14923 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY 01 CUPERTINO 14923
INSPECTION DIVISION
JOB INSPECTION RECORD
(� PERMIT EXPIRATION
JOB ADDRESS �Sto �sA��hZ Wyk/'�/Cr C-T UNIT# LOT# 6
PERMIT EXPIRES IF WORK
OWNER ,�6'Fr072. �d CONTRACTOR c(�-��c - ,Od IS NOT STARTED'WITHIN
INSPECTIO DATE INSPECTOR INSPEC ON RECO 180 DAYS OF PERMIT ISSU-
FOUNDATION� LASTANCE AL ED DAPS FROM
d NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. t
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN qIGNEO E - % "� "•�-�'`-''
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL -ISSUANCE DATE
MECHANICAL - BLDG ELECT I PLG: MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIL G PERMIT
WOOD FLOOR I ATION -
PLUMBING
MECHANICAL -
ELECTRICAL
PERMIT WA TO
FRAMING s);L
INSULATION - - STORIES TYPE corvsrR.
9 IF 3 10 SU
OCC GROUP RES UNITS
LACE NO SUBFLOOR UNTIL ABOVE HAS N SIGNED D R 3 I
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AR.EA TOTAL ACREAGE
R. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
UILDING USE
ROOF SHEATHING ( ,�',� � � � Res I❑ Ory ❑ ❑
I.: APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SANS ASSESSORS PARCEL NO
PLUMBING 'ELECT.ENERGY 11-7-e-1
TUBS 8 SHOWER PAN — - PLUMBING.ENERGY TRACT No. PARCEL NO
MECHANICAL Z^.f MECH.ENERGY '
_ ELECTRICAL BUILDING ENERGY ACC.DATE AC c FILE NO I
FRAMwG �J ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION ( n�. � - � /_ PLUMBING -
GAS TEST. ' GAS
FIRE SPR INK ENERGY Lj9
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNIED HEATINGY [:] .No Y [D NC]
FLOOOZONE ALU C.,
EXTERIOR SHEAR ELECTRICAL'RELEASE
INTERIOR SHEAR FIRE DEPT. " °0 NE) Y L IN
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING10-07 -
,INTERIOR LATH //•• TEMPORAR APPROVALS; of BUILDINGMon
SCRATCH COAT —/ —E ELECTRIC LAN CHECK , .�
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUP.ANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
L" ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLUMBING
PLEASE GIVE.JOB ADDRESS WHEN PHONING.
ZMECHANICAL
' - SEE.PERMIT FOR EXPIRATION DATE - � �
'IMPORTANT! CONST..rnx 2 .24
PLEASE READ REVERSE SIDE BEFORE TOTAL 13U.97
CALLING FOR FINAL INSPECTION.
OFFICE COPY
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
'BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
=NG 11567 Copper Spring Cwft APPLICATION & PERMIT 4AJGG J
r)1)
LOTy�169PLAN 2A BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
NWNEIPS regorJ`/ ' nson PLAN CHECK VALIDATION
Ulve10 IentsJ PHONE 415-595-2100 OTY. ELECTRIC PERMIT FEE
CONTRACTOR'S
NAMEInc. UTLETS;SWITCHES-RECEP .10.00/1.00
Gregory Gmp
LIC.NO.
8-430097 LIGHTING FIXTURES 10,00/1.00
C,ONTRACr n In APPLIANCES-RESIDENTIAL 4.00
ADDRESS CA 94%5 415-595-21
PHONE PANELS 10.00 DATE OF APPLICATION.
AARRCHITECT )^� SSenlan, Associates PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER LIC.NO. C-8395 SIGNS TRANS. 3.00
ARCH OR ENG. PERMIT VALIDATION
Aool3sht #10092707 SPECIALCIRCUIT . 5.00
' ZIP TEMP.METER OR POLE INS. 20.00 /J ,
APPLICANT - win In Or. MOTORS SEE FEE SCH.
ADDRESS M CA 94065
SERVICE CHANGE 20,00
woo LICENSED CONTRACTORS DECLARATION
a i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
(commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH.
zProfessions Code,aAd my license is in full fort ct.
i0H License Class_'_f5 Lic.Number_4 _
0 m - Date Contractor
'" - E PERMIT
¢ ¢w¢ OWNIi R-BUILDER DL'CLAR ION INF ATION
wO w U MISC.- REFER TO ORD
LL y I hereby affirm that I am exempt from the Contractor's License
F u m j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
Qa ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, N
to
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wm he is licensed pursuant to the provisions of the Contractors License
Fzi Law(Chapter 9(wifinencingwithSection 7000)ofDivision3ofthe SFDLVL
EE ¢ Business and Professions Code)or that he is exempt therefrans and QTY. PLUMBING PERMIT FEE
zZ D the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n3� by any applicant for a permit subjects life applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 3 5NM2
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,AR EA,COND. 5.00 R-3 1
Code:The 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 ACREAGE
himself re through his own employees.provided that such imhrd building
himself a thronget his or offered employees,
or provided that such
building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
1740
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ®• ❑ ❑ ❑ ❑
licensed contractars to construct the project(Sec.7044,Business ILAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions C'ode:1'he 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 it contractors)ticensed pursuant to
the Contractor's License Law, SEWER-SANITARY-STORM EA,200it/10.00 TRACT NO. PARCEL NO.
❑ tum exempt under Sec. ,B.&P.C.lot this WATER HEATERW/VENT 6.00 8067
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cer ificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance.or a certified
copy thereof(Sec.3800,Lab.Cf. United Pacific
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
((�1( Certified co ed with the cit inspection division.
Z p Al7dlicant - y p MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No
FmPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU CERTI CCOMPE COMPENSATION
FROM WORKERS'
LU � COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. PLC.
CL O (This Section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H 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.
W Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 776.00
} (ail NOTICE'l0 APPLICANT. If,after making this Certificate of Rx-
♦- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 155 f�
provisions of the Labor Code, you must forthwith comply with FEE/ energy
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1O,00DC.F.M.) 4.00
CONs'fRUCTION LENDING,AGENCY AIR HANDLING UNIT(OVER 10=1C.F.M.) 6.00 SEISMIC FEE 9.73
'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.). Security PdC1f. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nd re @PE }S-Fl"w= HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC 55.50
Lender's Address Wff
1 Certify that I hove 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 55.50
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 C
hereby authorize representatives of this city to enter upon life BOILER-COMP (Over 100.000 BTU)SEE FEESCH. MECHANICAL 55.50
' above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- * REFER TO ORD. OO
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 288.24
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 p7-
ranting of this permit. MECH.CONT. LIC.NO. MECH.
, TOTAL TOTAL
1317.9
$ignatu,eo ¢an[/Contactor Date
OFFICE COPY