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18752POST THIS CARD NEAR FRONT OF BUILDING - CITY OF CUPERTINO8752 INSPECTION DIVISION }!—I�J11OB INSPECTION �R%ECORD . JOB ADDRESS _L ` '- VK2S T /�� UNIT - _ LOT OWNER .CONTRACTOR LQ PERMIT Numeea PERM IT EXP 1, .5 N (� �'j l f, .S PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAXS FROM L•ASTCAL-�DINSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION .. NOTE: - -;; ALL GRADING'AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. p�® 699InI UFER PREGUNITE / PERAUT VALIDATION ISSUANCE -DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED AN V7 1290 UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - BLDG ELECT. ❑ PLG. MBC. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED A BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING ^� VALUATION N MECHANICAL ELECTRICAL' - PEHMI TO l FRAMING INSULATION - V \ STORIES TYPE CDNSTH. OCC. GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO' INAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so. IT FLOOR AREA TOTAL ACREAGE ' DIAPHRAGM ROOF SHEATHING BUILDING . RES IND CON USE Pe - om., ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS6AT&W Ig T ROUGH ' SAN.k ASSESSORS PARCEL NO TRACT NO. PARCEL No PLUMBING ; ELECT. ENERGY I T' I TUBS B SHOWER PANPLUMBING ENERGY MECHANICAL - MECH.ENERGY ,BUILDING EN ELECTRICAL ACC DATE ACC FILE NO FRAMING ELECT: FVALTEST INSULATION.. PLUMBI G ZONING ENG. SITE NO. GAS TEST GAS - MECHA [CAL RE SPaDNN Y "❑ ENERGY T.2a F-1 NEI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATIN EXTERIOR SHEAR ELECTRIC ELEASE ROOD ZO Y ❑ N A4 V L,• N❑ INTERIOR SHEAR FIRE DEP . SHEETROCK- GRADE FEES MMARV EXTERIOR LATH BUILDIN INZG .� JNTERIOR LATH - T PORARY APPRO SCRATCH COAT ELECTRIC P,64 N K GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY MIGFEE OCCUPANCYOF BUILDI NG ISNOT PERMITTED UNTIL BUILANG FINAL ISSIGNEDB ILDINGINSP TO ' _ ROFILM T ARRANGE FOR INSPECTION BY PHONING 252-4505, O� ONE WORKING'DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN'PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING / MECHANICAL' IMPORTANT! PLEASE"READ REVERSE SIDE BEFORE ' CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION. APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER I,18752 1i. ®a;DING _ ADDRESS Q OWNER'S NAME M `I_t*' _ • PRONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION / 9 �( 1 ` DATE OF APPLICATION CONTRACTOR'S NAME rJ �j LIC. No. / UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 r,ONTRA TOR's ADDFEP�APPLIANCES-RESIDENTIAL I�IrJUV / J ✓✓ PHONE ZO It 4.00 IPANELS 10.00 ARCHITECT CC R/�j on /77V�1 NGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE ,AP.�C, NO. GO VLL "1 _ [r.% SIGNS TRANS. 3.00 ADcu ES, G� O of -0 wb AODR EOR V CCI • VR WE 2F PARK SPECIALCIRCUIT 5.00 PERMIT VALIDATION 1� n�.� 11"jG ISSUANCE DATE BLDG. ELECT. PLC. MECH. " ❑ ❑ ❑ EMP. METER OR POLE INS. 20.00 t. ADDRESS / ADDREANrs C. , :+iN W • Q MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CON'T'RACTORS DECLARATIONMAIM 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 0( the Business nd Professions Code, and my license is in full for t License Class Lic. Number_ Dale Contractor- OWNER -BUILDER D[CLA RA'T'ION I hereby collo that I am exempt from the Contractors License Law for the followingres on.(Sea.uiresd.erminessand Professions alter, Code: e, dem y demolish. county whiny nquiture Permit o its issuance. improve, demolish, or repair any structure, prior to its issuance, also he isles the applicant for such revisit to file a signed actor s La that he is licensed pursuant en the ng with provisions of the Contractor's Lire nse the Buw[Chandprocosions Code) with Section is exempt Professions Code) or that he is exempt t ctionunl and Business for lire anbasy by any ehafora permit dojlars the 0).): am loacivil Penally applicant for the alleged exemption. Any violation of Section malty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered lot sale (Sec. 7044. Business and Professions Code: 'flue Contractor's License Law does not apply.to an owner of property who builds or improves thereon, and who does such work himself or through his own employees. provided that such imprne- ments are not intended or offered for sale. ll, however, rhe building or improvement is Sold within one year of completion, the owner - builder will have the burden of proving that he did not build or iin- Prove l'or purpose ofsale.)' _0- 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, BusinessLAWN and Professions Code: The Contractors License Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contmclorio licensed pursuant to the Contraanr's Lice nse Law. ❑ Tum exempt under Sec. ,B.&1'.C. lar tlris reasonWATER IAN n `�, - "d / OS r11np jR0 BUILDING PERMIT INFORMATION . MISC. - - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION U $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL /. PERMIT TO /tel 5e4 k'C L) V QTY. PLUMBING PERMIT FEE STORIES TYPE C NSTR. ALTER -DRAIN -WATER IEA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 DCC. GROUP RES. urvliS DRAINS -FLOOR, ROOF, AREA,CON D. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM - 1 1 NC. 4 OUTLETS 6.00 SD. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON . PB other INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA:) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. HEATER'W/VENT - 6.00 Owner Date WATER SYSTEM 5.00 WORK ERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of Consent Io self -insure, or a certificate of Workers Compensation Insurance, or a certified copy Iher,of(Scc. 3800, Lob.CJ. Polley No. Company Ace. DATE ACC. FILE No. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. - MISC. - REFER TO ORD. ❑ Certified copy is hereby famished. Certified copy '- fled with c city inspersion isi divon. Applicant iSA CERTIFICATE OF 17XFMPTION FROM WORKERS. COMPENSA'PION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS 1001 or le,) I certify that in the performance of tire work for which this per mil is issued, 1 shall not employ any person in any manner so as to become subject to tiro Workers' ComPensal ion Luws Of Calilomia. Dare Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- enlnlam, you should become ambjccl to lire Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions ser this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency lin (he performance of the work for which this Retail( a issued (Sec. 3097, Civ.C.l. Lender's Name Lenders Address FIRE SPRINK YE] N ENERGY T Z4 YE] NCJ PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ NC] A. L.0 C. Y ❑ N[J PLG.CONTR. LIC. NO. PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10MMOC-F.M.) 4.00 PLAN CHECK FEE AIR HANDLING UNIT(OVER 1Q000C.EM.) 6.00 SEISMIC FEE .2- EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM HEATI NG UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that l haveread thisapplictiom and,rare that the above information is correct. I agree to comply with u11 city and county ordinanecs and state laws relating to building construction, and hereby authorise representatives of this city to enter upon the above mentioned properly for inspection purposes. A(Wc).gr�� save, indenmify and keep harmless the City of liabilities, judgments, costs and expenses which accrue against Said City is consequence of the VENTILATION FAN (SINGLE) 4.00 PLUMBING gO1LER-CAMP/3 H. P. or 100,000 B.T.U.1 6.00 BOILER -COMP (Over 100,000 BTU( SEE FEE SCH. MECHANICAL MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00rmitMECH. CONST. TAX CONT. LIQ NO. MECH.ZZ OTALTOTAL 3 ,�QIfcant/Contractor Dare OFFICE COPY