15170 (4) POST THIS CARD,NEAR FRONT OF BUILDING' eR Ir NUMBER
CITY OF CUPERTINO �� �� ;
I NSPECTI ON'DI VISI ON
JOB INSPECTION RECORD
SaratogaSunnyvalePERM TEXPIR TION
JOB ADDRESS 1601 StSR�INITkk _LOT#
,I PERMIYEXPIRES IF WORK
OWNER Sys Scan Inc. - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-,
FOUNDATION (ANC OR 180,DAYS FROM
NOTE: "LASt�CALLED INSPECTION.
' UFER ALL GRADING.AND DRAINAGE SHALL.BE INSTALLED _
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED =`
UNDERGROUND /SLAB '
PLUMBING
r
ELECTRICAL 'ISSUANCE DATE
MECHANICAL - _� - BLDG ELECT, PLG, MECHI
❑ ❑ El ❑
DO NOT POUR FLOOR UNTIL ABOVEHASBEEN SIGNED _ BUILDING PERMIT
- INFORMATION
WOOD FLOOR
PLUMBING I woo
I wnw`A�oN slFr.
MECHANICAL • -
C«
Vey-
ELECTRICAL - PERIOD TO
FRAMING - + /-}s . . ... / •-� ,-;w`',ajw
INSULATION STORIES TYPE CON TR. -
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTAL ACREAGE
_ ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
R60FSHEATHING 'HEs iNBUILDING usEB ulhe,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED „ FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH 'SAN.N ASSESSORS PARCEI.NC. .
PLUMBING - - ELECT.ENERGY
-TRAGI ND, PARCELNO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL - ACC.DATE ACC FILE NO .
BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS -
' MECHANICAL FIRE SPRINK. ENERGY T�2a
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE
FLOOD ZONE A.L U C.
-3D
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ "❑,
SHEETROCK GRADE', FEE SUMMARY
EXTERIOR LATHBUILDING, '-y BUILDING
INTERIOR LATH _'TEMPORARY APPROVALS '`�^ •�
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY.. SEISMIC FEE
OCCOPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0� 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
CALLING FOR FINAL INSPECTION.'
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BU I LDING PROJECT I DENTIFICATI ON - .PERMIT NUMBER
"°'LUING DFL. APPLICATION & PERMIT 1517 O
1 ADDRESS
2_n Lj5 BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
/ OWNER'S -
PLAN CHECK VALIDAT
.x OTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S ( J
NAME t5oV-r ' - ' OUTLETS SWITCHES-R CEP 10.00/1.00
0�3r uc.NO. LIGHTING FIXTURES 10,00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
PRONE PANELS 10,00 DATE OF APPLICATION
ARCmTECT ht PLAN CHECK FEE P.C.NO.
OR 'rJ J [� PANELS (OVER 200 AMPI 20.00
ENGINEER //�� '
uc.NO. O* SIGNSTRANS. 3.00
ARCH,OR ENG. f/��j� PERMIT VALIDATION
AODR ss SPECIAL CIRCUIT 5.00
�- ZIP ✓'�J EMP.METER OR POLE INS. 20.00
AvvucANT s '
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE - 20.00
r o O LICIiNSEU CONTRACTORS DECLARATION
rtewi U I hereby affirm that I am licensed under provisions of Chapmr'l I&BUANCE DATE
wan Icnmmencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH.
r o z Professions Code, i
e• y license s in full fare •f ❑ ❑ ❑
z D'�- License Class sNmnher - y�
4 z CmntractOr G�`7
y F
M w 4 OWNER-BUILDER DECLAMATION BUILDING PERMIT
O INFORMATION
'xu ;u y I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
VA UATION
F u o J Law for the fallOWing reason.(Sec.]071.5,Business and Professions PERMIT ISSUANCE 10.00 1�� $/FT'
Code:Any city or county which requires a permit ioconstruct,alter, O:.
Ic c o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC.
w
w- DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he Is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapfer9(commencing with Section 7000)of Division3a(the - 1'V72--/-C1'Q /r J e ov
f i D Business and Professions Code)or that he is exempt therefrom and
R I- m the basis for the alleged exemption.Any violation of Section 7031.5 QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR.
a ';; _ ' by any applicant for a permit subjects lire applicant too civil penally ALTER-DRAIN -WATER (EA.) 5.00
of nor more than five hundred dollars(5500).):
❑ Las owner of the pill dot or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole r offered far will(S the work,and the structure o is not
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'fire Contractor's License Law does not apply to an owner of
properly who builds it improve,thereon,and who toes such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself'or through his own employees,provided that such improve-
!` ments are not intended or offered for sale.0',however,the building GAS-EA.SYSTEM-1 1 NC:4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS EASYSTEM-OVER 4(EA.) -2.00
builder will have the burden of proving that he did no[build or - .it- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with
- licensed'contractors to construct (lie poured(Sec.7044,Business LAWN SPR IN KLERS- 1 INC 5 V.B. 6.00 ❑ 0 0 0 ❑,
and Professions Code:The COntmelor s License Law does Pot apply ,ASSESSORS PARCEL NO:
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractons)licensed pursuant to
lire Contractor's License Law. - SEWER-SANITARY-STORM EA.200tt/10.00 , TRACT NO. PARCEL NO,
❑ lam exempt under Sec.—,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO.
WORKERS'COMPENSATION DECLARAIION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlificate ofconsent to seliNnsure. -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(See-3800,Lab CJ.
Policy No. Company
C ❑ Cedified copy is her by furnished. RE SPRINK ENERGYT-24
Z Z���111 CerriE•J co 's file.) withith thl _ Ilion division.
plmunl :. / / 177�I� • MISC.- REFER TO ORD. YE] NQ [:]
N�
� =
CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COM1IPF"NSATION INSURANCE PLG.CONTE: LIC.NO. PLO.
Z. (This section need not he completed if the permit is for one TOTAL Y�' N� Y F] N�
hundarldollars(SI00)orless,) -
U O 1 certify that in lire performance of lire work Cor which this per. DTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued,1 shall not employ any person in any manner so as to
C W become subject to the Workers'Compensation Laws of California.
Date # Applicant ALTER OR ADD TO MECH. BUILDING ("�
} DO NOTICE TO APPLICANT': IL after making this Certificate of fix- 500
.
F Z emption,you should become subject to the Warkers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor COLIC, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONST'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QFM.) 6.00 SEISMIC FEE 7S-
1 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's Na HEATING UNIT(OVER 100,000 B.T.U.)9.50
Leader's Address ELECTRIC
1 certify that 1 have read this application and state that rhe above VENTILATION FAN (SINGLE) 4.00 -
information 6 connect. I agree to comply wRh all city and county PLUMBING
ordinances and state taws relating tro building construction, and BOILER-COIVP(3 H.Ror 100,000B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP Ova,l0Qoo0 BTUI SEE FEE SCH. MECHANICAL
above-anentie ned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD.
uperli most liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may 'n any a against said City in•o nseluenc• of the
lin Its perm' . MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL /� 7
Si ,
of p of Contractor Date �]
OFFICE COPY