12871POST THIS CARD NEAR FRONT OF BUILDING
,.
CITY' OF 'CUPERTINO
PERMIT NUMBER
�0
12871
INSPECTION DIVISION ,.
.
JOB INSPECTION RECORD A94 1.u 1904
clot ot cup"
YIV•_-LOT
AVE
,PERMIT EXPIRATION
#��,
JOB ADDRESS " I `�� ZYZiwiSN UNIT#
�" : '
PERMIT,iXPIRES IF WORK.
•
OWNER CONTRACTOR
IS NOT' STARTED WITHIN
IS
x'180 DAYS OF PERMIT ISSUi
., ANCE. OR 180 DAYS FROM
'LAST
:LASTCALLED INSPECTION:
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION'.' -
-
.
UFER
PREGUNITE
-
I
PERMIT VALIDATION
ISSUANCE DATE
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
-UNDERGROUND/SLAB '
.PLUMBING:
!;
ELECTRICAL
MECHANICAL ' -
BLDG.
❑
ELEcr.
I ❑
PLG. cR�
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- .4 -BUILDING PERMIT
INFORMATION
' '• WOOD FLOOR
VALUATION $/FT.
PLUMBING '
MECHANICAL
ELECTRICAL -
PERMIT TO
��iC.`^^ylIc '
V r
FRAMING
-
_
,INSULATION'. i.
STORIES
TYPE CONSTR.
,.
IE
OCC. GROUP
RES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO, PT. FLOOR AOEA
- TOTAL ACREAGE
DIAPHRAGM
'
BUILDING USE
RES IND CON PBOtner
_
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
...
ASSESSORS PARCEL NO
ROUGH' •-...
..
PLUMBI NGI- ' -
GAS TEST. -
/Cebu c.r�✓.F�,p„i', O'K-f-�'
NDATE
TRArr No.
RCEL No
PA.
MECHANICAL.-'
ELECTRICAL" '•fI
FINALS INSP.
ACC.DATE
ACG FILE NO,
FRAMING -
SAN # -
INSULATION I
PLUMBING -
ZONING
ENG. SITE NO.
GAS - - -
.
MECHANICAL
FIRE SPRINK
3' NO
ENERGYT-24
° 0 T "❑
COVER NO'WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
LATH—INTERIOR'
ELECTRICAL _
FLOOD ZONE
Y❑- N❑
A. L. u.c, ,
y MN❑,
LATH—EXTERIOR i�"
FIREiDEPT, ,
SHEETROCK
GRADE +
FEE SUMMARY
SHEAR INTERIOR'. • •' - - ,
BUILDING,. '., -. _
BUILDING
-
SHEAR EXTERIOR
TEMPORARY APPROVALS
" -
FIREWALLS, '
ELECTRIC
PLAN CHECK
FEE
I
GAS - -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED,
OCCUPANcv
SEISMIC FEE
OCCUPANCY. OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR,
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505,
ELECTRIC
ONE'WORKI,NG,DAY,BEF.ORE REQUIRED INSPECTION.
NG,
Fw-�{
Ov` PLEASE GIVE JOB ADDRESS WHEN.PHONING.
PLUMSi
n
a(.%--
ZMECHANICAL
=SEE PERMIT FOR EXPIRATION DATE -
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
" CALLING FOR FINAL INSPECTION.
?
TOTAL
�� -"
` OFFICE COPY
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES - USE BALL POINT PEN ONLY
01 BUI-LDI NG PROJECT 1 DENTI FICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -'MECHANICAL
- PERMIT NUMBER
12871
BUILDING
ADDRESS
7582 Kirwin Ave'.
OWNERS
NAME C O B t e 11 O
PHONE 25.2-8618
QTY- ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
CONTRACTOR
NAME
NAME
A.A.A. Furnace'CACT.ND. 346361
UTLETS- SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
r-oN RAD OR's
E3s�2 Stone Ave. O -
PHONE 293-471
PPLIANCES -RESIDENTIAL - 4.00
PANELS '10.00
ARCHITECT.
OR
ENGINEER
LIC. No.
PANELS (OVER'200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.' -
ADDRESS
SPECIAL CIRCUIT S.00
PERMIT VALIDATION
,
EMP. METER OR POLE INS. 20.00
ZIP'
�. I
APPLICANTS
ADDRESS -
MOTORS SEE FEE SCH:
SERVICE CHANGE 20.00
I
1 -
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code. and my license Is In full force and effect.
Livensg Clas"s G �'_ 3' 1
ISSUANCE DATE
'
BLDG.
❑
ELECT.
❑
PLG. EC .
❑
•
_4C3Number
Date_yy=yly- Q Conlmcrnr_A_�-j-6 Ti ur
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law fertile following reason..(Sec. 7031.5, Businessand Professions
Code: Any city or county which n quiresa permit toconstmeLalter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to Ne 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 orthe
Business and Professions Code) or that he is exempt therefrom and
aC
'
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
VALUATION $/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO. ELEC.
TOTAL
CITY. PLUMBING PERMIT, FEE
PERMIT TO
1" 1eekne r.EC &I
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.$
by any applicant tofu permit subjectsthe licant toumvil penallyALTER-DRAIN&VENT-WATER(EA.)
of not more than five hundred dollars ($500).E500).1:
5.00
❑ I, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and Ore structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law du s am apply to an owner of
property,who builds or improves thereon; and who does such work
himself or through his own employees, provided that such improve-
meats are not intended or offered for sale. If. however, file huilding
BACK F LOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
50. FT. FLOOR AREA
_
TOTAL ACREAGE
-
GAS - EA. SYSTEM- 11NC. 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 int-
prove for purpose of sale.). -
C3 1, 1, as owner of the property, aexclusively contracting with
licensed contractors to Construct the project (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
contracts for such projects with a contractods) licensed pursuant to
the Contractor's License Law.
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON Pa other
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 6 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
.
SEWER -SANITARY -STORM EA. 200ftl10.00
TRACT NO.
PARCEL NO.
❑ l am exempt under Sec. ,BAP.C. for this
"-
'
WATER HEATER W/VENT 6.00
reason -
Owner Date
I
WORK IiRS'COMPENSAT ION DECLARATION
WATERSYSTEM .- 5.00
ACC. DATE
ACC. FILE N0.
WATER TREAT( P. 5.00
I hereby affirm that I have a certificate of consent to sclbinsure,
or a certificate of Workers' Compensation Insurance, or a certified
copy the,I Sxc 3606 Lab.C.).
Policy No. (_.5..]S.L/ISfapany _S -tate -COMP.. -I -n
ZONING
ENG. SITE NO.
F IRE SPR INK
'Y ❑ N ❑
ENERGY T 24
r ❑ N❑
❑ Certified Copy is hereby furnished.
Certified op is ,flied sµyh the 'ly FI �I division.
AAicunt A • N_.'_ n U.LII a.Ge_G.O�_
AA
MISC. - f CUPMER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 -
-FLOOD ZONE
A.L.U.C.
PLG, CONTR. LIC. NO.
PLG.
TOTAL
' COMPENSATION INSURANCE
(This semidn need not be completed if the permit is for one
Y ❑ N ❑
Y ❑ N❑
OTV MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars(E100) or lass.) - -
I certify that in the performance of the work for which this per-
mitis issued. I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO AYPLICANTi If, after making this Certificate of fix-
emotion, you should become subject to the Workers'Compensatiun
provisions of the Labor Code, you must forthwith Comply with'FEE
such provisions or this permit shall be deemed revoked.
'BUILDING
'.
ALTER OR ADD TO MECH. 5.00
APPLIANCE ,5.00
AIR HANDLING UNIT (TO 10SMCF.M.) -41 6 . 50
PLAN CHECK
AIR HANDLING UNIT (OVER 10MC.EM.) 6.00
SEISMICFEE
CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
'HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
Lender's'dme
A
Lender's Address
I certify that I have read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county.
ordinances and state laws relating to building construction, and
BOILER-COMP(3 H.P, or 100,000 B.T.U.) 6.00
PLUMBING
BOILER -COMP (Over 100,00 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city 10 enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence of the
TAX
.OeLCONST.
PERMIT ISSUANCE - - to-
granting of this penilit. I
8-14-8g.-
MECH. CONT. LIC. N0. MECH. ,
TOTAL
2]•50
TOTAL
/��J
Signatureof Applicant/Contractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
,.
CITY' OF 'CUPERTINO
PERMIT NUMBER
�0
12871
INSPECTION DIVISION ,.
.
JOB INSPECTION RECORD A94 1.u 1904
clot ot cup"
YIV•_-LOT
AVE
,PERMIT EXPIRATION
#��,
JOB ADDRESS " I `�� ZYZiwiSN UNIT#
�" : '
PERMIT,iXPIRES IF WORK.
•
OWNER CONTRACTOR
IS NOT' STARTED WITHIN
IS
x'180 DAYS OF PERMIT ISSUi
., ANCE. OR 180 DAYS FROM
'LAST
:LASTCALLED INSPECTION:
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION'.' -
-
.
UFER
PREGUNITE
-
I
PERMIT VALIDATION
ISSUANCE DATE
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
-UNDERGROUND/SLAB '
.PLUMBING:
!;
ELECTRICAL
MECHANICAL ' -
BLDG.
❑
ELEcr.
I ❑
PLG. cR�
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- .4 -BUILDING PERMIT
INFORMATION
' '• WOOD FLOOR
VALUATION $/FT.
PLUMBING '
MECHANICAL
ELECTRICAL -
PERMIT TO
��iC.`^^ylIc '
V r
FRAMING
-
_
,INSULATION'. i.
STORIES
TYPE CONSTR.
,.
IE
OCC. GROUP
RES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO, PT. FLOOR AOEA
- TOTAL ACREAGE
DIAPHRAGM
'
BUILDING USE
RES IND CON PBOtner
_
❑ ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
...
ASSESSORS PARCEL NO
ROUGH' •-...
..
PLUMBI NGI- ' -
GAS TEST. -
/Cebu c.r�✓.F�,p„i', O'K-f-�'
NDATE
TRArr No.
RCEL No
PA.
MECHANICAL.-'
ELECTRICAL" '•fI
FINALS INSP.
ACC.DATE
ACG FILE NO,
FRAMING -
SAN # -
INSULATION I
PLUMBING -
ZONING
ENG. SITE NO.
GAS - - -
.
MECHANICAL
FIRE SPRINK
3' NO
ENERGYT-24
° 0 T "❑
COVER NO'WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
LATH—INTERIOR'
ELECTRICAL _
FLOOD ZONE
Y❑- N❑
A. L. u.c, ,
y MN❑,
LATH—EXTERIOR i�"
FIREiDEPT, ,
SHEETROCK
GRADE +
FEE SUMMARY
SHEAR INTERIOR'. • •' - - ,
BUILDING,. '., -. _
BUILDING
-
SHEAR EXTERIOR
TEMPORARY APPROVALS
" -
FIREWALLS, '
ELECTRIC
PLAN CHECK
FEE
I
GAS - -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED,
OCCUPANcv
SEISMIC FEE
OCCUPANCY. OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR,
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505,
ELECTRIC
ONE'WORKI,NG,DAY,BEF.ORE REQUIRED INSPECTION.
NG,
Fw-�{
Ov` PLEASE GIVE JOB ADDRESS WHEN.PHONING.
PLUMSi
n
a(.%--
ZMECHANICAL
=SEE PERMIT FOR EXPIRATION DATE -
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
" CALLING FOR FINAL INSPECTION.
?
TOTAL
�� -"
` OFFICE COPY
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES - USE BALL POINT PEN ONLY
01 BUI-LDI NG PROJECT 1 DENTI FICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -'MECHANICAL
- PERMIT NUMBER
12871
BUILDING
ADDRESS
7582 Kirwin Ave'.
OWNERS
NAME C O B t e 11 O
PHONE 25.2-8618
QTY- ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION
CONTRACTOR
NAME
NAME
A.A.A. Furnace'CACT.ND. 346361
UTLETS- SWITCHES -RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
r-oN RAD OR's
E3s�2 Stone Ave. O -
PHONE 293-471
PPLIANCES -RESIDENTIAL - 4.00
PANELS '10.00
ARCHITECT.
OR
ENGINEER
LIC. No.
PANELS (OVER'200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.' -
ADDRESS
SPECIAL CIRCUIT S.00
PERMIT VALIDATION
,
EMP. METER OR POLE INS. 20.00
ZIP'
�. I
APPLICANTS
ADDRESS -
MOTORS SEE FEE SCH:
SERVICE CHANGE 20.00
I
1 -
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code. and my license Is In full force and effect.
Livensg Clas"s G �'_ 3' 1
ISSUANCE DATE
'
BLDG.
❑
ELECT.
❑
PLG. EC .
❑
•
_4C3Number
Date_yy=yly- Q Conlmcrnr_A_�-j-6 Ti ur
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law fertile following reason..(Sec. 7031.5, Businessand Professions
Code: Any city or county which n quiresa permit toconstmeLalter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to Ne 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 orthe
Business and Professions Code) or that he is exempt therefrom and
aC
'
BUILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
VALUATION $/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO. ELEC.
TOTAL
CITY. PLUMBING PERMIT, FEE
PERMIT TO
1" 1eekne r.EC &I
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.$
by any applicant tofu permit subjectsthe licant toumvil penallyALTER-DRAIN&VENT-WATER(EA.)
of not more than five hundred dollars ($500).E500).1:
5.00
❑ I, as owner of the properly, or my employees with wages as
their sole compensation, will do the work, and Ore structure is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law du s am apply to an owner of
property,who builds or improves thereon; and who does such work
himself or through his own employees, provided that such improve-
meats are not intended or offered for sale. If. however, file huilding
BACK F LOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
50. FT. FLOOR AREA
_
TOTAL ACREAGE
-
GAS - EA. SYSTEM- 11NC. 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 int-
prove for purpose of sale.). -
C3 1, 1, as owner of the property, aexclusively contracting with
licensed contractors to Construct the project (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
contracts for such projects with a contractods) licensed pursuant to
the Contractor's License Law.
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON Pa other
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 6 V.B. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
.
SEWER -SANITARY -STORM EA. 200ftl10.00
TRACT NO.
PARCEL NO.
❑ l am exempt under Sec. ,BAP.C. for this
"-
'
WATER HEATER W/VENT 6.00
reason -
Owner Date
I
WORK IiRS'COMPENSAT ION DECLARATION
WATERSYSTEM .- 5.00
ACC. DATE
ACC. FILE N0.
WATER TREAT( P. 5.00
I hereby affirm that I have a certificate of consent to sclbinsure,
or a certificate of Workers' Compensation Insurance, or a certified
copy the,I Sxc 3606 Lab.C.).
Policy No. (_.5..]S.L/ISfapany _S -tate -COMP.. -I -n
ZONING
ENG. SITE NO.
F IRE SPR INK
'Y ❑ N ❑
ENERGY T 24
r ❑ N❑
❑ Certified Copy is hereby furnished.
Certified op is ,flied sµyh the 'ly FI �I division.
AAicunt A • N_.'_ n U.LII a.Ge_G.O�_
AA
MISC. - f CUPMER TO ORD.
CERTIFICATE OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 -
-FLOOD ZONE
A.L.U.C.
PLG, CONTR. LIC. NO.
PLG.
TOTAL
' COMPENSATION INSURANCE
(This semidn need not be completed if the permit is for one
Y ❑ N ❑
Y ❑ N❑
OTV MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars(E100) or lass.) - -
I certify that in the performance of the work for which this per-
mitis issued. I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO AYPLICANTi If, after making this Certificate of fix-
emotion, you should become subject to the Workers'Compensatiun
provisions of the Labor Code, you must forthwith Comply with'FEE
such provisions or this permit shall be deemed revoked.
'BUILDING
'.
ALTER OR ADD TO MECH. 5.00
APPLIANCE ,5.00
AIR HANDLING UNIT (TO 10SMCF.M.) -41 6 . 50
PLAN CHECK
AIR HANDLING UNIT (OVER 10MC.EM.) 6.00
SEISMICFEE
CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
'HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
Lender's'dme
A
Lender's Address
I certify that I have read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county.
ordinances and state laws relating to building construction, and
BOILER-COMP(3 H.P, or 100,000 B.T.U.) 6.00
PLUMBING
BOILER -COMP (Over 100,00 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city 10 enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and expenses which
may in any way accrue against said City in consequence of the
TAX
.OeLCONST.
PERMIT ISSUANCE - - to-
granting of this penilit. I
8-14-8g.-
MECH. CONT. LIC. N0. MECH. ,
TOTAL
2]•50
TOTAL
/��J
Signatureof Applicant/Contractor Date
OFFICE COPY