12220POST THIS RD NEAR FRONT OF BUILDING
CIO OF CUPERTINO 6
INSPECTION DIVISION
T JOB'INSPECTION RECORD
JOB ADDRESS 10725• N. DeAnza Blvd. UNIT# LOT# -
•
OWNER 'Beim & I James CONTRACTOR
PERMIT NUMBER
ZZ2�
J PERMLT EXRIRATION \
!i
PERMIT'EXPIRES IF WORK
IS NOLISTARTED WITHIN..
ISU DAYS OF PERMIT ISSU•
ANCEFOUNDATION
LAST 180 DAYS FROM
ASTCALLED INSPECTION.
INSPECTION DATE I INSPECTOR
INSPECTION RECORD
6�(- % •
(�_•i••L�-] ,$� rel C er(•
UFER
PREGUNITE
- lL
PERMIT VALIDATION
..
C DATE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
,10- r7 R• �td
�/«vt d w
UNDERGROUND / SL B
PLUMBING
LIG• 1'"A6014- Al cik✓AL�/- % d%
-/)'4-? •U �4/
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ELECTRICAL -
MECHANICAL
L o'T Li •ji13 �R. L A .�•
BLD
FTECT.
LEcc
El
PLO. ME H.
1:1
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
L L br- `d' r_ ea�vp Ye
1 Lwvj 1 Jtol L- I
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION LUlA�n�O~N
rrrl
SIFT.
'
PLUMBING
MECHANICAL
S ^'i
tir.t�[c.— sfasIA_
ELECTRICAL
e-a
V r11•
vERMlr ro
I
FRAMING�e-�
INSULATION
sroRl s
rvPE CONR.
_ IN L/
Io z'� IkYr N-gL /-Gr 7 I1
,OCC. ROUP"
-
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
w2LG3 f
sArrx°rk
SO, FT. FLOOR AREA
dD O•,✓
TOTAL nCflEAGE
`� ?- At
DIAPHRAGM
RWL ING, USE
RES IND CON PB Other
❑ ❑ ❑ ❑ ❑
i�'r CeL •
/e-jo-8i 'fo/5'T
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
(-I vF7 Fe a Foo
l- . e'Y} +~ bd•l�Me�
ASSESSORS PARCEL NO.
-
PLUMBING �_
GAS TEST � _$
TRAC NO.
-
'
PARCEL NO.
MECHANICAL
ACC.DATE
ACC. PILE NO.
ELECTRICAL
FINALS DATE INSP.
FRAMING
SAN # ,
.ZOrvING
ENG. SITE NO.
INSULATION
PLUMBING ,�
GAS
VIRE $PRINK
N E:]
ENERGY ria
N[]i
MECHANICAL -
COVER NO WORK UNTIL.ABOVE HAS BEEN SIGNED
HEATING dT
FLOOD ZONE
o NK]l
A.L. u,c.
yo N
LATH -INTERIOR
ELECTRICAL
LATH -EXTERIOR
FIRE DEPT,
SHEETROCK %
E GRAD
FEE SUMMARY
SHEAR INTERIOR
BUILDI _
BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS
ELECTRIC -
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR,
I
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
H ONE WORKING DAY BEFORE REQUIRED INSPECTION..
O� V PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
—SEE PERMIT. FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
y/ ?
OFFICE COPY
APPLICANT TO FILL IN INFOOQi1ATION WITHIN RED LINES - USE g LL POINT PEN ONLY /
BUILDING PROJECT I DENTI FIC
-,NG
APPLICATION & PEWT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
12220
BUH
ADDRESS 1'D725
CUPL Wo / CA, -
•ANER'S
'
NAME
(4 r)
C.O� I!4" 1 I' �1� 'V/-Yrr'i GHONE Er✓1'�I YJI
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALID TION
p� f, S�
/
3 �d "
DATE OF APPLICATION
COrvrnacroR's�¢ gUIL1R..j
NAME ,�,,// p
Uc NO2CO7 J I33
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00 -
��p
CONTRACTOR'S -777 •`Y -'4-•I 6115 b
ADDRESS
vMONE
4up•` 1 I"MTmo "00 (4K. 2727
PPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT A^r'1
0 it•W6001& I'1''1'a-�T M5
ENGINEER
TIC. NO 04-b
PANELS (OVER 200 AMP) 20.00
PLAN CHELK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH, OR ENG. m1 O NAH
ADDRESS ,t
Lo At:TD CA. •DI'f,-, o(0 ZIP
SPECIAL CIRCUIT 5,00
PERMIT VALIDATION
I��
PAI
�J
A? .p 9 Z,�d 8 /
�ID"l
pp� f�
EMP. METER OR POLE INS. 20.0
APPLICANTS )M MES .I
ADDRESS rt%d
p !�� Alu RO. 15LO6 5110 � K'
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of C later
W �f 4E
(commencing with Section 7000) of DIVIsIOn 3 of the BIT San
. Professions Code, aEmmy license is in full for r%ef(e.f
I ss //�� Lir Number
BLD
ELECT.
❑
PLG. MECH.
❑ ElLicense
Dateq�.�L� Cantractof
BUILDING PERMIT
uu ,,
OWNER -BUILDER DEC RATION
I hereby affirm that 1 am exempt from the Contractor's License
Law for the following mason. (Sec. 7031.5, Busuco,and Professions
Code: Any city or county which requires a permit to construct, alter,
Improve, demolish, Or repair any structure, prior to Its issuance, also
requires the applicant for Such portio( to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000) of Division 3 ofllse
Business and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant loacivil penalty
of not mare than five hundred dollars (5500)):
INFORMATION
MISC. - REFER TO ORD
VALUATION
�7
/
PERMIT ISSUANCE 10.00
ELEC. CONTE. LIC. N0.
ELEG
TOTAL
PERMIT TO
W
j
OTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER IEA.) 5.00
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
BACK FLOW PROTECT. DEV ICE 4.00
OCC. GROUP
/L
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
himself or through his awn employees, provided that such improve-
mentsamnotintendedorofferedforsale, if, however, the building
-;e),-70c)2
/
25 AG
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.):
O 1, as owner of the property, am exclusively contracting with
GAS • EA. SYSTEM OVER 4 (EA.) 2.00
BUILDING USE
EES IND CON PB Other
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
3 7 / -!Q
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law dues not apply
to an owner of property who build$ or improves thereon, and who
contracts for such projects with a contractor(s) licensed pursuam to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO,
PARCEL NO.
❑ I am exempt under See,-, B,&P,C. for this
WATER HEATER W/VENT 6.00
reason
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE N0.
W'ORKERS'COMPENSATIO LARATION
WATER TREATING EQUIP. 5.00
I hereby al That I have a Ce mate o consent to self -insure,
or a certificate of Workers' Compe Ration In urance, or a certified
copy thereof (Sec. 3800, Lab.C)L _ U G
Policy No. Company
-
ZONING
ENG. SITE NO.
❑ Cer[If lay hereby f nishid.
�Ce is fd itIt the ct ms ecY i f' n.
( PPtican r
A
CE- OF 'IFICATF EXEMPTION FROM W RK F.RS'
FIRE SPRINK
Y� N❑
ENERGY T-24
YZ N❑
MISC• REFER TO ORD.
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.L.
PLG,CONTR, ❑C. NO.
PLG.
TOTAL
' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y ❑ N
Y ❑ N
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars ($100) cur less.)
I certify that in the performance of the work for which this per-
mit is issued, 1 shall not employ any person in any manner so as to
.BUILDING I'j
/
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK
FEE
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you Most forthwith comply with
such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT (TO 70 MC.F.M.) 4.00
AIR HANDLING UNIT(OVER 10000C.FM.) 6.00
SEISMIC FEE
p2Q�sa
I�
1 hereby affirm that there is a construction lending agency for
the performance of the work for which t s permit is issued (Sec.
3097, Civ.CJ. /� t r
Lender's Name f`IAN �' 0• d'1/,�L/(A
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
L HEATING UNIT (O VER 100,0008.T.U.)9.50
ELECTRIC
Lender's Address
VENTILATION FAN (SINGLE) 4.00
PLUMBING
I certify that I have read this application and state that the above
information is Correct. 1 agree to comply with all city and county
ordinances and state laws mg to building construction, and
BOILER-COMP(3 H.P, or 100,000 B.T.U.) 6.00
BOILER -COMP IOvar 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize Pox [alive of (his city to enter upon the
abovrmenlioned proper y for ins action purposes.
MISC. - REFER TO ORD.
CONST. TAX
(We) agree to save, indemni and keep harmless the City of
st liabili s, jud mems, costs nd expenses which
ay ace a ''d City ' consequence of the
pe so .
An
PERMIT ISSUANCE 10.00
MECH. CONT. LIC. NO. MECH.
i°TnL.TOTAL
7 763plicanl/Contractor
/
Date
OFFICE COPY