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9185POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD �� 1 �/ �rh; �J C75' JOB ADDRESS f� ✓ UNIT# —LOT#pERM1T C C�1.V1 OWNER J h,Q CONTRACTOR 1pCrfV,- PERMIT NONIB ER J 1oi (� ,85 —PERMIT EXPI ATI ON -' EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPEC ON DATE INSPECTOR INSPECTION R ORD FOUNDATION � LIFER PR EG UNITE PERMIT VALIDATION ^! 3 ISS6ANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING I - ELECTRICAL - MECHANICAL BLDG. ELECT. •'PIG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR vnwnnoN $YET. PLUMBING Q. MECHANICAL ELECTRICAL 3L ak- - PERMIT TO ' 'f 65''4 _-.6-crr FRAMING INSULATION STO S `' TYPE'CONSTR. OCCGROUP .RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SQ FT, FIOOR AIIEA TOTAL ACREAGEROOF DIAPHRAGM - - BUILD USE RES IND CONPB piner ❑ 0 ❑ 0 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGHr ASSESSORS PARCEI. NO, PLUMBING GAS TEST, TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FIN S DATE INSP. ACC. DATE ACC. FILE N0. .. FRAMING SAN INSULATION PLUMBING y �� --F) ZONING ENG. SITE NO. GAS MECHANICAL FIRESPRINK Y [N� ENERGY T Z< Y [D NEj COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING LATH—INTERIOR- ELECTRICAL � I FLOOD ZONE v� N� A.L.U. C. v� N� LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING y 3I'rs 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, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANTI PLEASE.READ REVERSE SIDE BEFORE r I ,;, CALLING FOR FINAL INSPECTION. TOTAL ' OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 918 5 BUILDING . ADDRESS UN !J. •I -Ail OWNER'S NAME Q PHONE N b�ZS� QTY ELECTRIC PERMIT FEE PEA NECK VAL A6 3 � �, NA.Eogsrr ; UTLETS-SWITCHES -RECEP *.-eO/1.00 LIGHTING FIXTURES 40-.M/1.00 ar C11 u c. No.14IItrt&4 CONTRACTORS ADURESS APPLIANCES - RESIDENTIAL 4.00 I•� PHONE 7_sJ" DATE OF APPLICATION PANELS 10.00 OORRCHITECT ENGINEER LIC NO. PANELS (OVER 200 AMP) 20,06PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG' AD D SS SPECIALCIRCUIT 5,00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP anaucagrs aD0RE55 MOTORS / SEE SERVICE CHANGE 20.00 S 64 111N��4( LICENSED CONTRACTORS DECLARATION TEMP. POLE Oto 'I I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cgdy, an m license is in full force nA of ec . License Class Yil sl Lic. Number nn J V ISSUANCE DATE BLDG ELECT DATE MECH. ❑y� U ASCI '�tlftf110 O Date �Jf�"y.y,C_�' 6-Contracto u LLII BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby collo that I'am exempt from the Contractors License Professions Law forthefollorcommeson.(Sea hrequires a permit Any city or county which requiresapermit In construct,alter, to construct, improve, demolish, Or repair any structure, prior W IIS Issuance, a150 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 Law (Chapter 9(commencing wit it Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC.- REFER TO ORD PERMIT ISSUANCE AGA)() -- VALUATION / ELE0. CONTR. LIC. NO. ELEC. 1 TOTAL azo OTY. PLUMBING PERMIT FEE PERMIT TO i� WaJ el the basis for the alleged exemption. Any violation of Section7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): STORIES ' TYPE CONSTR. ALTER -DRAIN -WATER (EA. !/a+ )SBO ❑ I, 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 GCC. 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 FIXTURES'- PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedorofferedforsale. If, however, the building ED. FT. FLOOR AREA TOTAL ACREAGE 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- of sale.). Provo 1. as owner ❑ d as owner of the property, be exclusively contracting with licensed colons od In construct the project (Sec. 7044, Business o Iimprov Law Joos not apply and Professions Code: The who to owner of property who builds improves and who GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES ❑ t❑ ❑N ❑ Other❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORSPARCEL NO. tr contracts for such cense L with a conframod s) licensed pursuant to tr used a the Contractor's License Law. ❑ lam exempt under Sec... B,&P.C, for this mason SEWER -SAN ITAR V•STORM'10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM AA 27 ERD ACC.DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to selfinsure. or a certificate of Workers Compensation Insurance, or a Certified pgyof Cupertinc ZONING ENG. SITE NO. copy thereof ( Sec. 3800, Lab .C.I ' Policy No, Compmsy ❑ Certified copy is hereby rnished. Cerrrc copy filed Y inspection division. A p icon �._ FIRE SPRINK v N ❑ ENERGY TP< v N MISC. - REFER TO ORD. PERMIT ISSUANCE '16:60 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one FLOOD ZONE Y ❑ NE] A.Lu.G. Y ❑ No PLG.CONTR. LIC. NO. PLG. TOTAL /O hundred dollars ( $100) or less.) I certify that in the performance of the work for which this per. mit is issued, 1 shall not employ any person in any manner so ns na QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex ALTER OR ADD TO MECH, 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workeri Compensation provisions of the Labor Code, you must Iorlhwilh comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.EM.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 I hereby affirm that there is a construction lending agency for MICROFILM the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's NamAddress Lender's Address H EATING U N IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE) 4.00 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING l� v BOILER- CON? (3 H.P. or 100,000 B.T.U.) 6.00 hereby authorize representatives ofthis purposes. is city to enter upon the above-mentioned property forinspectionh BOILER -COMP 10er, 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which "lay in any wa accn against 'd City In consequence of the granting of thi mail MISC. • REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO, , MECH. _ p1 ant/Com r Dale TOTAL TOTAL O OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING - ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 91.5 5 PLAN CHECK VALIDATION BDILOING ADDRESS OWNER - _ rvnmE PHONE QTY. ELECTRIC PERMIT FEE 3 •y Ps K CONTRACTORS'UTLETS NAmE 5s LIC.NO. - SWITCHES -RECEP 10..00/1.00 LIGHTING FIXTURES iR00/1.00 {--,A ' T Ra ADDRESS PPL'IANCES- RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION RCHITEC OR ENGINEER Llc, No, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG.PERMIT ADDRESS SPECIAL CIRCUIT. 5.00 VALIDATION 0 TEMP. METER OR POLE INS. 20.00 ZIP / �S APPLICANTS ADDRESS MOTORS SEE FEE SCH. /� .SC HJ SERVICE CHANGE 20.00 :751,0cc // c LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolessions Code, and my license is in full force and effect. L14Ynxe CIL1s2I4SGL1" LIC.Nulllllvr /_�1 Contractor ISSUANCE DATE BLDG. El ELECT_ PLG. MECH. ❑ E]Date � 14,e-fGa}j. OWNF,R-BUILDER DECLARA'rION I hereby collo that I am exempt from the Contractor's License Law for the ity or countyw hi Sec.uiresa•ermBusiness and lunch, cions Code: proe, y mulish county whiny structur e p prior t to is issuance. . ISOmr, improve, demolish, or repair any structure, prior to its issuane t also be is lislhe applicant for such permit ns file a signed actor's nt that he is licensed pursuant to the Provisions of the License BUILDING PERMIT t- INFORMATION MISC.- ,. REFER TO ORD PERMIT ISSUANCEI �0 CN - VALUATION $/FT. ELEC. CONTR. LIC. N0. TOTAL TOTAL a U PERMIT TO r 1 CITY. PLUMBING PERMIT FEE! ) ofD¢ision Law (Chapter r (commencing with Section is exe of Division 3 of the Rosiness and Professions Code) or that he is ezempLlhen•I'rom and I STORIES STORIES TV E CONSTR. - the basis for the alleged exemption. Any violation of Section 7031.5 byanyapplicuntforaperoulsubjcots the applicant to a civil penalty of not mora than five hundred dollars ($500).): ALTER-DRAIN&VENT-WATER (EA.1„-5.00 /iv ❑ 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 FIXTURES - PER TRAP 5,00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SO. FT. FLOOR AREA TOTAL ACREAGE property who builds no Improves thereon, and who does stmt work himsell or through hisbwn employees, provided that such improve- mentsarenotintendedorofferedforsale. l f, 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.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.1 2.00 RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and I'ro fessions Code :'I'lie Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who 6omrxets Ivor such projects with a tontractorls) licensed pursuant to the Contractor's License Law. LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCE L NO. LAWN SPRIN LERS - OVER 5 (EA.) 1.00 SEWER -SAN V -STORM EA. 2001t/ 10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-. BAP.C. for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKIiRS'COMPFNSA71ON DECLARATION 1 hereby affrrm ilial 1 have a certificate ofconsent m sell -insure, ic or a certifate 0 Workers' Compensation Insurance, or a Certified ZONING ENG. SITE NO. copy Ihaeof (Sec 3800, Lab.C.l- Policy No.Company - - ^� MISC. - REFER TO ORD. FIRE SPRINK Y ❑ N❑ ENERGY T-24 Y ❑ N❑ ❑ Ccltilicdc pyisllcrCI, ithhc �,i N pt }/ fL 'Aq���C]J Curl ilkd 'c)py '' tiled illi Iht Fl/y ns •�1 ion division., p jiLcu Cli TIFICATEOFEXEh1P O PR'ORKIiRS• PERMIT ISSUANCE 1n n0 &t._ [:FLOOD ZONE A.L.U.C. COMVENSATION INSURANCE (This section aced not he completed i1' the permit is to, one PLG.CONTR. LIC. NO. PLG. CA TOTAL ^! U V N ❑ ❑ V C]N❑ CITY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or co.) I certify that in the performwtee of the work for which this per- mit is issued, I Shall not employ any person in any manner so as to BUILDING S� -id become subject to lire Workers' Compensation Laws of California. Dart Applicant NO1'ICIi 'f0 APPLICANT': If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emption, you should become subject to the Workers' Compensation provisions of the Lnhor Code, you must loxthwith comply with such provisions or this permit shall be declined revoked. FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE . CONSTRUCTION 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 UNITJTO 100,000 B.T.U.) 8.00 Lender's Nmn° Lender's Address HEATI NG UN IT 100,000 B.T.U.) 9.50 ELECTRIC _ 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING "-' BOILER- H.P. or 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 abovommnioned properly for inspection purposes. MISC_- REFER TO ORD. CONST. TAX CWC) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, Costs and expenses which may ill any way income against said City' m COnSCrnence Of the PERMIT ISSUANCE 10.00 gra ntingohhi. rani MECH.CONT_ LIC. NO.MECH. orAL TOTAL S/ ()0 INSPECTOR COPY