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15200 (2) POST THIS CAD NEAR FRONT OF BUILDING PERMIT NUMBER CITY- OF CUPERTINO 15200 INSPECTION DIVISION JOB INSPECTION RECORD 11/ PERMIT EXPIRATION JOB ADDRESS/093 a' V° �'K�IJ-SO'� I/C.f UNIT# _LOT# 13 - �. ., ^ ' PERMIT EXPIRES IF WORK OWNER ".6 er, C y, CONTRACTOR (3/ V/C7tT�/ L�1/, yIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD teO DAYS OF PERMIT ISSU-' ANCE OR 180 DAYS FROM . FOUNDATION . IS-$U NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE--INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VAuoATION cP_E�RTy1f�OTAND9RDS.S��"�Y�Q Ok „F GARAGES LABS - - "J SO qT F POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 5.77j-" gµawT- pqy p(- uLQ:z; „ UNDERGROUND /SLAB PLUMBING - I. ELECTRICAL - t� '�100 ISSUANCE DATE MECHANICAL ( BLUG EUECT, I PLG. MECO log E DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED RMIT INFORMATION WOOD FLOOR VALUATION SOFT. PLUMBING ` MECHANICAL 7,j ELECTRICAL vERnoT To FRAMING STORIES TYPE CONSTH INSULATION — . • OCC GROUP w RES,UNITS Y vg caC O.vc y S io-siy I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID - Fs. ,7 NG ROOF SHEATHING - cI C:&ti HCS IND uoCON USEP13O'l— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. Q 0 ED E:l 1:1 ASSESSORS PARCEL NO ROUGH SANI PLUMBING Old ELECT.ENERGY TUBSB OWER_PA PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL q' MECH.ENERGY .ACC DATE ACC,FILE NO. ELECTRICAL BUILDING ENERGY FRAMING - S S-B`i ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION S S PLUMBING GAS TEST os-%.t( / GAS FIHESPRINK ENERGY T-24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING !gum UC Y'0 "EI iv E "(_] EXTERIOR SHEAR C ELECTRICAL RELEASE FLOOD ZONE TIL1.1 INTERIOR SHEARmitmt 37-50-P FIRE DEPT. Y[j NE] Y L, N� SHEETROCK Z GRADE FEE SUMMARY EXTERIOR LATH p4z7 BUILDING INTERIOR LATH O TEMPORARY APPROVALS BUILDING �. SCRATCH COAT ELECTRIC �/� ��+{ PLAN CHECK I. GAS .FEE I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 1 . SEISMIC FEE OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING•FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC _ a� 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 FINAL GRADE T, ROUTE SLIP I: Date Location _ Subject _ Notes Approve _ D e Inspector CITY OF CUPERTINO, CERTIFICATE OF COMPLET-IOW BUILDING INSPECTOR'S OFFICE ( , �J �.�. 152�0- Date ...-C.�..._�1......... .....-.., 19.......... Building Permit No. .................. 1I0 . .ki1�`aa�?...6 � ............. The Building Located at ...4...-��---� ...... 1?.j..l Owned by -...Q ...... .F. ....�.1�:................... Co leted For Use As: Has Been . w` (Altered) ............................................................................ ............................... ........ ................................................................................................. ................................................................................................ 5..`...c............ ........ �tn � ................................ ... .... ........... PD-7 BUILDING INSPECTOR APPLICANT TO FILL IN INFORMATION WITHIN RED LdNES — USE BALL POINT PEN ONLY - 4BUIL6ING PROJECT IDENTIFICATION, PERMIT NUMBER BUILDING // # APPLICATIOI*&,PERMIT 15200 ADDRESS i InS� I J_ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'9 - I �j PLAN CHECK VALIDATION SME W. OTV. ELECTRIC PERMIT FEE PNONE NAME acTons UTLETS-SWITCHES-RECEP 10.00/1.00 LIC.No, LIGHTING FIXTURES 10.00/1.00 - CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ' ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION • ARCHITECT PLAN CHECK FEE P.C.NO. on PANELS (OVER 200 AMP) 20.00 ENGIN R f Lc.No. � SIGNS TRANS. 3.00 ARCH,EOR ENG. F SPECIALCIRCUIT 5.00 PERMIT VALIDATION P EMP.METER OR POLE INS. 20.00 ' APPuc rvrs . MOTORS SEE FEE SCH. (/(�1"✓(j/Y�LU-�-C.L� AO RESS ' SERVICE CHANGE 20.0 JJ? w o o LICENSED CONTRA ORS DECLARATION 4• v/cY�� iw 1 hereby affirm that I am licensed under provisions of Chapter 9 , ESOANCE DATE y a n (commencing with Section 7000)of Division 3 of the Business and `\n G. ELECT. PLG. MECH. r w z Professions Code,ryryry�ayyyyyyll1IIl my license is in full farce and effect. i m o License P Lic.Number f'q 9 ,,, E J Datc Contrxclor - • ``\� R a se s 67 BUILDING PERMIT m ¢ OWNER-BUILDF-R DECLARATION o i U INFORMATION X ; 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD w VALUATION $/FT. F LL o a Law:Any ityfolowingreason. rywhich e. uires a penninessand Professions pERMIT ISSUANCE ,a r Code:Any mol sh coon pairny reqstructure, prior it to consuance,also 2 AQ a 6 Q S, Q O improve,demolish,or repair any s1nlCtum,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �O /"J oC [P'P v a u requires the applicant for such permit to file a signed statement that TOTAL r/L w$m he is d pursuant to the provisions of the Contractor'sDivision SofLicense PERMIT TO 5 y < Business (Chapterand Pr(almm¢nCode)or Secthat ion is exempt therefrom o ded eSiCw`) w X E 4 o Business and Professionsxempt or that he is exempt Ihmo rem and QTY. PLUMBING PERMIT FEE I- $ the basis for tan alleged permit subject, Any violation of Section malty STORIES TYPE CONSTR. by any applicant forapermitsubjects $500).applicant tea civil penalty ALTER-DRAIN -WATER (EA.) 6.00 5��2 Of not more than five hundred Dollars(my em: ❑ Las owner Of the property,or my employees with w I.s not BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS tended or offered for sale fSec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5,00 . rte— 3 ' Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So.FT,FLOOR AREA TOTAL ACREAGE himself or through de own employees,s pe,If,however,that such improve- mentihimsear¢ notinthhisor empldfeesalroided thatsthenpoing GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner, GAS-EA.SYSTEM-OVER 4 IEA.) 2,00 builder will have the burden of proving that he did not build or im- B LDING USE provespurpose of sale.). RES IND CON ' PB Omer. dEf I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensed contractors ID construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00ASBESSOR$PARCEL NO. and Professions Code: Tile Contractor's License Law docs net apply g to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 /"/ /3 _ contracts for such projects with n mntructar(s)licensed pursuant to SEWER-SAN EA.200ft/10.00 V 10 the Contractor's License Law. � TRACT NO. PARCEL N0. ❑ I a,, xempt under Se . ,B.&P.Cr to [is WATER HEATER W/VENT 6.00 reason H�g Owner f Late WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby Strom 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 thercof(See.3800,Lab.C.l.�s Policy No. ContpunY—IJ.ILIq_ -1 G O ❑ fie copy Is hereby fr mi Icd. 0 Z Z Certifi, j �j ryjl��jledx.r III i eJPon division. - FIRESPRINK ENERGYTRO p Applicant Y_� _[a U/l4C�t MISC.- REFER TO ORD. Y�. N� Y ❑ N[] CC a PERMIT ISSUANCE -i9:9B LU CERTII'ICC04ENSAEXEMPTION NSUR N WORKERS' FLOODZONE A.L.U.C. . W > COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. rpm) ' CL 0 (This S¢Cti6p need not be completed if the permit is for one TOTAL (J✓ Y[3 NE] Y[D N[D hundred dollars IS 100)or less.) - U.O 1 certify that in the performance of the work for which this per- OTV. MECHANICAL PERMIT'. FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner seas to O U become subject to the Worked Compensation Laws of Calif nifla., a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING OsJ } to NOTICE'10 APPLICANT: If,after making this Certificate of Ex- H ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of 'Ile Labor Code, you must forthwith comply with FEE U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 CONSTRUCTION LENDING AG17NCY AIR HANDLING UNITIOVER 10=C.FM.) 6.00 SEISMIC FEE /x-540 I hereby affirm that,there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 I - the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG UN IT(O V ER 100,000 B.T.U.)9.50 (� Lender's Address ELECTRIC 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 intonation is Correct. I agree to comply with all city and county PLUMBING ordinances and state laws rotating to building construction, and BOILER-COMP.I3 H.P.Of 100,0008,T.U.) 6.00 E7 hereby authorize representatives of this city to enter upon the BOILER-COMP(Oliver 100,000 BTU)SEE FEESCH. MECHANICAL n • above-mentioned property forinsp of this purposes is '(We) agree t0 save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 1 CONST.TAX 03 may in any way accrue all sit saiA City in consequ-ace of the m ng r(Ihis germy MECH.CONT. LIC.NO. MOTAL 6 V � . TOTAL Signature Of A pplicant, Detractor OFFICE COPY