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18168ul • POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINOQ INSPECTION DIVISION ,. JOB INSPECTION RECORD JOB ADDRESS V d V �a' UNIT I _LOT# � 1 OWNER V/� ( �P(lLCI Q CONTR nCTOR � 4\-Kdev PERMIT NUMBER 8i �U PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180DAYS OFPERMIT ISSU- ANCE OR 180 DAV$ FROM LAST CALLED INSPECTION. INSPECTION DATE I INSPECTOR INSPECTION RECORD NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. EAU> UFER PR EGUNITE PERMIT VAI.mnRlON C� /�. N.`�f �Jl UCC. r li' ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED „�-fld�. l'1 1989 UNDERGROUND / SLAB PLUMBING City of Cupertino ELECTRICAL MECHANICAL BLDG O ELECTPLG. Ai MECD _] 0 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SEPT. PLUMBING MECHANICAL' ELECTRICAL _ PERM TO 'y��- • �l Lga— FRAMING INSULATION SIOHIESP TYPE CONSTR Occ GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID $D fi GI.UOR AN EA IVTAL ACIIBAGF. DIAPHRAGM BUILDING USE HES IND CON PB O'l-, El ❑ 0 (__1 ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SANA PLUMBING ELECT. ENERGY ' TRACTNO PARCEL NO ' TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC.DATE - ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT. FINAL TEST ZONING ENG SITE NO. INSULATION - PLUMBING GAS TEST GAS FIRE SPNINK Y [_] . N❑ ENERGY T,lE v N� I ' MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLobo zorve r NE] n L,u c. v L N� EXTERIOR SHEAR - ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK F EE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0-0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC p�V Cp( PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.- TOTAL �� OFFICE COPY o M i F00 QUU yZ"a a , Z p w H u,� It FJ It Q cc U W i aU F u O j f"so Z ¢ 4 0 ca A omu A w ii Ex0 a o A. ; m • O Z z F O L CIL 0 00 L I- 0 Ow } a u APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,0-* -BUILDING PROJECT 1 DENTI FICATION APPLICATION & PERMIT 6VILDN - ELECTRICAL- PLUMBING - MECHANICAL IA J PERMIT NUMBER C O , U o BUILDING tz ADDRESS OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE CA As ME DTOn NAME NAME d e OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 caNTR c DR'sV ADDRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 PRONE DATE OF APPLICATION ARCRITECT OR ENGINEER uc. NO PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 A 'e s ENC' ZIP SPECIAL CIRCUIT S.00 PERMIT VALIDATION b EMP. METER OR POLE INS. 2400 TO APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 '` / ! ' V �T 14 J l LICENSED CON TRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE with Section 7000) of Division 3 of the Business and (commencingUIV Professions Code, and my license is in full force and effect. Lie nse Clus Lic. Number BLDG. ❑ ELECT. PLG. MECH. ❑ ❑ Date Contractor City, of Cupertino BUILDING PERMIT OWNER -BUILDER DECLARATION 1 hereby a(linn that 1 am exempt Iran the Contractor's License Law forthe followingrcason,(Sec. 7031.5, Business and Professions Code: Any city orcounty which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requite, lite appllcaN for such permit to file a signed RIAround that he is licensed pursuant to the provisions of the Contractors License Law, (Chapter 9 (commencing with Section 700(fof 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. TOT AL1 PERMIT TO e4, QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pem,it subjects lire applicant toa civil penalty of not more than five hundred dollar, (S500).). ALTER -DRAIN -WATER IEA.) 5.00 13I, 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, 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 SO. FT, FLOOR AREA TDTALACREAGE himself or through his own employees. provided that such improve- mentsarcnuthqcnded or offered for sale. IL however, the building GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- on,will have the burden of proving that he did not build or int- proveforpurposeofsaleJ. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct Ore project (Sec. 7044, Business -GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code :'I'lie Contractors License Law docs not apply to an owner of property It. builds or improves thereon, and who LAWN SPRINKLERS - OVER 5 (EA.) 1.00 . contracts forsuch projeels with a eontruetor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ l am exempt under Sec.., If &KC, kir this naso. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00 1 herchyaffirm that I have a certificate of consent to self -insure. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy theaof 1 Svc. 3800, Lab.C.). Policy No. Company ❑ ,rtifmd copy is hereby co i,sheA. FIRESPRINK ENERGY T-24 Certified py rs I nth the city' inspection division. Ap,liant "`"`4 > Y❑ N❑ Y N❑ MISC.- REFER TO ORD, CER '1'IPICA'I'Ii 017 1iXEMPTION ('ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A. L. u.c. PLO. CONTR. LIC. NO. PLG. TOTAL COi11PENSA'60N INSURANCE (This sectma need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundmd dollars IS 100) or less.) I certify that in Bre performance of the work for which Ibis per- out is issued, I shall not employ any person m any manner so as to ' BUILDING become subject to the Workers' Compensation Laws of Calitornia. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: II', after making this Certificate of Ex- mnption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code. you must I'orlhwith comply will, such provisions or this permit shall be deemed revoked. FEE ' AIR HANDLING UNIT (TO 10=CF.M.) 4.00 AIRHANDLING UNIT(OVER 10=C.F.M.16.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD WITH DUCT) 5.00 I HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM I hereby affirm that there is a construction lending agency for file performance of the work for which this permit is issued (Sec. 3097, Cie.C.), HEATING UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC D V Lender's Name Lender's Add,css 1 certify that I have read this application and startthat Om above ration is correct. I agree m comply with x11 city 'and county intbm ordinances and state 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 BOI LER-COMP (Ova, 100,000 BTU) SEE FEE SCH. MECHANICAL hereby amlmn,e rcprcnentaR,v, of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree to Save, indemnify and keep harmless the City of upertimo against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LID. NO. MECH. TOTAL TOTAL d� ,cortin, of this permit 6 ^ Signature of Applin /Conlmctor Datc OFFICE COPY