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17086 y PUSI THIS CAHU NEAR FRUN I OF BUILDING 1,11 NII 111111 CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD 1�I\ly� PERMIT EXPIRATION .108 ADDRESS Iv f __V _ !+J. .I:vr. .. .UNIT O - -----LOTH. PERMIT EXPIRES IF WORK OIVNIN m CONT11ACTOH �u IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTIO RECORD 180 DAYS OF PERMIT ISSU NOTE: FOUNDATION ANCE OR 180 DAYS FROM LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PI IIn11I VM.IOAIINN CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE Ann MECHANICAL luno ELECTvLl nn cN ❑ ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VATUAnuN SIT MECHANICAL ELECTRICAL PEn1,11I TO FRAMING INSULATION SIM U.S IvPL CONSM W, 4101101 In s IINI 111 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE I I LOVI AI L. 1111.1 A1:II A1,1 DIAPHRAGM THE CONSTRUCTION TAX IS PAID uun ulNr,USE ROOF SHEATHING Ins IND I:uN nn u,..... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L L L ❑ .5SLSS01151'A.C1,1,NO ROUGH SAN 11 PLUMBING ELECT.ENERGY INAI:1 NU PANCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY AIC un'I act FILE N FRAMING ELECT.FINAL TEST TUNING LNG SITE NU. INSULATION PLUMBING GAS TEST GAS I'll SPIIINN 1 Nil'[;' I JA MECHANICAL NL 1 NL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El EXTERIOR SHEAR ELECTRICAL RELEASE 1 Un FIT ION Al. JC INTERIOR SHEAR FIRE DEPT. L __NL L NL SHEETROCK GRADE FEE SUMMARY EXTERIOR IATH RUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS i(,R/'TCH COAT ELECTRIC PLAN CHECK GAS F f:E NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC I__ ONEONE WORKING DAY BEFORE REOUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MI:CLIANICAL CONST.TAX -I' n TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL,POINT PEN ONLY -"'BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER SUILOING APPLICATION & PERMIT 17086 ADDRE BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWN R'S PLAN CHECK VALIDATION NAME t QTY. ELECTRIC PERMIT FEE HONE CONTRACTORS ' NAME OUTLETS-SWITCHES-PIECED 10.00/1.00 U/�"� sec No.' GJ/ZLIGHTING FIXTURES 10.00/1.00 . r-ON Ra TOR's APPLIANCES-,RESIDENTIAL 4.00 ADDRESS �/ �$N/�1 �J �• (/ AJ �PHONE6 /0 PANELS 10.00 DATE OF APPLICATION" ARCHITECT PLAN CHECK FEE P.C.NO. on PANELS (OVER 200 AMP) 20.00 ,- , ENGINEER Lie.No. SIGNS TRANS. 3.00 ARCR.OR ENGPERMIT VALIDATION .ADDRESS SPECIAL CIRCUIT 5.00 Q ZIP EMP.METER OR POLE INS. 20.00 q APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 02 LICENSED CON'I'RACfORS DECLARATION < is w I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and �A ¢ ,AA I BLDG. ELECT. PLG. MECH. r w z Professions Code, sed p .lilyense is in full forcej Z o at - License loss Lia NumM1e�� -� ❑ ❑ am H w Date C'Ontmcn mr ¢ y s r BUILDING PERMIT Eo a U OWNER-BUILDER DECLARATION INFORMATION wI hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD r w o J Law for the following reason'(Sec.7031.5•Business and Professions PERMIT ISSUANCE 10.00 VALUATION 0Z Code:Any city or county which requiresa permit to construct,alter, _ 2 ¢¢O improve,demolish,or repairany struclum,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ta m u retinues;the applicant for such permit to file a signed statement that TOTAL PERMITTO n w he is licensed pursuant to the provisions of the Contractor's License rii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE W r $the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(5500).): ❑ 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 Sx Oo Code:The Contractor's License Law does not apply m an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50,FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,Provided that such improve- himselfonotinlcnhisoroffered for oyeesarovided that such ebiddingmproe- GAS-EA.SVSTEM,-1INC.4OUTLETS 6.00 or improvement is 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 in, RES IND CO PB Omer prove for purpose of CdC.L INDUSTRIAL WASTE INTER. 30.00 � 1:1 ❑ El I,as owner of lhe.property,am exclusively contracting with licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSSPARCEL 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. ❑ I am exempt under Sec. ,B.&P.C.for thisWATER HEATER W/VENT 6.00 (rQ mason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sel6insure' ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ CCUitied t'opy is here by fumisI d. FIRESPRINK ENERGY T-24 Z Z CLC•eF(ified o/(,y�is f d x'it city inspection division. F Q Applicant -+ VMRA MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ CC W CERT�A'I'E01'EXIiMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 tr2,w FLOODZONE - A.L.U.C. LU > COMPFNSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. CL 0 (This section need not be completed if the permit is for one TOTAL -LOCD Y❑ N❑ Y ❑ N❑ =) 2 IT undyed do llars(5100)or less.) U 0 I certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL F mit is issued,I shall not employ any person in any manner so as to Ow become subject to the Worlico Compansxtioi Laws of Culitornia. BUILDING u Date Applicant ALTER OR ADD TO MECH. 5.00 } W NOTICE T'O APPLICANT: If,after making this Certificate of lix- F" 2 emptioa,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE CJ such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 - CONS'I'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE . 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. - - MICROFILM 3097,Civ.CJ. I HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name - HEATI NG UN IT(OVER 100,000 B.T.U.)8.50 Lender's Address ELECTRIC Ic'ertiy that l have read this application and state flat the above VENTILATION FAN (SINGLE) , 4.00 0 information is Correct. I agree to comply with all city and county BOILER H.P.or 100,000 B.T.U.1 6.00 PLUMBING ordinances and state laws relating to building construction, and t� above- authorize representatives of this city es enter upon the BOI LER-COMP Over 100,000 BTU)SEE FEE SCH, . MECHANICAL herebymautiorizned properly forinsp of this purposes, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 025�_� irs) liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX wayaccrue against said City in consoquence of theis permit MECH.CONT. LIC.NO. MECH.rorAL TOTAL I YtC6 Sig tureof Applicant/Contractor Data OFFICE COPY