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17857 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMITNUM BER CITY OF CUPERTINO 17857 INSPECTION DIVISION JOB INSPECTION RECORD qv//� �j� •y/�' ./7- EryMIT PIRfP�ON JOB ADDRESS � [ • O —UNIT# LOT# I r ZVI&`�� PERMIT EXPIRES IF WORK OWNER CONTRACTOR •IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU- ANCE OR 180 DAYS FROM FOUNDATION NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED „LAST CALLED INSPECTION. TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PERMi/VnLiD4Tl0N PREGUNITE CUPERTINO STANDARDS. - I GARAGE SLABS _ rr�r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDP UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE .11 MECHANICAL AUa x 81989115"RL ELE PL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ��{{�� ^�'�,��.{�� BUILDING PERMIT Gill If k"m INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING /O! MECHANICAL PERMIT TO p ELECTRICAL / �OL m � FRAMING INSULATION STORIES TYPE CONSTR OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED T.F SOFLOORpA TOTAL ACREAGE ROOF 0E:NO.FINALINS .SHALL BEMADE BEFORE SOFT, DIAPHRAGM _ THE CONSTRUCTION TAX IS PAID r nulun ON USE ROOF SHEATHING RES IND CON PB Olnn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 1:1 11 ❑ El ASSESSORS PARCEL NO ROUGH SAN.q PLUMBING ELECT,ENERGY TUBS B SHOWER PAN PLUMBING ENER RAC NO PARCELNO MECHANICAL MECH•ENERGY ELECTRICAL BUILDING EN RGY cc TE ACC FILE No FRAMING - ELECT.FINAL EST INSULATION PLUMBING G ENG SITE NO. GAS TEST GAS FIRE SPRINK ENERGY T 2 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ` E] N[3 EXTERIOR SHEAR ELECTRICAL RELEASE PL000 zoNE aL uc INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ Y ❑ N❑ SHEET ROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING vs, INTERIOR LATH TEMPORARY APPROVALS BUILDING 7 SCRATCH COAT ELECTRIC PLAN CHECK ...- GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE r l OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL B UILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. � c, PLUMBING 0-0 PLEASE GIVE JOB ADDRESS WHEN PHONING. z Je — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX — PLEASE READ REVERSE SIDE BEFORE r II CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER DAPPLICATION & PERMIT A 17857 ADDRESS neasa/q66 lyeN /E Cotlier BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAM '•' -,//p/ PLAN CHECK VALIDATION &{J VV Gb`7U(� Zfs 939 OTV ELECTRIC PERMIT FEE VHONE G CONTRACTORS tO s3 OUTLETS 10.00/1.00 Q �� E 7. LIC.NO. LIGHTING FIXTURES 10.00/1.00 ,QQ CONTRACTORS ONTCTOR'S ONTRA _ PPLIANCES-RESIDENTIAL 4.00 go C PHONE PANELS 10.00 W.OO DATE OF APPLICATION ARCHITECT PANELS 20.00 PANELS (OVER 200 AMPLAN CHECK FEE P.C.NO. on AMP( 20.00 ENGINEER RAL-s r& D LIC.No. ISIGNS TRANS. 3.00 ARCH.OR ENG, 0 r AP MIT VALIDATION ADDRESS TAl 950 7 SPECIAL CIRCUIT 5.00 �Q / /11 O G�� If rLL C/� xIP EMP.METER OR POLE INS. 20.00 Tem off( APPLICANT Z 9,6(o MONTa G MOTORS SEE FEE SCH. .�Q ADDHESS CC LV eerrAfa CA 9✓Q iJ/ SERVICE CHANGE 2665/1,I$ o a LICENSED CONTRACTORS DECLARATION ri u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a (commencing with Section 7000)of Division 3 of the Business andBLDG. LECT. PLG. MECH F D i Professions Code,and my license is in full force and effect. Z, i w W License ClassLic.Number N L Date Contractor AUG Z 81 BUILDING PERMIT ¢ ¢ a OWNER-BUILDER DECLARATION ¢ w u INFORMATION K 3,'N 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- w VALUATION SIFT. F u o J Low for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Ew� f Code Anycily orcounty which requiresa permit to construct,alter, D ¢ ¢ ¢ O improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ♦ u g;e u requires the applicant for such permit to file a signed statement that TOTAL PERMIT 0 w m he is licensed pursuant to the provisions of the Contractor's License U r� Q Law(Chapter 9(cotnmenciagwlth Section 7000)of Division 3 ofthe f i D Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE lb D�ti It H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, by any applicant for a permit subjects the applicant loo civil penalty ALTER-DRAIN -WATEfl (EA.) 5.00 of not more than five hundred dollars(S50OM: ❑ 1,as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.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 Contractor's License Law does not apply to an owner of T Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.()0 le'y Sa(F/T..FLLOOR AREA TOTAL ACREAGE himself or through his own employees.Provided that such improve- ` I IFI r) meNsfo our ughintended onemployeeSale.provided that suhebullding GAS-EA.SYSTEM-11NC.4OUTLETS 8,00 '2 0 Z 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 RES IND CON PB Osne, prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- i 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 cuntractoAs)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ 1 sal exempt under Sec.-.B&P.C.for this / WATER HEATER W/VENT 6.00 O reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE N0. WORK ERS'COMPENSATTON DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have o certificate of consent to self-iluure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certilled copy thereof Ise,3800,Lub.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. ❑ ❑ ❑ ❑ F 0 Applicant V N V N CC - CIS RT I FICATF:OF EXEMPTION FROM WO RK Ii RS' PERMIT ISSUANCE 4&60 FLOOD ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTR. w LIC.NO. PLG. /^ � Z (This section need not be completed if the permit is for one - TOTAL a too Y❑ N❑ V E] NEI dollars(S 100)c r less.) U O I certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY L mit is issued,I shall not employ any person in any manner so a-l0 beco s c1 the Workers' mye,ny�5orr,(a s II or � y Date�'y�Applicant. r�'✓�K I� BUILDING } w NOTICE TO APPLICANT: If,after making this CeH rite of rix. ALTER OR ADD TO MECH. 5.00 ( r )... ? emption,you should become subject to the Worked Compensationqpp APPLIANCE 5.00 .SQ PLAN CHECK _ provisions (if the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE 1 6 I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 fjfl the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 ,Q Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 W-eo Lender's Address ELECTRIC ( certify that correct. read agrees applicationandall etyat and Coile unty VENTILATION FAN (SINGLE) 4.00 ��• information is correct 1 agree to comply with all city and county PLUMBING ordinances and state,luws relating to building construction, and . BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00 of hereby authorize representatives nsp ec thpurposes.is city to enter upon the BOIL above-mentioned property for iER•COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL Gj M QQ h (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments,costs aad expenses which CONST.T may in any way accrue against said City in sequence of the PERMIT ISSUANCE U1B0, mntin f ti's p t... •/ MECH.CONT. LIG NO. MECH. K y /5 8 TOTAL L S•0 TOTAL q 7e �3 Sign tureof Applicunl/Contractor )a OFFICE COPY V7_'( PER7T^!o A TTnl �,. To An/ To .0 u cc L tie /d2Ile i✓aT ycT 0C7Ar ^J5D f `rrJA-WCrA/ G rot dog. Co q/ SIrl?0G -rrioAj P2U-1Ec ? ,. PE/RMr- T NoM6E!z / 7957 An/ P Wo UL Lr �C 7o CJ Tv. - 6 )( Tcnl p ou t OA -r T f X P r 9 A Tx o ,u Q A T6 T H E- 2 1 S iA YS . E no D JAN 311990 � BLDG. INSPECTION DEPART I C S 7 O, 6' iia U CITY, OE CUPERTIL . z �i o City of Cone