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18176 POST THIS CARD NEAR FRONT OF .BUILDING PERMIT NUMBER CITY OF CUPERTINO g176 d INS PECTION'DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS a �?(,��In o+- . � 9q UNIT^#^' ,�,�,,/(��_��L-�O.T# PERMIT EXPIRES IF WORK OWNER �/ coNTgACTORJ 3 " 1 (IY},]111,(,�(10 V IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM NOTE: LIFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vA.PAT ID PREGUNITE - CUPERTINO STANDARDS. - GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .UNDERGROUND /SLAB &oi�8t� PLUMBING - - EI.ECTRICAL SSUANCR DATE MECHANICAL RLOG LEc PLc. MecR 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PER IT WOOD FLOOR INFORMATION , PLUMBING - !969vAwA ION. S/FTS. MECHANICAL ly✓� ELECTRICAL - I PERM TO FRAMING WG INSULATION .STORIES TYPE CONSTRI OCC,GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINALINSP.SHALL BE MADE BEFORE $O.FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING - Re INBUILDING USED CON PO On,,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. � ❑ ❑ ❑ ROUGH - SAN.# ASSESSORS PARCEL NO PLUMBING ELECT.ENERGY TRACT NO. PARCEL & NO TUBSSHOWER PAN PLUMBING ENERGY 3r, MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC.OATE ACC FILE NO 'FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST - GASP FIRE SPgINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑ EXTERIOR SHEAR I ELECTRICAL RETMFLOOD ZONE A.L UC. INTERIOR SHEAR FIRE DEPT. r❑ "❑ ° ❑ N❑ SHEETROCK - GRADEFEE SUMMARY EXTERIOR LATH D BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING Q� SCRATCH COAT ELECTRIC' PLAN CHECK do GAS FEE •J NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 6 , FW— ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING. z° PLEASE GIVE JOB ADDRESS WHEN PHONING. , I6. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING,FOR FINAL INSPECTION. TOTAL s J OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY " Ii, BUILDING PROJECT IDENTIFICATION • aAuDOlRo APPLICATION & PERMIT PERMIT NUMBER UMBER BUILDING -ELECTRICAL-PLUMBING-MECHANICAL �a1;4 /G , 181 76 A OWNER'S I,^I,� PLAN CHECK VALIDATION 7" Yx��Y� /7 OTV. ELECTRIC PERMIT FEE dB Sic a EtJ r �R PHDNE(�] 73 CONTRACTOR NaMF 11 OUTLETS-SWITCHES•RECEP 10.00/1.00 LIGHTING FIXTURES 10:00/1.00 CONTRACTORSAPPLIANCES-RESIDENTIAL 4.00 ZVI ADDRESS � r 3 N L PRONE /( PANELS 0.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 coo Ess ENG SPECIAL CIRCUIT 5.00" PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 J • kjnLxL1 H• DDRE Aaas d MOTORS SEE FEE SCH. ADDRE [. �L� )a �V SERVICE CHANGE 20.00-113 Alwa Doo LICENSED CONTRACTORS DECLARATION - < c u I hereby affirm Thal I am licensed under provisions of Chapter 9 - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and wan _ BLDG. LECT. PLG. kMECH. r D i Professions Cole,and my license is in full force and effect. 1rtrrr-y o t: W License Class Lin.Number H y, H J Datc - Conlrucmr' 1 a M 2 _ BUILDING PERMIT ec w owNliR-nuaDl:R DECLARATION MISC.- O ORD INFORMATION w3 v y I hereby affirm that I am exempt from the Contractor's License ac as Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE VALUAT:ONT Code:Any city or county which requiresa permit to construct,alter, 4@'80 a�J QQ¢ Improve,demolish,or repair any Structure,prior to its ISSUmCe,ills, ELEC.CONTR, LIQ NO. ELEC. 1 �1/ nwD, - requires the applicant for such penult to fila u signed statement that TOTAL/ Jv , PERMIT TO he isCapte 9(com la the provisions oC the Cnntr:eixi s3oftilLicense - „�� H U K' Law.(essandProcosionsCodeng )orth Section7000)onttherefrom and n a Busness and ProfessionsCode)or Ohm he is exempt therefrom and ATV. PLUMBING PERMIT FEE ¢�� the any applicant the alleged exemption.is the applicant t to action 703L5 STORIES TYPE CONSTR. by any applicant far a permit subjects the 0).): am to a civil penally of not more.than five hundred dollars(85001.1: ALTER-DRAIN&VENT-WATER (EA.) 5.00 • ❑ I,as owner.1 the property,in,nhy employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP rf�//V G Silo SO.FT.FLOOR AREA TOTAL ACREAGE meet, re through his own employees. le.If,ed what such improve. mrnsuffc through ot oroffered for employee,provided that suheinpong GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,Ole owner -EA.SYSTEM-OVER 4(EA.) 2.00 auaOING USE builder will.have the burden of proving that he did not build or im- prove for purpose ofsale.). STE INTER. IND CON PB omen ❑ I,as owner of the properly,am exclusively contracting with INDUSTRIAL WA30.00 REs 11 [10 ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 - contracts for suet,projects with a Contructol(s)licensed pursuant Io the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.F,P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. _. WORK I iRS'COMPHNSA'I'ION DI!C LA RA TION WATER TREATING EQUIP. - 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. or a Certificate of Workers'Compensation Insurance,or a cell it ied copy thereof(See.3800,Lab.C.). Policy No. ' Company U ❑ Certified copy is hereby l urnished. FIRESPRINK ENERGYT-24 Z2 [I Certified copy is filed with the city inspection division. MISC- REFER TO ORD Q Applicant . V ❑ N❑ V F] N❑ p: rnPERMIT ISSUANCE t&.-60 CC - CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE a.L.u.c. LU > _ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, Q.Q. 0 (This section need not be completed if the permit is for one _ TOTAL / V❑ N❑ V❑ N❑ hundred dollars IS 100)or less.) U O 1 certify that in the performance n1the work for which this per. QTY MECHANICAL PERMIT FEE - FEE SUMMARY LL F• mit is issued,I shall not amp) any person is any rummers.as Io O m becoy,e subgeI he Worker'C he s- in L�sAf 'forniu. Dm V2" Applicant_ . CC BUILDING �0 C. Pp ALTER OR ADD TO MECH. 5,00 } N NOTICE TO AVPLICAN'r: If, er making this Certificate of Ex- Z entption,you should b cone subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of wile Labor Code, you must f,rthwith comply with FEE �a� `� C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00DC.F.M.)' 4,00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 101MC.F.M.) 6.00 SEISMIC FEE 60 I hereby affirm that there is a "Instruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit Is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nam Addn HEATING UNIT(OVER 100,0008.T.U.)9.50 "50 Lender's Address ELECTRIC 1 certify that I have read this application and%line that the above VENTILATION FAN (SINGLE) 4.00 information.is correct. I agree to comply with all city and county PLUMBING ordinances and-state laws relating to building construction, and BOILER�COMP(3H.P.Or100,000B.T,U.) 6.00 1 hereby authorize representatives of this city to enter upon the 8OILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upenin, against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in Consequence of the tin of this pennil. MECH.CONT. LIC.NO. MECH. 0_ G 1 TOTAL TOTAL 6o Si lure of Applicant/Contractor Ua( 1[Ii� OFFICE COPY