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10086• POST THISD NEAR FRONT OF BUILDING CIT)7OF CUPERTINO Alu! INSPECTION DIVISION JOB INSPECTION RECORD �,.,� JOB ADDRESS �D�•✓'✓ �(/E�lf��!\VINIT# L T# - OWNER / CONTRACTOR PERMIT NUMBER PERMIT EXPIRA,ION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1110 DAYS of PERMIT Issu- ANCE. OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR i ECTION RECORD FOUNDATION 2-LZ'� CQ-VLS' S LY��-{C` �d fid- "�-p UFER •PREGUNITE - �,y��,(„(-�IC'p , I 1/ 3-3sd - PERMIT VALIDATION PA10 - FEB ISSUAN5E DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 3-1-j'b VTLcQ Ig PcAeuld UNDERGROUND/SLAB PLUMBING -y ELECTRICAL -MECHANICAL MECR. 0 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PoA-r--rev6 zj,�/ ro y, BUI IRMATION PERMING T I WOOD FLOOR PLUMBING .G. ,T Lr` 'F►�L.vwe. $/FT. MECHANICAL ELECTRICAL .'Am �,PERMIT <�. C.XZ4, TO FfItelo r "•I, q, -'r r-y� sroRlEs TYPE CNST . FRAMING INSULATION _ / PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCQ GROUP RES. UNITS ROOF SQFT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - - .. BUILDING USE RES IND CON PB O,hM, ❑ 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED • ROUGH ASSESS ORS PARCEL NO. PLUMBING 3 -'i -8Q GAS TEST MECHANICAL - ACT NO, PARCEL NO. . 'ELECTRICAL FINALS DATE INSP. ACC.OATE ACC. FILE NO. FRAMING - - SAN # - INSULATION PLUMBING ZONING ENG. SITE NO. trw.- 3-4-8iGAS •yL 7`• -yo kjX MECHANICALFIgE SPq INK Y ❑ N ENERGYFZ4 ` [3 N[D COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED IHEATING LATH -INTERIOR - ELECTRICALS a O �-� FLOOD ZONE .Y ❑ No A,LDC, ° ❑ NO LATH -EXTERIOR FIRE DEPT. SHEETROCK 5-y3-$ GRADE. FEE SUMMARY SHEAR INTERIOR BUILDING :p, BUILDING - - SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC - PLAN CHECK FEE - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED GAS OCCUPANCY SEISMIC FEE // ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE.FOR INSPECTION BY PHONING 252-4505, I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0 - PLEASE.GIVE JOB ADDRESS WHEN PHONING. —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC - PLUMBING MECHANICAL CETAXPLEASE IMPORTANT! READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY O Z H � y L 0. 0 UO LL U Ow i ♦- Z Z A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . {'BUILDING PROJECT I DENTI FICA APPLICATION & PE PERMIT NUMBER AADDRESS DDRESS BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 10086 ' OWNER' 'NAME ( ✓�Ql OTy- ELECTRIC PERMIT FEE PLAN CHECK VALIDATION " NAME ACTOR ` UTLETS- SWITCHES -RECEP 10.0011.00 Z11- C 4A 11 uc. NO. LIGHTING FIXTURES 10.00/1.00 . OR's ADDRESS II �(� V v6/ APPLIANCES- RESIDENTIAL 4.00 ate' 2 r NE DATE OF APPLICATION PANELS 10.00 ORRcnI ECT ENG( Llc. rvo PANELS (OVER 200 AMP) 20,00 PLAN CHECK EEP.C. NO. SIGNS TRANS. 3.00 ADDRESS ENG. It // SPECIAL CIRCUIT S,QQ PERMIT VALIDATION PaD FEB 1986 EMP. METER OR POLE INS. 20.00 APPuc NTS /`� ADDRESS j�� C/�JI1�1 2 / yF�JV MOTORS SEE FEE SCH. SERVICE CHANGE 20,00 LICENSE( CONTRACTORS DECLARATION TEMP. POLE 30.00 1 hereby affirm Ihat I am licensed uoderprovisions ofClmplot 9 /a CI (commencing with Section 7000) of Division 3 of the Business and Professions Code W my license is Nffu[If urc�,an of et. N License Class Lit. NumberN Date _�� f/ Contractor BLDG. EL L MECH. ❑ ❑ ❑ , BUILDINGPERMIT OWNER BUILDER DECLA ION 1 hereby collo that I am exempt from the Contractor's License Professions Law for the ity owingreason. (h requi3ta Business to Code: Any city or county which requirese permit to construct alter, any structure, prior lu its issuance, also improve, demolish, or for requires the applicant for such permit to file a signet statement that he is licensed pursuant to the provisions of the Contractor's License INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION �(J . SIFT. ELEC. CONTR. LIC. N0. To. TOTAL PERMIT TO i heien 3 of the (Csa and Business Business ant Professions Code) or that he Is Proco soon$ Code) Dr Seelion is exempt therefrom and DTV. PLUMBING PERMIT FEE / i�l the basis for the alleged exemption. Any violation of Section en L5 tion of by any aomIrtifor ive permit subjects the 500).)canlLou civil penalty of not more than five hundred dollars (my STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.)5.00 em): ❑ Las owner at the properly, or my employees with weas their sole compensation, will the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES, UNITS ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions (S Code: Code: The Contractor's License Law does not apply to an owner of property who buildsimproves thereon, and who does such work himself through hisis own employees, provided that such improve- mentsare renot intended oroffered for Sale. IL however, the building FIXTURES -PER TRAP 5.00 GAS-EA.SVSTEM-11NC.40UTLETS 8.00 gD, FT. FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner- builder will have the burden of proving that lie did not build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with BUILDINGUSE RES IND CON nine, ❑ ❑ ❑ - ❑ GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 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 (hereon. and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSES5uHRi PARCEL NO. contracts for such projects with a contractors) licensed pursuant to the Conimctar's License Law. ❑ I um exempt under Sec.., B.&KC, for this reason SEWER -SAN V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM 5.00 ACL. DATE ACC. FILE NO. WATER TREATING EQUIP, 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a cerlified .). copy (hereof !Sec. 3800, Lab,C1. 51A Policy No. Company ❑ Certified copy is hereby furnished. Cert ificd py f i h the city inspection Division. ph nt__J� FIRE SPRINK v❑ N❑ ENERGY T24 Y❑ N❑ MERGI REFER TO ORD. PERMIT ISSUANCE 10.00 CIiHTIFICA 'li FIiXEMPTION FROM WORKERS' C IN ATION INSURANCE alods Section need not be completed if the permit is for one FLOOD ZONE Y ❑ N❑ A. L.u.C. Y ❑ N❑ PLG. CONTR. LIC. NO. PLG, TOTAL hundred dollars is 100) or Tess.) 1 certify that in the performance of the work for which this Per- mit is issued, 1 shall not employ any person in any manner so as to OTV MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensation Laws of Calil'omin. OR ADD TO MECH. 5.00 DileApplicantALTER BUILDING NOTICE '10 APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.)' 4.00 PLAN CHECK FEE emption, you should become subject to lire Workers'Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION L17NDING AGENCY I hereby affirm that there is a construction lending agency for the perfmmance of the work for which this permit is issued (Sec. 3097, Civ.C.L EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Lender's Address - - HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that 1 have read this application and state that the ahoveVENTILATION FAN (SINGLE) 4.00 information is Correct.'I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER-CON1P(3 H.P.Of t00,000B.LU.) 6.00 hereby euthorirc representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless th City of Cu rtino against liabilities, j m stn and expert es which m i ny way rue a s s in conmque 'e of he gr li If this pe JJ �r Si t f p t/ ntrn for Dal MISC. - REFER TO ORD. CONST. TAX PER ISSUANCE 10,00 AWH. CONT. LIC. NO, MECH. TOTAL TOTAL 1 OWA OFFICE COPY