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17274yr, POST THIS CARD NEAR,FRONT OF BUILDING, PERMIT NUMBER ' CITY OF CUPERTINO ' 17"4- . INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION A JOB ADDRESS __ l L/ V— VL UNIT# _LOT# �� PERMIT EXPIRES IF WORK OWNER S D4, CONTRACTOR 'e IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU OR 180 DAYS FROM INSPECTION I DATE I INSPECTOR INSPECTION IRECORID FOUNDATION. -ANCE NOTE: ` ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. UFER PREGUNITE , PERMIT VALIDATION CUPERTINO STANDARDS.. - f— l�v{�T tJtL i ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED W UNDERGROUND/SLAB PLUMBING ..jq ELECTRICAL MECHANICAL BLDG. ELECT PLG. MECR ® 1 ❑ - ❑ •! DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. ! PLUMBING flr ✓yCOG-v MECHANICAL ELECTRICAL - PEVE/HM�IT rlo/�` FRAMING INSULATION - TORIES TYPE CONSTR. - OCC GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED ROOF I NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so, FT FLOOR AREA 1oTAL AweACE - DIAPHRAGM ROOF SHEATHING BUILDING USE HES IND CON PB 011111 ❑ E APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' 'ROUGH SAN.p ASSESS0 PARCEL NO •- - - PLUMBING ELECT. ENERGY TUBS'& SHOWER PAN PLUMBING ENERGY TRACT NO '• PARCEL NO.: " MECHANICAL . MECH..ENERGY - ELECTRICAL BUILDING ENERGY ACC.DATE ACC. FILE NO FRAMING ' ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST - GAS ` MECHANICAL FIRE SPRINK v. N� El ENERGY T 24 v N� COVER NO WORK UNTIL ABOVE'NAS BEEN SIGNED HEATING EXTERIOR SHEAR ' ELECTRICAL RELEASE F LOOD ZONE - No A.LUC. Y L NE) INT,ERIOR'SHEAR � FIRE DEPT. SHEETROCK", " GRADE- FEESUMMARY EXTERIOR LATH '•` BUILDING 2<Fel BUILDING PLAN CHECK ,INTERIOR LATH' ' TEMPORARY APPROVALS SCRATCH COAT ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , OCCUPANCYOF BUILDING IS NOT PERMITTED UNTI L BU I LONG FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC. Ilia ' w•' BEFORE REQUIRED PLUMBING .G. F ONE WORKING DAY INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX IMPORTANT! TOTAL r� PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.! 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 +�� 17274 gU,Lp^•.a� A. O M/«filEJ ZA-N� OWNER'S "nMIa I, - PHONE , OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CID _ DATE OF APPLICATION CONTRACTORS NAME f.-/��'-'Y'•e N�%1�l� sec. No.�Q�rC 7" OUTLETS - SWITCHES -RECEP 10.00/1.00 a LIGHTING FIXTURES, 10.00/1.00 CONTRACTORS '- ADDD�RL/SSS �r''��y p y�`' ,/T6 . ✓vAaY .00. PHONe 6-/ZZ�{ PPLIANCES'-'RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR - I ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ... ISIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. - 20.00 zip �7 p• APPLICANT'S- AODRE5s' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 V + ' LICENSED CONTRACTORS DECLARATION '� I` FEB 2BLDG. I hereby affirm that I am licensed under provisions of Chapter 9, of (commencing with Section, 7000) of Division 3 Ilse Busine sand Professions Cods nCl is in full (or 11 Ifo 1 C Lic. Number 4 , Date GOntDECL ISSUANCE DATE ELECT. PLG. I MECH. El ❑ ci� at ixnweaiti BUILDING PERMIT INFORMATION ' OWNER-BUILUIiR DECLARATION R I hereby cthe ollo That Ing so exempt from the Contractor's License ycitllor countywhin. Sec. 703ta permit to and Professions Law forAnyor rep which structur e permit to construct, alter, Cope: e, dem y demolish, improve, demolish, or repair any permit r toff prior to its iateme t, also reis tic the dp ursua t t ouch roviito file a signed actor's i that provisions of the )oflAvisi s License he is (Chapter 9 (co of to (coiremmencing oof the Business d Professions Business and Professions Cole) or That he is exempt therefrom and de) or Section is exempt therefrom MY�Y� MISC. - REFER TO ORD PERMIT ISSUANCE - 10.00 A VALUATION S/FT. ELEC. CONTE. LIC. N0. ELEC. TOTAL �D DTV. PLUMBING PERMIT FEE PERMIT BILD TQ, nA //`(-I1/,y/\VI) I A STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.$ by any applicant for a permit subjects the applicant to a civil Penally of not more than five hundred dollars (8500).): ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property or my employees with wages as chair sole compensation, will do the work, and the structure is not intended or offered for sale (See. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 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- mentsarenotintendedoroffered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -11 NC.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 it,.. - prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with .. GAS - EASYSTEM -OVER 4 (EA) 200 BUILDING USE RES IND CON PB OrM1ar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. -. 30.00 licensed contractors to construct the project (Sec. 7044, Rosiness and Professions CoJe'. 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 (EA.) 1.00 gSSESSORS PARCEL NO. ' contracts for such projects with :I contractor(s) licensed pursuant to tiro Contractor's License Law. SEWER-SANITAR V -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ I ons exempt. under Sea ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner - Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORK 17RS'COMPENSATION DECLARATION _ ehy a(flrm that I have a certificate o(consent to self.insure. tr a car 'ca[e M Workers' Compensation Insurance, or a eerlified copy 11 (Sec. 3804 Lab.C.). ZONING - ENG. SITE NO. - I'ol'c mpany ertif Co hereby furnishe Certi is witl - action division. pplica - FIRE SPRINK Y ❑ N❑ ENERGY TZO Y ❑ N❑ MISC. - REFER TO ORD. CERTIF GATE E Y NTROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.u.C. PLG. CONTE. -LIC. NO. PLG. TOTAL COA1P1: ATION INS URANCI'. (This section It be completed if the permit Is for one Y ❑ N❑ Y ❑ N❑ hundred dollars ( 00) or J ' I certify that i the Perrot ance o c work for which 0 is per. mil is issued, 1 al not empl a rs .41 ma as to been a Workers' ens Rama. Dale ppllcaALTER NOT I i T At PL1 . If, ler akinµ s Certificate of Ex QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING N.. OR ADD TO MECH. 5.00 APPLIANCE 5.00 - PLAN CHECK FEE •-� emption, you should become so 'ec orkers'Compensation Provisions of the Labor Code, to, most forthwith comply with such provisions or this permit sit' I be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 AIR HANDLING UNIT (OVER 10pODC.FM.) 6.00 SEISMIC FEE -CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction loading agency for the performance of the work for which this permit is issued (Sec. 3097„Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM .� HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UN IT 100,000 B.T.U.)9.50 ELECTRIC rr9� Lender's Address I certify that I have read this application and stale Ihat the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city a,I coo ty ordinances and state laws relating to huilding'constructinn;-and PLUMBING BOILER-COMP(3H.P.or100,000B.T.U.) .6.00 BOILER -COMP IOver 100,000 BTU) SEE FEE SCH, MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of upertino agar st liabilities, judgments, acts and expenses which n yin an y accrue against said City in consequence of the CONST. TAX - .� PERMIT ISSUANCE 10.00 r is potmit /7 �. MECH. CONT. - LIC. NO. MECH. TOTAL TOTAL /YUr if Ign a of Apj l antra or Date OFFICE COPY yr, POST THIS CARD NEAR,FRONT OF BUILDING, PERMIT NUMBER ' CITY OF CUPERTINO ' 17"4- . INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION A JOB ADDRESS __ l L/ V— VL UNIT# _LOT# �� PERMIT EXPIRES IF WORK OWNER S D4, CONTRACTOR 'e IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU OR 180 DAYS FROM INSPECTION I DATE I INSPECTOR INSPECTION IRECORID FOUNDATION. -ANCE NOTE: ` ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. UFER PREGUNITE , PERMIT VALIDATION CUPERTINO STANDARDS.. - f— l�v{�T tJtL i ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED W UNDERGROUND/SLAB PLUMBING ..jq ELECTRICAL MECHANICAL BLDG. ELECT PLG. MECR ® 1 ❑ - ❑ •! DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. ! PLUMBING flr ✓yCOG-v MECHANICAL ELECTRICAL - PEVE/HM�IT rlo/�` FRAMING INSULATION - TORIES TYPE CONSTR. - OCC GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL'ABOVE HAS BEEN SIGNED ROOF I NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so, FT FLOOR AREA 1oTAL AweACE - DIAPHRAGM ROOF SHEATHING BUILDING USE HES IND CON PB 011111 ❑ E APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' 'ROUGH SAN.p ASSESS0 PARCEL NO •- - - PLUMBING ELECT. ENERGY TUBS'& SHOWER PAN PLUMBING ENERGY TRACT NO '• PARCEL NO.: " MECHANICAL . MECH..ENERGY - ELECTRICAL BUILDING ENERGY ACC.DATE ACC. FILE NO FRAMING ' ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST - GAS ` MECHANICAL FIRE SPRINK v. N� El ENERGY T 24 v N� COVER NO WORK UNTIL ABOVE'NAS BEEN SIGNED HEATING EXTERIOR SHEAR ' ELECTRICAL RELEASE F LOOD ZONE - No A.LUC. Y L NE) INT,ERIOR'SHEAR � FIRE DEPT. SHEETROCK", " GRADE- FEESUMMARY EXTERIOR LATH '•` BUILDING 2<Fel BUILDING PLAN CHECK ,INTERIOR LATH' ' TEMPORARY APPROVALS SCRATCH COAT ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , OCCUPANCYOF BUILDING IS NOT PERMITTED UNTI L BU I LONG FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC. Ilia ' w•' BEFORE REQUIRED PLUMBING .G. F ONE WORKING DAY INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX IMPORTANT! TOTAL r� PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.! 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 +�� 17274 gU,Lp^•.a� A. O M/«filEJ ZA-N� OWNER'S "nMIa I, - PHONE , OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CID _ DATE OF APPLICATION CONTRACTORS NAME f.-/��'-'Y'•e N�%1�l� sec. No.�Q�rC 7" OUTLETS - SWITCHES -RECEP 10.00/1.00 a LIGHTING FIXTURES, 10.00/1.00 CONTRACTORS '- ADDD�RL/SSS �r''��y p y�`' ,/T6 . ✓vAaY .00. PHONe 6-/ZZ�{ PPLIANCES'-'RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR - I ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ... ISIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. - 20.00 zip �7 p• APPLICANT'S- AODRE5s' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 V + ' LICENSED CONTRACTORS DECLARATION '� I` FEB 2BLDG. I hereby affirm that I am licensed under provisions of Chapter 9, of (commencing with Section, 7000) of Division 3 Ilse Busine sand Professions Cods nCl is in full (or 11 Ifo 1 C Lic. Number 4 , Date GOntDECL ISSUANCE DATE ELECT. PLG. I MECH. El ❑ ci� at ixnweaiti BUILDING PERMIT INFORMATION ' OWNER-BUILUIiR DECLARATION R I hereby cthe ollo That Ing so exempt from the Contractor's License ycitllor countywhin. Sec. 703ta permit to and Professions Law forAnyor rep which structur e permit to construct, alter, Cope: e, dem y demolish, improve, demolish, or repair any permit r toff prior to its iateme t, also reis tic the dp ursua t t ouch roviito file a signed actor's i that provisions of the )oflAvisi s License he is (Chapter 9 (co of to (coiremmencing oof the Business d Professions Business and Professions Cole) or That he is exempt therefrom and de) or Section is exempt therefrom MY�Y� MISC. - REFER TO ORD PERMIT ISSUANCE - 10.00 A VALUATION S/FT. ELEC. CONTE. LIC. N0. ELEC. TOTAL �D DTV. PLUMBING PERMIT FEE PERMIT BILD TQ, nA //`(-I1/,y/\VI) I A STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.$ by any applicant for a permit subjects the applicant to a civil Penally of not more than five hundred dollars (8500).): ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the property or my employees with wages as chair sole compensation, will do the work, and the structure is not intended or offered for sale (See. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4,00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 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- mentsarenotintendedoroffered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -11 NC.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 it,.. - prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with .. GAS - EASYSTEM -OVER 4 (EA) 200 BUILDING USE RES IND CON PB OrM1ar ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. -. 30.00 licensed contractors to construct the project (Sec. 7044, Rosiness and Professions CoJe'. 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 (EA.) 1.00 gSSESSORS PARCEL NO. ' contracts for such projects with :I contractor(s) licensed pursuant to tiro Contractor's License Law. SEWER-SANITAR V -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. ❑ I ons exempt. under Sea ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner - Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORK 17RS'COMPENSATION DECLARATION _ ehy a(flrm that I have a certificate o(consent to self.insure. tr a car 'ca[e M Workers' Compensation Insurance, or a eerlified copy 11 (Sec. 3804 Lab.C.). ZONING - ENG. SITE NO. - I'ol'c mpany ertif Co hereby furnishe Certi is witl - action division. pplica - FIRE SPRINK Y ❑ N❑ ENERGY TZO Y ❑ N❑ MISC. - REFER TO ORD. CERTIF GATE E Y NTROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.u.C. PLG. CONTE. -LIC. NO. PLG. TOTAL COA1P1: ATION INS URANCI'. (This section It be completed if the permit Is for one Y ❑ N❑ Y ❑ N❑ hundred dollars ( 00) or J ' I certify that i the Perrot ance o c work for which 0 is per. mil is issued, 1 al not empl a rs .41 ma as to been a Workers' ens Rama. Dale ppllcaALTER NOT I i T At PL1 . If, ler akinµ s Certificate of Ex QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING N.. OR ADD TO MECH. 5.00 APPLIANCE 5.00 - PLAN CHECK FEE •-� emption, you should become so 'ec orkers'Compensation Provisions of the Labor Code, to, most forthwith comply with such provisions or this permit sit' I be deemed revoked. AIR HANDLING UNIT (TO 10MC.F.M.) 4.00 AIR HANDLING UNIT (OVER 10pODC.FM.) 6.00 SEISMIC FEE -CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction loading agency for the performance of the work for which this permit is issued (Sec. 3097„Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM .� HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UN IT 100,000 B.T.U.)9.50 ELECTRIC rr9� Lender's Address I certify that I have read this application and stale Ihat the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city a,I coo ty ordinances and state laws relating to huilding'constructinn;-and PLUMBING BOILER-COMP(3H.P.or100,000B.T.U.) .6.00 BOILER -COMP IOver 100,000 BTU) SEE FEE SCH, MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of upertino agar st liabilities, judgments, acts and expenses which n yin an y accrue against said City in consequence of the CONST. TAX - .� PERMIT ISSUANCE 10.00 r is potmit /7 �. MECH. CONT. - LIC. NO. MECH. TOTAL TOTAL /YUr if Ign a of Apj l antra or Date OFFICE COPY