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10011 ST THIS CARD,NEAR FRONT B IfJG, • t ,:� PERMIT Ivurw+aely CITOOFI CUPERTIN . . K - INSPECTION DIVISION, ' 1001, 1 JOB INSPECTION RECORD I PERMIT EXPIRATION •JOB ADDRESS• UNIT# LOT# PERMIT EXPIRES IF WORK. OWNER CONTRACTORt` ,IS NOT STARTED WITHIN INSPOCTIONF DATE INSPECTOR - - INS CTION ECO D '180 DAYS OF PERMIT ISSU- FOUNDATION - `, - ANCE,OR 180 DAYS FROM UPERv 1 LASTCALLEDINSPECTION. V PREGUNITE PERMIT VAUDAT ON ' � ' POUR NO CONCRETE UNTIL ABOV�AS BEE IGNED UNDERGROUND /SLAB PLUMBING; , ELECTRICAL IssUANCE rirE. MECHANICAL .' SLOG. .CECT. PLG. MELR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDINFORMATION BUILDING PERMIT - - WOOD FLOOR VALUATION SBFT."' �. PLUMBING � � - MECHANICAL :J i ' ELECTRICAL + - PERMIT TO ` FRAMING _ `„' .11) � STORIES TYPE CONSTR. IN ULATION ,2 �( 1 OCC.GROUP' IRES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED +' .ROOF. BO FT,FLOOR AREA TOTAL ACREAGE, DIAPHRAGM --BUILDING USE RES 'IND CON PB., 00ee, « APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSES❑ �• ' SORS PARCEL NO. ROUGH PLUMBING _Y �"7-P- .t 'I C'.��. GAS TEST ' - TRACT NO. PARCEL NO. MECHANICAL - .�. _� �' •. 'i•�• ACC.DATE ACC FILE NO. ELECTRICAL - _ :�. FINALS -DATE INSP:,. ` FRAMING SAN # .ZONING .•ENG.SITE No, INSULATION PLUMBING GAS - p FIRE SPRINK ENERGY T.24 ME ANGAL _. . ].�r0 Y ❑ NO VE] 'NE] NO WORK UNTIL ABOVE HAS BEEN SIGNED' H TN VA F.LOOD ZONE, A.L.U.C. LATH-INTERIOR - f• 6 - E ECTR I CAL 3D-� ., Y❑ N O El N❑ LATH-EXTERIOR ey' IRE DEPT. SHEETROCK ADE - (q FEESUMMARY. SHEAR INTERIOR - _ BUIL ING BUILDING ' SHEAR EXTERIOR - TEMPORARY APPROVALS FIREWALLS _ ELECTRIC 'PLAN CHECK GAS FEE NOTAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMICIFEE . OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL.ISSIGNED BY BUILDING INSPECTOR. MICROFILM- ,.ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION.-' : PLUMBING Z� PLEASE GIVE J06 ADDRESS WHEN PHONING. — SEE PER FOR EXPIRATION DATE —' MECHANICAL IMPORTANT! CONST.Tax' PLEASE READ.REVERSE SIDE BEFORE , TOTAL CALLING FOR FINAL INSPECTION, 'OFFICE COPY - ` FINAL GRADE -RUUTE-S= File No. Date Location _ Sub,j ect Notes �3 Approved _ Dat T-nspector �-- ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO "L To You`are hereby authorized to Connect electrical service for Owner or Tenant ^�QX At '2 3C. —7p No.of Wires Size of Wires Size of Switch ' l Motor Load Voltage Phase Heating Load K.W. Voltage Light—]10—New Service Reconnect No.of Meters Heat 120Three Wire More Service_ No.of Add.Meters Power. i(Fye Phase Move Meter ©• ELECTRICAL INSPECTOR. BUILDING INSPECTOR'S OFFICE Bldg.Dept. CITY OF CUPERTINO Office Copy If�. Backflow Device Sanitary Permit No. 9 I/ ! O Sewer Connection Plumbing Permit No. ePlumbing Final Lot No. {] Owner or Tenant At- Tract 1 Date Connected 1 9-E-6/-Date Final 3 19 .l ©. PLUMBING INSPECTOR Jr OFFICE CITY OF CUPERTINO COPY GAS SERVICE NOTICE 19 1p'41 To `O.. You are hereby outhorized to connect the GAS service for Owner or Tenant ���r �d A 4. / 'NewService No. of Meters - .Reconnect ' I� No. of Add. Meters Move Service ' f Move Meter g �7 PLUMBING INSPECTOR �S�/-!il!�` (E l �! CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO DATE tq a 6 BLDG. PERMIT NO.—/ U'0 r THE BLDG. LOCATED AT / S //h 2-� p� f �-{., V P OWNED BY �Ci 1n C rA HAS BEEN ICO)OR USE AS (ALTERED) i i I �I BUILDING INSPECTOR APPLICANT TO FI L' IN INFORMATION WITHIN RED LI S - USE BALL POINT PEN ONLY 6 BUI LDI NG PROJ ENTI FIC N $ PERMITNUMBER .BUILDING APPLIC ON & PAT A ziw BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 10011 ' O NE0.b NAMFPLAN CHECK VALIDATION • '/n�^�a J CO ��q J/ _g� (.RJL�kUp'O>•-v� CPHONE'2404(2 QTYELECTRIC PERMIT FEE CONTRACTORS LITLE NAME FGHTI S-SWITCHES-RECEP 10.00/1.00 P k uc.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 i ADUREss p� �p .NE2 PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER A 1 PrYIcam, IC.NO, SIGNS TRANS. 3.00 ARCH.OR ENG. - PERMIT VALIDATION A 2;S((s LD, Q SPECIAL CIRCUIT 5.00 `�d'/ - Ou/1k zIP TEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH. 4 ,alt S- SERVICE CHANGE 20.00 ,00 LICENSED CO TRACTORS DECLARATION TEMP.POLE 30.00 pp t) U u I hereby affirm Ihal 1 am licensed under provisions of Chapter 9 ISSUANCE TE I- z (commencing with Section 7000)of Division 3 of th e Business and H Hy x, 33. BL�CC qL�T. MECH. z Professions Code,an y license is in full force an e f f Z o m - Date a CI, s Lic.Number O w r ar Ualc_ Contactor_ } 0 w OWNER-BUILDER DECLARATION �I" FO MATRON T KO. , 3 LL H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u O¢ Law for the following reason.(Sec.703 L5,Business and Professions VALUATION $/FT. H _ PERMIT ISSUANCE ' 10.00 Code'.Any city or coon pair any reqstructure, a Lure p riot tlocator isissuance, .)so 2 te Q Q improve,demolish,ut repair any vUucture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG O u reytiires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u w m he i(Chapter pursuant to the provisions of the Contractor's License Hzi Laww(Chand Professions Codeng )or Section is 00)exempt therefion oofthe a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE F o the basis forphi the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR. a ; ° by any applicant fora permit subjects lie applicant toacivil penalty ALTER-DRAIN 500 yy ( of not more than five hundred JD - . . llars(8500).): pL, ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 R•-3 Code:The Contractor's License Law does not apply to an owner of property who builds or improves Thereon,and who does such work FIXTURES-PER TRAP 5.00 $0.FT,FLOOR AREA TOTAL ACREAGE e himself or through his own employees.provided that such improve- -EA.SVSTEM-11NC.40UTLETS 6.00 meats are not intended or offered for sale.If,however,the building GAS31 or improvement is sold within one year of completion, - . -OVER 4(EA.) 2.00 // the owner- GAS EASYSTEM builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose ot'salc.). INDUSTRIAL WASTE INTER3000 RES IND CON Pa Omer ❑ I,a . . owner of the Property,an,exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:T'he Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 366-16- 067,3 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 lire Contractor's Lie m..v Law. TRACT NO. PARCELNO. ❑reasonI ail exempt under Sec,-,B.&BC.for this WATER HEATER W/VENT 6.00 '760 g2 Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure. or a certificate of Workers'Compel sat ion Insurance,or u certified ZONING ENG.SITE NO. copy thereof(See. Lab.C.). Po�licy No. Company 'O �L CcrliOed -ol ishee (uric FIRESPRINK ENERGY T-74 Z Z ❑ Certified is d w h t e city,inspection division. � O Applicant MISC.- REFER TO ORD. YO N❑ Y ❑ N❑ CC w CE RTI PI T'Ii0'EX Ii M PTI ON FROM WORKERS' PERMIT ISSUANCE ' 10.00 FLOOOZONE .A.L.U,C. 111 > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. C- O (This section need not be completed if tiro permit is.for one TOTAL Y❑ N❑ V ❑ N❑ D Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to 0 U become subject to the Workers'Compensation Laws of California. BUILDING �p a Dam Applicant ALTER OR ADD TO MECH. 5.00 ' } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z_ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK. provisions of the Labor Code, you must forthwith comply with - FEE U such provisions of this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE /�3S I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 3097LCiv.C)nce of the work for which this permit is issued(See, HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Addrev I certify that 1 have read lhii application and slate that the above VENTILATION FAN (SINGLE) 4.00 • information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-CON)P 13 H.P.or 100,000 E,T.U.) 6.00 hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. gO1LER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue as ash said City in consequence of(be PERMIT ISSUANCE 10.00 ✓ granting of IT fiL /q-/�J MECH.CONT. LIC NO. MECH (1 . TOTAL Q TOTAL - ST Signatu pl iwnt/Contractor Uu[e �� "' OFFICE COPY -