14777POST THIS CARD NEAR FRONT OF BUILDING
CITY. OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
_
JOB ADDRESS 10627 BANDLEY DRIVE • UNIT#' _LOT#
• ' - -
OWNER APPLE. FITNESS CTR. CONTRACTOR REDWOOD CITY ELEC.
eRN+Ir NUMBER
1477T
PERMIT EXPIRATION
., PERMIT EXPIRES.IF, WORK 1
ISNOT STARTED WITHIN.,
180 DAYS OF PERMIT ISSU.,
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION DATE .INSPECTOR
, INSPECTION. RECORD
FOUNDATION -
- '-
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH .THE APPROVED PLANS ANDOITY OF
CUPERTINO STANDARDS:
-
LIFER - -
PREGUNITE
PERMIT VALIDATION
-I
a.f� �� e'
ISSl14NCE DATE' '
GARAGESLABS -
POURNOCONCRETE•UNTIL. ABOVE, HAS BEENSIGNEO
'
UNDERGROUND/SLAB •
PLUMBING
sr 88 cr:. of," A
- y-'�
r _
ELECTRICAL (��
MECHANICAL
-
B4o[i. EEEcr.
PEG. MEC..
E El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
OF
Qe�l�, I DING PERMIT
' WOOD FLOOR'
PLUMBING
,
VTION
ALUATION
SIFT,
MECHANICAL'
ELECTRICAL -�
•�
PERMrr To
t.: :_. �_L% `
FRAMING .'I
INSULATION
sroRlEs -
TYPE CONSIR
'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
OCC. GROUP
RES UNITS
`ROOF -
NOTE: NO FINAL INSP, SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
-'
5O FT, rLDUR AREA
!OTAL ACREAGE
DIAPHRAGM.
ROOF SHEATHING
BUILDING USE
RES IND, CON PB oa,�•,
❑ ❑' ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
- FINALS DATE INSP.
.:ROUGH ,
$AN.p -
- ASSESSORS FARCELNO -
PLUMBING - - -
ELECT. ENERGY -
TUBS & SHOWER PAN'. -
PLUMBING ENERGY -
TRACT No.
PARCEL No,
MECHANICAL:. -- - ..
MECR ENERGY--
ELECTRICA
.!-f[1r
BUILDING ENERGY ,
ACC DATE.'
ACC. FILE NO.
FRAMING..; - -
ELECT:FINALTEST -
INSULATION _
PLUMBING _
ZONING
ENG -SITE No,
GAS TEST " - - .
GAS
•
MECHANICAL
FIRE SPRINK.
-
Y'❑' N❑
ENERGY T 24
Y ❑ , NO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING- -
EXTERIOR SHEAR
ELECTRICAL RELEASE
rLooD eorvE
❑ N❑
A.E D.C. _
Y ❑ NO
INTERIOR SHEAR`,.
FIRE DEPT. '`"
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH''
INTERIOR 'LATH ..
BUILDING
TEMPORARY APPR
BUI LOING
.
SCRATCH COAT
ELECTRIC.
PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,
O~� ONE -WORKING DAY BEFORE.REQUIRED INSPECTION:
Z-,`PLEASE'GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —
MICROFILM
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSESIDE BEFORE; _
CALLING'FOR FINAL INSPECTION.
TOTAL
OFFICE COPY•
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMIT .
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER1
IA � � � "
4
14777
BUILDING
AooRE s
/
OWNER'S -
NAME
QTY. ELECTRIC PERMIT FEE
Y
PLAN OHECKVALIDATION
.'
NON R c fls
DOUTLETS - SWITCHES -RECEP..10.00/1.00 ) 0
uc. iuo.
LIGHTING FIXTURES - 10.00/1.00,-
'.
r-orurflgcroR's -
q0 RESS
'
PPLIANCES-RESIDENTIAL '4.00
PANELS 10.00
.P� PHONE
DATE OF APPLICATION'
ORCRITECT
OR
ENGINEER
' nuc. NO
- Q ^
PANELS (OVER 200 AMP). .20.00
PLAN CHECK FEE P.C. NO.
-
ISIGNS TRANS. 3.00
ARCH. Os ENG.
ADDRfS'
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 20.00
"ZIP
ADDRESS -
MOTORS SEE FEE SCH. .:Z
-
SERVICE CHANGE 20.0 N
ISSUANCE DATE '
g ELECT. PLG. MECH.
.P
.
1, El El
LICENSED CONTRACTORS DECLARATION
'I hereby off rm that tam licensed iNismir3.1 fns of Chapter
Cwith Sectionebsc. of f11 fml3 of thegBueinese and
Professions
Professions Code, and, n}7(license is in full force aqd f c
License Curs .c1A I Lic. Numberrumor
Canl{�,p�,�y11 Qi�y
`
l
BUILDING PERMIT
INFORMATIONraclor's '
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt fromrom the License
the Cmm
Law for the following reason. (Sec. 7031.5, Business and Professions
Codec Any city or county which requirese patois toconstruct•,
MISC. - REFER TO ORD
PERMIT ISSUANCE 10.00 J D-.6,
VALUATION
$/FT.
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL �i
improve, demolish, or repair any structure, prior n its issuance, also
also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
PERMIT TO '
Law(Chapmr9(commencing with Section 70001 of Divisiun3 of the
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation ofSection 7011.$
by any applicant for a permit subjects the applicant toa civil penally
ofnotmore than five hundred dollar, ($500.)-
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
-
ALTER -DRAIN & VENT -WATER (EA.) 5.00
❑ 1, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACKFLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS-FLOORROOFAREAGOND.500
, , , . .
intended or offered for sale (Sec: 7044, Business and Professions
Code: The Contractor's License Law does not apply m an owner of
-
FIXTURES - PER TRAP 5.00
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
property who builds or improves thereon, and who does such work
himself or through his own employees• provided that such improve-
mentsamnotintendedor offered for sale. Il', however. the building
50. FT. FLOOR AREA
TOTAL ACREAGE
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or inn-
prove for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Other
0 ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
Iicenscd contract orsto.L.Gorret lire proiect(Sec. 7044, Business.
and Professions Code: The Contractor's License Law does not apply
LAWN SPRINKLERS- 11NC5,V.B. 6.00
ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a contractorts) licensed pursuant lG
the Contractor's License Law.
❑ I am exempt under Sec.., BAP.C. for this
reason -
-
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
'
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00 ,
qCC. GATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSA'FION DECLARATION
'
I hereby affirm that I have a certificate of consent to self -insure,
ZONING
ENG. SITE NO..
or a certificate of Workers' Compensation Insurance, or a CcTlified
copy the""b /`f7ff�
Policy No. YLmlrart3'
Certifid'py is hereby fumishCQ.'
Certifi copy is f wi l the p'ty inspectiy ns 1.
AI/plicanl. { � �1[y(Idp'IQC
MISC. - REFER TO ORD.
FIRESPRINK
Y [] No
ENERGY T-24
v N�
PERMIT ISSUANCE 10.00
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
1'rhis Section need not be completed if the permit is for one
FLOOD ZONE
Y N
A.L. U.C.
Y,Q N
PLG.CONTR. LIC. NO. -
PLG.
TOTAL
hundred dollars 1$100) or lees.) '
1 certify that in the performance ut the work lot which this per.
mit is issued, I shall not employ any person in any manner so as to
become subject to tile Workers' Compensation Laws of California.
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
,
ALTER OR ADD TO MECH. 5.00
Dale Applicant
BUILDING
`
NOTICE 'f0 APPLICANT: If, after making this CertificWe of 1'.-
APPLIANCE 5.001
PLAN CHECK
FEE
emption, you should become subject to the Workers' Compensation
provisions of lire Labor Cod,• you most Ibrthwith comply with
such provisions or this Permit shall be deemed revoked.
AIR HANDLING UNIT ITO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMICFEE' -
-
- CONSTRUCTION LENDING AGENCY
- I hereby affirm that there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5;00
MICROFILM'
the perl'orman cc of lire work 1'or whielLthis permit is Mucci (Sec.
3097, Civ.C.).
Lender's Name
-
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
VENTILATION FAN (SINGLE) 4.00
I certify Oil I have read this application and slate that the above
-
information is correct. I'agree to comply with all city and county
ordinances and state laws relating to building construction, and
hereby authorize representatives i
this
of Ots city in e,. enter upon the
above-mentioned property for insp ofpurposes
g01LER-COMP13 H.P. Or 100,000 B.T.U.) 6.00
PLUMBING
BOILER-COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We) agree to save, indemnify and keep harmless the City of
MISC. = REFER TO ORD.
uPertino against liabilities, judgments, costs and expenses which
ay i any way accrue against id City inconsequence of the
tariff g this permits. /f
Tjr , Q ,
Signature pplicam t/Contractor - Dale I-
PERMIT ISSUANCE '10.00
CONST. TAX
MECH. CONT. LIC. NO. MECH.
'Y TOTAL
-
TOTAL
-
-OFFICE COPY