12651 ' POST THIS CARD NEAR FRONT OF BUILDING. ,
CITY, OF CUPERTINO RM11TNDMBER
INSPECTION DIVISION
/ JOB INSPECTION RECORD
� /h PERMIT EXPIRATION
JOB ADDRESS_! ✓ ro�5 ' rnr� 'g�-/ 4=y�nNIT# LOT# `' -pERMIT.EXPIRES IF WORK
• -OWNER abrdr - 1. CONTRACTORkkac 62- IS NOT STARTED WITHIN `
INSPECTION DOATE INSPECTOR INSPECTION RECOR 180DAYS OFPERMIT ISSU-
ANCE OR 180 DAYS'FROM
I.
LASTCAL LED INSPECTION.
LIFER. ;
PREGUNITPERMIT VALIDATION
E - ,, , .� -
OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r'r
UNDERGROUND /SLAB
PLUMBING r 1`d' ? ..
ELECTRICAL Y ISSUANCE DATE
MECHANICAL +' ,QLDc. ELECT. - PLG. MECH.
�� ❑' 0
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING
MECHANICAL
PERMIT TO
,ELECTRICAL- ' - ERMIT '
FRAMING' O / , STORIES TYPE CONSTR.
INSULATION
' ^ ` OCC,GROUP •RES.UNITS '
%P,L'ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OV „ ,
FLOOR AREA "TOTFL ACREAGE
( ROOF' F ,,
DIAPHRAGM - t
BUILDING USE
l RES IND CON PB 00,e,
-APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ^[9. ❑ ❑ ❑ ❑
ROUGH ' ]] ASSESSORS PARCEL NO.
PLUMBING TO NT Q- � ' 7 - V�
LASTEST
TRACT NO. PARCEL NO.
- _
MECHANICAL,'
• FINALS ' ACC,DATE" ACC,FILE NO.
ELECTRICAL !-
� ^-� +YI � DATE INSP. -
FRAMING - _ SAN S ,
INSULATION 1Z
PLUMBING ZONING ENG.SITE NO,
GAS Aim
- MECHANICAL � 'O FIRE SPRINK ENERGY TPG'
COYER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING CCd Y ❑ N'❑ '.Y ❑ N❑
ELEC6
TRICAL FLOOD ZONE - A.L.U.C.
LATH-EXTERIOR
LATH-INTERIOR FIRE DEPT. • •. 'Y,❑ NE] Yo N[3. � -
2 SHEETROCK GRADE . FEE SUMMARY -
SHEAR INTERIOR BUILDING
TEMPORARY APPROVALS BUILDING 3
SHEAR EXTEAIOFL.
- FIREWALLS. - ELECTRIC PLAN CHECK
f GAS .FEE
NOJAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED, OCCUPANCvsesMlc FEE'
>p OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC —
`�� W' ONE WORKING DAY BEFORE-REQUIREDINSPECTION.
p H' PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN�PHONING.
11777 2 Ie i
•ry.� { — SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! coNsr.TAX ,
PLEASE`READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL / I �
OFFICE COPY - -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL, POINT PEN ONLY t-
B I LDI NG PROJECT I DENTI FICATION - PERMIT NUMBER
BI ILOINGAPPLICATION & PERMIT J
ADDRESS _,I
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
O 'S PLAN CHECK VALIDATION
E _ CITY. ELECTRIC PERMIT FEE
A446-1911
NAMeracTORs qq OUTLETS-SWITCHES-.RECEP 10.00/1.00 -
- Debcor Corporation LIc.svO LIGHTING FIXTURES 10.0011.00
ADDRE55TOR's 21625 Stevens Creek Blvd. PPLIANCES-RESIDENTIAL 4.00 '�
CU PHONE _ PANELS 10.00 O DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR Seals & Assoc c-15162 PANELS (OVER 200 AMP) 20.00
ENGINEER
lie.NI,
_ SIGNS TRANS. 3.00 _
ADDR
RCO OR EN�`ea1SPben Clark u, Oakland, CA SPECIALCIRCUIT 5.00 k-PERMJVALIDATION
LP EMP.METER OR POLE INS. 20.00 � n ?} 7 r
APPLICANT s MOTORS SEE FEE SCH -�'I )
ADDRESSDDRESS .
2162S Stevens Creek Blud Clipt SERVICE CHANGE 20.00 a• '
woo LICENSEDCONTRACfORS DECLARATION _ _ 'IIY Cf !�G7
a ri w 1 hereby affirm that I am licensed under provisions of Chapter 9 u - ���+•/ ISSUANCE DATE
iith Section 7000)of Division 3 of the Business a n (commencng wecness an , . BLDG. ELECT. PLG. MECH.
F L z Professions Code,�IJ my license is in full forregrsd�0e t.
G L w o License la} G7ff7 Lir.Number Phbb llo _I I (a a 1 _/ - � ®,
F,A H J Data !-�/-a-7-Contractor_D r-CO -
a r 3 -+ City
BUILDING PERMIT
¢ a a OWNER-BUILDER DECLARATION - - -
0 a 0 MISC.- 1 REFERTTOIORD INFORMATION
w ; u H 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
as 04 Law for the following mason.(Sec.7031.5,Businessland Professions - PERMIT ISSUANCE 10.00 O
,A0 Code:Any city or county whichreyuiresapermi[to construct,after,
Q K a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 179
9 OOO
IF requires the applicant for such permit to file a signed statement that TOTAL /600^�
` w$ he is licensed pursuant to the provisions of the Contractor's License MIT TO
� PERMIT
I- z >0 Law(Chapter 9(commencingwith Section 7000)of Division 3afthe
i t o Business and Professions Cade)or that he is exempt therefrom and, DTV. PLUMBING PERMIT FEE at the basis for the alleged exemption.Any violation of Section 7031,5 „ STORIES TYPE CONSTR.
u ; by any applicant fora permit subjects the applicant too civil penalty'my emALTER-DRAIN&VENT-WATER IEA.) 5.00 ��
of not more than five hundred dollars( 1:
❑ I,as owner at .the property,or my employees with wages BACK FLOW PROTECTDEVICE 4.00 OCC.GROUP RES.UNITS ,
their sole compensation,will Jo the work,and the structure isnot -
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 _3
Code: The Contractor's License Law does nor apply to an owner of
property who builds or improves thereon.land who does Such work FIXTURES-PER TRAP 5.00 - - sa FT.FLOOR AREA TOTALACBEAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 C-a 9 OJ�0 '=Hfe,,
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that h - . BUILDING USEe did not build or im- - RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with
licemedcontractors to construct the project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:Tie Contractor'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 36-7--7147- 001
contracts forsuch projcetswith aconuacmr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200tt/10.00
the Contractors License Law. L, TRACT NO. PARCEL N0.
❑ fames craft under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00t-
reason
.Owner - - Dam WATER SYSTEM Y - --".+' 5.00
I- ACC.DATE ACC.FILE NO.
• WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP._ _ 5,00 -
I hereby affrm that l have a certificate ofconaent to self-insure.
or a certificate of Workers'Compensation Insurance,gr a cenified 4 - ZONING ENG.SITE NO.
copy Ol ereof(Sec.3800,La b.C.).
Policy No. Company USE' & G_ ... -
0 ❑ Certified copy is hereby fu rnished. Ulsy bI {lOLl illi FIRE SPRINK, ENERGY T-I4
C• ih�1 co is filed with the city inspection division.
,trida
Zo (:OY MISC.- REFER TO ORD. yN[] r [:] NE]
P: y PERMIT ISSUANCE 10.00 O '-
� CERTIFICATE OIs EXEMPTION PROM WORKERS' PERMIT ZONE A.LLLC.
UJ COMPI:NSATION INSURANCE PLG.CONTH. LIC.No. PLO,
CL 0 41 his section need nol be completed if tile permit is for one TOTAL Qa'- V 0 IN � Y E] No
hundred dollars(S 100)or Tess.)
U O .. I certify that in the performance of tile work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. Sa
Date Applicant BUILDING 3Q
a ALTER OR ADD'TO MECH. 5.00
} N NOIFICI: 1'0 APPLICANT: IL after making this Certificate of F _
F ? emption,you should become subject to the Workers'Compensation APPLIANCq 5.00 .PLAN CHECK
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=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE �d
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD IWITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.
3097,Civ.CI TT�� HEATING!IUNIT1rIT0.100!000 B.T.U.) 8.00 ` - MICROFILM
Lender's Addle t�1 Za�Ban � �9 HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
- LCRdL,s Name ma a
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct. I agree to comply with all city and county - PLUMBING
ordinances and state laws relating to building conslruclwco and BOILER-COMP I3 H.P.or100,000B.T.U.) 6.00 - �a
hereby authorize representatives of this city to enter upon the BOILER-COMP to. 100,000 BTU)SEE FEE BCH. MECHANICAL
above-mentioned property for inspection purposes.
(WeT agree to save, indemnify and keep harmless the City of MISC.-• REFER TO ORD.
- Cupertino against liabilities,judgments, costs and expenses which - ''CONST.TAX
may in any way accrue.'PWAinst said City in consequence of the PERMIT ISSUANCE 10.00 Q Q
Ming OT tltis permit MECH.CONT. LIC.NO. MECH.
l TOTAL 1,-e{ �- �� Q, 03
Signungaturol'Applican[/Con[Toet /16IR7e s!V TOTAL
OFFICECOPY -