13958 i
POST THIS CARD NEAR FRONT OF BUILDING
' PC RAtIi NUMBER
CITY OF CUPERTINO3958
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 19000 HOMe Stead Road UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Siemens Oprn CONTRACTOR nr _ I IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
-
UFER LASTCALLED'INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS REMSIGNED
UNDERGROUND /SLAB
- PLUMBING
ELECTRICAL J[( j J � / ( O ` J 'P ��" L+I�'/ 136e4CO DATE
MECHANICAL G /. BLDG. ELECT PLG. MECH.
l ❑ ,� ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 9 / i BUILDING PERMIT
WOOD FLOOR / V G /( � vnwnnoN INFORMATION s/RT.
PLUMBING Ow
MECHANICAL Ally10
ELECTRICAL J PERMIT TO
FRAMING Gc '
INSULATION ' STORIES TYPE CONSTR.
OCC.GROUP PES.UNITS
_ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES INC) CON PB Olnei
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBINGEXP RED
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC,DATE ACC.FILE No,
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T ZC
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y N❑ Y ❑ N 1
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BYILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o�
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 7y �J
CALLING FOR FINAL INSPECTION.
OFFICE COPV
PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
VolyBUILDING PROJECT I DENT[FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDREas, 000 IlmtlF ST,_4_0 139 5 8
�� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NA E• OTY. ELECTRIC PERMIT FEE
�r7l I/%kl-1 O PMONE
CONTRACTOR'S
NAME UTLETS-SWITCHES-RECEP 10.00/1.00 '
-GE -J G• ,C.NO. 67�(,�7 ILiGHTING FIXTURES 10.00/1.00
CONTRA
ADPPLIANCES-RESIDENTIAL 4,00
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP( 20.00 I�
ENGINEER - sePZ'
c.No. SIGNS TRANS. 3.00
ARCH.OR ENO. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS - SEE FEE SCH. �•�
SERVICE CHANGE 20.00 OnC(Ap(fl
woo LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that I am licensed under provisions of Chapter 9 y (f ANCE GATE
I" (commencing with Section 7000)of Division 3 of the Business and
w Q y G� _s BLDG. ELEC PLG. MECH.
F.w z Professions COOand my license is in full for e' d•e Uc�7 �J ❑ ❑ ❑
0 O w - Licese s Co Number (9(�
9 w� w Dat." Comractor l�/➢��,.PT9}
c a OWNER-BUILDER DECLA ATIOq N BUILDING PERMIT
o it U INFORMATION
K
3 LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LLO ¢ Law for the following reason,(Sec.703 1.5,Business and Professions VALUATION $/FT.
� - Code:Any city or county which requiresa permit toconstruct,alter, PERMIT ISSUANCE 10.00
rtm�
a ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
a wD u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
S he is licensed pursuant to the provisions of the Contractor's License '
HiQ Law(Chapter 9(commencingwith Section 7000)o f Division 3 ofthe �G�
s 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE T
IC $ the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
a- ; by any applicant for a permit subjects the applicant toa civil penalty
of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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
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-
mentsare Got intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or unprovement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with
licensed Contractors 10 construct the project(See. 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(hereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
rea❑son 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C,).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE$PRINK ENERGY T]4
Z Z ❑ Certified copy is filed with the city inspection division.
F O Applicant MISC.- REFER TO ORD. y N Y ❑ No
CCN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LOU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO.
PLG.
1 O (This action need not be completed if the permit is for one TOTAL v NV N�
:D Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mi(is issued, I shall not employ any per ots in an manner sa as to
becom ec he Workers' pe on La 'California.
LU Uate o Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NOTIC 'r0 A PLICANT: If, ter making this Certificate of Ex-
Z emption,you should becomes CC(10 the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this pcon it shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWGF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the orma
pedrfnce of the work for which this permit is issued(Sec.
3097,performance
HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
t
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I Certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the g01 LER-COMP (Over 100,000 OTU)SEE FEE$CH.
above-mentioned property for inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which 0 CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.0
gra ti go permit MECH.CONT. LIC.NO. MECH.
CF AIC S��J TOTAL TOTAL
5 store of A pplican t/Contractor Dae ,��
OFFICE COPY