13184 POST THIS CARD NEAR FRONT OF BUILDING
' PERMIT NUMBER
CITY OF CUPERTINO , 13184
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS s 10250.De Anza Blvd. UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Great Western Savings CONTRACTOR Northern Neon Co. IS NOT STARTED WITHIN
W INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED s/
UNDERGROUND /SLAB -U1(` 1 � �/
PLUMBING viG
ELECTRICAL ;! CD
lerfino ISSUANCE DAT
BLDG, ELECT. 'PLG. MECH.
I` MECHANICAL Ej
DO NOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIILDING
NFORM PERMIT
'WOOD FLOOR . INFORMATION
VALUATION'
PLUMBING IC
r �U '' '
MECHANICAL
NgELECTRICAL
FRAMING '
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
JP,LVACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED"
SO,FT,F LOOP AREA TOTAL ACREAGE
'
!DIAPHRAGM ROOF
' BUILDING USE
HES IND CON .PB Omer
`?APP.LY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED C] [3 ❑ ❑ ❑
�\ ASSESSORS PARCEL NO.
'ROUGH .
S PLUMBING
TRACT NO, PARCEL NO.
GAS TEST
MECHANICAL " '
- "4• � ' FINALS ACC.DATE ACC.FILE NO.
ELECTRICAL
DATE INSP.
'FRAMING SAN #
INSULATION 1 PLUMBING - ZONING ENG.SITE ND.
GAS
-FIRE SPRINK ENERGY L24
MECHANICAL '
;.,-COVER NO WORK UNTILLABOVEAASOBEEN SIGNED HEATING NC] ❑ N�
FLOODZONE A.L.UC,
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT. - - •Y❑ N� - 'Y 0 N❑
SHEETROCK GRADE _ FEE SUMMARY '
SHEAR INTERIOR BUILDING - - .
' SHEAR EXTERIOR TEM ORARY APPROVA BUILDING - '
FIREWALLS ELECTRIC FEEN CHECK
GAS
(NO TAPE OR PLASTER UNTIL ABOVE'H'AS BEEN SIGNED OCCUPANCY I I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
ONE WORKING DAY BEFORE REQU•IRED.INSPECTION. PLUMBING
.z PLEASE GIVE 'JOB ADDRESS WHEN PHONING. .,
— SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
IMPORTANT! coNsr.Tax
PLEASE READ REVERSE'SIDE BEFORE TOTAL
1 CALLING FOR FINAL INSPECTION.
I ` OFFICE COPY -- — -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
fa APPLICATION & PERMIT
BUILDING 13184
ADD p' ZS b O F A-Nz 6LV�.
` BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNEF'S - A ,11 N PLAN CHECK VALIDATION
( "GFWAr ( F-�T �v OTV. ELECTRIC PERMIT FEE
ONTRA W 1 PHONE
coNTnperoR'sC-0 UTLETS-SWITCHES-RECEP 10.00/1.00
Np Ep �
� _ t(-F-,N IVNO adu�c.No. LIGHTING FIXTURES 10.00/1.00
ADDRESS oRs GT1��OICJI PPLIANCES-RESIDENTIAL 4.00
CONTRACTOR
'ISSOR pp
er nTU LAuk P"DNRi 3�2--44 PANELS 10.00 - DATE OF APPLICATION
ARCHITECT -r��p�� L..l`�, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.O.NO.
OR 06I�I CCxUw N W,C.N '
ENGINEER
1c.No. SIGNS TRANS. 3.00
ARCH.On ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
-�- ` • '� ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH. - J
ADDRESS SA '
t--k& SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION 4//
<u u I hereby affirm that 1 am licensed under provisions of Chapter 9 It SSUANCE DATE -
s,a i (commencing with Section 7000)of Division 3 of the Business and L •ELECT. PLG. MECH.
r z Professions CoAAed my license is in full fill E6 E st.1 ❑ ❑
Z O L"i - ice. Cl.. .-- Lia Number JI I I �^ ❑,
o H °w ate Contractor BUILDING PERMIT
Sr Ww OWNER-BUILDER DECLA T INFORMATION
i o a MISC.- REFER TO ORD iys
w s- I hereby affirm That I am exempt from the Cont'cm Licen a P�1)Qry $/FT.
Law(or the following reason(Sec.7031.5,Businessa dProfessions PERMIT ISSUANCE 10.00 �•p�
w'^ Code:Any city or county which requires a permit to construct.,lter, a V
.4¢Q Q improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. 'ELEC. /
se O 2 requires the applicant for such permit to file a signed statement Thal TOTAL PERMIT TO
wm w he is licensed pursuant to the provisions of the Contractor's License L•� /
r a% Caw(Chapter 9(commencing with Section 7000)of Division S of
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
'M 1- the basis for the alleged exemption.Any violation of Section 7031.5 'STORIES TYPE CONSTR.
s ; byany applicant fora permit subjeexthe applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars f$500)J:
❑ 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 nor apply to an owner of
Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP AP 5.00 So FT.FLOOR AREA TOTAL ACREAGE
Sl�l/ himself or through his own employees,provided that such improve. GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
moreets e not intended or offered for sale.If,however.the budding
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder willfiave the burden of proving that he did not build or em- RES IND CON PB Other
i°+-frA prove(or purposeof sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,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 ILAWN SPRINKLERS-OVER 5(EA.). 1.00
contracts for such projects with a contootods)licensed pursuant to SEW ER•SANITARVSTORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Conlmctoi s License Law. _
❑ l am exempt under Sec. .B.&P.C.for this AT ER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ALC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to sell'-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compel Salton Insurance,ar, certified
copy thereof(S c.3800,Lab.CA
?.lie y No. Company
O ❑ Cc,i d o y is hereby fur She FIRE SPRINK ENERGY T 24
Z Zl ❑ Corti c c y is filed w 1 t1 city inspection division. MISC- REFER TO ORD. y❑ N❑ y ❑ N❑
F O/ APP licant
� to CERTIFICATE F EXEMPTI PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOO 20NE, A.L.U.C.
LUCOM ENSATION INSURANCE PLG.coNTR. LIC.NO. PLO.
IL
QTOTAL Y[:] N❑ V❑ NE]section need not be completed if the permit is for one
:) Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
F mit is issued,1 shall not employ any person in any manner so as to F�s
O w become subject tothe Workers''Compensalion Laws of California. BUILDING V L/
Date Applicant ALTER OR ADD TO MECH. 5.00
>_ t6/a NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 3 6 �2
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=CF.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DMC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction leading agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit N issued(See. MICROFILM
3097,Cw C.). I HEATING UNIT(T0,100,060 B.T.U.) 8.00.
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• Lenders Address _
"n 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 BOILER•CDMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
�i ordiuunaes and state laws relating to building construction, and
F' hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL
afro Llhisapy�13.cicl
roperty for inspection purposes.
1 / ( ave, indemnify nd keep harmless the City of MISC.- REFER TO ORD.
up rliabilirle i nts, costs and expenses which PERMIT ISSUANCE - 10.00 'CONST.TAX
It
a ins id City in consequence of the
r. tinn MECH.CONT. LIC.NO. MECH.
Ill . f TOTAL TOTAL 3 L-�"
Signa ure.1 Applica ontra - Dale
OFFICE COPY