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10837 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 10837 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB AODR ESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR e3kIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION AWE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED i - UNDERGROUND /SLAB PLUMBING ELECTRICAL - UANLEDATE MECHANICAL - BLDG, ELECT, I PLG. MECH. n El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION s/FT. MECHANICAL. 'e e- e D ELECTRICAL PERMIT TO ♦ r� FRAMING 2 • Q V � ' INSULATION YPE sTORI�Es,, corvsTR. 'I ew OCC.GROUP IR ES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .SQ FL FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE R' IND CON PD 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El I] El El ROUGH _ ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE N0 FRAMING SAN # INSULATION - -!ELEC UM G - - zoNlrvc ENG.SITE NO, S CNI AL FIRESPRINK ENERGY T ZA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED A ING Y [] NY � N[] FLOOD ZONE A.L.U.C. LATH-INTERIOR RICA LATH-EXTERIOR - IF D Y❑ N❑ Y ❑ N❑ SHEETROCKGRADE FEE SUMMARY SHEAR INTERIORBUILDING -y- SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC ' PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. �1 Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY' BUILD-eNG PROJECT 1 OENTI FICATION PERMIT NUMBER am LD,IjG APPLICATION & PERMIT i OWN , 1 • , �C� '- G11/DSVC-7BUILDING � 10837 OWNERS i4 PLAN CHECK VALIDATION NAME d QTY. ELECTRIC PERMIT FEE N.v MOF.pHONE Name ac7oR OUTLETS-SWITCHES-RECEP 10.00/1.00. ' LIC.NO. LIGHTING FIXTURES 10.00/1.00 , ADDRESS TOR's APPLIANCES RESIDENTIAL 4.00 PHONE PANELS 10,00 DATE OF APPLICATION OR RCHIrecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER Lm.NO. SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG ' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION APPLICANTS ZIP TEMP.METER OR POLE INS. 20.00 - , ADDRESS � MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 o D LICENSED CONTRACTORS DECLARATION v I hereby affirm that I am licensed under provisions of Chapter 9 - DATE b Q N (Commencing with,Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H z Professions Code,and my license is in full force and effect. - '.❑ O0 ov'i o License Class Lic.Number � N L'J Date Contractor BUILDING PERMIT IF 0 w U OWNER-BUILDER DECLARATION I F RM 71-ON X ;u� 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD aa Lc Law for the following reason.(See.7031,5,Business and Professions PERMIT ISSUANCE 10.00 I $/FT.' Ew0 Code:Any city orcounty which requires a permit to construct,alter, /�7--b ac ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. i 0 S, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO X $ he is licensed pursuant to the provisions oche Contractor's License z¢ Law(Chapter 9(commencingwilh Section 7000)of Division 3 ofhe R[� E i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �-ALtd /.,Gr�- /N M1- the basis for the alleged exemption.Any violation ofSection7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ' of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP BEs.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- y ments 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- GAS-EA.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 with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ 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 such projects or ts for sects with a conlrSctoAs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00 the Contractor's fors LICeo a Law. TRACT NO. PARCEL NO. ❑ Iamexemptmder ec ,B.&P.C.forhis WATERreason ATER HEATER W/VENT 6.00 Owner r ' Dae WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WOR ERS'COMP ATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I'have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof ISne.3800,Lab.C.. Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ N❑ O Applicant V N V ~ 9 PERMIT ISSUANCE 10.00 LU CERTIFICATE COMPENSATION IINSURANCE WORKERS' FLOOD ZONE a.L.0 c. PLG CL o (This,section need not becomple ed iPLG.CONTR. LIC.NO.the permit is for one TOTAL Y❑ N,❑ Y ❑ N❑ D Z hundred dollars IS 100)or less. U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. 0 go D. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } US NOTICE TO APPLICANT: If,after making this Certificate of Ex. - Z' emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1 .F.M.) 4.00 CONSTRUCTIONLENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE I hereby affirrn 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC r� 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 coun ly 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 to enter upon the above-mentioned property for inspection purposes. BOILER-COMP IOver 100.000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep learoless the City of MISC.- REFER TO ORD. , Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way ap�rIt against said City in consequence of the granting of is pe it MECH.CONT. LIC.NO. MECH. Z� y, TOTAL E'"- TOTAL LK D Signatur of Applicant/Conlrac at .� OFFICE COPY l� "1 �W ��.�..0� I'� �ti�.'E_•..,µ ,�.». NO. STREET LOT NO. DATE �I 19' "` FILE NO, CITY OF CUPERTINO OWNER RECORD OF 1NSPECTIO)i APPROVALS JOB COPY 1 V PROJECT (v •L_ C Jc�^.;r: . TELEP`HON�E�\:2� -4505 BUILDING INSPECTION RECORD ,DATEI INSPECTOR. DAIE INSPECTOR FOU DA N FLOOR STEEL PRE-GUNITE'J FRAME BOND BEAMS LATH H' WALLBOARDS N &EXT "r " FIREWALLS; MEMBRANE LANDSCAPING F.M.O. INSPECTION FINAL BLDG. 1S_jl UNDER-FLOOR_ TIEDOWNS V :-MISC- DIAPHRAMS ELECTRICAL INSPECTION RECORD RESIDENTIAL DALE IINSPECTORI MWIRING KDAT� INSPECTOR 02 /f� UNDERGROUND ROUGH UNDERROUGH WIRING ROUGFINISH WIRING �. FINISHFIXTURES, INTERI MOTORS EXTERI FINAL 6 MOTORS FINAL PLUMBING INSPECTION RECORD HEATING&A/C INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR BACK FLOW REQUIRED UNDERFLOOR S.M. BACK FLOW INSTALLED DUCTS&INSULATION UNDERGROUND ROUGH FLUES&COMB.AIR PARTIAL ROUGH CONDENSATE DRAINS ROUGH COMPLETE FINAL APPLIANCE ROOF DRAIN&LEADERS MAIN DRAIN . FINAL GAS FINAL PLUMBING YOp11f�V)IM 1f IO11Y)IIIC..II. NOTE: INSPECTOR MUST BE GIVEN 24 HOURS NOTICE FOR INSPECTION. I CH BUILDING INSPECTOR