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17967 (2) �—' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY' OF CUPERTINO 17967 INSPECTION DIVISION 1 JOB INSPECTION RECORD c �j�/ � /�7� - PERMIT EXPIRATION IJOB ADDRESS -770 O�0 GU�4N{J�/ UNIT# _LOT# +'• PERMIT EXPIRES IF WORK ; -OWNER - .CONTRACTOR IS NOT-STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSUI FOUNDATION - .w.r;�, ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALLGRADINGAND DRAINAGE SHALL BE IN A.�"L�j +•. ' PREGUNITE p TO COMPLY WITH THE APPROVED PL.3fl�,A�J I Iyr Y� PERMIT-VALIDATION ' 'CUPERTINO STANDARDS,: �i�111 •�t�I 1 ^ GARAGE SLABS „•� \�.,: 1,!'i i(,.A�^!�w.�•• -�� POUR NO CONCRETE UNTIL ABOVE HAS-BEEN SIGNED - ��=>'•:�/ ":�". '-.� UNDERGROUND /SLAB PLUMBING .r• ELECTRICAL ISSUANCE DATE MECHANICAL SLOG ELECT PLG. mECR. ❑ ❑ 2 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR: _VALUAI ION SIFT. PLUMBING - � • , • MECHANICAL - ;PERraI T.To• ELECTRICAL FRAMING f 1 - STORIES TYPE CONSTR INSULATION , GCC.GROUP RES.UNITS I0VACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED c - - ' �SD.IT,[LOOR AHfn TOTAL ACNEAGf. +ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ®• DIAPHRAGM - - '- �: THE CONSTRUCTION TAXIS PAID BUILDING use . ROOF SHEATHING - - RBS IND CON PB OR.... ! - APPLY NO ROOFING UNTIL ABOVE HAS.BEEN SIGNED FINALS DATE INSP. El 0 .0 El- ASSESSORSPARCLLNO. 'ROUGH SAN.k - PLUMBING ELECT.ENERGY ` TRACT No. PnaceL No., TUBS B SHOWER PAN PLUMBING ENERGY . MECHANICAL . MECH.ENERGY, - ELECTRICAL BUILDING ENERGY ACC,DATE ACC.FILE NO, FRAMING ELECT.FINAL TEST zorvwc ENC,SITE NO. .r INSULATION PLUMBING. $ ,' ' GAS TEST GAS ' FIRESPRINK ENCRGY T 24 MECHANICAL - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y H�. , . ❑ ry❑' FLOODmNE A.L.U.C: EXTERIOR SHEAR ELECTRICAL RELEASE � � ' INTERIOR SHEAR FIRE DEPT.. rrv� ❑ N❑' SHEETROCK GRADE FEE SUMMARY EXTERIOR'LATH °• BUILDING - FELtCTRIC .INTERIOR LATH - � � . TEMPORARY APPROVALS SCRATCH COAT ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED- OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. L ARRANGE'FOR INSPECTION BY PHONING 252-4505, t o ' P ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING s PLEASE GIVE JOB ADDRESS WHEN PHONING. / Z' —,SEE PERMIT FOR EXPIRATION DATE'E- MECHANICAL, I IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. - OFFICE'COPY `?:''4? -'APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 13UI LDING PROJECT I DENTI FICATION d PERMIT NUMBER BUILDING �(///�f /� APPLICATION & PERMIT 1r7967 ADDRE /� � {fes' //1 L= 1 J IJ O 020 /V�•fd 6�G UILDING-ELECTRICAPLUMBING-'MECHANICAL OWNER' , _ PLAN CHECK VALIDATION NAME L(� DTV. ELECTRIC PERMIT FEE 1 PHONE CONTRACTOR5 /-k- OUTLETS-SWITCHES-PIECED 10.00/1.00 q V/` e- '{'{.A/"'1•/ K LIC.N /'Q(J LIGHTING FIXTURES 10.00/1.00 CDNTRACTOms PP.LIANCES-RESIDENTIAL 4.00 ADj� 1.55 / �j�(f{�. / �3 �r j/' (vPHONE PANELS 10.00 DATE OF APPLICATION ARCNrtscT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ' ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH'Ess ENG. PERMIT - SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 + APPUCANTs MOTORS ° SEE FEE SCH V ' +. ADDRESS _ SERVICE CHANGE 20.00 O o LICENSED CONTRACTORS DECLARATION Ic E, 1 hereby al'Grm that I am licensed under provisions of Chapter 9 W.0ISSUANCE DATE G Z e y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. N d Professions Cod h h license hs in lull fore f - n:.., _[ n, '. e❑ ❑ ©� ❑ Z,o u,z License Class_.. Li c. "to"1._ f s.ser .o w•[ .rJ !` o r o; Dutc Contractor Y•, 'OWNER-BUILDER DECLARATION BUILDING PERMIT MISC.- REFER TO ORD INFORMATION E ;u I hereby affirm that um exempt from the Gmtmcfor's License VALUATION S/FT. HuoJ Law for the followingreason.(Sec.7031.5.Business and Professions PERMIT,ISSUANCE 10.00 Code Any city or county which requiresu permit to construct,alter, ' 2 rt¢ 0 improve,demolish,or repair any structure,prior to its issuanm,also ELEC.CONTR. LIC.NO. - ELEC. O e requires the applicant for such permit to life a signed statement that TOTAL PERMIT TO wm u he is licensed pursuant to the provisions of the Contractors License r z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ������� a Business and Professions Code)or that he is exempt lhcrcfnon and QTY. PLUMBING PERMIT FEE W F o the basis for the alleged exenplion.Any violation of Section 7031.5 STORIES TYPE CO VTR. a ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER MA.) 5.00 of not mon than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wades as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES,UNITS their suite compensation,will do the work,and the fracture is not _- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 CodeaThe 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 SO,FT,FLOOR AREA .TOTAL ACR EAGE ( himselfor through his own employees,Provided that such inhprove- mentsmenotintendedorofferedforsale.I L however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 ®' or improvement is sold within one year of conhplelion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving thathe did not build or it... prove for purpose ofsale.): INDUSTRIAL WASTE INTER. 30.00 - RES IND CON PB other -O 'I,as owner of the property.am 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:The Contractor's License Law docs not apply " to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for su License ucontmdortsl licensed pursuant to SEWER-SANITARY-STORMEA,2001t/10.00 TRACT NO, PARCEL NO. the Contractor's fin s's License Law. ❑ laohcxempumeer Sea B.S.P.C'for l his WATER HEATER W/VENT ,JO reason Owner - Dule WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO. WORSERS'COMPBN'SA71ON DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cerlifmale of concent to self-insu¢, - ZONING or a cirti0cam of Wo ked Compensattohylrouranee,uS a cJertified ENG.SITE NO. col �l+6rtaT.lfiYr.'T :Lab.Y.l�/)•/(..,�. .p r I'o PIT lIJ!/V ll/kN1 ry 11 Q ❑ CeRi Led copy ish clay furnished. ' - FIRE SPRINK ENERGY T-74 Z Z Certi op is -led with the oily inspection divisi< h. •. O nl_` '� MISC.- REFER TO ORD. v❑ N❑ - v ❑ N❑ F rn - PERMIT ISSUANCE .UO FLOOD ZONE A.L.U.C. LU CIiRI'I-I'A'1'Ii I EXEMPT IDK PROh1 WORAF:R$' DJ COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL Q ('I'Ins section need not be cmnplded if the permit is for one' TOTAL Y❑ N❑ Y ❑ rv❑ Z hundeddollurs(S100)orless.) U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL (- mit is issued,I shall not employ any Person in any sooner so as to ' U 0 become subject o the Workers'Compensation Laws of California. w Date A licant FELECTRIC a PP - ALTER OR ADD TO MECH. 5.00 } m NOTICIi-TO AI'I'LICAN'I': II',alter making this Ccrt it icalc of Ex F Z emption,you should become subject to the Workers Compeasmlon APPLIANCE 5.00 provisions of the,Lubor Code, you nest forthwith comply with suh provisions or this permit shall be decried revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING,AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perfrmance of the work for which this permit a issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.003097.Civ.C.).Lender's Nese HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lenders Address I cBrlhly that I have read this application militate that Ilie above B.T.U.1 6.00 VENTILATION FAN (SINGLE) 4.00 into roution is,correcf. I agree to comply with all city and count PLUMBING y(J ordinances and slam laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 hercby'KAIRRl> representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL tabove-mentioned roperty for inspection purposes, - (We)�agree to ve, indemnify and keep harmless the City of MISC.- REFER TO ORD. ertinu against II battles,judgments, costs and expenses which CONST.TAX a in any way a me against said City in consequence of the PERMIT ISSUANCE 10.00 fgrantiliofill' Fermi MECH.CONT. LIC.NO. '• MECH. TOTAL TOTAL Sign r o Applicant/Contractor Hare OFFICE COPY -