12046 POSTTHISCARD NEAR FRONTOF BUILDING
CITY OF CUPERTINO "112046
INSPECTION DIVISION
JOB INSPECTION RECORD
N� PERMIT EXPIRATION
JOB ADDRESS 11226 BUBB ROAD UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER KRZICH CONTRACTOR ATLAS HEATING IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
•, PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
❑ Ll ED El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING '
MECHANICAL -
ELECTRICAL - vERP/MITrl
1
at
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO'SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB 00 ,
— "'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ Cl ❑
, ROUGH - ASSESSOHS PAHCEL NO.
PLUMBING
TRACT NO. PARCEL NO
' GAS TEST
MECHANICAL '
ACC.DATE ACC.FILE NO.
ELECTRICAL - FINALS DATE INSP.
FRAMING SAN * A.
INSULATION PLUMBING r ZONING ENG.SITE NO.
, -
' MECHANI L FIRE SPRINK ENERGY T 24
NE Y E] -NE]'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _�y 7
FLOOD ZONE A.L.u.c.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. - Y❑ N❑ Y 0 NQ
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING /1-/fr-jrAw BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
}
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING. ,
— SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT!
CONST.rnx
• I PLEASE READ REVERSE SIDE BEFORE TOTAL
y CALLING FOR FINAL INSPECTION.
OFFICE COPY f
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN.ONLY
BUI LOI NG PROJECT IDENTIFICATION PERMIT NUMBER c
aDILDING APPLICATION & PERMIT 120
6
ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
J/c31a
OWNER'S PLANCHECK VALIDATION
NAME ' OTY. ELECTRIC PERMIT FEE
PHONE
CONT AC ORS
NAME /y G_ /_ UTLETS-SWITCHES-RECEP 10.00/1.00
7/5 LIC.No.�✓�(!/ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR oR's/'_ S APPLIANCES-RESIDENTIAL 4.00
CO ,.
•PHONE / PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 '
A OGRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANT'S/Cl MOTORS SEE FEE SCH.
ADORE55�' "✓� /L
.�9if/✓
SERVICE CHANGE 20.00
F
00 LICENSE CONTRACTORS DECLARATION /_[///� b-.y
<v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANOE DATE/
w< w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H N i Professions Cod an my,license is in full force n of ecL ( ❑ ❑ ❑ ❑
a0 m O License ss Lie.Number Al•
F x r j Date Contractor
¢ y E BUILDING PERMIT
w u OWNER-BUILDER DECLARATION
X 3 u. y I hereby affirm that I um exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
o ¢ Law for the following reason.(Sec.7031.5,Bromessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
w u Code:Any city or county which requires permit to construct,alter,
¢ a¢ p improve,demolish,or repair any structure,prior(o its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires(he applicant for such permit to file a signed statement that TOTAL PERMIT TO ,
w$ he is licensed pursuant to the provisions of the Contractor's License
La..(Chapter 9(commencing with Section 7000)ofDivision3of(he
i c th
Business and Professions Code).or at he isexempt therefrom and QTY. PLUMBING PERMIT FEE
rc H the basis for the alleged exemption.Any violation of5ection 7031.5 STORBES TYPE GUNNI H.
i; by any applicant for a permit subjects the applicant(oacivilpenally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Oce.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 docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments1 are not intended or offered for sale.If,however,the building
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 im- . . .
RES IND CON PB Osber
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 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 PAROELNO.
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 contractors)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
(he Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam 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 certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereoLL SS.c.3. BOQ.•Lab.C.). �
Policy N any
❑ Certified
ified copy is hereby furnished. FIRE SPgINK ENERGY T 2¢ '
Z Z �Q/Certified co y is filed h the cit inspection division.
O Npplicarn �2(,Ir,�_} �/ a MISC.- REFER TO ORD. v ❑ N❑ y ❑ N❑
CCw � PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
� CIiRTIFICCOM E EXEMPTION FROM WORKERS'
W COMPENSATION INSURANCE PLG.corvrR. LIC.No. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dollars(SHOO)or less.)
L.1 O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued,1 shall not employ any person in any manner so as to
U become subject(o the Workeri Compensation Laws of California.
ad Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emplion,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=11F.MI.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 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.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Ad
Lender's Address HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COI H.P.or 100,000B.T.U.1 6.00
' t hereby aulhonm representatives of this city m enter upon rile BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property 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 sai City in consequence of the PERMIT ISSUANCE 10.00 Q;
gratin of this per MECH.CONT. LIC.NO. MECH. i
TOTA TOTAL o
Signature of Appl'•ant/ ntra or Date
/17
5� q�
OFFICE COPY