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17208POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION T JOB INSPECTION RECORD " JOB ADDRESS 'D% s--(/� V' h� S -/r UNIT#. LOT 4t -1 `- OWNER ��-I�� C�F1—. CONTRACTOR w ( PERMIT NUMBER 17208 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. PO4,11,OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - - - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STAN[)ARDS. UFER PREGUNITE - PERMIT VALIDATION ' r• ,j l•ISSUANCE DATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED FEB p FEB 3,1.73 .UNDERGROUND/SLAB PLUMBING�Nu .s �y...�{� W Of ELECTRICAL MECHANICAL - ui L�Oc ELECT I PLC. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION " WOOD FLOOR VALUATION! - 02 �..)Q..,� s/FT, PLUMBING - MECHANICAL - ELECTRICAL 10 FRAMING` INSULATION s oglEs„ TVP coNSrR OCC GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID . • soFT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM _ ROOF SHEATHING BUILDING USE I+Es IND CON PB om, El F-10 ED- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. " ROUGH SAN.H ASSE 5SOR5 FARCE L NO PLUMBING ELECT. ENERGY TUBS &SHOWER PAN . PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL .. MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC. FILE NO FRAMING ELECT. FINAL TEST INSULATION, - PLUMBING, zoNlNc. ENc.sTENo. GAS TEST GAS _ MECHANICAL FIRE SPRINK ° ❑ "❑ ENERGY r.24 ` ❑ N❑ COVER NO WORK UNTIL ABOVE -HAS SIGNED HEATING EXTERIOR SHEAR � ELECTRICAL RELEASE rlOOD 20Nf. Y ❑ "❑ UC. A.L . v ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING -,Qo INTERIOR LATH • TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ISEISMIC FEE /F OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. z° PLEASE GIVE JOB ADDRESS WHEN PHONING.. —'SEE PERMIT FOR EXPIRATION DATE — ELECTRIC n at; PLUMBING ' oe MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR, FINAL INSPECTION. TOTAL OFFICE COPY H"§(PPCICANTi ILr 1N INFORMATION WITHIN RED LINES - USE BALL POINT PEN'ONLY o0 0 Foo QOU z w H z O_w Q yO Q Q w U w3a. - O N fW 1 f 2 K G O u e w m H z a s i o O Z z {-'O 2N W CL0 UO LL U Oa } N U BU LD1 NG PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL ,PERMIT NUMBER , 17208 SoIIDING ADDRESS �Q OWNER'S NAME L ��, PHONE 0A5 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR wC.NMSE�7 OUTLETS - SWITCHES -RECEP 10.00/1.00 r sD LIGHTING FIXTURES 10.00/1.00 .f0 CONTRASDDRESS oR's A PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 jm�NE - LI DATE OF APPCATION ARCHITECT p.� .- OR NIJVVrR",,_. ENGINEER ' �^^ sec. NO. PANELS (OVER 200 AMP( 20.00 C. P. , PLAN CHECK FEE NO. ' SIGNS TRANS., 3,00 nooeess ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 29.00 L APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ' on i o��c- �jt�l- 15 GNS I hereby affirm that I am licensed under provisions of Chapter ')FFR (commencing with S til n 7000) of Division 3 of the Bi slnese and Professions Ca Amy license is in full fore c . License Closs LiLiNumber Da[c_� _Cornructor 8 h' ISSUANCE DATE BLDG. ELECT. PLG. MECH. IY7-C'1_ �� City of, Cope�u BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION affirm that I ant exempt (tont the Contractor's License I hereby the Law I: Athefollowingreason(Sec. 7031.5,business and Professions Code', Any city m county which requirese Permit tots isou cq. also improve, demolish, or repair any structure, prior in its issnan[C, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors Licene s MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION GYJC ^�O $/FT. ELEC. CONTR. LIC, NO. , ELEC. TOTAL ERtgl� ty " PEI QTY. PLUMBING PERMIT FEE Law (Chapter 9(commencing with Section 7000) of Division 3 oflhe Business and Professions Code) or that he is exempt therefrom and 'ew b STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant lop civil penalty of not more than five hundred dollars (S5001.): 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, anti 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 docs such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 ref SO. 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 int prove for purpose critic.). - ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractDr(S) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C. lot this reason WATER HEATER W/VENT 6.00 Owner Dam WATER SYSTEM 5.00 ACC. GATE ACG FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate ofconsent to self -insure, or a certificate of Workers' Compensalion Insurance, or n certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Luh.C.). Policy No. Company O Certified 'opy is he Chy t rnlshed. PJ-1Cerffie co) y��is h He ity irrµµp�e{ct.i.p division Applicant - -�: :J= -'K �. FIRESPRINK Y ❑ N ❑ ENERGY T 24 Y ❑ N❑ MISC.- REFER TO ORD. CFR'I'IFICATEOh I: EMPTIONFROM ORKERS' PERMIT ISSUANCE 10.001 0 FLOOD ZONE A.L.U.C. PLG.0NTH. LI N0 I JMD PLG. (� TOTAL a D . COMPENSAI'IONINSURANCE (This section need not be completed if the pe nn it is for one Y ❑ N ❑ Y ❑ N ❑ hundred dollars IS 100) or less.) I certify that in the perlormance of the work for which this per- mit is issued, I Shall nor employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws or California. Date Applicant NOTICE TO APPLICANT: If, after making Ibis Certificate of lix- ALTER OR ADD TO MECH.. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with it shall be deemed revoked. such provisions or this permm AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10ACC.F.M.) 6.00 SEISMIC FEE / 8 O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency Pore EXHAUST HOOD (WITH DUCT) 5.00 tire pc,monance.of the work Pore which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Nam H EATI NG U N IT I OV ER 100,000 B.T.U.) 9.50 ELECTRIC S Ob Lender's ess - VENTILATION FAN (SINGLE) 4.00 s - I certify that l have read this application and state that theove information is correct. I agree to comply wilt all city and Couabnty ordinances and sett, haws relating to building construction, and PLUMBING r Ub BOILER- COMP(3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL t� tltl b( �1 4 hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. MISC. - REFER TO ORD. 'CONST. TAX (We) agree fo save, indemnify and keep harmless lea City of Cupertino against liabilities, judgments, costs and expenses which may in any way ace a against said City in consequence of file ranting of ihis.Rennl. It a PERMIT ISSUANCE 10.00 ,]� MECH. CONT. LIC. NO. 1 3 / 4 MECH. TOTAL/io �O TOTAL A 06 Signature o Applicant/C trvcror Date OFFICE COPY