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9186_ POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO. INSPECTION DIVISION JOB INSPECTION RECORD. ' /9J` L/ ,+ /nr`•I � JOB ADDRESS ```�JJ VG n UNIT# LOT# - - Ger OWNER k CONTRACTOR r "JII RMITNDMBER , 8 PERMIT-EXPIRATIONZ i. PERMIT EXPIRES IF WORK ISNOT STARTED WITHIN 180 DAYS OF, PERMIT ISSU- OR 180 DAYS FROM LASTCALLE DINSPECTION. INSPECT, N DATE INSPECTOR INSPECTION RECORD FOUNDATION-ANCE ` ,• , LIFER. � 'I . PREGUNITE - PERMIT VALIDATION n -- ISSUANCE UA1e POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL, BLO ELECT. �Y PLG. MECH. T ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL PERMIT TO / ✓"`-^' •�` " FRAMING INSULATION . STORIES TYPE CONSTR. OCC: GROUP PES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - BUILDING USE HES IND CON PB Omer ❑ 0 ❑ ' ❑ 1:1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO, PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE ,NSP. ACC, DATE ACG FILE NO. i FRAMING SAN * . " INSULATION PLUMBING �_ Q ZONING _ ENG. SITE NO.�"� GAS MECHANICAL FIRE SPRINK Y'Q No ENERGY T 24 Y ❑ N11 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH -INTERIOR _ - ELECTRICAL FLDDD ZONE Y ❑ - N❑ A.L.u.C. , Yo NQ LATH -EXTERIOR IF IRE DEPT. 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 FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ..... ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION.' z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST!TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE '9?'=': CALLING FOR -FINAL INSPECTION. TOTAL OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUIL I NG PROJECT 1 DENTI FICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL _ PERMIT NUMBER 9186 ATNEss OWNER' NAME ONE k 6����OTV. PR ELECTRIC PERMIT FEE PLAN CHECK VA L A IQN Y` NAME ACTOR 1 t uO.No, 1414g44 OUTLETS - SWITCHES -RECEP 10,00/1.00 LIGHTING FIXTURES 10.00/1.00 10141 AOTOR's ADDRESS ADDRE PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 00, PHONE ROWCHrtECT DATE OF APPLICATION onn ENGINEER -� u -- c.NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 moo Ess ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 20.00 n1 [_,D , wX,/{�+/CJI APPucFNra ADDREss MOTORS SEE FEE/490 SERVICE CHANGE 0 , ,[, / J �I g�� LICENSED CONTRACTORS DECLARATION TEMP. POLE 30x00 ;! ` I hereby affirm that I am licensed under provisions of Chapter 9 V t ISS AN E (commencing with Section 7000) of Division 3 of the Business and Professions Co old in license Li is in full fort an e License Class ee}�[,bl+Lic. Number' Dete ` Commcluy.y-�4pQ� 0 BLDG. ECM. ❑ ❑ ❑ ❑ C1tY N BUILDING PERMIT , OWNER -BUILDER DEC-LARATION I hereby affirm that I am exempt from (tic Contractor's License Lowfor the following reason, (Sec. 7jiresa Bosinessand Professions Code: Any county whiny structure p issuance, MISC. - REFER TO ORD PERMIT ISSUA NCE � VALUATION p O 4 S/FT. ELEC. CONTR. LIC. NO. ELEC. /� (/1' EC. TOTAL -� mulish improve, demolish, or repair any r mit Wfi prior n its issuance, also prior its also requires the applicant for such permit ❑s file a signed actor's i else he is licensed pursuant to the provisions OI the Contractor's License Law (Chapter 9(commencing with Section 7000)0 f Division 3ofthe PERMIT TO SO4"Q r-l�yy Business and Professions Code) or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE vers �Z 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 T PE CONSTR. ALTER -DRAIN -WATER IEA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do 11se 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 Low 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 or iniproves 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 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 for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with RES IND CON PB Other 0 0 D 0 INDUSTRIAL WASTEI 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 property who huilds or improves thereon. and who LAWN SPRINKLERS - 1 NC 5 V. 6.00 LAWN SPRINKLERS - OtVE ( A.) 1.00 ASSESSORSPARCEL NO. contracts for such projects with a contractorts) licensed pursuant to the Contractor's License Law, ❑ lam exempt under Sec. ,B.&P.C. for this reason SEWER -SANITARY- MEA. 20 Q1.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT CQ 6.00 Owner Date WATER SYSTEM \ 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. .6.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self-insur, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, PoNo. Company 0 J � Cetlified copy is he eby furnished. W� t�ry Certify- o y i dud 1 nspec[ion drvi I n nphlicunt 4, FIRE SPRINK YD N� ENERGY T24 Y ND MISC.- REFER TO ORD. CERTIFICATE OI' EXEMPTION PROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for mu, PERMIT ISSUANCE "-00 FLOOD ZONE Y ❑ NC] A.L.U.C. Y 0 N� PLG. CONTR. LIC. NO. PLG, TOTAL U C+ hundred dollars (S 100) or less.) I certify that in the performance Of the work for which this per- mil is issued, I shall not employ any person in any manner so as 10 become subject to the Workers' Compensation Laws of California. Date Applicant '1'O QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING fps a ,6 ALTER OR ADD TO MECH. 5.00 NOTICE APPLICANT: If, after making this Certificate of Ex- emption, you should become subject 1O the Workers' Compensation provisions of the Labor Code, you must forthwith comply Willi such provisions or this permit shall be deemed revoked. APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT(OVER 10=r-F.M.) 6.00 SEISMIC FEE If_(o 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 ]'or which this permit is issued (Sec. 3097, Civ.C.), MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Under', Nome Lender's Address HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLET 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 PLUMBINGW .0 BOILER- COMP 13 H.P. or 100,000 B.T.U.) 6.00 hereby authorize o representatives This city to enter upon Ilse above-mentioned properly for representative, ec lino purposes. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify ,it keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any ac a against said City in consequence of the gran ing of �ye r MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. N0, MECHJTOTAL TOTAL �I/ Unature ofp It lCo tear Date OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION &PERMIT - ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER �� BUILDINGAPPLICATION Aa ADDRESS oREss le 5 CCPLAN rBUILDING OWNED' NAME PHONE/-// CITY. ELECTRIC PERMIT FEE CHECK VALIDATION {,[ �f-, j'!A V /UU R NAME UTLETS-SWITCHES-RECEP 10.00/1.00 i. uc. No. LIGHTING FIXTURES 10.00/1.00 R D's ADDRESS PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 _ PHONE _ DATE OF APPLICATION A IEC OP ENGINEER uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS LNG.SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 zIP (�/TO ADDRESS ANT ADDRESS MOTORS 1 SEE FEE SCH. SERVICE CHANGE% 20.00 V / G1;� 7�l� LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 I hereby 11no that 1 ant licensed under provisions of Chapter9 (commencing with Seek.... 7000) of Division 3 of the Business anti Professions Code, and my license is in full force and effect. License Class_!'�Ii['.da , Lic. NO n. ber ISSUANCE DATED) BLDG. ❑ ELECT. ❑ PLG. MECH. 1-1 ❑ DateViLJulef "Vy"''�^, 'r Contractor. OWNER -BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professio ns Code: Any orcounty which requires y y y q pennittoconsuanc. abr. improve, demolish, or repair any structure, Prior n its issuance, also requires the applicant for such permit 1O file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 l commencing with Section 7000) of Division 3 ofthe Business and Prol'¢ssionS Code) or that he is exempt therefrom and ' BUILDING PERMIT INFORMATION MISC. - ,� REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEC. CONTR. LIC. NOY ELEC. /� TOTAL PERMIT TO SOA/4-W .�% QTY. PLUMBING PERMIT FEE STORIES T E CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant toacivilpenalty of not more titan five Imndred dollars (S500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their win compensation, will do the work, and the structure .s not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 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 Out such improve- mentsarenotintendedoroffered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO, 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 h;uden of proving that he did not build or in. pr°vc In, purpose of sale.). tcting with, e properly, am exclusively nra Cl 1. as owner of thco GAS EASYSTEM -OVER 4 IEA.) 2.00 - . - BUILDING USE REB IND CON PB Omer 0 11 ❑ 11I, I INDUSTRIAL WASTE INTER. 30.00 I' licensed contractors to construct the pro,icct (Sec. 7044, Business and Professions Code, Thu Contractor's License Law docs not apply to an owner of property who builds or improves thereon. and who LAWN'SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts tor such projects with a contraclons) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ tuns exempt under Set.-, B.&P.0 for this WATER HEATER VV/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK ERS'COMPENSATION DECLARATION . WATER TREATING EQUIP. , 5.00 , oLl 1 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.L Policy No. Company FIRESPRINK y[] No ENERGY T 24 yF] N� ❑ CeUiOcd cop), is hereby faiandfofSm/ t d�hn ��pQ Cified opy i dee t T.. lie M1h . Apg1;¢ altl¢ny MISC.- REFER TO ORD. CERTIFICATE 01' EXEMPTION FROAI WORKERS' PERMIT ISSUANCE .10.00 (je FLOOD ZONE A.LD.C. f COMPENSA'PION.INSURANCE (This section need not be completed if the permit is for one PLG. CONTR, LIC. NO. PLG. TOTAL / f/V�„ Y ❑ No Y NE] hundred dollars IS 100) or less.) I certily that in the performance of the work for which this put- mit is issued, I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE �. FEE SUMMARY BUILDING 6k4 become subject to the Workers' Compensal ion Laws of California. Dale Applicant '1'0 ALTER OR ADD TO MECH. 5.00 NOTICE APPLICANT: [Later making this Certificate of E.- cmption, you should beconm mlo,ct to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Coda, you must forthwith comply with Such provisions or this permit shall be deemed revoked. FEE AIR. HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY I hereby affirm that there is a construction lending agency her EXHAUST HOOD (WITH DUCT) 5.00 the performance,of the work for which this permit is issued (Sec. 3097, Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenders Name Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC W VENTILATION FAN (SINGLE) 4.00 1 certify that I have read this application and state that the above inlbrmalion is OR...ct. I agree to comply with all city and county ordinances and state Idws relating to building construction, and PLUMBING / W BOILER-COMP13 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 above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way,acc a against said City in consequence of the granting oft . per CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIQ NO. _[MA H_ TOTL TOTAL 06 o n 16T DIED, INSPECTOR COPY