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16109 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO161.09 • INSPECTION DIVISION �e JOB INSPECTION RECORD Q.1 I PERMIT EXPIRATION tir JOB ADORESS 1012-3 UNIT# LOT# {{�� \• PSERMITEXPIRE��IF WORK , OWNER n D -� CONTRACTOR CdS v C-0 - INOT STARTED WITHIN INSPECTION F DATE FINSPECTOR INSP C ON RECORD 180 DAYS OF PERMIT ISSU FOUNDATION. NOTE: ANCE OR 180 DAYS FROM UFER • ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLE DINSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEvvmITvALUATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL A80VE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE GATE MECHANICAL - BLDG ELECT I PLG. VECH., ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL OCTN"mt,TO FRAMING U 12 19�8 INSULATION + STORIES TYPE CONSTR City of Cupertino OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT.FLOOR f,RE/+ -TOTAL HLREFCE. .ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID r i BUILomc usE ROOF SHEATHING Res INC CON .PB oro., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.k A5SESSORS PARCEL NO - '_ _ - PLUMBING ELECT.ENERGY - ,. TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT No. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO FRAMING - ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST IA ICAL - FIRE SPRINK ENERGY T ua , COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ❑ No Y ❑ N❑ EXTERIOR SHEAR ' CAL RELEASE -�! FL000 zorvE .A INTERIOR SHEAR T.' - - `"I] N❑ Y ❑SHEETROCK EXTERIOR LATH G 4 ` BUILDING INTERIOR LATH . TEMPORARY APPROVALS " ' SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUI LDI NG FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SE-E PERMIT FOR EXPIRATION DATE,,— MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE r ' CALLING FOR FINAL INSPECTION. TOTAL X00; OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BJI LDI NG PROJECT 1 DENTI FICATION (PERMIT NUMBER ADDRESS1-143N. wo 5Q APPLICATION & PERMIT . 16109[� _xd46lep �/DAJ 64)r_1GC�., BUILDING -ELECTRICAL-PLUMBING -MECHANICAL N 9 Nzr- mow' 1•sr� PLAN CHECK VALIDATION - ' NAME I '-'' VI-'--' OTY• ELECTRIC PERMIT FEE AK PHONE X57- 5 �G: . l :L6 NA eRAcioRs t; OUTLETS-SWITCHES-RECEP 10.00/1.00 s AJ LIC.No. LIGHTING'FIXTURES 10.00/1.00 �f -2.& C� ADDRESS rGRs `' APPLIANCES-RESIDENTIAL 4.00 1 ' PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. EN . OR GP PANELS (OVER 200 AMP) 20.00 ' GINEER ,ENO uc.No. �- SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 5.00 o r . 3& O 'J {l/ ZIP EMP.METER OR POLE INS. '20.00 APPLICANTS ssTSMOTORS "SEE FEE SCH. (bla3 vL1. WoGF n+7: w SERVICE CHANGE 20.00 , F o o - LICENSED CONTRACTORS DECLARATION RAID ' a u ' I hereby atlirm on that I am licensed odder provisis of Chapter 9 H.2 w - _ ISSUANCE DATE .v ¢ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H o 2. Professions Code,and my license is in full force and effectOCT ! 2 1988 ❑. 1:1 ❑ ZOO.- License Class L' umber O Z.r 0 Date 1tl w a __R-BU._D DECLARpT1oN BUILDING PERMIT INFORMATION X g LL I hereby affnm that am exempt from the Contractor's License MISC.- REF ORD u 0 ¢ Law for the followingreason.(Sec 7031.5,Business and Professions VALUATION $/FT. H -w PERMIT ISSUANCE 10.00 w> Coda:Any city or coumy whish requiresa permit to construct,alter, - 21'� /'�'\/ tEE S R ¢O 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. _ vll �(Jl� n requires the applicant for such permit to file a signed statement that TOTAL a w m S he is licensed pursuant to the provisions of the Contractor's License - PERMIT TO H 2 a r Law(Chapter 9(commencing with Section 7000)of Division 3 of the I -ice 4 0 Business and Professions Code)or that he Is exempt therefrom and OTY. PLUMBING PERMIT FEE I1.-- Or H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 - of not more than five hundred dollars($500).): ❑ 1,as owner or the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCG GROUP RES.UNITS - their sole compensation,will do the work,and the structure is not intended or offered for said(Sec. 7044, Business.,,it ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such Improve- - ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- - builder will have the burden of proving that he did not build or fire- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). RES IND CON PB GO., i, ❑ I,as owner of the property, INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑' ❑ ❑ p p y,um exclusively contracting with - 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 does 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 contracml(s)licensed pursuant to . the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 are exempt unifier Sec. R&P.C.for this reason WATER HEATER W/VENT 6.00 - Owner r Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. -'- 5.00 ,1 hereby affirm that 1 have a'certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or r eertil in ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab,C I - - lX Policy No. Company, ompany - (] ,\ ❑ Certified coepy is he�"G z �Certil red Ropy•istion division. FIRE SPRINK ENERGY TZ4 licantREFER TO ORD. v ❑ N❑ v ❑ 'N❑Ir CER 1 ICA FKERS" PERMIT ISSUANCE 10.00 FLOODZONE -A.L.U.C. W CO 1 ;NSATION INS URANCIi PLG.CONTH. 'LIC.NO. PLG. CL CI (This section need not be completed if the permit Wfor one TOTAL Y❑ N❑ Y E] N❑ 0 Z hundred dollars($100)or less,) U O 1 certify that imthe performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mi[is issued,I shall not employ any person in any manner so as to QW beco a he Workers'Compensation Laws of California. i ,p_ _. Date at ALTER OR ADD TO MECH. 5.00 BUILDING a' } to NOT C. LICANT', If,after making this Certificate of Ex- F ? emption,you should become subject 1n 01cWorkers'Compemsatron APPLIANCE, 5.00 PLAN CHECK provisions of the Labor Cade, you must lorthwi[h comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 14�SD 1 hereby affirm that there is a construction 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 Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC " I certBYthat l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information incorrect. I agree to comply with all city and county - PLUMBING ordinances and state luws,relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby.authorize representatives of this city to enter upon the BOILER-COMP(Over 1110,000 BTU(6EE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. , uperlino against liabilities,judgments, costs and expenses which CONST.TAX ay many way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 'J�j anting oft is mil, - MECH.CONT., LIC.NO, MECH. y TOTAL TOTAL 8 y g o Applicant/Contractor ate - ' OFFICE COPY