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17877 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17877 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDR1IESS_�� ( �1�120_ UNIT 4--LOT# PERMIT EXPIRES IF WORK OWNER V �v\ lkq7 .e CONTRACTOR - (� ^-S \ IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. J GARAGE SLABS PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB MAY I1 198 J N 1, N V�-L. j PLUMBING {.� ELECTRICAL - Cly OIt CUperfinO ISSUANCE DATE J BLDG ELECT PLG MECH MECHANICAL ,y/-1 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �1 BUILDING PERMIT WINFORMATION WOOD FLOOR V-Ayyy UA TIO�Nq A,� SIFT. PLUMBING TCu3t"^' MECHANICAL / ERMIT i ELECTRICAL hml� 11— FRAMING , STOHIF.S Tv1' CONSTR, INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 fl FLOOR AHf,P TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE - S DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUII.WNG USE ROOF SHEATHING RES IND CON PB Oln., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 ❑ 0 0 ❑ ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY ' LIiALI NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY - - MECHANICAL MECH.ENERGY ACC DATE ACE FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG SITE NO, INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENC.RGT'L24 MECHANICAL ❑ NE-] 0 NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOU ZONE A,L U C EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. V ❑ NO y L N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING Qo INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK �1 Vi1 FEE Iatlt GAS (C_ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL p CALLING FOR FINAL INSPECTION. ® ' OFFICE COPY APPLICANT•TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENT[FICATI ON I - PERMIT rvumRER 9UILDIN^y APPLICATION & PERMIT 1 �� ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER' PLAN CHECK VALIDATION a QTY. ELECTRIC PERMIT FEE • en NAME DNE As UTLETS-SWITCHES-RECEP 10.00/1.00 Ta NAME � LIc. () ? LIGHTING FIXTURES 10.00/1.00 ADDRESS DOR PPLIANCES-RESIDENTIAL 4.00 - RE55 / [� o + Y HONE S� PANELS 10.00 DATE OF APPLICATION ARCHrtELT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. Ofl ENGINEE OY f- uc.N SIGNS TRANS. 3.00 ARCH, RC Ess END, SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. [ _ ADDRESS SERVICE CHANGE 20.00 `1 [��T Kv�J� ' 02 LICENSED CON'T'RACTORS DECLARATION l �I 1 f 1 J <v UI hereby ullion I[,.( 1 um licensed mWur provi.+ionx of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r�i Professions Code.and my license is in full force and effect. MAIY 11 1989 ❑ ❑ ❑ z O m - License Class Lic.Number D z r Dale Contractor Tim a y s -aBUILDING PERMIT ¢ ¢ ¢ ¢ OWNER-BUILDER DECLARATION City of'a o to" MISC.- Melt TO ORD INFORMATION F. ;LL I- I hereby n(linn That I am exempt Crum the Contractor's License u D¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 DALUATION B V S/Fi. � - Code:Any city or county which re4uiresa permit to construct,alter, �� IZ 2 Q ilnprove,demolish,or repair any structure,prior to its issuance,alxo ELEC.CONTE. LIC.NO. ELEC. -DLL requires the applicant for such permit m file a signed statement that TOTAL PEHMI I TO a w m he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)o(Division 3 Of lire I a Business and professions Code)or that he is exempt Therem froand QTY. PLUMBING PERMIT FEE � `� a ¢ r o the basis for the alleged exemption.Any violation of Seclion 7031.$ STORIES' TYPE ONSTR. u ; m by nny applicant Porn Pcrmil suhiccts Dm aPplieaat loo civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500).): ❑ I,as owner Of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their Mole compensation,will do the work,and lire structure is nal OCC.GROUP RES.UNITS intended or offered for Sale (Sec 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner oil property who builds or confuses themun,and who does such work F IXTUR ES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE • himself re through his own emendemployec,,provided that such impnme mems are not intended Or offered for sale.IL however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING u5E builder will have the burden of proving that he dill not build or if... RE5 IND CON PB Ouber Provo for purpoxe of sale.l. INDUSTRIAL WASTE INTER. 30.00 - El El ❑ ❑ E]❑ ],as owner of the property,um exclusively contracting with licensed contractors to construct the project(Sec 7044.Business LAWN SPR INKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects with a contruuloos)licensed pursuant to the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 rggcr No. PARCEL NO. ❑ I am exempt tinder Sec. ,B.S.P.C.hr this WATER HEATER W/VENT 6.00 on Owner Dale WATER SYSTEM 5.00 ACC.DATE ACG FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of cunsent lu self-insure. ZONING ENG.SITE NO. or u rer6Gcate of Workers Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). policy No. Company Q ❑ Ccrlil ieJ copy is hereby(urnishcd. FIRE SPRINK ENERGY T 24 Z Z ll Cert ificJ y is tiled wit m• city ins Omar division. MISC.- REFER TO OR D. Q Applicant rG�--- Y❑ N❑ Y ❑ N❑ Cc: T CER I'I FICA1 E OIr EXEMPTION FROM WORK I-RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. D. O This sccliou need nut he compW ed it the pennit is 10, one TOTAL Y❑ N❑ Y ❑ N❑ Z) Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U W become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } y NO1l CF TO APPLICANT': If,after making this Cert ificmc of F Z emption,you should become subject to the Workeri Compensal ion APPLIANCE 5.00 PLAN CHECK 1 (3� provisions of the Labor Code, you must forthwith comply with FEE �/' U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONS I RUCI ION LI1NDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.010 SEISMIC FEE , I hereby affirm 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.C.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nara HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify mut I have read this application and late that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-CON?(3 H.P.or 100,000 B.T.U.) 6.00 hereby aunlorim representatives of this city to enter upon the BOILER-COMP lover 100,600BTUISEE FEESCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indenmify and keep harmless tine City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting�of this permit MECH.CONT. LIC.NO. MECH. S_ Q TOTAL TOTAL 7? Signature of Applicant ontractor Uute OFFICE COPY