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15424n� POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO ., INSPECTION DIVISION '. JOB INSPECTION RECORD JOB ADDRESS 10171 East Estates Drive UNIT# _'LOT# - OWNER Steve F1e ShIRaR CONTRACTOR - PERMIT NUMBER 15424 PERMIT EXPIRATION .PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN ' 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCAMLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION.. _ NOTE: ALL GRADING AND DRAINAGE SHALL' BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITEi PERhIIT VAUOATION F{ #' .ISSUANCE UPiE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING `°,�:� ELECTRICAL iJ,i3. >� MECHANICAL - BLDG_. SELECT. PLG, MEG. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT '^�'• INFORMATION WOOD FLOOR, - PLUMBING � " VALUATION 1 -1..,n Li SIFT. - MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION - - STORIES TYPE CONSTR ., OCC. GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE: NO FINAL INSP. SHALLBE MADE BEFORE THE CONSTRUCTION TAX IS PAID so rr, rLoa+AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB ow., ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS :' DATE INSP. ROUGH SAN.q ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY' TUBS 85HOWER'PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO. , FRAMING . ELECT. FINAL TEST &Ar INSULATIONPLUMBING -2 zo"'"G ENG SITE No. GAS TEST i i � GAS' ' MECHANICAL FIRE SPRINK Y ❑ N ENERGY T-24 ` ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ElN❑ AT, UC. Y 01 El INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING oL _ 3_ � BUILDwG., INTERIOR LATH TE PORARY APPROVALS - SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BU ILDING IS NOT PERMITTED UN TIL BUILDING FINAL IS SIGNED BY BU ILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE -GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING . , . MECHANICAL ' IMPORTANT! • PLEASE READ REVERSE SIDE BEFORE - CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-. USE BALL POINT PEN ONLY - BUILDING PROJECT IDENTIFICATION -APPLICATION &PERMIT .PERMITNUMBER 1 -, 5424 AD ADDRESS NEss D 171 �'�' Aar 1-94BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAME edI./ PNON MA 64 QTY. ELECTRIC PERMIT FEE' PLAN CHECK VALIDATION L (/ , DATE OF APPLICATION NDAM1ERAciOR oRs - 00 LS CLIC. No.3 /„�O UTLETS.-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ADDRESS TORpS "�"� L / S�3a,VL PNorvELS.Z-�i/ APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ORRCNIT CT ENGINEER LIc. NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P. C. NO. .,_ -. SIGNS TRANS. 3.00 ADDRESS Ervc ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION J ' /✓� ( Lt ra ' ISSUANCE DATE '9LOQ ELECT. PLG. MECH. 5Ll_ IRl-, bill TEMP. METER OR POLE INS. 20.00 AS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSIiD CON"FRACTORS DECLARATION I hereby affirm That I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolessions Cogy„r license is in full for B License lass 4• Con Number gy j� Date-- ^ Contractor - so OWNER -BUILDER DECLARATION affirm that I am exempt from the metra d Pr License I (for the Law for the l'ollnwing reason. (Sec. 7031.5, Business and Professions Cod-: Any city or county which Structure permit tnconsuanL, also or repair h p rtrot tole, pa signed n ILS issuance, that reqmiluires, he applicant requires the applicant for such permit m file a signed statement That he is licensed pursuant en the provisions of the Contractor's License t Division om the Law (Chapter 9lcommenC de) or Section is 00) exempt Professions Code) or that he is exempt lhercl'rom and Business for the any basis plc thealleged aexemscion. Any vire iolation ofSection malty fora permit subjects S500).litunuoacivil penally .1 net more of not marc than Coo hundred dollars (45 ems ❑ Las owner at the property, or my employees with wages as their sole compensation, will do the work, and the structure rs not 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 does such work himself or through his own employees, provided that such improve- menuarenotintendedorofferedforsale. IC however, the building or improvement is sold within one year of completion, tie owner - builder will have the burden of proving that he did not build or im- prove fors owner at sale.) ❑ L as owner of the properly, am exclusively contracting with licensed contractor, ors to construct the project (Sec. 7044, Business 's License Law docs not apply and Professions Codv: The who to tr owner of progeny who builds or improves thereon, and who contracts for such projects with a centurions) licensed pursuant to the Contractors License Law. ❑ 1 am exenmt under Sec. , BAP.C. for this reason _ // EL�z7 ��t d 0 L _� ,1 r. ,-. a,l I BUILDING PERMIT INFORMATION MISC.- REFER TO ORD PERMIT ISSUANCE 10.00 U - VALUATION D �O $/FT. ELEC. CONTR. LIC. NQ ELEC D V TOTAL 3 �'-' PERMIT TO S"N/1�lHiH - �O �� DTV. PLUMBING PERMIT FEE ALTER -DRAIN 5.00 STORIES ' TYPE CONSTR. NS BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 so. FT, FLOOR AREA TOTAL ACREAGE BUILDING USE ❑RESI❑ ❑N ❑ Dollar❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SA NITAR V -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 WORK ERS' COMPENSATION DECLARATION I hereby anti.... that I has- a certificate of consent to sel'-insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof lSec. 3800, Lnb.C.h Policy No.ere 00 Lab y-�(� ❑ Certified copy is hereby furnished. Ce Diifn c0 Is fled th the city inspection division. Apphcanl�tP'N.ItQ--- CLR'I'IFICATE OF EXEMPTION FROM WORKERS' COAIPENSA7'ION INSURANCE (This section need not he completed if the permit is me one hundred dolls rs IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner m as to become subject to the Workers' Compensation Laws of Calitbmia. Date Applicant ACC.DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING - ENG. SITE NO. L` C- _ Oo L O MISC.- REFER TO ORD. FIRESPRINK Y❑ NE] ENERGY T 24 YE] NE) PERMIT ISSUANCE 10.00 v_ FLOOD ZONE V ❑ N❑ A.L.U.C. Y ❑ N❑ LIC. NO. _ PLG. C;ALTERORADD PLG. TOTAL OTVCHANICAL PERMIT FEE FEE SUMMARY TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should hecome subject to the Workers'Compensation provisions of the Labor Codc, you must forthwith comply withsuch provisions or this permit shall he deemed revoked CONSTRUCTION LENDING ACENCY I hereby affirm that there is a construction lending.ugency for the performan e- of the work for which this permit is issued (See 3097, Civ,CJ. �� Lender's Name Lender's Address I certify that 1 have read this application and state that the above information n correct I agree to g to b with all city and county ordinances and state laws roves to building construction, and lois city es enter upon the hereby autboriee representatives for ins inspection above-mentionnl property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which ay in any way accrue against said City in consequence of the ran oft 's per If -�� Sl !w of Applicant/Contractor Date 5.00 PLAN CHECK FEE UNIT (TO 10)=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10,000GF,M.) 6.00 SEISMIC FEE 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 on VENTILATION FAN (SINGLE) q,Qp BOILER - COMPO H.P. or 100,000 B.T.U.) 6.00 PLUMBING rn - Q BOILER -COMP foyer 100,000 BTU) SEE FEE SCH. MECHANICAL `t MISC. - REFER TO ORD. J "_ PERMIT ISSUANCE 10.00 dY CONST. TAX MECH. CONT. LIC. N0. MECH. TOTAL a f TOTAL �0 OFFICE COPY