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15177I. . POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO -15177 INSPECTION DIVISION - JOB INSPECTION RECORD' ��75' ��^/L� - PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF'WORK OWNER'CONTRACTOR G/1-r-�=r - IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS`.FROM N IN DATE INSPECTOR PECTI - INSPECTION RECORD FOUNDATION .. NOTE: ALL,GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITHTHE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION CUPERTINO STANDARDS: - '' I" ,f �` ' • °'-�'� -- ` ,- ? �- f / '� 4 ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .;UNDERGROUND / SLAB ' PLUMBING ELECTRICAL MECHANICAL - BLDG ELEcr. vlc. M77EE�C-��. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING • PERMIT INFORMATION ' WOOD FLOOR VALUATION T. - PLUMBING - MECHANICAL ELECTRICAL � ' PERMIT TO -�•I/7t Cil FRAMING STORIES TYPE CONSTR, - INSULATION.. - UCC. GROUP - RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' - ' ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE' THE CONSTRUCTION TAX IS PAID SO. FTaPLOCR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE ROOF SHEATHING RES- IND CON PB Onna ❑. 11 1:10 13 - - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ' ASSESSORS FARCE L NO, PLUMBING ELECT. ENERGY - TUBS B SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY DATE - ZONING - . NO. - ALL, FILE ' - ENG. SRTE NO. - FRAMING - ELECT. FINAL TEST_ INSULATION - � - PLUMBING GAS TEST GAS - FIRESPRINK Y NE. .ENERGY T 24 Y U Ni - MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING jIC •_� EXTERIOR' SHEAR. ELECTRICALRELEASE .-FLOOD ZONE Y ❑ N❑ aL,u c. Y (] N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR, LATH BUILDING e ' BUILDING iNTERIOR'LATH TEMPORARY APPROVALS SCRATCH COAT - ELECTRIC PLAN CHECK ' FEE GAS • . NO TAPE OR PLASTER UNTIL ABOVE -H,AS BEEN,SIGNED OCCUPANCY - .• SEISMIC FEE ' OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC U-1 ONE WORKING DAY BEFORE REQUIRED INSPECTION. -I PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL ) Z ' —SEE PERMIT FOR EXPIRATION DATE'— . CONST. rax IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION: OFFICE COPY O ZZ I"'N CC UJ j— ao 0 Z 00 UL U Oa h = Ab APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY - lTV?LDING'PROJECT IDENTIFICATION ABUILDING APPLICATION & PERMIT BUILDING - ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER } 5 5177 ADDRESS to6zs D�Arz� g� "NEP TO rvnmE )�9 F0.PtA,p 4.w d e. e ) Nelson, �S-%64 - TV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION " CONTRACTORS NAME R P L.Ci� LIC, Nodyfllll UTLETS-SWITCHES -RECEP 10.00/1.00 ILIGHTING FIXTURES 10.00/1.00 AODIR�EssroR AveU, A&I pA�7 Z AvRdNe 4q-6 IVC APPLIANCES - RESIDENTIAL 4.00 ' PANELS 10.00 ARCHITECT OR ENGINEER LIC. No, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARC"OR ENG. ADDRESS ' ZIP . SPECIAL CIRCUIT 500 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 AS ADtDREasS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ✓ //�� s _ LICENSED CON TRACTORS DECLARATION I hereby affirm that I am licensed underprovisionsof ChapleT9 (commencing with Section 7000) of Division 3 of the Business and Professions :pr�l 'cense is in full I d.4ire1. Licenw C s V Lic. Numhe /L ISSUANCE DATE SLOG. ELECT. ❑ PLG. MEECH. ❑ - Dale eel Contmcto� OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Businessand Professions Code. Anycityorcounty which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement (hat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(Commancing with Section 7000) of Division 3 oflhe Business and Professions Code) or that he is exempt therefrom and ' BUILDING PERMIT . INFORMATION MISC. — REFER TO PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL LUATION $/FT; PERMIT T AA /-'' ' DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. (he basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, 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 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- memsamnot intended oroffered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 or improvement is Sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with . .. GAS - EASYSTEM -OVER 4 (EA.) 200 "BUILDING USE RES Irv0 CON PB OIM1er ❑. ❑ ❑ ❑ ❑ 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 ASSESSORSPARCEL NO. contracts for such projects with a cnntractortsl licensed pursuant In 01e Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. .tl.&P.C. forthls reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ALL. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSA'I ION DECLARATION 1 hereby aftlrm that I have u certificate ofcamwnl to set Fissure' Or a certificate of Workers' Compensation Insurance, oT a certified copy then ( Lab.C.). C ZONING ENG. SITE NO. C B Policy No11-i Snipany ..l..H ❑ Certified copy is hereby fornislilhi. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑. N ❑ ENERGY TQ4. Y ❑ N❑ MISC- REFER TO ORD. CERTIFICATE 01' EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 .FLOODZONE A.L.U.C. PLG. CONTR. LIC. NO. I.G.P TOTAL COMPENSATION INSURANCE: (This section need not be completed if the permit is for nue Y ❑ N ❑ Y ❑ N❑ hundred dollars f$100) or less.) I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, af�ler making this Certificate of Ex- emption, you should become subject to the workers Compaltsation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10p00 C.F.M.)S:OB — SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby .(T m that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance of the work for which this permit is issued (Sec. MICROFILM " HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Addrms I certify that I have read this application and state Ili al the above information is correct. I agree to comply with all city and County ordinances and state laws relating to building crustruction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purpous. VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 BOILER -COMP IOver 100,000 BTU) SEE FEE SCH. MECHANICAL 9 a3 MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep hatless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE A0100 ' ranting of this permit, MECH. CONT. LIC. NO. MECH. TOTAL 6-0 TOTAL Signature of Applicant/Contractor Date OFFICE COPY GAFFIG IN COMPANY Heating . Air Conditioning . Sheet Metal I Maintenance Contracts 1217 S. Railroad Ave. San Mateo, Ca. 94402 Floyd Boyer 574-5740