12509 ^' POST THIS CARD NEAR FRONT OF BUILDING
' CITY OF CUPERTINO PPHMIr NUMBER
INSPECTION'DIVISION 12509
JOB INSPECTION RECORD
If
+.. PERMIT EXPIRATION-
JOB ADDRESS 10656 N. BLANEY UNIT# 3 LOT#
PERMIT EXPIRES IF WORK
OWNER GIN-LU-SHUE CONTRACTOF CREATIVE CONST: IS NOT STARTED WITHIN
INSPECTION DATE INSPE,CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE,OR 180 DAYS FROM
UFER - LASTCALLED INSPECTION.
PREGUNITE - - PERMIT VALIDATIQN
YolfoV
OUR CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .
PLUMBING
ELECTRICAL
ISSUANCE DATE
MECHANICAL' BLDG. ELECT. I PLG: MECH.
E El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
VALUATION $IFT.
PLUMBING - _
s o-�
' MECHANICAL ."41- ,s, � � � /
ELECTRICAL- PERMIT To
P"--
FRAMING -
INSULATION - STORIES TYPE CONSTR
_ OCC.GROUP RES.UNITS
� 0
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SQ,'T,FLOOR AREA TOTAL ACREAGE
l
" DIAPHRAGM
BUILDING USE
FES IND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ E] ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO
PLUMBING -
GAS TEST - A- �cJ>-qq y` rRACT No. PARCEL Na.
MECHANICAL
ELECTRICAL - FINALS DATE INSP. ACC.DATE Acc.PILE No.
' FRAMING, y SAN
INSULATION PLUMBING ZONING ENG.SITE NO:
GAS
MECHANICAL _ - EIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.uc.
LATH—EXTERIOR - i2 FI RE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCKGRADE FEESUMMARY
SHEAR INTERIOR I BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.
IMPORTANT! _
PLEASE READ REVERSE SIDE BEFORE » ".j TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPbICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�. BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
I ADD 5b BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 12509
/ OWNER'S
, � PLAN CHECK VALIDATION
y
- �
AMEc� _GU �1Jfif'E ��$�'
DTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
�. NAME l �� UTLETS-SWITCHES-RECEP 10.0011.00
Y'I
(VVX1 .No. LIGHTING FIXTURES 10.00/1.00
CONTRAOTORs � 5+ APPLIANCES-RESIDENTIAL 4.00
ADDRESS
CP&NE J�}✓� PANELS - 10.00 DATE OF APPLICATION
hRCHITECT PLAN CHECK FEE P.C.NO.
oR (/' PANELS (OVER 200 AMP) 20.00
ENGINEER r' pn -
D� LIC,rvo. 3'; ) SIGNS TRANS. 3.00
ADDRESS ENG' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 ,r
Ars
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
'00 LICENSED CONTRACTORS DECLARATION
Q Z w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
2 o m w Professions Code,V t license is in full foto f pDx SIo r4l
L License las _jz�Lie.Number_ - Vim.
O y f w Dute Contractor-(gJV/J- '
¢ y f YM•N BUILDING PERMIT
¢ ¢a
WINE -BUILDER DECLARATION
o a u INFORMATION
E
;¢ I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o < Law for the following reason,(Sec.7031.5,Business and Professions VALUATION $/FT.
P- - g PERMIT ISSUANCE 10.00 O
Code'.Any city or county which requirese permit to construct,alter,
Q re G a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
¢ requires the applicant for such permit to file a signed statement that TOTAL �Q
w " he Is licensed pursuant 10 file provisions of lire Contractor's License PERMIT TO
r z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
f i o
¢ I- $ the basis for the alleged exemption.Any violation ofSedion 7031.$ STORIES TYPE CONSTR.
a3 - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(1500).):
❑ 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 ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractors 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 TOTALACHEAGE
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- qg.EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or air- BUILDING USE
prove for purpose ofsale.). RES IND CON PB Other
0 I,as owner of the property,am exclusively contracting with DUSTRIAL WASTE INTER. 30.00 ❑ '❑ ❑ ❑ ❑
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 does not apply
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 contractons)licensed pursuant to SEWER-SAN EA.200ft/10.00
the Contractors License Law. Q TRACT NO. PARCEL NO.
O lam exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
.Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificmeof consent to self-Insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q '❑ Certified copy ishereby fmmshed� - FIRE SPRINK ENERGY T-24
F � q^Certifie copy is file) with the cit inspection division. MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N❑
A Icunt
Wrn i�A PW PERMIT ISSUANCE 10.00
CERTI 7CCOMPENSATION INSURANCEOP'ORK13R5' PLG.CONTR. LIC.NO. PLG. O FLOOD zorvE A.L.u.c.
0- Cl (This section need not be completed if the permit is for one TOTAL 0 Y❑ N❑ v❑ N❑
hundred dollars($100)or Iess,)
U O I certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. l�
0 y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING SD
} f0 NOTICE TO APPLICANT: If,after making this Certificate of Ex.
Z emption,you should become subject to the Workers'Compensation APPLIANCE
)- provisions of the Labor Code, you must forthwith comply with 5.00 PLAN CHECK
V such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10000QF.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �D
1 hereby affirm that there is a construction lending agency for XHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,C1v.C.). EATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Q�
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING Q
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
bA
save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Copet liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX,
em oat said City in onsequence oC theMECH.CONT. LIC.NO. MECH.OTALTOTALlicant/Contractor Date
OFFICECOPY