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17573POST THIS CARD NEAR FRONT OF BUILDING ' - CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' JOB ADDRESS /00S0 NO UNIT# _LOT# - OWNER CONTRACTOR 1'IiHMIT NUM111{fi li 17573 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN - 180`DAYS OF PERMIT ISSU., ' ANCE OR 180 DAYS FROM LAST CALLED 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 STANDARDS. PAT 'LIFER PR EGUNITE PLIWIT VALI)ATION ^� ISSUANCE )ATE/(T//- GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED OCT 111989 UNDERGROUND / SLAB PLUMBING - Clfv Of rimprtlN) ELECTRICAL - MECHANICAL BLDG. ❑ ELECT I PLG. MELH 11 nn I� ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION PLUMBING - MECHANICAL ELECTRICAL - PERMIT TO �L�6 FRAMING INSULATION sT ORICs - rvvE cONsn+. . 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 ' so IT n.00R ARLA *ornL ACRLAcc DIAPHRAGM ROOF SHEATHING BUILDING USE Rus IND CON Pe ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - ASSESSORS PARCEL NO - ROUGH SAN.#' 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 ZONING ENG SITE NO. INSULATION PLUMBING 12 , GAS TEST GAS FIRE SPRINK v ❑ NOr ENERGY A]4 N[j MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE v[:] NC] ALUC v ❑ N1:1 EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING / INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT 1ELECTRIC PLAN CHECK FEE rJ GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505 w ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC, PLUMBING L16 OG MECHANICAL — CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL L16r' OFFICE COPY r, 0 at i Foo Qua ay H Z 2 O ¢ or or u w 3 a G F LL 0< w>2 ¢ 2 G O ca o LL 6 W m N ? 40 ¢ H $ a 3 O Z_ z 0 ir - LU > ao Z)z UO U. V Ow } N F � `a. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER ;a 7573 euaDlNc ADDRESS ,�7�, /00sz1) G- OWNER'S PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE PHONE CON TFOUCTORa NAME / y7 UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ZSIOU� / DATE OF APPLICATION CONTRACTORS A DRESS E ,/ PHONE ] APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 RCHIiECT O OR ENGINEER LIC. No, PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. 3.00 ARCH, OR ENG.SPECIAL AODRESS CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 A/L�TptiCiGGI LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (T ISSUANCE DATE O (commencing with Section 7000) of Division 3 of the Business and Professions Co ti. a y license is in fu�_'g License Class �' Lic. Num r -s 1 / 'TJ BLDG. ❑ ELECT. ❑ PLG. � CH. ❑ OWNIiR-BUILDER I hereby noun that 1 am exempt trait the Contractor's License Law for the following reason. (Sec. 7031.5, Business and Professions e BUILDING PERMIT INFORMATION MISC. - REFER TO ORD VALUATION S/FT. PERMIT ISSUANCE 10.00 Code: Any city or county which requiresa permit Wemutolet, alter, improve, demolish, or repair any structure prior to its issuance, also ELEC. COKER. LIC. NO. ELEC. requires the applicant for such permit to ]tic a signed statement that he is licensed pursuant to the provisions of the Contractor's License TOTAL PERMIT TO DTV. PLUMBING PERMIT FEE Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Corte) or that he is exempt therefrom and the basis I'or the alleged exemption. Any violation nl'Section 7031.5 STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00/j 00 by any applicant to, a permit subjects the applicant Lou civil penalty of not more than five hundred dollars (5500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law dues not apply to an owner of Property who builds or improves thereon, and who docs such work F IXTUR ES - PER TRAP 5,00 Co 50. FT. FLOOR AREA TOTALACREAGE himself or through his own employees, provided that such improve- mentsarenotimendddorofferedl'or sale. It, however, me budding ' GAS - EA. SYSTEM -11 NC. 4 OUTLETS 6.00 or improvmnent is sold within one year of completion, the owner- builder will hive the better, of proving Out he did not build or ice- prove for purpose of sale.). O 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seo. 7044, Business GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's License Law dues not apply to an owner of property who builds or improves thereon. and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contracind,u licensed pursuant to the Contractor's Licer,e Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ I oln cxmnpl under Sec. ,B.&P.C. Por this mon Owner Data WATER SYSTEM 5.00 ACC.DATE ACC, FILE NO. WORK IiRS'COVIPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a Certificate of consent to self -insure. or a certificate of Workers Compensation Insurance. Or a Cernlied ZONING ENG. SITE NO. copy therypjJ-Sy;..3 LAC I Policy N ✓i npany CeHilic I cup, is hereby lumishcJ. Cerufle py Is c with. the city inspection divi'mu. Applicant�LV d; FIRE SPRINK Y ❑ N ❑ ENERGY T 24 Y ❑ N❑ MISC. - REFER TO ORD. CERT117ICA1 E 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00/2_, FLOOD ZONE A.L.0 C. P .CONTR. LIC -N -0 -PLG. / O U TOTAL �(� COMPENSATION INSURANCE Y ❑ N❑ Y [:] NE] (This section need not be completed if the permit is for one OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dol l urs 15100) or lea.) 1 certify that in the per ma ance of the work for which mix per- mit is iaucd, I shall not employ any parson in any manner so as to BUILDING become subject to em Workers' Couq,v -hose Luwx of C:dm,rm.. Dam AppEduni NOTICE '1'0 APPLICANT: If, uftcr making this Certileam of Iia - creation, you should became subject to the Workers' Contpensation ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10,000CY.M.) 4.00 FEE AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE CONS'IRUCfION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby afl'ina that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000B.T.U.0.50 ELECTRIC Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING 00 I certify that I have read this application add Slate that the above information is correct. 1 agree to comply with all city used county ordinances and state laws relating to building construction, and BOILER-COMP13 H.P. Dr 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorim representatives of this city to enter upon the above-mentioned property for inspection purposes MISC. - REFER TO ORD. (We) ugrco to save, intetnnil'y and keep harmless the City of upertmo ugmust liabilities, judgments, costs and expense. which may in any way ac ue agai t said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL rafthlsperm . utlnW. /2�19�,1 ca /d -//•-�'X Signature of Applic2Ant/Contractor '-Date OFFICE COPY