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14041 POST THIS CARD NEAR FRONT OF BUILDING M' d PERMIT NUMBER _ CITY OF CU . PERTINO 14041 #rc�` INSPECTION DIVISION , JOB INSPECTION RECORD _ r PERMIT EXPIRATION JOB ADDRESS 19787 LAMAR DRIVE UNIT# LOT# PERMIT EXPIRES IF WORK OWNER MAX K. AGOSTON CONTRACTOR GARY COLLINS IS NOT STARTED WITHIN' INSPECTION DATE INSP CTOR INSPECTION RECORD 180 DAYS OF PERMIT Issu- ANCE OR 180 DAYS FROM- FOUNDATION b—OF LAST CALLEDINSPECTION: UFER f �. PREGUNTE r _ 'PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . UNDERGROUND /SLAB PLUMBING '��� r r ELECTRICAL - - p.1C UrCUQ' IssuANCE DATE MECHANICAL BLDG. ELECT, PLG. MEDIA 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITNFORMATION I WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PERnnr TO ELECTRICAL -- FRAMING I INSULATION 5_lO_L9F _/C STORIES TYPE CONSTR, _ OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN.SIGNED ROOF SO,FT,FLOOR AREA TOTAL ACREAGE (11 ; DIAPHRAGM _ BUILDING USE RES IND CON PB .Omer APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - 0 0 El 0 ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL No. MECHANICAL ELECTRICAL 757MIS FINALS DATE INSP. ACC DATE ACC.FILE NO. FRAMING 51�S 8 - SAN # ' zoNlNc ENC.SITE No, INSULATION PLUMBING GAS FIRE SPRINK ENERGY T 2 MECHANICAL Y ❑ NC] Y ❑ NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.u.a LATH–INTERIOR ELECTRICAL LATH–EXTERIOR ^L FIRE DEPT. v� N� v � N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING, -( – SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING Li d FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE N e' OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Ilk F ONE WORKING DAY,BEFORE REQUIRED INSPECTION. PLUMBING p+ O� PLEASE GIVE JOB ADDRESS WH,EN'PHONING. P Z — SEE PERMIT FOR EXPIRATION DATE-- MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL t/ CALLING FOR FINAL INSPECTION. OFFICE COPY I J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER RUILOING p APPLICATION & PERMIT 140 1 L ..Awns l�'w ^7 q � _ (�r/I1/6 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S _' ,U/ / ,�1L VIS V PLAN CHECK VALIDATION NM(LJ 1( LJI`r��� IS- �,1(�- / QTY. ELECTRIC PERMIT FEE IS J� 1- W I O �PMONE 0�I+�/ CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 -� � NAME �/ (� / 1 COW N1 LIC No iq 1 0110 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S qjs-•� �Aq(, PPLIANCES-RESIDENTIAL 4.00 CONTRA ���0 7 7 101 gcWK 2767,SAA0 HONE PANELS 10.00 DATEOFAPPLIC ION ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. OR � L ENGINEER QQ pD uc.NO. SIGNS TRANS. 3.00 •ASC 0� ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 , Pool ssTS MOTORS SEErFEE SCH. . �G'-� /j - � - p-� l yip �1 Q .�; _ ��`9'W"cc'v�.i V(..�1�C (.(//�71M SERVICE CHANGE �,v" 20.00 ,r✓ 0 0 o LICENSED CONTRACTORS DECLARATION � Irl Dl�U u Hj I hereby affirm that I am licensed under provisions of Cha ter 9 ``� ) ¢ Y P P r _ t.dt ISSUANCE DATEEII' H a- BLDG. ELEC (commencing with Section 7000)of Division 3 o([tie Business and a •,n' P` 'P.LG: MECH. H m i Professions Code,and my license is in full force and effect. E P.l1U p� a '❑ ❑ z o w - License Class Lia ^ Number t V• �V DC7 ^ O m F w Date - Contractor V,M a y s BUILDING PERMIT or I[ w ¢ OWNER-BUILDER DECLARATION INFORMATION seoAoMISC.- REFER TO ORD g LL w 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. FN0 J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 �- Code:Any city or county which requires a permit to construct,alter, 5 ,�y._�) 2 ¢4 p improve,demolish,or repair any structure,prior Io its Issuance,also ELEC.CONTE. LIC.NO. ELE0. O u requires the applicant for such permit to file a signed statement that TOTAL(/V PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's Liwnse F z Q Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE or 1- the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR. S u3 � by any applicant for a permit subjects the applicant to a Civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(S500).): ❑ 1,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. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND, 5.00 Code:The Contractors License.Law does not apply town owner oI' - propertywhobuildsorimprovesthereon,and who does such work FIXTURES-.PER TRAP 5.00 SO.FT.FLOORAREA. TOTALACREAGE himself or through his own employees,provided that such improve. mems are of intended or offered for sale.If,however,the building GAS-EA.SYSTEM-.11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE builder will have the burden of proving that h . . . e did not build or int- RES 'IRO CON PB Other Pry for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ 1,as owner of the property,um exclusively contracting with TV licensed contractors to construct the project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's Licenw Law docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 commas for such ce tswith acnntracmgs)licensed pursuant to Licen the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ tele exempt under Sec. ,tl.&P.C.for this WATER HEATER W/VENT 6.00 reason -( Owner - Date WATER SYSTEM 5.00 ACC.DATE ACC-FILE NO. WORK,RS'COMPEt ATIONDECLARATION WATE R TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insum• ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy BmreoffSee.3800,Lab.CJ. Policy No. Conmany - O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z2 ❑ Certified copy is filed with the city inspection dNision. MISC.- REFER TO ORD. V Applicant - J�IY❑ N❑ Y ❑ N❑ � N CERTIFICATE OF BXEMPI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU >_ COMPENSATION'INSURANCE PLG.CONTE. LIC.NO. PLG. d 0 (This section need not he completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ ::) Z hundred dollars IS 100)or 1.0 U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to _ V become subject to the Workers'Compensation Laws of Culifornia. O w Dalc Applicant BUILDING a ALTER OR ADD TO MECH. - 5.00 l� �- m NOTICE TO APPLICANT. If,Idler making this Certificate of fix- F ? emptbm,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 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=C.F.M0 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 " SEISMIC FEE t 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Leader's Address 1 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100.00OBTU)SEE FEESCH. MECHANICAL above-mentioned property for Inspection purposes. (We) agree to save, indemnify and keen 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 gra If oflhiiper .t MECH.CONT. LIC.NO. MEET.\I 10 /Cj/Q7 TOTALTOTAL 7/ Ob T Signature of Applicant/Contr or Dnte OFFICECOPY '