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18581 (4) POST THIS CARD NEAR FRONT OF•BUILDING PERMIT NUMBER ; CITY OF.CUPERTINO 18581 INSPECTION DIVISI0 N ' , , i JOB INSPECTION RECORD IO Pn ' JOB ADDRESS dWei is L`� . ' Q IUNIT# _LOT`# PER TON' _ PER I 'X E WO'RI�,,` OWNER V "CONTRACTOR 4, � Cv „�� .'IS- MTSTA E INSPECTION DATE INSPECTOR INSP CTIONRECORD O�DAVSO , EAMIT ISS FOUNDATION NOTE: ANCE OR-180 DAYS FROM SLASTCALLED INSP� TION. LIFER ALL GRADING AND DRAINAGE SHALL.BE`INSTALLED '= %c,, 'PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND,QTY OF PERMIT VALID ATIONGARAGE SLABS - CUPER71N0 STANDARDS. ^ np® POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED G�Y1 - �zl UNDERGROUND /SLAB PLUMBING _ /��u�y�1,,�J�1� `V�µ L.$ E• 1 t'P Y. ELECTRICAL ISSUANCE LATE MECHANICAL ... -a Lo ELECT PLC. , +MEC ;.r: . Ell ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED, BUILDING PERMIT WOOD FLOOR - - "..i' - INFORMATION PLUMBING _ q VALUATION $,FT. .` S .. o,. MECHANICAL ELECTRICAL PERMIT TO ' FRAMING •' ' ' INSULATION - ' STORIES TYPE CONSTR - OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.FLOOR AREA TOTAL ACREAGE NOTE:NOFINAL INSP.SHALL BE MADE BEFORE ' DIAPH RAOM THE.CONSTRUCTION TAX,IS.PAID ROOF SHEATHING BUILDING USE RES ,ND CON. -PB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ 'ROUGH SAN.q � ASSESSORS PARCEL NO. ' - � � ' PLUMBING _ - ELECT.ENERGY " TUBS&SHOWER PAN. PLUMBING ENERGY .TRACT NO. ,PARCEL No MECHANICAL MECH.ENERGY ELECTRICAL - - Acc.DATE Acc.FILE No / BUILDING ENERGY ` •FRAMING r� ELECT.FINAL TEST _r 'INSULATION PLUMBING zowrvc ENG.SITE No GAS TEST ' GAS .• MECHANICAL FIRESPRINK ENERGY L.2. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDHEATING -y 11N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE ' FLooO zorvE wL,u.c, INTERIOR SHEAR FIRE DEPT. /�� Y'❑ N❑ ':.rY L ' rv❑ SHEETROCK GRADE FEE SUMMARY ' EXTERIOR LATH BUILDING /� / INTERIOR LATH ; TEMPORARY'APPROVALS BUILDING - I+ SCRATCH COAT ELECTRIC - PLAN CHEG t c' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY' sEISMIc FEe C' : ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGN ED BV.BUILDING INSPECTOR. .,,�.�• MICROFILM ARRANGE'FQR INSPECTION BY PHON.ING,252-4505, ELECTRIC z F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLEASE GIVE JOB-ADDRESS.WHENTHONING. PLUMBING ' SEE PER IT FOR.EXPIRATION Z DATE MECHANICAL = — IMPORTANT!. coNST.Tnx 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 BUILDING PROJECT IDENTIFICATION PERMIT NUMBER,IION gppLICATION & PERMIT 18581: 'ENAIMS LDIry I LT+ rWt• ORES- NCO F5 '✓ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL h. NER'S x-11``11 E��,wr PLAN CHEC V LIDATION�1�,7 FUNIJIF_S' J� �(�j, L[ f�1S DTV. ELECTRIC PERMIT FEE 5V V" 9f, 4C/ z1 EAC PION 3'/x88 INANE CONTRACTORS NAME 1� OUTLETS-SWITCHES-RECEP 10.0011.00 '?X,'Al •7,' SS..5 'S3 LIGHTING FIXTURES 10.00/1.00 uc.NO r ADDRESS APPLIANCES PPLIANCES-RESIDENTIAL 4.00 ADDRESS JLy,x„ y7 DO/' 'r-��yP''H``�•ONE q�'xj G}2� PANELS 10.00 DATE OF IC TION OR "ITEC' PANELS (OVER 200 AMP( 20,08 PLAN CHECK FEE P.C.NO. ENGINE �}/]/j/ ✓`J 1� t- ,%Sjri� LIC.No.C• / SIGNS TRANS. 3.00 PL�JIY ARCH. 8ENG, .' SPECIALCIRCUIT 5.00 PERMIT VALIDATION f'4P S'I• O> zIP/G70„� EMP.METER OR POLE INS. 20.00 („^ Ct APPLICANTS MOTORS SEE FEE SCH. (L// ADDDRESSDRESS �/ /topr w 1+��•3� .$ 9S/�a SERVICE CHANGE 20.00 //A1,I_ T`' 0o LICENSE:[)CONTRACTORS DECLARATION / rt is w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE y< (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH. 0'^ Professions Code, nd m license is in full force n as�.e� ,fJt S-; Z O y License CLSS_, Lic.Number S° JSEP k 9 1989 El ❑ z -0 Datc 0�_Contractor ¢ x f J -��- BUILDING PERMIT ¢ ¢w u OWNER-BUILDER DECLARATION INFORMATION X ;LL.y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION S/FT. LLO¢ Law for the following reason.(Sec.703 L5,Businessand Professions PERMIT ISSUANCE 10.00 ✓+ � Code:A ny cit y or co nt ty wh ieh req Lines a pe rat i t to construe t,alNet, - ¢ ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O a, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ' w$ he is licensed pursuant to the provisions of tine Contractor's License - -{' pp/� HiQ Law(Chapter 9(commencing with Section 7000)of Division3of the, I� 1• IMI 1'VV� f 4 C Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ H $ the basis for the alleged exemption.Any violation o(Scclic 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN III VENT-WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,ar 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 Cade:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- Hands are Hot intended oroffered for sale.l f,however,file building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ofsaleJ. INDUSTRIAL WASTE INTER3000 RES IND CON PB Omer ❑ 1,as owner of the property,um excites . . sively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors m 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 docs 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 conlractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft110.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ lam exempt under Set;. .B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I hove a certificate ofcomant to self-insure, - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy Chede8L +) Policy eS!pr'� aW 440A.O ❑ -..... 1-1.1 i-herebyfuGhd / FIRE SPRINK ENERGY T-24 ZZ O Certified copy is Bled with the city.inspection division. p Applicant MISC.- REFER TO ORD. Y ❑ IN Y ❑ N❑ CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LJC.NO. PLO. d O (This section need not be completed if tiro permit is for one TOTAL Y❑ N❑ -Y ❑ N❑ 0 2 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 LL H mit is issued,1 shall not employ any person many manner so as fo U become subject to the Workers'Compensation Laws of California. 0 Ed Datc Ap licint BUILDING' 4,I (L p ALTER OR ADD TO MECH. 5.00 } W NOTICE:TO APPLICANT: If,after making(his Certificate of Ex- F Z tradition,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHE provisions of the Labor Cade, you most forthwith comply with FEE V such provisions or this permit Shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 l CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction hooding agency for EXHAUST HOOD(WITH DUCT) 5.00 (lie performance of the work for which INS permit is issued(Sec. MICROFILM 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lendds Name /(ONE - Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC • 1 certify that I have read this application and ,are 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-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the 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 (antiage f permit MECH.CONT. LIC NO. MECH. 9//z/,* TOTAL TOTAL y'C� S' a e' fAppliant/ n actor - U i, ( I OFFICE COPY