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16613t Z` ®r POSTTH IS CARD NEAR FRONT OF BU I, LDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS �Z�9S �S'%C—Yc%x/�f l���K ^� ✓L� UNIT# _ LOT# OWNER WOQ•7' fr Zo /C.E1L� TRACTOR-7Z�, eRmlr NumBER f 16613 PERMIT EXPIRATION pERM1T EXPIRES IF.WORK IS NOT STARTED: WITHIN IOU DAYS OF PERMIT ISSU-' ANCE OR 180 DAY -.FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. UFER PREGUNITE -PIi 11 FnI vAI.i OAnom , ISSUANCE DATE -BLDG. PLECT Plc. mECR. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 0/0-L•t/ _ g�r' UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDAE ~Bt11JpgMATIONIT AWATION $/FT. 0 WOOD FLOOR PLUMBING � �' C`` MECHANICAL, ELECTRICAL - Ell I TD _ LG FRAMING INSULATION - STORIES iYPECONSTR 1 9PL�'QCE4NOjSU,'8FLOOR UNTIL ABOVE HAS BEEN SIGNED OCC GROUP RES UNITS ROOF NOTE: NO FINAL INSP, SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID � � SO, FT,FLOOR RHEA TOTAL ACREAGE FDIAPHRAGM ROOF SHEATHING � e W CUING u5[ RES IND mN PB on„•, 1 1:1 I] ❑ ❑ ❑ u APPLY NO ROOFING UNTIL ABOVE HAS.BEEN SIGNED., FINALS DATE INSP. ' ROUGH SAN.N ASSE$SORS PARCEL NO. I PLUMBING ELECT. ENERGY. TUBS 8 SHOWER PAN. PLUMBING ENERGY iHACI NO PARCEL NO ' MECHANICAL - MECH. ENERGY ELECTRICAL BUILDING ENERGY ' ACC. DATE ACL FILE NO FRAMING ELECT. FINAL TEST -INSULATION PLUMBING 2 ZONING ENG. SITE NO. GAS TEST GAS MECHANICAL '+' FIRE SPRINK Y "� ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE 7 i ll WNE Y ❑ Nol A.LU'C. 10 N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE • ”' GAS 4NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, �'ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0'-0 PLEASE, GIVE JOB ADDRESS WHEN PHONING., ' Z -MECHANICAL —,SEE PERMIT FOR EXPIRATION DATE ELECTRIC PIviBING d� i coNsr. rax IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r "- Ceti F00 ar Q y OXJ o V F j ¢ x 2 J a OiD w ; as F u 0 4 J s- 4 E 0 $u a w w r z < Fx0 I a rem, �7 'a BUILDING PROJECT -IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER ". .':. 1661 I BUILDING U64 ✓5 /��� pp :ViA/1 p� r OWNER'S - VbJZr jjue1r0AJ ' QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION v PHONE , - DATE OF APPLICATION r CONTRACTOR'S uc. No.�/ Q3 OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 - CONTRACTOR'S �AAD(DRIESSS (I / j� /f /r 1p� ' (O/"r/:(Ix /LUPI F` PHONE hep .�/9 APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT oR ENGINEER1. uc.No.' , PANELS (OVER 200 AMP). 20.00 PLAN CHECK FEE P.C. N0. ' SIGNS TRANS. 3.00 -ADOREOS ENG. SPECIALCIRCUIT 5.66 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP APvucarvrs' ADDRESS - MOTORS SEE FEE SERVICE CHANGE 20.000.00 V,• -A"//. y LICENSED CONTRACTORS DECLARATION I hereby affirm that'1 ren licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect License 'Lic. Nlimhe JI - - CBS ANCE DATE BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ I)atejOr/'_e � Contractor, BUILDING PERMIT INFORMATIONLaw OWNER -BUILDER DECLARATION / I hereby affirm that I am exempt from etre Contractor's License Code inycitytic or countyw hi (Sec. ]Orel S,Busin town Professions Code: Any city or roanty which requirese permit to construct, _ - D MISC. REFER TO OR PERMIT ISSUANCE 10.00 VALUATION S/FT. ELEC. CONTR. LIC, NO. ELEC. TOT- improve, demolish', or repair any structure, prior to its issuance, also also requires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencingwith Section 7000) of Division 3 ofthe Business and Professions Cade) or that he is exempt therefrom and ' PERMIT TO ^ ' Q V. PLUMBING PERMIT the basis for the alleged exemption. Any violation of Sect ion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dol lats($ 500).): STORIES TYPE CONSTR. -gLTER-DRAIN&VENT-WATER 0 •n A ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not51 BACK FLOWPROTECT. DEVICE 4.0 C 'OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -11 NC. 4 OUTLETS 6.00 properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- nientsarenotintendedoroReredhusale. IL however; the building so. FT. FLOOR AREA TOTAL ACREAGE Or Improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not buil) or ire- prove for purpose of sale.).RES ❑ I, as owner oPthe property, and exclusively contracting with - . -.. GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE IND CON PB Other - 11 INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, BusinessLAWN and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who SPRINKLERS - 1 INC 5 V.B. - 600 . LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL contracts I'orsuch projects with a conlractur(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. li,&P.C. fur this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL No. WATER HEATER W/VENT 6.00 Owner - Date WATER SYSTEM 5.00 pZ ACC. GATE ACC. FILE NO. .. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certdicate of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified cPoliopy thereof ereabLof +4Y/✓T'-�- `❑ Certified copy is hereby furnished. ys. Cetlitf�ie,d��c��opyy is f3�i wilt the cit itpetition is n. Applicant.plz(tG.i}:_ - FIRE SPRINK y[] N ENERGY T;24 Y[] NEI MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' ' . COMPIINSATION INSURANCE (This Section need not he completed if the Permit is I'or one PERMIT ISSUANCE *e:1i0 /p1 - FLOOD ZONE Y C IN A.L.U.C. Y [:]N PLG. CONTR. LIC. No. - PLG, TOTAL hundred dollars (S 100) or IcssJ 1 certify that in the performance of the work for which this per- mil is issued, I shall not unlploy any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensat inn Laws of California. 'ALTER OR ADD TO MECH. 5.00 Date Applicant BUILDING NOTICE TO APPLICAN11 If, after ... king this Certificate of Ex- APPLIANCE 5.00 PLAN CHECK FEE emption, you should beco re Subject to the Workers' Compensation provisions of fire Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10MC.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I 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 ITO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATING UNIT (OVER 100,000 B.T.U.) ELECTRIC I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and aerebybove- authorize representatives moves of this city to enter upon the above-mentioned property for insp of this purposes. VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER-OOMP(0 H.P.OF 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEESCH. MECHANICAL to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. 7(We)-agree upertino against liabilities, judgments, costa and expenses which may in any way accrue against said C'ly in consequence of the m 'ng oft petmif PERMIT ISSUANCE 10.00 CONST-. TAX MECH.CONT. LIC. NO. MECH. TOTAL TOTAL Signature of Applicant /Contractor Date OFFICE COPY OFFICE COPY `. POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS .2 09S UNITfk _LOT tt — rnAcron 0-1. 16613 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: LIFER ALL GRADING AND DRAINAGE SHA.L BE INSTALLED TO COMPLY WITH THE APPROVED Pt ANS AND CITY OF PRE GUN I TE f.UPERTINO STANDARDS. GARAGE SLABS vI ,IE,II vw, „All r, ISSNANf! „PII POUR NO CONCRETE UNTIL ABOV�HAS 'v ' j ' ""y" UNDERGROUND/SLAB / -a PLUMBING ELECTRICAL MECHANICAL incl .r ElING vu• —• hLJ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Ulr W000 FLOOR �p BtTl�YppMAT1pN'T .AwnnuN s!! I PLUMBING MECHANICAL vu,enl ru L�(r ELECTRICAL FRAMING ;Homs rn•, cuh•,I•• INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .A.. onuw• nls uwl . ROOF NOTE' NO FINAL INSP. SHALL 8E MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING HIAf UINL u5f 1,15 INU LUN Yfl APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS GATE INSP. Assl ssuNs vANu, n.. ROUGH SAN.p PLUMBING ELECT. ENERGY TUBS d SHOWER PAN PLUMBING ENERGY MECHANICAL MECH. ENERGY A— UAtf All flLl -.• ELECTRICAL BUILDING ENERGY FRAMING ELECT. FINAL TEST IUhlhli ENG slif NU INSULATION PLUMBING GAS TEST GAS ,IRE SV,IINR NC] fNL,IGv 1 N , o NO MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , wuu nm! NC:] AE N� . ❑ No EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS PLAN CHECK F E E SCRATCH COAT ELECTRIC GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — TOTAL � i ELECTRIC PLunnswG 0-a MECHANICAL coNST.Tnx IMPORTANT! 6• •� I � i?Li PLEASE READ REVERSE SIDE BEFORE At u OFFICE COPY CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USL HALL POINT PLN (.INLY BUILDINOPROJECT IDENTIFICATION Pf RMIT NUMBEN APPLICATION &PERMIT .DrLDhNG .DOHrga -v BJ 7v BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 16613 s 14 a.NER' PLAN CHECK VALIDATION J '` "M"f�hlN�'r•0� V OTV. ELECTRIC PERMIT FEE `„� UTLETS-SWITCHES-RECEP 10.00/1.00 c,NTNwcTONs -BXFACIff AQ 60Nwu{ L,..j7/J,03 LIG HTING FIXTURES 10.00/1.00 eow-ACTUHs IAPPLIANCES. RESIDENTIAL 4.00 Auwfrs! Nl rj 35,70limiw4VrRC PANELS 10.60 I GATE OFIAPLICATION CH"ECT PANELS (OVER 200 AMP) 20.00 Pum NCHECK E .C. NO iwGinern LIC ND SIGNS TRANS. 3.00 t An.H LNING.SPECIAL wDw Eb! CIRCUIT 5.66 { PERMIT VALIDATION to EMP. METER OR POLE INS. 20.00 ' MOTORS SEE FEE SCH. / APPLICANT It woonrga .. SERVICE CHANGE 20.60 I P"•' (Fou .¢i 9 � � 11 �3/ Pd�y LICENSED CONTRACTORS DECLARATION i i ih 1 batch, aff thin I am lictnsd under Pruvisiom of ChaPler 9 ISS ANCE DATE MECH IcommeM'Ina wtlh Seclwn 7000) u( Diri+lon J of the Budneu and BLDG. ELECT. PLG. a Nofeviom Cute. uhJ my Ikenw u m full furor• and c(f.e.cl�1 Ltc. Number j.Pa a-_� ❑ ❑ ❑ 4 r Dale Co. ,�tl�/M� - BUILDING PERMIT i Y ¢ ¢ e � OWNER-BUILDER DECLARATION INFORMATION REFER TO ORD W1 ie Comrr. LkenM hereby affirm that I am '...PI from twm MISC. - VALUATION SIF T. lop o Law for the following rnwn.(Sec. 7031.1. Busmef.and Professions PERMIT ISSUANCE 10.00 Cafe: Anycilyoscuunty which rc9uitoapennu wcomtrucLaller, in "wan., ELEC. CONTN. LIC. NO ELIC. ¢ < O y O imOrure, damulish, ,r repair any atrwwrc. rylor alw 4.D the applicant fur Such permit to Idea wgned'llitement that TOTA PERMIT TO LL x winhe w blamed Donlo-I to the pr-is of lite Contractor'. Ltnv u c-1. Section 70001,1Uiriuun3uf the �fy ` Law (Chapter 9 lcummencina with Eho ell and Pro(euiuns Code) or that he n e.enhrl metefrwn and ate, Oi�Y. PLUMBING PERMIT ¢ 2 the bans for the alleged e.emplwn. Any -Ulwn of Section 7U31.3 by tete •pph,a31.-0 penalty STORIES TYPE CONSIH any appficam mr. permd..boll, w not more than fire hundred Johan (S300) ) ALTER-DRAIN &VENT•WATER E 0 �O ❑ 1, a. owner of the rr,reny, w my empl.y.. with wages a+ BACK F LOW PROTECT. OEV ICE 4.0 C OCC, GROUP RES. UNITS Iheu Dale contp n lion, will Jo the work. and the alum n tial intended or ot(sred for ole ISec. 7044. Bmmcsf and Yrotevium DRAINS•FLOOR. ROOF. AREA& COND '\i$(1 - Code: The Co u-Hu i L-ri. Law don not apply to an owner u1 Property who builds or imp,.,. the..., and who doc,oh work FIXTURES• PER TRAP 5.00 SO.FT.FLOORAREA TOTALACHEAGL himself or through boriam.mPkyeea. Provided Out--, intvm.e GAS-EA.SYSTEM-11NC.40UTLETS 8.00 . If. huwer. the b..g mcnts are not tntendcd or offered rw ukndJ or provmncot i+ will wmrm one yen of completion, me owner GAS • EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE budder will have the burden of pronng that he did not budJ or on: prove for -I- of gale.). RES IND CON PB 0' . INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ Cl ❑ ❑ .I a with ❑ 1, of owner of the property, am culudvely mm I-med mmmetor+ to comirwec. l the piom,l (S7044. Bloineu LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 A---SSORS PARCEL NO. and Prufe+Non. Code. The C'un,ractw i Locn. Law d.,..l apply to an owner or p__"' wlw bodes w mipm, n 11mmon. and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 mntn.0 far swh propel.. with a conlnclunal hcenfed purwanl SEWER-SANITARY-STORM EA. 20017/10.00 TRACT NO. PARCEL NO. the ComrwtoA Lkanw Law. ❑ lama.rmptunda Sec. .HkP.c.for thro is -i'm WATER HEATER W/VENT 6.00 WATER SYSTEM 5.00 oZ ACC.OATE ACC. FILE NO Owwr Date WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 l hereby affirm mal I have acelttf atentmnwnl I. self-inwre, ZONING ENG, SITE NO. •7 Da cr,trfic.lI of Worken' Comperlvtlun Insurance. ter a c.I,fkd copy thereof JMW, Lei (.1. FQ{t�1JOA�% Policy No.IA�_;oRr//a{.j1J�FFxa� Q ❑ Certll ped copy H hereby (urmdwJ. FIRE SPRINK ENERGY T-24 Z 2 �('11.2d copy rap Dail me dty irrrection, a ADDlicant.lY XJaa�a./., MISC.- REFER TO ORD. r❑ NO, r❑ N❑ p o - -A.� CERTIFICATE OF EXEMPTION FROM WORKERS' 2 N-/ PERMIT ISSUANCE 1A:00 01 FLOOO ZONE A.L.U.C. LLIa COMPENSATION INSURANCE PLG. CONTH. LIC. No. PLG. ra v r ❑ N❑ r ❑ N❑ TOTAL 0 :3 2 U O (This feclion need not he completed if lite permit h for one hundred Julian lfl Wlor kv.l 1 gena, that I. me pofornhanc. of the work for whi.h it per. _ - -. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL I- colt a owed. 1 man not employ any wrwn many manner w a. 1, - U O became wb)ccl lir me N'm kcri Cmnpenut wit L--f CAI.­.. bate App o-I ALTER OR ADO TO MEC... 6.00 ALTER i NOTICE TO APPLICANT: If, after making 11,11 Cerlifkale of E.- empt... you Hmidd became wb3.0 to the Worke Compen.I.o APPLIANCE 5.00 PLAN CHECK } w ? prorifi,nf of the Labor Code, you m.I forthwith comply with FEE 4.00 U loch provis ons or ma permit +hall tr deemed rcv,ked. AIR HANDLING UNIT (TO IOAWC.F.M) CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10p0OC.F.M) 6.00 SEISMIC FEE 1 hereby affirm mal mere is a construction lending agency rot EXHAUST HOOD (WITH DUCT) 5.00 me Performa". of the work for which mu permit u ..,d IS­ 3097,Cir.C.E 1ana, HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lenderi 4Name Lender's U H EATI NO N IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC 1 .reify Ihat 1 h... read Ihitapplicalwn and slate that the abo.c VENTILATION FAN (SINGLE) 4.00 mtonninlon a corrca. 1 agree m comply will, all city and mucor wdmancea and Hate law+ relining to budding mnstmetnn, and PLUMBING BOILER-COr.P(3 H.P.or 100,000 B.T.U.) 6.00 hereby awhoriu rcprcsenntires of Ill. Illy 1, anter ,Pon the BOILER-COMP IO..r 100.000 BTUI SEE FEE SCI. MECHANICAL ' abom!intntioned property for inspection purlxtes. fillet agree to gave, indemnify and keep harmleu the City or MISC. - REFER TO ORD. uperltno again.. liabiltlI,.. judgments, gusts and a.penws which PERMIT ISSUANCE. 10.00 CONST. TAX y to any way accrue against ted Cly in mnw4uence of the 'ng oft permit.MICH. CONT. LIC. NO. MECN. S� /O�ffA TOTAL TOTAL Sgnatun of ADPBcnIUCumrwlur Date