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17276 (2) r `{904THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17276 , INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION' JOB ADORE GK `'may UNIT# - _LOT# '1 f1� .may. PERMIT EXPIRES IF WORK OWNER Iv Z �-rV CONTRACTOR U-rrO.l� y{aQ�1 '�S`GOOy�M. IS .NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM- NOTE: LASTCAL'LED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. / POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . . UNDERGROUND /SLAB TOIV- A PLUMBING - ELECTRICAL - .-ISSUANCE DATE . MECHANICAL - Rluc ELECT. - PLG, nnecR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT ' INFORMATION WOOD FLOOR VALUATION sJET. . PLUMBING rif('. ,.t MECHOgNICAL PERMIT TO ELECTRICAL: FRAMING INSULATION - STORIES TYPE CONSTR, GCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' ' ROOF - NOTE:NO FINAL INSP. BE MADE BEFORE sn.pT,PLUDR AREA TOTAL ACREAGE THE CONSTRUCTION TAX IS PAID DIAPHRAGM - BUILDING USE ROOF SHEATHING RES IND CON Pa Our,., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED. FINALS DATE INSP. W ASSESSORS PARCEL NO ROUGH SAN.#, PLUMBING . ELECT.ENERGY 4 - TUBS 8 SHOWER PAN PLUMBING ENERGY FACT NO PARCEL NO- MECHANICAL MECH.ENERGY, ' ACC DATE ACG FILE NO. ELECTRICAL BUILDING ENERGY ht,, � Tl FRAMING - - .. ELECT.FINAL TEST "" ZONING ENG.SITE NO. 'INSULATION PLUMBING .. —CityGAS TEST GAS - MECHANICAL FIRE SPRINK ENERGYT-Z< COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y Y "� EXTERIOR SHEAR ELECTRICAL RELEASE .a FLOODOD ZONE A.LU,c INTERIOR SHEAR FIRE DEPT. v N[] - YL "� SHEETROCK— _ - GRADE i FEE SUMMARY EXTERIOR LATH - BUILDING INTERIOR ,LATH TEMPORARY APPROV LS BUILDING O� SCRATCH COAT ELECTRIC PLAN CH ECK FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPAN CY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE —. MECHANICAL IMPORTANT! covsT.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPI.,RrANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY' BUILDING PROJECT IDENTIFICATION PERMIT NUMBER I SoI7r] 6LDING - APPLICATION &-PERMIT 1. C ADDRESS I '1 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S f Will y - PLAN CHECK VALIDATION- NA Elfil QTY, ELECTRIC PERMIT FEE - .ONE ' NAMERacroPs UTLETS-SWITCHES-RECEP 10.00/1.00 LIC. LIGHTING FIXTURES 10.00/1.00 ADDRESS APPLIANCES-RESIDENTIAL' - 4.00 _ M�Ae n PANELS 10.00 DATE OF APPLICA TION PHONE ARCHITECTPLAN CHECK FEE P.C.N0. OR PANELS (OVER 200 AMPI 20.00 - ENGINEER coa LIC.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 . PERMITVALIDIAATION 'ZIP TEMP.METER OR POLE INS. 20.00 Z�Zh'8l ADDRESS r'S MOTORS SEE FEE SCH. 1� SERVICE CHANGE " 20.00 Doo LICENSED CONTRACTORS DECLARATION - - a U U I hereby affirm that I am licensed under provisions of Chapter 9 -ISSUANCE DATE w,u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. N w z Professions Code nd my license is in full fur' nd fe L ❑ ❑ ❑ License Class Lie.Number 9 m Dale Contractop ¢ a 2 G�� BUILDING PERMIT ¢ ¢w OWNIi R-BUILDfiR DECLARATION INFORMATION E ; n w 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD . 0 < Law for the following reason.(Sec,7031.5,Business and Professions PERMIT ISSUANCE 10.00 //VALUATION E/FT. Hy Cade:Any city or county which requires a perm i ttoconsiruct,alter, H(/ O_d ac so Q p Improve,demolish,or repair any Structure.prior to Its Issuance,also ELEC.CONTR. LIC.NO. ,. ELEC. _ D ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO A w m c he is licensed pursuant to the provisions of the Contractor's License FiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the �ZP wtwiz E 4 D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE '¢ r the basis for the alleged exemption.Any violation mrSection 7031.5 1 STORIES TYPE CONSTR. n ;$ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00 l of not more than five hundred dollars($5001.): ❑ 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 Code:The Contractor's License Law does not apply to an owner of property who buildsor improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 mems are not intended or offered for sale.If,however,the building of improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) '!2.00 BUILDING USE builder will have the burden of proving that he did not build or im' RES IND CON PS Omar prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed Contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. '6.00 ASSESSOBSPARCELNO. and Professions Code:The 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 contacts for such projects with a imuracturls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO.. ❑ lam exempt under Ser.-,BATC.for this WATERHEATER W/VENT 6!.00 reason - Owner Date WATER SYSTEM 5.00' - ACC.GATE ACC.FILE NO., WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 23ro QA , I hereby affirm[hat I have a certificate of consent to self-insure, ZONING ' ENG.SITE NO. ar a certificate of Workers'Compensation Insurance,or a certified copy thercof(Sec.3800,Lab.C.). ' Policy No, Company Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-ZO Z 2 ❑ Certified copy is Filed with the city inspection division. O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ )••' yPERMIT ISSUANCE 10.00 _ FLOOD ZONE A.L.U.C.. � CERTIFICATE OF EXEMPTION FROM WORKERS' , LU Q COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLYO,❑ NC] Y ❑ N❑, (This section need not be completed if lire permit is for one TOTAL D Z hundred dollars IS 100)or less) V 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL H mil is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. .Q CL Date Applicant 'ALTER OR ADD TO MECH. 5.00 BUILDING .Q �- } m 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 FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 . CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE - -' I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER100,000 B.T.U.)9.50 ELECTRIC Lender's Address I Certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is c correct I agree to comply with city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and stale laws relating to building construction, and hereby authol representatives of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE BCH. MECHANICAL above-mentioned properly for inspection purposes. (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 against said City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit MECH.CONT. LIC.NO.- MECH. TOTAL .TOTAL q,W Signature of AppliwntlContractor Date OFFICE COPY GENE BARNES CONSTRUCTION License #B525580 (408) 978-9799 r ✓S h C6 ad3 �G Gl� ffoh wby tr� M0VIC ->:IeAe /'� Y� e� Gvr �Gt'e �e� /ace WedWiry eej l4 z f vvme 6-W • APPR YED a I r, t �c,et 1% IN ACCORDANCE KITH THE CITYF Li �n1 I CUPERTINO CODESIAND ORDINAN9V•jES. DATE R —md l w t rr a;(/ ��areY SIGNED �— kit ?. :r{� ! b_ S F' This set of pans Ord spec jxafo ns flusI'�Z- --- — — be kept on tho joo �a.l tnres.nd it s un lawful to mate any c'.m;es or aaeia:ion: r. on same w.!hru: n pe m ssion ;from the bw d ' ;4,V, C;ty Gepc Lno. f The stain{ nR ;:r h t I;:.n nu :peciixations — SHALL N0! be i:ed Lj I,,—ma or to be an +pproval o1 the v,-iaii-n of any provisions A any City O:d,nance Pr State Law. FEB 2 _ 1989 5LDG. INSPECTION DEPARTMEdL OFFIL �f "10 M �'V, �� Binder No. or . S100004 NAME AND ADDRESS OF AGENCY COMPANY American States Suess Insurance Agency Effective p m - •19 1221 B Park Avenue Expires ❑ 12:01 am ® Noon 4-21 ,19 89 San Jose, CA 95126 ❑This binder is issued to extend coverage in the above named company per expiring policy p ' (except as noted local NAME AND MAILING ADDRESS OF INSURED Description of OperatfonlVehiclesf Property Gene Barnes Construction 5252 Garwdod Drive Construction Company Remodeling San Jose, CA 95118 Type and Location of Property Coverage/Perils/Forms Amt of Insurance Ded. Coln,. P- R O P E R T Y Limits of Liability Type of Insurance Coverage/Forms L Each Occurrence Aggregate I' ❑ Scheduled Form q Comprehensive Form Bodily Injury $ $ Premises/Operations L Products/Completed Operations Property Damage $ $ I A Contractual Bodily Injury & V ❑ Other(specify below) Property Damage $ 300,000 $ 300,000 ❑ Med. Pay. $ Per $ Per Combined Personal Injury Person Accident 1-1 A ❑ 8 ❑C Personal Injury $ Limits of Liability A ❑ Liability ElNon-ownedEl Hired Bodily Injury(Each Person) $ U T ❑ Comprehensive-Deductible $ Bodily Injury(Each Accident) $ 0 ❑ Collision-Deductible $ M 0 ❑ Medical Payments $ Property Damage $ B I ❑ Uninsured Motorist $ L ❑ No Fault (specify): Bodily Injury & Property Damage E ❑ Other(specify): Combined $ WORKERS' COMPENSATION — Statutory Limits (specify states below) ❑ EMPLOYERS' LIABILITY — Limit $ SPECIAL CONDITIONSIOTNER COVERAGES r _ NAME AN D ADDRESS OF'❑ MORTGAGEE ❑ LOSS PAYEE ❑ ADD•L INSURED LOAN NUMBER Ipnatu of Author d Representative Date ACORD 75(1107.0) CONDITIONS This Company binds the kind(s) of insurance stipulated on the reverse side. This insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when • replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company.