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187221• POST THIS CARD NEAR FRONT OF BUILDING CITY .OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD Po / JOB ADDRESS _(9 DSD lv• `�' O `�\ �VL UNIT# _LOT# 11 �� ,�� OWNER 4e N/�/` CONTRACTOR PO kkrrk CLJ r PERMIT NUMBER 18722 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 NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF .CUPERTINO STANDARDS.A. PAiQ UFER PREGUNITE PEHMn VALIDATION '" 41 „� L 14 ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Oct a 1959 UNDERGROUND /SLAB PLUMBING city of CD V YRS ELECTRICAL MECHANICAL RLUG ELFCi. PLC. MECH ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION W WOOD FLOOR VALUATION $ITT, PLUMBING - MECHANICAL ELECTRICAL PER MIL i0 L FRAMING INSULATION ' STORIES TYPE CONSTH. 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 I SO IT FLooI+ARFA TOTAL ACReAr,F DIAPHRAGM BUILDING USE HITS NO CON PR O'l— ❑ ❑ ❑ ❑ ❑ ROOF SHEATHING _ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH - SAN.a PLUMBING ELECT. ENERGY TUBS IS SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ACC DATE ACG FILE NO ELECTRICAL BUILDING ENERGY, FRAMING ELECT. FINAL TEST ZONING ENG. SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE $PRINA r ❑ N� ENERGY T -]t - v ❑ N� MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' "Loop ZONE' v N� A.L u.c. v L_ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE .2—�- INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS ' SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY. BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, L ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING.. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC S�V PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL 6� U OFFICE COPY ti3� 1! O Z F O ir - LU > EL Q D z U O U_ U 0 a } N A 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL?. PERMIT NUMBER � n i� 18722 (,G ABUILMOORENC �%oat V NER'S NAME 72 n 'I'A' PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION C THACTORs NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 ,b � > LIGHTING FIXTURES 10.00/1.00 .ONTRACTORsPPLIANCES ADDREss S C. - RESIDENTIAL 4.00 PANELS 10.00 DATE OF APPLICATION ARCHITECT OR ENGINEER uc. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N.O. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 0 i _ TEMP. METER OR POLE INS. 20.00 APPLICANTS ADORE SS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �14VLC.�' _A"'�' LICENSED CON "I RACTORS DECLARATION U F ��•UV 1 hereby.Ilion, that I am licensed un der provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. - Ner License Class Lie umb S BLDG. ElEl❑ ELECT. PLG. I MECH. _ _ Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hoe- the aollrin Ills[ I an, exempt fr0.5 thCCantrandof:u License Law for❑wI'ollowing rcasnn.IScc. 7031.S,Bmincss.nd Pralcssions INFORMATION MISC.- REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 I]..,,U Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure, prior to its issuance. also ELEC. CONTR. LIC. NO. ELEC. I ( 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 with ScCI ion 70001 of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exanption. Any violation of Section 7031.5 TOTAL PERMIT TO G e L QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. gLTER-DRAIN-WATER (EA.) 5.00 by any applicant for a Permit subjects the applicant to a civil penally of not nmre than I Ive 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 docs not apply to an owner of property Who bllllds or Improve] thereon, and Who does such work FIXTURES - PER TRAP 5.00 50. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- mems are not intended or offered for sale. IC however, the building GAS - EA.SVSTEM -I INC. 4 OUTLETS 6.00 r improvement is sold within one year of completion, the owner- buildu will hove the hurdun if proving that be did not build orim- prove for purpose ofsale.). ❑ I, as owner of the property, amt exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB otaer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Cantractor s License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts forsuch projects with a contractor(s) licensed pursomd to the Co ntractor's License Law. SEWER -SANITARY -STORM EA. 200ft110.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ lam exempt under Sec. ,B.&RC. for O,is rea, u, Owner Date WATER SYSTEM 5.00 aCC. DATE ACC. FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self -insure. or a certificate of Workers' Compensation Insurance, or a c,rtil'wd ZONING ENG. SITE NO. copy Ihcrjs�v'�,jf�s� Policy N(1YO94lGfAdlp- �J. - FIRE SPRINK v N ❑ ❑ ENERGY T-24 v N ❑ ❑ ❑ Ce,rifiedcopyishereby furnished. Id-CertifigdAc"o'�py i"�J led 'w. It it ciI inspection division. Applicant_ C/tl�q{,&,E,C�.y4 MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O. CERTIFICATE Y017 EXEMPTION FROM WORKERS' PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE se,ti.. need mol he Comp tried if the permit is for one Y❑ N❑ Y NE]t'I"his QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I draft not employ any person in any manner w as to become subject to the Workers'Compensation laws of California. Date Applicant N'OTIC17 TO APPLICANT: IC after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this peunit shall be deemed revoked. ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 CK FSEISMIC AIR HANDLING UNIT (TO 14000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 EE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 I hereby alfirn that there is a construction lending agency far lire perfonnanae of the work for which this permit is issued ISce 3097, Civ.C.l.Lender's HEATING UNIT (TO 100,000 B.T.U.) 8.00M HEATING UNIT(OVER 100,000 B.T.U.) 9.50 6 S�(' Name Lender's Address I certify that l have read this application and swtr that the above inlonnation is correct. I agree to comply will all city and county ordinances and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING gQILER-CCNAP I3 H. P, or 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. CONST. TAX (We) agree to save, indenmify and keep harmless the City of upertino against liabilities, judgments, costs and expenses which ay in any Way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH.CONT. LIC. NO. MECH. TOTAL TOTAL �r� t ,and is fthis permit. �� , Si azure of Applicant oat actor Date OFFICE COPY