12655 POST THIS CARD NEAR' FRONT OF BUILDING
• PERMIT NUMBER
CITY OF CUPERTINO "
f 12655
•- INSPECTION DIVISION r ' , '
"JOB INSPECTION RECORD
/ PERMIT EXPIRATION
JOB ADDRESS J� '�'�O �M 9ER i7J-L A ✓�T UNIT# LOT# /�
`^/ PERMIT.EXPIRES IF WORK
OWNER �- C•O CONTRACTOR' - `0,0 IS NOT STARTED WITHIN
INSPECTION ATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
- -ANCE 6R',180 DAYS FROM
'FOUNDATION " - LAST CALLED INSPECTION. 1
UFER - -• t
PREGUNITE I PEHMIT,VALIDATION
11
URN A CONCRETE UNTIL OV A BEN SIGNED
UNDERGROUND /SLAB '`
PLUMBING
PAI ,
ELECTRICAL J) ISSUANCE DATE'
IBLDG.^ PCECT: PLG. MECR.
MECHANICAL
n IT ❑\
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED u L w G PERMIT
WOOD FLOOR I J INFORMATION
, VALUATION $/FT.
PLUMBING ' I -
MECHANICAL - --
PERMIT TO
ELECTRICAL
FRAMING " STORIES, TYPE CONSTR.
INS CATION
OCC.-GROUP HES.UNITS .
■RLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED N /r
Y-� ., SO.Fr.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
GUILDINQ
USE
RES'. ,IND CON PBOm"
-° APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ ❑ ❑ ❑
ROUGH
ASSESSORSPARCELNO.
pp X5 ,1
PLUMBING, TRACT NO. PARCEL NO,
GAS TEST, IA; ' . �,
MECHANICAL
-•t � '
ELECTRICAL p - 'S(9 FINALS DATE I INSP. ACC,GATE ACC.FRE NO.
FRAMING E--f SAN.#/„) �� zoNlNc ENG!SITE NO.
INSULATION' b- - PLUMBING
0 _ GAS .
MECHANICALFIRE SPRINK ENERGY T.24
OVER NO WO K NTIL ABOVE HAS BEEN SIGNED HEATING �l ❑ "❑ [D NE]
. FLOOD ZONE
LATH—EXTERIOR A.L:u.c.-
LATH—[NTERIOR� ELECTRICAL
y' - FIRE DEPT. Z_S Y❑ "❑ Y ❑ . IN[]
SHEETROCK 0 GRADE FEE SUMMARY
SHEAR INTERIOR c. BUILDING
SHEAR EXTERIOR ,
TEMPORARY APPROVALS BUILDING "� _
FIREWALLS ELECTRIC - _ - .PLAN CHECK
GAS 41. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY-BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252.4505,, ELECTRIC
,o�. ONE WORKING'DAY+B•EFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING. 1D
zz - - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL r
CALLING FOR FINAL INSPECTION. A. 47
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY,
BUI LDI NGMROJECT IDENTIFICATION PERMIT NUMBER
BUILDING' APPLICATION.& PERMIT . '
ADDRESS', C
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL J
Ow - PLAN CHECK VALIDATION
f 10�`QQ TiTippriAl Au 1265
"•,E- CITY. ELECTRIC PERMIT FEE
ONE446-1913 _
CONTRACTORS qy ' UTLETS-SWITCHES-RECEP 10.00/1.00
Debcor Corporation uc.No. 385712 - 3 LIGHTING FIXTURES 10.00/1.00 36
- C-ONTRACTOR's,21625 Stevens CreekBlvd APPLIANCES-RESIDENTIAL 4.00
ADDRESS
Cupertino, 95014 PHONE 446-1913 PANELS 10.00 AD DATE OF APPLICATION
ARRCHITECT Seals & 'ASSOC C-15162 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGI"EER
Stephen 'Clark LlC.NO, c-6382 SIGNS TRANS.' '3.00
ARCH.OR ENG. IT PERMIT VALSealsIDATION
s
ADDRESS
Clark,, SaratoOaklanga CCAzur SEMP.METERR OR POLE INS. 20.00 /J
APPLICANTS - MADDRESS OTORS 4^,J RiSEEIFEE SCH. CZ
21625 Stevens Creek Blvd Cupt SERVICE CHANGE 20.00Ili) !. o
Woo LICENSED.CONTRACTORS DECLARATION 7�y���i'TJt)J,0
a u w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
h<n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
o z IJ W Professions Cad rinse is in full ford effr ha., n$ .IInO��li 10
i 0 License Clads Lie.Number Qyµ�I /1 `• �• �'
Date `} Contractor Dee+..=OY 07_;
OUILDIRM PERMIT
¢0 w ¢ OWNER BUILDER DECLARATION INFORMATION
w 3 P, r 1 hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD
y / VALUATION SIFT.
uo¢ Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00
Eyw� Code:Any cityorcounty which requinesa permit(a construct,alter, /�i'1 "-0
¢ o improve,demolish,or repair any structure,prior l0 its issuance,also ELEC.CONTH. .LIC.NO. ELEC. /
- D w requires the applicant for such permit to file a signed statement that TOTAL �10 PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's License
H z r Law(Chapter 9(commencing with Section 7000)of Division3of the
f 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT • FEE
IF I_ $ thebasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE C NSTflr
by any,applicant lbr a pernniPsubjects the applicant to a civil penalty ALTER-DRAIN&VENT•WATER (EA.) 5.00 S
of not more than five hundred dollars($500).1:
❑ Las owner of the property,or my employees with wages as 'BACKFLOW 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 R-3- /
Code:The Contractor's License Law does not apply to an owner of -
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 _ SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. �+
meats are not intended or offered for sale.If,however,the building I GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner GAS-SEA.SYSTEM'-OVER 4(EA.) 2.00 BUILDING USE
builder will have Lite burden of proving that did not build or im- RES IND CDN PB . Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000
❑ I,us owner of the property.am exclusively contracting with . .
Cl' ❑ , ❑ .❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6:00 ASSESSORS PARCEL NO.
and Professions Code:'I'Iie Coritlnclor's License Law does not apply '
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3S 7-19 -OO/
contracts for such cense with a contractor(s)licensed pursuant m
the Contractor's License Law. ORMI SEWER-SANITARY-STE200ft/10.00 0 TRACT NO. PARCEL N0.
A. ry
❑ l am exempt under Sec.' ,B.&P.C.]or this WATER HEATER W/VENT 6.00 /y
reason lr
.Owner Date WATER SYSTEM ry �r11 r+`
11 i-0 11 1 n , 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSAIION DECLARATION WATER TREATING EQUIP. 5.00 ,
I hereby affirm that 1 have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified 1174v n9 I`D,,iTYinpr ZONING ENG.SITE NO.
copy thereof(See.3800,Lab.C.. I' - . , '
Policy No. Company USE & G
C) Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Certifne inl the cit inspection division.
Z O Applicant �e �b� O y MISC.- REFER TO ORD. '- .Y❑ N❑ y❑ -N❑
G: to CI:RTIFICATI:OF I'xEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 0 - FLOOD ZONE A.L.U.C.
LU COMPEN$AIION INSURANCI. PLO,CONTR. uc.No. PLG.
Q. O (This section need not be completed if the permit is for one TOTAL W Y❑ N CJ Y❑ N❑
D Z hundred dollars IS 100)or less.
L) O 1 certify that in tine performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mil is issued,1 shall not employ any person in any minor,so as to
O W become subject to the Workers'Compensation Laws of California.
Is. Date-Applicant ALTER OR ADD TO MECH. - 500 BUILDING 6 -
} W NOTICE TO APPLICANT: if,after....king this Certificate of Ex- .`
I.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions' of the Labor Code, you must forthwith comply with u ^ FEE
U such provisions or this permit shall]redeemed revoked - AIR HANDLING UNIT(TO 10,000CF.M4)-'4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(0VER. 0=C.F.M.) 6.00 SEISMIC FEE l�Lz
I hereby affirm that (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 5-
the performance of the work for which this permit is issued(Sec. , MICROFILM
3097,Civ C.). HEATING UNIT(TO 100i006B:T.U:)uB'00
Lender's Name P1Li'Zd Bank
Lender's Address QIL V _8P_"U HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 60'-
I certify that l have read this application and state Dot the above VENTILATION FAN (SINGLE) 4.00 a -
information is correct. Imine to comply with allcity 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 tow
So
upon the BOILER-COMP (Ovar100,000BTU)SEE FEESCH. MECHANICAL 3S
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 1
Cupertino against liabilities,judgments, costs and expenses which O = CONST:TAX 6,c
may in any way acerae against said City in consequence of the PERMIT ISSUANCE 10.00 U V
tin fthis permi - MECH.CONT. LIC.NO. MECH.
4/16/8.7- TOTAL 3S. TOTAL' a
Signature of pli m/Contractor Date -
OFFICECOPY