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18014 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NOMBER "w CITY OF CUPERTINO � 80� � INSPECTION DIVISION JOB INSPECTION RECORD, —� E (�!"y, 7L PERMIT.EXPIRATION G. n UNITrI]Q.J_LOT# JOB ADDRE$ Q � `r r PERMIT EXPIRES IF WORK OWNER Ci�( oR<<}.�, .�E` '� •( ' . IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ANCE.OR 180 DAYS FROM- NOTE: LAST CALLED INSPECTION.. • OFERALL GRADING AND DRAINAGE SHALL BE INSTALLED. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED / UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCF.DATE . MECHANICAL TI � .} `y J - BLDGELEc PLG MEC H. �u El ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CItY,SEE 0{CUQB 1 BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATIONSIFT. MECHANICAL - ELECTRICAL - - /yr PERMIT TO FRAMING INSULATION - sroRlEs TYPE CONSTR. - OCC GROUP RES.UNITS !� PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "•r"' 7 STI FT.-FLoaR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND ..�,OV PB APPLY NO NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 1, INSP. El E El AssEss ARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO, PARCEL NO TUBS&SHOWER PAN - PLUMBING ENERGY MECHANICAL MECH.ENERGY - ' ELECTRICAL BUILDING ENERGY ACC.OATE ACC.FILE NO. _ FRAMING ELECT.FINAL TEST INSULATION ZONING ENG.SITE NO, PLUMBING GAS TEST, GAS MECHANICAL FIRE SPRINK ENERGY T;24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y F] " Y "[:] EXTERIOR SHEAR ELECTRICAL RELEASEFLOCOZONE A,L.0 C.• 1 Y❑ N❑ Y L N❑ INTERIOR SHEAR - FIRE DEPT. L_I SHEETROCK. GRADE FEE SUMMARY EXTERIOR LATH BUILDING ' - INTERIOR LATH - TEMPORARY APPROVALS, BUILDING SCRATCH COAT. ELECTRIC PLANCHECK I GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF.BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM' ELI ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC 5� F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. Q `I, Z - SEE PERMIT•FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFOREr�C,,. CALLING FOR FINAL INSPECTION. •V TOTAL OFFICE COPY ELECTRIC'SERVICE NOTICE P.G.&E.COPT / BUILDING INSPECTOR'S NOTICE v .CITY OF CUPERTINO i To You ore hereby authorized to Connect ^electrical service for Owner or Tenant No.of Wires .Size of Wires Size of Switch Motor load Voltage Ph Nesting load is K.W. Voltage ( , 5, ' Light IIO.New Servsce Reconnect �.* No.of Meters Neu, ITO_—IDne Wire More Servrca sMove Merer j� Power Three Phose C No.of Add.Meters QQ r EIECTRICAI INSPECTOR APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY UI LDING PROJECT IDENTIFICATION PERMIT NUMBER a';�p,NG �,� APPLICATION & PERMIT , ^ ^ A ADOREss A 801. 4., `W? �� UILDING-EL2CTRICAL-'PLUMBING-MECHANICA L '. IIIJJJ OWNER'S - PLAN CHECK VALIDATION" } NAME - QTV. ELECTRIC PERMIT FEE *1 pAIcc) PHONE NAM>ERAcroR's _ S - OUTLETS,-SWITCHES-RECEP 10.00/1,00 _ A LIGHTING FIXTURES 10.00/1.00 _ COATRACTORs- AODRE55 APPLIANCES-RESIDENTIAL' 4.00 RE Q5rv4 1 ;If 1% PHory 'S7(( PANELS 10.001 ,150 DATE OF APPLICATION ARCHITECT - PLAN CHECK FEE; P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 _ ADDRE08 SS ENG. _ SPECIAL CIRCUIT 5.0D PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 '1, APPLICANTS - MOTORS " SEE SCH. A a `�c�D"la o: SERVICE CHANGE .00 (0 D o 2 LICENSED CONTRACTORS DECLARATION - a U I hereby affirm that I am licensed under provisions of Chapter 9 - J U N -198 1 ISSUANCE DATE ¢ i (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. H m i Professions Co a &license Is In full force and effect ❑ Z i H G License Class 1.J Lic.Numberpu ❑- ❑ , r- 2 Hw Date. Contractor , S! �, - SEm s - BUILDING PERMIT ¢ ¢w u OWNER-BUILDER DECLARATION r - INFORMATION w ; u. 1 hereby affirm that I it exempt from the Contractor's License MISC.- - REFER TO ORD , VALUATION /FT. H u 0 f Law for the following reason.(Sec.7031.5,BusinessandIsrofessions PERMIT ISSUANCE 4990 IZ,eo Code:Any city or county which requires a permit.to construct,alter, Qa, ¢ Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTE. - LIC.NO. - ELEC O ¢ requires the applicant for such permit to file a signed statement that TOTAL3 PERMIT TO u w m he is licensed pursuant to the provisions of the Contractor's License /� 1 ^ H z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe S/ , ') 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE CUA ¢ H ora the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n ;- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).):. ❑ I,as owner of the property,or my employees with wages as 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 . 1 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00 SD,FT,F LOOK AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 merit are not intended or offered for sale.If,however;the building or improvemerip s sold"within one year of completion,the owner-, GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CO _ PB Otne. prove for purpose of sale.). INDUSTRIAL WASTE INTER.' 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ . 1:1 licensed Contractors to construct the project(Sec 7044,Business - LAWN SPRINKLERS,1 INC 5 V.B.` 6.00 ASSESSOPPS 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 -TRACT NO. PARCEL NO. ❑ lam'exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date, WATER SYSTEM 5.00 Ace.DnrE ACC.FILE N0. ,. WORKERS'COMPENSATION DECLARATION WATER TREATI NG,EQUIP. 5.00 -I hereby affirm that I have a certificate of consent to selfinsure, - - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sac.3800,Lab.CJ. " Policy No. Company - 0 ❑ Certified copy is hereby furnished. sFIRESPRINK ENERGY TQ4, - -Z Z �'Certififd co isicd witA the city inspection division. Applicant MISC.- REFER TO ORD. y ❑ N❑ y E] N[:] r. O � ! ." In- CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLO.CONTE. LIC.NO. PLG. , CL O _ (This section need not be completed if the permit is for one- - - TOTAL Y❑ N❑ v❑ N❑ Z hundred dollars(S 100)or less.) U O- 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL F mil is issued,I shall not employ any person in any marnci so as to U become su5ect to lite Workers'Compemation Laws of California. 0 tU Date "L Applicant - ALTER OR ADD TO MECH. - 5.00 PBUILDINGdo NOTICE TO APPLICANT: If,after making this Certificate of Bxemption,you should become subject to the Workers'Compensation APPLIANCE 5.00 -provisions of the Labor Code, you must forthwith comply withsuh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00CONSTRUCTION LENDING AGENCYAIR HANDLING UNIT(OVER 10=C.RM.) 6.00 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.003097.Civ.CJ:Lender'sNme' HEATING UNIT(OVER 100,000B.T.U.)9.50 Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - information is correct. I agree to comply with all city and county PLUMBING ordinances and,state laws relating to building construction, and BOILER-ODMP(3H.P.or10O,000B.T.U.I 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP,(OJer 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes,' (We) agree to save, indemni nd loc armless the City of MISC.- s REFER TO ORD. upertino aga" iabilities;j ents,c s and expenses which CONST-TAX may in any or said C' in consequence of the PERMIT ISSUANCE 10.00 I of" MECH,CONT. LIC.NO. MECH. �^ 13 VN TOTAL i TOTAL " i a ppl ant/Con for7 Date OFFICEZOPV ' '