15554 I • POST THIS CARD NEAR FRONT OF BUILDING ERMITNUMBER '
CITY . OF CUPERTINO 15554
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10991N. De _Anna -Blvd. UNIT# _LOT#
PER EXPIRES IF WORK
OWNER
IV]dY ldril DE!VeZO merit CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD '180 DAYS OF PERMIT ISSu.
FOUNDATIONANCE OR, 180 DAYS FROM
NOTE: '.LASTCACLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMI1 VALIDATION
PREGUNITE . CUPERTINO STANDARDS.
GARAGE SLABS i .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB p►�� /�y f
PLUMBING - Vii` '
ELECTRICAL ', ISSUANCE UA r E'
MECHANICAL _ E,Lecr Pic. MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
.WOOD FLOOR ,VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL ,.
FRAMING - T
STORIES -TYPE CONSTH,
INSULATION -
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO TT,FLOORANEA TOTAL ACREAGE
.. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -
DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - Hes IND cory Pe OL..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ EDEl13 CD
ROUGH SAN.H - - ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL - - MECH.ENERGY
ELECTRICAL BUILDING ENERGY -ACC.DATE AEC.FaE No
FRAMING ELECT,FINAL TEST - k
• INSULATION
PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
' MECHANICAL FIRE SPRINK ENERGY T.2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N1:1 ❑ "�
FLOOD LONE 0.LUC
EXTERIOR SHEAR • ELECTRICAL RELEASE
-INTERIOR SHEAR FIRE DEPT. Y❑ "❑ Y ❑ "❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR 'LATH _ BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING .
SCRATCH COAT ELECTRIC PLAN CHECK
• GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED 16CCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM ,
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _
I" ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT�FOR EXPIRATION DATE'—
I
'IMPORTANT!' CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION,
OFFICE COPY
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTOR'S NOTICE
CITY OF CUPERTINO
ToG_ /6 19 2F
A/
You are hereby authorized to Connect electrical service for
Owner or Tenant rA�! /��l !J 11 y!<' Lyp,L„1,,�7' j
� G � I
` At
1T �No.of Wires Size of Wires Size of Switch
ti Motor Load Voltage Phase
't Heating Load K.W. Voltage
�oLx
No.of Meters
Light I10 New Service Reconnect
L(11
Heat 1907hree Wtre More Service_
No.of Add,Meters Power�l,I�fL�/,}- Three Phase Move Meter
@• ELECTRICAL INSPECTOR +�
j
" `APPLICANT TO FILL IN INFORMATION WITHIN:RED LINES -.USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION -PERMIT NUMBER ,.
aun'.NG APPLICATION & PERMIT . 15554 J J J
ADDRESS I
��U. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S PLAN CHECK VALIDATION
NAME
DTV. ELECTRIC PERMIT FEE
�) TORS 'P.
PNDNE
1AMERacraRs ,�/ OUTLETS-SWITCHES-RECEP 10.00/1.00
Q1 LJC.NQ`7 Q 'LIGHTING FIXTURES 10.00/1.00
CONTRACTORSPPLIANCES-RESIDENTIAL
ADORE55 - 4.00 -
PHONE PANELS 10.00 DATE OF APPLICATION
A cHrracr PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE IP,C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 -
ADDRESS ONE. SPECIALCIRCUIT 5.06 PERMIT/VALIDATION
' ZIP TEMP.METER OR POLE INS. MCI O -' /. --•�
APPLICANT'S - MOTORS SEE FEE SC L`-s^
ADDRESS
fSD
SERVICE CHANGE 20.00
CO LICENSED CONTRACTORS DECLARATIONau .0
a U u I hereby affirm that 1 am licensed under provisions Of Chapter 9 �nO ISSUANCE DATE
H z 'a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
rD i Professions Cade,and my license is in full for and effect. ❑
Z. 0m W License Class Lia Number-
Datc_�pnl-f_�$�_Contractor .4
a y f BUILD NG PERMIT
a c,w a OWNER.BUILDER DECLARATION INFORMATION
U REFER TO ORD
K
LL H I hereby affirm that I am exempt(rain the Contractor's License. MISC.r Vq LUATION $)FT.
toe. Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE -99:00 -- -
Code:Any city or county which requires a permit to construct,alter,
aM¢ o' improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC
n E o u requires the applicant for such permit to file a signed statement that T0T _ PERMIT TO
m he is licensed pursuant to the provisims of the Contractor's License
R z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe .7
�" FL T
4 o Business and Prol'essians Code)or That he is exempt therefrom and DTV. PLUMBING PERMIT FEE r �� I
(e i-$ 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& VENT-WATER (EA.) 5.00 '
ofnot more than five hundred dollars($500)J: -
❑ 1,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 So.FT.FLOOR AREA TOTAL ACREAGE'
. himself or through his own employees,provided that such improve.
OHMS are n at intended or offered for sale.If,however,lire budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.) '2.00 BUILDING USE
builder will have the burden of proving that lie did nolbuild or im-
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Omer
❑ 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 dues 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 contructorfs)licensed pursuant to SEWER-SAN ITARV-STORM EA.200tt/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ Iain exempt under Sec. ,BAPC.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
1 heathy affirm that I have a certifmata of consent tD self-tenure' ZONING ENG.SITE NO.
_ or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company-CJf�L1eA
0 ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T-24
Z Z ❑ Cerhf opy Is Ile with c City spec tion�drvLsior/y� MISC.- REFER TO ORD.
O Applicant It, co �QAV V❑ N Y ❑ N❑
fry CERTIFICATE OF EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE -A.L.U.C.
W _ COMPIiNSAT'ION INSURANCIi PLG.CONTR'. u0.N0.- PLG.
CL 0 (This Section need not be completed if the permit is for one i TOTAL V❑ N❑' V❑ IN
0 Z hundred dollars IS 100)or less.) -
0 O 1 certifr"that in the:performance of the work for which this per DTV. MECHANICAL PERMIT FEE
FEE SUMMARY
LL 1- mit is issued,I shalt not employ any person in any manner so as to
Ow become subject to the Workers Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TOAPPLICANT: If,after making Ihis Certificate of lix- -
F ? emption.YOU should become subject to the Workers Compensation APPLIANCE 5,00 PLAN CHECK'
provisions of tire,Labor Code, you must forthwith comply with FEE
(�. Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) -4.00
CONSTRUCTION LI:NDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm ihat 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 Name H EATI N G UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC - I
Lender:S Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) ,. . 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autlioriee representatives of this city' to enter upon the .gQILER-COMP(Over 100,000 BTU)BEE FEE SCH. MECHANICAL
above-mentioned property lot inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- -I. REFEWTO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in,any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting of lir is pe'rmlt. ./-,� MECH.CONT. LIC.NO. MECH.
'�13• 6= - - TOTAL TOTAL
Signature of Applicant/Contractor Date y
OFFICE COPY