOR vnwnnoN $/RT. PLUMBING - - ' MECHANICAL ELECTRICAL -. PERMIT TO , 1 /i I! FRAMING INSULATION -, STORIES TYPE CONSTR. OCC, GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO Fi, FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES INDCON PB ' 0111.-IAPPLY CK. El " NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH " ASSESSORS PARCEL NO. % PLUMBING GAS TEST TRACT No. PARCEL No, MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACC FILE NO. FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE NO, GAS MECHANICAL .FIRE SPRINK ❑ "� ENERGY T24 •: Y ❑ NEI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL FLOOD 'N❑ A.L.U.C. Yo N❑ LATH—EXTERIOR FIRE DEPT. ��.��.. Ey SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, 0�ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS.WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC .� (". PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY " APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' ' BtII CDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 14061 aUILDIrvG ADDREi+3 UA Il Co fq OwPhR'S PLAN CHECK VALIDATION NAME "7 CITY. ELECTRIC PERMIT FEE A PHONE NAME Actors UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. No. RRACroWs ADDRESS AD PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ORR[HITECT ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS END' SPECIALCIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 o ZIP APPLICANTS ADDRESS MOTORS SEE FEE SCH. 73 VA I CD SERVICE CHANGE ,t RrAl. 20.00 LICENSED CONTRACTORS DECLARATION �� I hereby affirm that 1 am licensed under provisions of Chapter 9ISSUANCE (commencing with Section 7000) of Division 3 of the Business and - Professions Code, and my license is in full force and effect. Licenu Class Lic. Number Date Contmctor DATE ' - T w ... - BLDG. ❑ ELECT. r,.,s IYX�I PLG. MECH. ❑ ❑ �{; phr { u)1`J3l lti� ' VNa U7 OWNER-BUILDGR DECLARATION I hereby affirm that I am exempt from the mess andOir License Law forAny the Professions countywhihng reason. e. requires a permitto alter, Code: Any city or county which structure permit to is issuance, improve, demolish, or repair any structure, prior to its issuance, also he Ai res theapplicantpurmafor such permit tD ofile ftaSCntStatementthat he is licensed pursuant to the provisions of the Contractor's License BUILDING PERMIT INFORMATION MISC, - REFER TO ORD VALUATION $/FT. PERM(T ISSUANCE 10.00 Q - ELEC. CONTE. LIQ NO. ELEC. ad TOTAL 3O�� PERMIT TO ' QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and TE o W r Z STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more them five hundred dollars ($500),): ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCD. 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 himself or through his own employees, provided that such improve. meats are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SQ FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I 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- Prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer El❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 q ESSORSPARCELNO. contracts for such projects with a contractor( s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lapp �yemptundLr Sec. B.&P.C. for this WATER HEATER W/VENT 6.00 mason.�d7Q / /� Owner VVUU )are WATER SYSTEM 5.00 ACC. GATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.C.). Policy No. Company , FIRE SPRINK v❑ N❑ ENERGY T-24 v❑ N[] ❑ Certified copy is hereby furnished. ❑ Certir. c y is til I with th• inspection division. Applicantl[.. MISC- REFER TO ORD. CE�R``T177FICAFE81 1EF.M7T10 ONKERS' 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 Y ❑ N ❑ Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($ 100) or Ie..) 1 certify that in the performance of the work for which this per- mit is issued, I Shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compcns'ation Laws of California. Date ApplicantALTER . . OR ADD TO MECH. 500 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 10MC.F.M.) -4.00 AIR HANDLING UNIT (OVER 10= C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00 the 3097LCiv.0 )Ace of the work for which this permit is issued (Sec. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC O� Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and countyPLUMBING ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 BOILER-COMP(3 H.P. Df 100,000 B.T.U.) 6.00 BOILER -COMP (Over 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 MECH. CONT. - LIC. NO. MECH. TOTAL TOTAL 3 0 0 O gran o this permit. 41 Ignemre o -T- p r AOL r Datc_-- OFFICE COPY