13485 POST T%91S RD NEAR FRONT OF BUILDING •
• PERMIT NUMBER - d
cliq OF CUPERTINO 3485
INSPECTION DIVISION
JOB INSPECTION RECORD
° - PERMIT EXPIRATION
•' "I JOB ADDRESS 10883 A&B S. BLANEY, uNIT# LOT#
PERMIT EXPIRES IF WORK
s OWNER MIKE' S BIKE SHOP CONTRACTOR TRIPLEA SEWER SERVICE IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .
PLUMBING
ELECTRICAL
' - ISSUANCE GATE
MECHANICAL - - BLDG. ELECT. PEG. MECH.
E:] El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING -
VALUATION $/FT.
MECHANICAL
ELECTRICAL
. FRAMING
INSULATION _ STORIES TYPE CONSTR.
- OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB Otlw,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH. - ASSESSORS PARCEL NO,
PLUMBING
GAS TEST TRACT No. PARCELNO
MECHANICAL
ELECTRICAL - FINALS DATE INSP. ,)ACC.DATE ACC.FILE No.
• FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
- MECHANICAL FIRE SPRINK ENERGYT24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ N
LATH—INTERIOR I JELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑
• SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING '
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILOING FINAL ISSIGNED BY BUILDING INSPECTOR.- MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 1.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!, CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY -
�1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE ALL POINT PEN ONLY
TI
BU LD1 NG PROJECT I DENT(FI N PERMIT NUMBER
/ DING
APPLICATION & P IT 13485
REss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL3 Aa t3 50, I nlER'S PLAN CHECK VALIDATION
(� DTV. ELECTRIC PERMIT FEE
C t C J PHONE
NAME
TRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00
'x'(91 IE A5ESuNo
WER� LIC.VI(
LIGHTING FIXTURES 10.00/1.00
nONTR CTOR's APPLIANCES-RESIDENTIAL 4.00
aoIOREss 4D '5
I z-0 Pe At/E P `Vz 5 Lf(?qc PANELS 10.00 DATE OF APPLICATION
ARCHITECT /W,V PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
AOCREss ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TrMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 �+ ,//
ami
LICENSED CONTRACTORS DECLARATION p�S /g(f
< U U 1 hereby affirm
that I am licensed under provisions of Chapter 9 ISSU NCE D//ATE
(commencing with Section 7000)of Division 3 of the Business and
¢ y BLDG. ELECT. PLG. MECH.
r M z Professions Co a y license is in full for 1
z oLicen lass ' Lic.Number 0
T!:w Date- Contractor �^
a K s w� BUILDING PERMIT
¢ ¢ a' OWNER-BUILUF:R I]CCLARATION
o t V INFORMATION
Z
g I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u Ow VALUATION $/FT.
¢ Law for the following reason.(Sec.703 1.5,Businessand Professionsf
- 0 � Code:Any city or county which requiresa permit to construct,alter,
PERM(' ISSUANCE 10.00
QQ ¢ M Improve,demolish,or repair any structure,prior to Its issuance,also ELEC.CONTE. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTALPERMIT TO
X $ he is licensed pursuant to the provisions of the Contrcl
noi s License p� ,S
Law(Chapter 9(commencing with Section 7000)ofDivision 3 oflhe b
f ¢c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ 1-$ the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500).1:
❑ I,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 builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA.SVSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner GAS EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that he did not build or int - . . .
EES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 El ❑ El ❑ 13❑ 1,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 does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER .) 1.00
contracts for such projects with a contructons)licensed pursuant toSEWER-SANITARY-STD .200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT
reason \. 6.00
Owner Date WATER SYSTEM
ACC.GATE ACC FILE NO.
IN
WORKERS'COMPENSATION DBCLARA'I'ION WATER TREATING EO IP, "Q%8:00
I hereby affirm that 1 have a certifreate of consent to self-insure, '� ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800.Lab.C.). .rnTC
Policy No. Company_)
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Cem copy Is//-"y1�d y��yp. the coy in"'cction division.
Applicant l•K'j1V�Y•G)11, u� MISC.- REFER TO ORD. y❑ N❑ v ❑ N❑
F-' yPERMIT ISSUANCE 10.00 U -
CC CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.u.c.
W COMPENSATION INSURANCE. PLG.CONTE. 13C.NO. PLG, / aV
1 O ('Phis section need not be completed if the permit is for one TOTAL /r0 Y❑ N❑ Y❑ N❑
Z) Z hundred dollars IS 100)or lest
U O I certify that in the performance of the work for which this per- OT,. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers Compensation Laws of California.
Date Applicant BUILDING
a ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICANT: If,utter making this Certificate sa Iix
E Z wovisio,you should become e, you
to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.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 OVER 100,000 B.T.U.)9.50
Lender's Name H EAT]NG UN IT ELECTRIC
16 I certify that l 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 Co..ly PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP I3 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 EE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.001CONST.TAX
may in any wayacaccrue against said City in consequence of the
ft
gra I ng o rm t MECH.CONT. LIC.NO. MECH.
r} y+ - _1�-d '�✓ TOTAL TOTAL
dlg0at are of Applicant/Contracfor Date
OFFICE COPY