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18819 (2) - POST THISCARD NEAR"FRONT OF BU LDING' PERMIT NUMBER CITY .OF CUPERTINO PAID, 18$19 I' INSPECTION DIVISION JOB INSPECTION RECORD - 'x/ ,y^—^' (�1 r GItV of (;HOQItIRD PERMIT EXPIRATION JOB ADORE SS `� - «_ �� 1 ` I 1 UNIT# -LOT# - PERMIT EXPIRES IF WORK 'OWNER p•1 CONTRACTOR .- 1 I ISNOT STARTED WITHIN , INSPECTION DA E INSPECTOR I PECTION RECORD IOU DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE:," - LASTCALLED INSPECTION. LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 11*1''^ UNDERGROUND /SLAB PLUMBING .: ., 10,3 'y ` ELECTRICAL - iSSUANce,UA 1 MECHANICAL' ELECT. PL MEC" 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN.SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION s/FT. '� - � -.� � _ MECHANICAL ' ELECTRICAL - J�J PERMIT TO, .FRAMINGvM rJ r .INSULATION ., STORIES TYPE CONSTR . OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED + ROOF NOTE:NO FINA8 0 FT,FLOOR L INSP.SHALL BE MADE BEFORE • AREA TOTALACREAG6 •. DIAPHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE ROOF SHEATHING •, RES IND CON PB 0"', APPLY NO ROOFING UNTIL ABOVE.HAS BEEN SIGNED FINALS' DATE INSP. ❑ ❑ 0 ❑ ❑ ASSESSORS PARCEL NO "ROUGH PLUMBINGQc,�'t— ELECT.ENERGY THACT N PARCEL NO MECHANICAL PAN PLUMBING ENERGY - MECHANICAL MECH,ENERGY ELECTRICAL' BUILDING ENERGYAC' E ACC. ILE NO. FRAMING ELECT.FINAL TEST 20NI ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS i MECHANICAL FI e sv"INK ENE/Gy T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' [:] "❑ t�L OU Z N - EXTERIOR SHEAR ELECTRICAL RELEASE ALL U,C. INTERIOR SHEAR F v N v N❑ SHEET,ROCK ' GRAD FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT' ELECTRIC PLAN CHECK, r GAS FEE'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY _ SEISMIC FEE OCCUPANCY OF BUILDING' MI IS NOT PERM ITTED UNTI L BUILDING F INAL IS SIGN ED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. % PLUMBING z PLEASE GIVE JOB.ADDRESS WHEN PHONING: - SEE PERMIT FOR EXPIRATION DATE= MECHANICAL IMPORTANT! . CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL / a— CALLING FOR FINAL INSPECTION. OFFICE'COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILADDDING APPLICATION & PERMIT I Q [� (.1,_ A4"fler BUILDING-ELECTRICAL-PLUMBING-MECHANICAL v J OWNER'S -PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE PHONE NAME TOR UTLETS-SWITCHES-RECEP 10.00/1.00 PAI® 4If__ LIC,Na, LIGHTING FIXTURES _ 10.00/1.00 ry�ytlry ADD SS crow's ADO PPLIANCES-RESIDENTIAL 4.00 �r t) 1989 .3 PHONE -445t- 'PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN ff K IID,LIIPBG NO, OR U ENGIN uC.NO. - SIGNS TRANS. 3.00 ARCH.OR ENG. - - PERMIT VA LI DATION AOO82:_ _ . . SPECIALCIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 ADDRESS Aa MOTORS - SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 w¢ i' F o D LICENSED CONTRACTORS DECLARATION a v u I hereby affirm that I am licensed under provisions of Chapter 9 - . . ISSUANCE DA G. Z, "' (commencingwith Section 7000)of Division 3 of the Business and Q - DG. ELECT. PL ECH. r w i Ucenxs Cb a and n license ILics.In full fort r}Jepy.w O m '� Dale Contractor_ /4l>Y � �� ' a x s 1• BUILDING PERMIT ¢ ¢ a OWNER.BUILDER�DECLARATION o aa U MISC.- REFER TO ORD INFORMATION E: 3: r I hereby affirm that I am exempt from the Contractor's License w VALUATION _ $/FT. a_ U. Law for the following reason:(Sec.703L5,Rusinessand Professions PERMIT ISSUANCE 10.00 T u Code:Any city or county which requires permit to construct,alter, e2< improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. a a O u requires the applicant for such permit to file a signed statement that TOTAL w M he is licensed pursuant to the provisions of the Contractors License PERMIT TO > Law(Chapter 9(commencing with Section 70000of Division 3 ofthe / g i a Business and Professions Code)of that he is exempt therefrom and OTY. PLUMBING PERMIT FEE l V V"'E ¢ I- the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE C))NSTR. dby 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).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC:GROUP RES.UNITS intended or,offered dor sale (Sea 7044, Business and.Professions DRAINS-FLOOR,ROOF,AREA,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-P,ER TRAP 5.00 so.vu FLOOR AREA TDTALACREAGE himself or through his own employees,provided that such improve. .cuts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or*,in- - .*,in- mer BUILDING USE - prove lot purpose ofsale.). INDUSTRIAL WASTE INTER. ' 30.00 RES' IND CON - PB O ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑' ❑ ❑ licensed contractors to construct the project(See.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 contructor(e)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ I am exemr.apt on under B.&P.C.for this WATER HEATER W/VENT 6.00 Ownc _ _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORKBRS'COMPENSATION DE.0 LARATION, .WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consult to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certlfled copy thenyl 3800,Lah.C.M/.f�Go Policy NoJjCompany�iS[f _ O P❑��Csrit led copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ertife4py lIS filed yith 0 • C' ins lion d#n. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicant -/Y/'h9'LG Y N V N F m PERMIT ISSUANCE 0 LU - CIiRTIFICCOMPENIKEMPTINS PROMWORKERS' FLOOD ZONE A.Lu.C. W >_ COMPENSATION INSURANCE PLG.CONrR. LIC.NO. ,PLG. a O (This section need not be.completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ 0 Z hundred dolls(S100)o,lc..l ' U O 1 certify that in the performance of the work fo h this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY U. F mit is issued,1 shall not employ any pIcrs ny manner so as to O W become subject to the Workers'Co 'ution Laws of California. Dam Applica BUILDING r-+ a . 'ALTER OR ADD TO MECH. 5.00 } N NOTICE you APPLI : If,pfter making Ibis Ccrt it icnte of Ex- ' I- Z Crop(an,you s become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK pruvis' the Labor Code, you must forthwith comply with FEE U - such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 -SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for whi Yif-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 Addr- ELECTRIC I ccrti y that I have readthis application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correcL11 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and - BOILER-OOMP(3H.P.Or 100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harndess the City of MISC.- REFER TO ORD. uper tom against liabilities,judgments, costs Ind expenses which .CONST.TAX may in any way accrue.against said City in consequence of the PERMIT,ISSUANCE '10,00 rantingathisP it. MECH.CONT. LIC.NO. MECH. 3p_ TOTAL TOTAL !) Signature of Applicant7Contractor Uufe OFFICE COPY