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18923POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO INSPECTION DIVISION PAID JOB INSPECTION RECORD NOV 1 1983 JOB ADD5RE1SS�_\1A. L--UNIT#IRE, �ILOTi# OWNER O CONTRACTOR PERMIT NUMBER ' 18923 PERMIT EXPIRATION 41, S TrE1 F WORK +RE WITHIN ISSU- 100 DAYS OF PERMIT ANCE OR .780 DAYS FROM y��ST�CGLLEDINSPEC710N. / INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: - ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITU OF CUPERTINO STANDARDS. LEER PREGUNITE PE Hn+IT vnLlUnr10N �•J , // ``((�� // 94 O —114 ,c5i ISSUANCE DATE GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL pLT�c E, LEcr PO MrcR 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BuaO PERMIT INFORRMM ATION WOOD FLOOR SIFT. PLUMBING MECHANICALELECTRICALPERMIT rVALU�ATION TO FRAMINGCS INSULATION TYPE CONSTR OUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO. FT, FLOOR AHIA TOTALACIICACIE ROOF INOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID DIAPHRAGM bUILOI USE HSS INDEl 0 CON ory Pb El 1:1 El ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. nssEssoRS 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 BUILDING ENERGY FRAMING ELECT, FINAL TEST zorvlNc ervc. SITE No. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK Y ❑ 'NE] ENERGY 7.14 Y ❑ N❑, MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLaoD LONE Y ❑ Ng ALuc L7 rv❑ EXTERIOR SHEAR INTERIOR SHEAR ELECTRICAL RELEASE FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING �s INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT z ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I I OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, JONE WORKING DAY BEFORE REQUIRED INSPECTION. 0� PLEASE GIVE JOB ADDRESS WHEN.PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC �a PLUMBING r MECHANICAL .rte CONST. TAX .--p IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY ' .6.01"CN ANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY o¢i Foo QVU G H Oil 4H w a ¢ w w�6so F ec s S, O amu ¢ w H1 si'a o ¢ 1-0 O Z 2 H I. IU - ao 02 UO U- I- 00 ED � a A BU LDI NG PROJECT I DENTI FICATI ON APPLICATION & PERMIT B UILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER '- 18923 BUILDING ADDRESSSS �� A/•EY/ OWNER E i QTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION PHONE DATE OF APPLICATION " CONTRACTOR'S NAME 4Ic. No. ��Dit7� UTLETS-SWITCHES-RECEP 10.0011.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR OR EssTRAC _5 Y PHONE �r Lin PPLIANCES-RESIDENTIAL 4.001 PANELS 10.00 ARCHITECT OR ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK SEE P.C. NO. •� SIGNS TRANS. ./ ARC H.ss EENG, ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATIONADDRE`` t n^ W I�LMSLN // / /v /6 TEMP. METER OR POLE INS. 20.00 A ADORE] vvucANrs 2. t., rod MOTORS SEE FEE SCH. SERVICE CHANGE- 20.00 LICENSED CONI' RACTORS DECLARATION HAMA " NIn1r'1 --1nn1 I hereby uftirin that l:un licensed under provisions of -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and PIUfCSIilU11F L'ofl�a t mY-I IeCI1Re IS Ill loll fUfyL` d eft-'}� _ License Cl -ss_ Lia Number {% S" 7"/ Date-{./_ t /Contmclnr.Q. _<•1%V OWNER -BUILDER DECLARATION I hereby alfirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessand Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Els Issuance, also requires the applicum for such ,Cr11III to file a signed stateirent that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter9(commencing with Section 7000)of Division 3 o f the Business and Professions Code) or that he is exempt therefrom and ISSUANCE DATE ay v v y V I V V J ELECT. PLG. MECH. ❑ ❑ Cit, Pt �'I"Ot'�II10 BUILDING PERMIT INFORMATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE ELEC. CONTE. LIC. NO. ELEC. JFY TOTAL PERMIT TO QTV. PLUMBING PERMIT FEE STORIE TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than five hundred dollars (5500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of Ole property, or my employees with wages as their sole Compensation, will do the work, and the structure is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such work himselfor through his own employees, provided that such improve- ments are nor intended or offered for sale If, however, Ole building FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA TOTALACREAGE GAS-EA.SYSTEM-11NC.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 im- prove for purpose of sale.). D I, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM -OVER 4 (EA) 200 BUILDING USE REB IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code; 'I'he Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts Joe such projects with a contructons) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.AVC. for this naso WATER HEATER W/VENT 6.00 Owner Dae WATER SYSTEM 5.00 ACC. GATE ACO FILE N0. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby alfirm that I have a certificate of consent to self -insure. of u certificate of Workers' Coinperedion Insurance, centified ZONING ENG. SITE NO. •Ecol (SCC. 3800, Lab.C.4, pYl �.r 6ti e/'`u (otic Cnmlrny-_�JG`�/�"" FIRE SPRINK v❑ N❑ ENERGY T 24 V❑ N❑ Ceniriedcopy is hereby furnished. ❑ Certified copy is filed with the City inspection division. Applicant C / ... S L6?� • CIiR IFICA' OF XBMP ION PROM WORRIils S' MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be hmnideted if the pencil is for ona Y ❑ N❑ Y ❑ N❑ hundred dollars ( $100) or hnos ) I certify flim in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING S becoCie subject lU the Workers' Compensation Laws of Celilbrnia. Due Applicant NOTICE TO APPLICANT: If, aOCr making this Cenificate of Ex- emption, you should become subject to the Workers'Compensation ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK Z provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10,000CF.PA) 4.00 AIR HANDLING UNIT (OVER 10DWC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the pfnbmlancc of the work for which this pencil is issued (5ec. 3097. Civ C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Add ress I certify that I Inve read this applicatlml and slate that the above information is correct. I agree to Comply with all City and County ordinances and stale laws relating m building construction. and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER- ODMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP IOver 100,000 BTU) SEE FEE SCH. MECHANICAL hereby aulhoUte representatives of this city to enter upon the abuvvmentioned property for uspec - n purpmes. MISC. - REFER TO ORD. (We) agree to save, indemnify 1 d keep harmless the City of Cupertino 11inst Iiabllities, judgn •ata, costs and expenses whichCONST. G any w y e against aid City in consequence of he TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIG NO. MECH. TOTAL TOTAL lar Ingo s / 16� gl re o Applicant/Cunt a or [late OFFICE COPY