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14577POST THISCARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS BO SCJ 2.0 i v.� UNITjk _LOT#- - > OWNER Oyn/ Q,J CONTRACTOR TERM IT NUMBER 14577 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION INSPECTION RECORD ATIONOTE: LL GRADING AND DRAINAGE SHALL BE INSTALLED COMPLY WITH THE APPROVED PLANS AND CITY OF UPERTINO STANDARDS. EGARAGE MH'AS'zIrNrn ITEO PERMIT VALIDATION , ' !`, '. -• ^� r; V ISSUANCE DATE' 0 ELE(iT PLG. MECR.. 1 6„{ p 0" SLABS POUR NO CONCRETE UNTIL A UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI G PERMIT MATION WOOD FLOOR PLUMBING VACUATION s/FT. MECHANICAL ELECTRICAL - - PERMIT TO ~srORles FRAMING IN TYPE corvsrR. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC GROUP RES UNITS ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID sO. FT FLOOH ARIA IOTAL ACRVAII DIAPHRAGM ROOF SHEATHING BUILDING USE . RES IND CON PB omn' ❑ ❑ ❑ 0 ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.p ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY TUBS 6 SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING -i ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK V ❑ N❑ ENERGY T.74 I ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICALRELEASE FLOOD ZONE v ❑ N❑ ALOC. v ❑ No INTERIOR SHEAR FIRE DEPT. - SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT - - ELECTRIC - PLAN CHECK FEE - - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE - ) OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. • ARRANGE FOR INSPECTION BY PHONING 252-4505, U.1 ONE,WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE — MICROFILM ELECTRIC PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL —" OFFICE COPY 41 0" S' t QQUnU z0Oy� Oyo r F. R 0 w U w ins F LL04 Ew ¢Ew0, u m w m H z a sic d ; O ZZ P: N = W j_ CL Uo LL U Ow � d F Z A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION&PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER - �[/] ,. J j BUILDING ADDRESS JZ OWNER' PLAN CHECK VALIDATION ' "AM OrvE Z- QTY. ELECTRIC PERMIT FEE - MEflAcro s OUTLETS -SWITCHES-RECEP 10.00/1.00 ' LIC. NO, ILIGHTING FIXTURES 10.00/1.00 ' ADDRESS Ofl's APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT - ENGINEER LIC, No, PANELS (OVER 200 AMP) 20.00 - PLAN CHECK FEE P.C. NO. SIGNS TRANS. _ 3.00' ARCH. ORENG. ohri nlierne,ZIP SPECIAL CIRCUIT S.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 APPLI DDRESS ADDRESS - MOTORS - SEE FEE SCH. SERVICE CHANGE 20,00 '/ ✓� ��, LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force and effect. Class Lin. Number SSUANCE DATE BLDG. ELECT. 'PLG. MECH. ❑ . ❑ 11License - Date Contractor ' �D BUILDING PERMIT INFORMATION VALUATION B/FT. - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License old Professions Law forthe following reason.(Sec.7031.$,Busit toconst Code: Any coup ro cons her, any strucres e p ralprior ` MISC.— REFER TO ORD PERMIT ISSUANCE ' ELEC. CONTR. - LIG NO. ELEC. - TOTALofja - Cap QTY. PLUMBING PERMIT FEE mulish improve, demolish, or repair any structure, e a si n its issuance, also pair issuance, requires the applicant for such permit to file a signet statement that he is licenses pursuant en the provisions of the Contractor's License n3 ofthe Law(ChapterProfessions Business and Pro Code) or Section is 00) exempt or that he is exempt therefrom and PERMIT TO /1 /{`/ (,(/�/V �7H.Q• liege exemption, the basis for the alleges exemption. Any applicant oto act ion malty by any applicant for ive Im rlddollars subjects the applicam tnacivil penalty of not more than five Imndred dollars ($500).): � 1, as owner of the property, or my employees with wages as t I it sole compensation, will do the work, and the structure is not STORIES TYPE CONSTR. . ' ALTER-DRAIN&VENT-WATER(EA.). 5,00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AR EA,COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS -EA.SVSTEM-1INC. 4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himaelf or through his own employees, provided that such improve- mentsarenotintended or offered for sale. If, however, the building SG. FT, FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner-- builder will have the burden orproving that he did not build or ar- GAS - EA. SV STEM OVER 4 (EA.) 2:00 BUILDING USE prove for purpose of sale.).RES ❑ I, as owner of the property, am exclusively contracting with IND CON PS Other ❑. ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. , contracts for such projects with a contractors) licensed pursuant to the Contractors License Law. Cl tum -xem mder Sec. ,BAP.C. far this reason , SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 OwnerDale 47 WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. /• WORKERS'COMPENSATION DL'CLA RAT ION WATER TREATING EQUIP.5.00 1 hereby affirm that 1 have u certificate of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified - copy thereof(Sec. 3800, Lab.CJ. Policy No. Company - ❑ Certified copy is hereby furnished. ❑ Certified copy is Bled with the city inspection division. Applicant FIRE SPRINK v❑ N❑ ENERGY T-24 v❑ No MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE, (This section need not be completed if the permit isl for one PERMIT ISSUANCE 10.00 FLOODZONE YE] N❑ A.L.U.C. V ❑ N❑ PLG. CONTH. LIC. NO. PLG TOTAL hundred dollars ($100) or less.) - - I certify that in the performance,of the work for which this per- mit is issued, I shall not employ any person in any manner anas to QTY. MECHANICAL PERMIT FEE - FEE SUMMARY BUILDING 607NOTICE become subject to the Workers' Compensation Laws of California. Date Applicant ALTER ORADD TO MECH. 5.0 0 TO APPLICANT: If, after making this Certlficale of Fx- - APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=QF.M.) 4.00 PLAN CHECK FEE emplion, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER I0,000GEM.)6.00 SEISMIC FEE CONSTRUCTION LEND] NG AGENCY 1 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. 3097, Civ.C.). - - HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Na... Lender's AddressELECTRIC HEATING UNIT (OVER 100,000 B.T.U.) 9.50 VENTILATION FAN (SINGLE) 4.00 I certify that l have read this application and slate that the above ' information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and PLUMBING BOILER-COMP(3 H.P. Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU) BEE FEE SCH. 'MECHANICAL (We) agree to save, Indemnify and keep harmless the City of MISC. - REFER TO ORD. upertino against liabilities, judgments, costs and expenses which ey in any wa accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST. TAX ran, oflhi errnit. MECH. CONT. - LIC. NO. MECH. TOTAL' TOTAL - Si afore o pelican[/Contractor le OFFICE COPY