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10893T THIS CARD NEAR FRdNT Or 1pING � - CITY OF CUPERTIN� INSPECTION DIVISION "' JOB INSPECTION RECORD JOB ADDR ESS /02 QS'UNIT# LOT# • n OWNER CONTRACTOR PERMIT NUMBER Q893 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION I DATE I INSPECTOR INSPECTION RECORD FOUNDATION_Z UFER PREGUNITE P{$F✓�Ty6IDATION 'JUN, 4 - 1986 I - City Of Cupedino • ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING . ELECTRICAL MECHANICAL OLD ❑ ELECT. 1 ❑ PLG. MECN. ❑ ❑ i�� DaAOT PIOUR FLOOR UNTIL A VE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION lI7L� ~ SIFT. PLUMBING MECHANICAL y>y ELECTRICAL P RMIT TO �'Y J")/t ,G •. FRAMING INSULATION '�� % STORIES TYPE CONSTR. O M OCG GROUPRES NITS �' PLACE NO SUBFLOOfl UNTIL ABOVE HA BEEN SIGNED' ROOF SO, FT, FLOOR AREA t'tl TOTAL ACREAGE DIAPHRAGM - BUILDING USE NES,{ IND CON PB Olhe, ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEE SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING. GAS TEST _y�, rNAcr .� i PARCEL No. MECHANICAL. ELECTRICAL FINALS DATE - INSP. ACC.DATE ' ACC. FILE NO, FRAMING — _*? SAN # INSULATION PLUMBING -/ ZONING ENG, SITE NO, j- GAS FIRE SPRINK V ❑ N ❑ ENERGY T-24 Y ❑ N ❑ aA� MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 3 LATH—INTERIOR ELECTRICAL FLOODZONE Y ❑ N❑ A.L.U.C. Y ❑ N❑ LATH—EXTERIOR H-44 FIRE DEPT. SHEETROCK gZ42GRADE FEESUMMARY 12= SHEAR INTERIOR - 0-6' BUILDIN BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRICPLAN — CHECK FEE Cryl C -II� GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. /; MICROFILM AF'RANGE FOR INSPECTION BY PHONING 252.4505, E WORKING DAY BEFORE REQUIRED INSPECTION. � �IEASE z AGIVE JOB ADDRESS WHEN PHONING. = SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL CONST. TAX .. e IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL J OFFICE COPY I CITY OF CUPERTINO CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE Date .......3..-....L...(".......... . ....... 19.4iBuilding Permit No. Z.O.R9Z Tlie,Vuilding Located at ..... ...... Mer-Tkt-d ...... .................. Ownedby ....... ....... ....................................................................................................... Com leted Has Been � Com or Use As: ............... ....................................... ........................................................................ .................... ....................................... 00, ..... ............ .............. * ...... PD -7 Ui MING INSPECTOR - APPLICANT TO Fjhj, IN INFORMATION WITHIN RED LIJ&S - USE BALL POINT PEN ONLY II BUILDING PJROJ ENTI FICATION APPLIC ON & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER so.oLOTINO ADDRESS /O• !_/� C� YV t� OWNER'S NAME - PHONE ��JJF /62 TY. ELECTRIC PERMIT FEE PLAN C ATION fJ �� - y� ��Q�y LJ�%Q f�perhno C NTRACTORS .s -v NAME �_Lghv/l , �/Or/C! C,,S /' "-t V `. O LIC . No. OUTLETS - SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 r,ONTRAcroRs /.j' ZQi� SGi/G 9�JqC / ADDRESS / APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 / 0 ONE`J `�- DATE OF APPLICATION ARCHITECT �Gr/Ory // �q/ ENGINEER i%/J •, / !ilCf�Q LIC. No. 3;17/4(p PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ISIGNS TRANS. - 3.00 ARCH. OR ENG. /2y p/, CJ.'a �-Q C/ IVQ AOORFSS E3 6) SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER Ofl POLE INS. 20.00 y Fi/ O zIv rrf^^^��, l y p_/� rUp W 111 4 / APPLICANTS ADDRESS n // 1 - - '(..(l MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSL'D CON TRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businessi d PTOI'CSSIOns Code, a y license is in full forcW 1 License Cl's Lic. Number Dale Contractor_ ISSUANCE DATE B ELECT. ❑ PLG. MECH, ❑ ❑ BUILDING PERMIT r/_��� OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the followingreason.(Sec.7ires it Business and Professions Cade: Any city or county which requires a Permit to construct, nL alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License I.e. (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and INFORMATION MISC.- REFER TO ORD VALUATION $/FT. ' PERMIT ISSUANCE 10.00 ELEC, CONTR. LIC. NO. , ELEC. TOTAL P RMIT TO QTY. PLUMBING PERMIT FEE STORIES TYPE COrQN,NSaTTA. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit omjeel9 the uppreant toa Civil penalty of nol more than fisc hundred dollars ($500).1: 1 ALTER -DRAIN &VENT-WATER (EA.) 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 docs such work // FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building 1 i GAS-EA.SVSTEM-I 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 ofsale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE R IND CON PB Omer ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 ILAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not upply to an owner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I uns Cxcmpl under Sec.-, BAP.C. for this reason WATER HEATER W/VENT - 6.00 Owner,_. - _��,. //,,��_�{jppt/e IPENSA'I'ION DI CLARAT�OR7 WATER SYSTEM 5.00 CQ DA E ACC. FILE NO. WATER TREATING EQUIP, 5.00 I here affirm that l have a certificate afc.asent to self -insure, or a certifl e of Workers' Compensation I 'sara`n�, or a certifiedZONING m copy Ther ec. 3800, LQ ENG. SITE N0. Policy No, Company FIRESPRINK v ❑ N❑ ENERGYT24 v ❑ NE] ❑ Certified Copy is hereby furnished. ❑ Certified copyi filed with the city inspection Co.divisi Applicant Ijw - f �^- - MISC. - REFER TO ORD. CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U,C. PLG. CONTR. LIC. NO. PLG TOTAL COMP17NSATION INSURANCE (This section need not be completed if the permit is for one V❑ NE] Y❑ N❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 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 BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation 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 10,000CF.M.) 4.00 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 07 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending 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 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address I certify that 1 have read this application and stale that the above information is correct. I agree to comply with all city and county Ordinances and slate laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Ove, 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 [o sav indemnify and keep harmless the City of Cupertino against 1' Rios, judgments, costs and expenses which may in any way e a at 'd City in consequence of the granting of this p 1 ...fff 3I /,/n CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ✓ / Signature o pp Icanl on rac o Dale OFFICE COPY