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17138 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY_ OF CUPERTINO 17138 INSPECTION DIVISION " JOB INSPECTION RECORD ' •. ', +, v� • , ' .. PERMIT EXPIRATION V JOB ADDRESS le,I �—.3 KJ, V L(�4I UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER . D-S CONTRACTOR- IS NOT'STARTED"WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD IOU DAYS OF PERMIT ISSU FOUNDATION - - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnuT VALIDATION PREGUNITE _ _ CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB '-JAN 2+ 3 19& �f`.}.� PLUMBING �{ Joe—' 4 o r' ELECTRICAL �I� YI RD - ISSUANCE DATE MECHANICAL + �� - W BLDG ELECT Plc. MEu�. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .7- 1z 7- Z 7,7 ` BUN ORMATIONDING T WOOD FLOOR VALUATION sFT. PLUMBING MECHANICAL r.11G IT TO ELECTRICAL - -' FRAMING TYPE CONSTR. INSULATION RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED TOTALACREAGE ' • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING ON USE ROOF SHEATHING .HES 'IND CON P9 MT APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L L L L L ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO, PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY - MECHANICAL' MECH.ENERGY ACC DATE_ ACC.FILE NO. ELECTRICAL-- -ZZ BUILDING ENERGY FRAMING, ELECT.FINAL TEST' ZONING ENG.SITE NO. . INSULATION PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T.79 _ _ v� N� � rL N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR. ELECTRICAL'RELEASE FLOOD ZONE A"Luc. INTERIOR'SHEAR FIRE DEPT. YL ,.NE] YL NL SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH - BUILDING BUILDING INTERIOR LATH - TEMPORARY APPROVALS SCRATCH COAT ' ELECTRIC , PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC p�) LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL -SEE PERMIT FOR EXPIRATION DATE = I • IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ;I „TOTAL CALLING FOR FINAL INSPECTION. , f0,•� OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE,BALL POINT PEN ONLY ,. BU I LDING PROJECT IDENTIFICATION - .PERMITNUMBER BUILDING �I q �� APPLICATION &.PERMIT /✓ 2J illT � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL' 17138 OWNER'S NAME QTY. ELECTRIC PERMIT FPLAN CHECK VALIDATION EE ' CONTRACTORS PHONE NAMEe . - v NAME - ' ' UTLETS-SWITCHES-RECEP 10.00!1.00 4V ' 11C,No V` , LIGHTING FIXTURES . 10.00/1.00 x00 - coNTRAcaons APPLIANCES-RESIDENTIAL 4.00 A �G,�� 1�/y-/ 3 lY PHO/ /rd / PANELS 10.00 / Z.0 ARCHITECT DATE OF APPLICATION on - - - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.' g0. ENGINEER LIC,NO. SIGNS-TRANS. 3.00 ARC H.OR ENG. - ADDRESS - SPECIALCIRCUIT 5.00 PER MITVALIDATI ON t - ZIP TEMP.METER OR POLE INS. 20.00 ' APPLICANT' " MOTORS - ' SEE FEE SCH. o¢ z SERVICE CHANGE J. 20.00 ,,rA1 w FOO- LICENSED CONTRACTORS DECLARATION - 'V( I/C i" Q Z w 1 hereby affirm that I am licensed under provisions of Chapter 9 ' Q a (commencing with Section 7000)'of Division 3 of[he Business and ISSUANCE DATE BLDG. ELECT. PLG. MECH. r H i Professions Code an, ny license is in full to •f + ' z O w License CI F -F Lie.Number �I 9 m H Dale contractor Citg OfCUperbnu a ❑ Jr--' ¢ Y ¢J _ ¢ w ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT u MISC.-. REFER TO OR INFORMATION E R. a,0< - 1 hereby affirm that 1 so exempt from the ContractBusiness and is License - uOJ Law for the following reason.(See 7031,5,Rusinessand Professions - VALUATION Code:An - PERMIT ISSUANCE' S/FT. Ymolish county which structure,prmittoconsuanc ,aeq 10.0.0 j.F�� Q Q ¢C improve,demolish,or repair any structure,prior[o its issuance,also EL'EC.CONTR. LIG NO. o'IS requires the applicant for such permit to file a signed statement that - ELEC. e,O e w m he is licensed pursuant to the provisions of the Contr:mtor's License _ ,, TOTAL PERMIT TO H z a Bme(Chapter 9(com Run" g with Section 7000)of D ivision3 of the - - 4 D Business end Profcssiods Code)or,that he is exempfthemfmm add QTY. PLUMBING PERMIT FEE e < Iz o. the basis for the alleged excmpthm Any violation of Seclinn,703 LS STORIES • TYPE CONSTR. a, P. by any appllcantfor a PenniI'Ubjcets Ole applica'tto a eivilpenalty ALTER-DRAIN (EA.) 5.00 "of not more than five hundred dollars($500).): ' ❑ I,as ownel-of he property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole cmnpenadion,will do the work,and the structure isnot - OCC.GROUP . RES.UNITS intended or offered for sale(Sec. 7044, Buslneas and Professions DRAINS-FLOOR,ROOF,AREA,COND. .5.00 Code:The Contractor's License Law does not apply to an owner o1' property who builds or no thereon,and who docs such work FIXTURES-PER TRAP , S.00 50.ET.FLOOR AREA TOTAL ACREAGE IT or through his own employees,provided that such improve. meats are not intended or offered for sale.If,however,the building. GAS-EA.SYSTEM-1 INC.4 OUTLETS 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 im-HM�5 SYSTEM-OVER 4 (EA,) 2.00 BUILDING USE ' prove for purpose of sale.). "RES IND .CON PB Other ❑ I,as owner of the property,am exclusively contracting withAL WASTE INTER.- 30.00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,BusinessINKLERS-1'INC 5 V.B. 6.00 ASSESSORSPARCEL NO. and Professions Code"The Contractor's License Law does riot apply to an owner of property who builds or improves thereon,and whoINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contmetor(s)licensed pursuant to the Contractor's License Law. ' NITARY-STORM EA.200ft/10.00 --TRACTNNO. PARCELNO. ❑ lam cxcmpt'undcr Sec B.&P.C.orthi, ATER W/VENT. "reason - 6.00Owner Dat, STEM ' 5.00 ACC.DATE ACG FILE NO. WORKERS'COMPENSATION 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 ac rtified ZONING . O. copy there*cc.3800,L.b.C.). ENGSITE NO Policy N.. Company .0 _❑ �erlified copy' ereby furnished.. ' " Z Z etlified c . ¢ a/eh it Yt- city inspection division. FIRESPRINK ENERGY T-24 Applicant MISC.- REFER TO'ORD. v N�' y❑ N� � N. CERTIFICATE OF EXE PTION.FROM WORKERS' PERMIT ISSUANCE ^ 10.00 LU > COMPENSATION INSURANCE PLG.CONTR. FLOOD ZONE A.L.UC. d I] 0 ,LIC.NO. (This section need not be completed if the permit is for one _ TOTAL V[:]. N V i❑ - N hundred dollars($100)or less.) _ I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY IL U mil is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. - y Datc Applicant ALTER OR ADD TO MECH. -5.00 .BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit,shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 FEE, CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a conelruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 - the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ, HEATING UNIT(TO 100,000 B.-T.U.) - 8.00 Lender's Name Lender's Address- - HEATI NG UN IT(OV ER 100,000B.T.U.19.50 ELECTRIC 4 QQ I certify that I have 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city-t0 enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. ' MECHANICAL (W-),agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments coats`and expenses which ' CONST.TAX L�ain ny 'a ue againa a' ity in consequence oP[he - PERMIT ISSUANCE 10.00 pe MECH.CONTC LIC.NO. MECH. ,��z� TorAL TOTAL of Ap hcan[7Contractor Date • Q OFFICE COPY..'-