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16601 POSTTHISCARD NEAR FRONT'OF 13UIL61NG c - PE MIT NUMBER•, ' CITY .OF CUPERTINO 16601 INSPECTION DIVISION JOB INSPECTIONRECORD ! xx �� /� PERMIT EXPIRATION JOB ADDRESS.—_[491 2— /��• Wil-_UNIT4* LOT*'t &I '', 1. • FERMi EXPIRES IF W"ORK ^' OWNER , ®. Q CONTRACTOR C(' W` . - IS NOT STARTED WITHIN I INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DA vs of PERMIT ISSu • FOUNDATION, -- - ANCE OR 180 DAYS FROM I NOTE: LAST CALLED INSPECTION. LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLED' ' PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF 7 PEHpuTVALIDATIDN- I CUPERTINO STANDARDS. - GARAGESLABS - - ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING,,, : ELECTRICAL., ISSUANCE DATE MECHANICAL - BLuc, ELECT. PLG. . MECR. ❑ ❑ ❑ Isl DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT .. - INFORMATION WOOD FLOOR PLUMBING - VALUATION MECHANICAL - ., ELECTRICAL - PERMIT TO FRAMING CT 13,1989 , INSULATION sroHlEs TYPE co"srH. OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - • ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE so.Fr.FLOOR AREA TOTAL ACREAGE. DIAPHRAGM THE CONSTRUCTION TAXIS PAID BUILDING USE . ROOF SHEATHING - HES IND CON PB o. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ E ROUGH IMEC�H. ASSESSORS PARCEL NO, - PLUMBING - - NERGY - TRACTNO. PARCEL NO TUBS$SHOWER PAN•, G ENERGY MECHANICAL ERGYELECTRICAL ENERGYAcc.DarE . Aca FH.E NoFRAMING NAL TE STZONING ENG SITE NO. INSULATION G GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " "� ' EXTERIOR SHEAR - - - ELECTRICAL RELEASE 8000 ZONE A L U.C.- .. INTERIOR SHEAR FIRE DEPT. v F] NE] , Y L "E]. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR' LATH TEMPORARY APPROVALS BUILDING ; SCRATCH COAT_ ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNE JOCCUPANCY SEISMIC FEE. OCCUPANCY OF.BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM. ' ARRANGE FOR INSPECTION BY PHONING 252-4505,' ELECTRIC C)'0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING . Z 0 PLEASE.GIVE JOB ADDRESS WHEN PHONING. MECHANICAL La — SEE PERMIT FOR EXPIRATION DATE — '' IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE . "A"AA04, TOTAL X14'+DD CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 60 'BUILDING.PROJECT IDENTIFICATIOGPERMIT NUMBER i. `f APPLICATION & PERMIT eBUILDINGP � i • AooREss D �3 , .W �YJCI � C[� 0� ` I BUILDING —ELECTRICAL—PLUMBING—MECHANICALJ I?; U o OWNERS' I NAME _ PLAN CHECK VALIDATION -• +i OTV. ELECTRIC PERMIT FEE CXNTRA�N NAME °R UTLETS-SWITCHES-RECEP 10.00/1.00 e LC.N . LIGHTING FIXTURES 10.00/1,00' /D�f —3 CONTRACT oR's LV+f%+�� APPLIANCES:RESIDENTIAL 4.00 ( 1�/ t. PNONE PANELS 10.00 DATE OF APPLICATION .-h. ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE U.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 AARC"DDRE04 SS ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS.' - 20.00 ICA APPPLNT'S ADDRESS MOTORS SEE FEE SCH. ' SERVICE CHANGE20.00 '02 LICENSED CONTRACTORS DECLARATION ((AA �a i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ^ ISSUANCE DATE w a (commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT. PLG. -MECH. F N ve Professions Co .,and my license is in full force and effect ❑ ❑ . '2 O m — License Class __Lie.Number Ie17Jr\ 4 w r w Date/,5t4zc Luc r 13 BUILDING PERMIT ¢ ¢ m OWNER-BUILDER DECL^ TION a A - D A D MISC.— - 1 at INFORMATION wi,,� H 1 hereby affirm that I am exempt from the Contractor's License FLLN J Law for the following reason.(Sec.7031.5,Businessahid ProfessionUA Professions PERMIT ISSUANCE 10.00 VgLTIDN S/FT. fw Code:Any cityor County which requires a permit to construct,alter, ¢ ¢ Q D improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.. LIC.NO. La TELE.. ¢ requires the applicant for such permit to file a signed statement that OTAL - PERMIT TO F leis licensed 9(copursuanitoingprovisions of the )ofDivdon License r i 4 Law(Chapterand ProcommenC de)a,Section is exempt theref om the O a Business orad Professions Code)or that he is exempt llmrefrom and OTY. PLUMBING PERMIT FEE ¢s¢-� the basis for the alleged exemption.Any violation of Section 7031.5 STORIES YPE CONSTR. by any applicant for a permit subjects lite applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(SSODf.): ❑ 1,as owner of the properly,or my 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,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees.Provided that such improve. mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im prove for purpose of sale.). INDUSTRIAL WASTE INTER30.00 ' RES IND CON PS Other . ❑ 1,as owner of the property,am 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 IEA.) 1.00 contracts for such projects with a commetots)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ IamexempImmcr Sec. ,B.&P.C.I'..this WATER HEATER W/VENT 6.00 reason Owner Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK F-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ' 1 hereby affirm that I have a certificate of consent to self-insure, .ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). .. - Policy No. Company O O Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z 2 ❑ Certifi c % is filed with the city inspection division. MISC:- REFER TO ORD. APPlica Y❑ N❑ Y ❑ N❑ ~ r2 PERMIT ISSUANCE 10.00 - FLOOD ZONE A.L.U.C. Lu Cli IFICCOI OF FAX I PTINS FROM WORKERS' Ql � COd a., be completed INSURANCE if the? PLG.CONTR. ' LIC.No. PtG. Y❑ N❑ Y ❑ N❑ 0 Z (This dollars $10 not be completed if the permit is for one TOTAL hundred dollars 18100)or less) U O 1 certify that in the performance of the work for which this Per- TY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued, I shall not employ any person in any manneror is to 0 w become subject to the Workers Compensation Laws W'California. a Date—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } N NOTICE TO APPLICANT''. If,after making this Certificate of fix. _ , F. ? emption,you Should become subject to the Workers'Compensation`.''-f' 'APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith complyPwith FEE hU such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10p00 C.F.M.) 4,011 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GFM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending,agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work lot which this permit is ssued(Sec. 00 MICROFILM 3097,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.19.50 ELECTRIC Lender's Address - I certify that I lube read this application and state 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-CDMP(3 H.P.or 100,000 ELT.U.) 6.00 ,xt�� hereby authorize representatives of this city to enter upon the BOILER-COMP fdas,100,000'BTUI SEE FEE SCH. MECHANICAL OV above-mentioned property for inspection purposes.styto (We) agree to save, indemnify and keep harmless the City of MISO.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against aid City in consequence of the PERMIT ISSUANCE ' ranting O([his pe IL ECH.CONT- LIC.NO. MECH. ' I 1� TOTAL. TOTAL 24� D O Signa plicant/Contractor - Dale - OFFICE COPY