14116 n. POST THIS CARD NEAR.FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1.4116
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10055 MILLER AVE. ,ADIA SUITAIT# Lor#
_ PERMIT EXPIRES IF WORK
OWNER ' AIDA (Kontrabecki Grp) CONTRACTOR. CAL-AIR, INC,. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
_FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE • PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED r
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. FELECT. PLG. MECH.
❑ o ❑ 1 Q
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT '
-W _ INFORMATION
WOOD FLOOR
VALUATION S/FT.
PLUMBING -
MECHANICAL
PEaM/T TD
ELECTRICAL
FRAMING I
INSULATION
STORIES TYPE CONSTR.
� -
OCC GROUP RESwUNITS
,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF. _ 5 ,FLOOR AREA TOTAL ACREAGE
DIAPHRAGMn�
BUILDING USE
HES IND CON PB OII,e,
D1:1 0
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED % .❑
AlESSORS PARCEL N0.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICALAcc.DATE Acc.FILE No. .
FINALS DATE INSP.,"
FRAMING SAN #
INSULATION PLUMBING
ZONING ENG,SITE NO.
'
GAS
• MECHANICAL FIRE SPRINK ENERGY T-ZG
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - ' HEATING E] N❑ NE]
.
' LATH—INTERIOR ELECTRICAL FLOOD ZONE AL.UL.
LATH—EXTERIOR- FIRE DEPT. YC3 N[] Yo No
SHEETROCK GRADE ' FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR . ,TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTI LABO,VE HAS;BEEN'SI GNEDILI OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
,. o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. i
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE.COPY
588-089 Bldg Permit #14651
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
APPLICATION $f PERMIT
AoidNG 14116
� l`l�5 Miller Ave. , Adla Suite BUILDING— ELECTRICAL—PLUMBING—MECHANICAL
o ER'S {' PLAN.CHECK VALIDATION
III . OTY. ELECTRIC PERMIT FEE
Kon Group��
PHONE
Go
NAME ACTOR'S UTLETS•SWITCHES-RECEP 10.00/1.00
Cal-Air Inc. LIC.NO. 137195 LIGHTING FIXTURES 10.00/1.00
CODRESS.OR's
APPLIANCES-RESIDENTIAL 4.00
1775 S. 1st St. ,S.J&H;NE 947-0155 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARC" OR ENG. SPECIAL CIRCUIT ' 500 PERMIT VALIDATION
ADDRESS .
ZIP TEMP.METER OR POLE INS. 20.00 ,_�J n
ADORES rs MOTORS SEE FEE SCH. X ^ I - '
ADORES lAW-G(.h-i
1775 S.: 1st St., San Jose SERVICE CHANGE 20.00
w 0 o LICENSED CONTRACTORS DECLARATION
a v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
H Z w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
a 1° Professions Cct- gmy license is in full force e
i o L S License CIAsy,-C�-+2�U-�--Lic.Number - �` ❑ ❑ ❑
9 L w Date—ULK.�{-ea---Contractor_ Y_
P: m s .,,, BUILDING PERMIT
IS M u OWNER-BUILDER DECLARATION INFORMATION
°< I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
I" O¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
_M PERMIT ISSUANCE 10.00
,A Code:Any city or county which requires a permit to construct,alter,
rt 2¢G improve.demolish,or repair any structure,prior to its issuance,also ELE C.CONTR. LIC.NO. ELTC
O IS requires the applicant for such permit to file a signed statement that TOTAL AA PERM T TO
' w >� m he is licensed pursuant to the provisions of the Contractor's License /( -J/ '
I- ¢ > Law(Chapter 9(commencirig with Section 7000)of Division 3 of the
a Business and Professions Code)or that he is exempt therefrom and OTY: PLUMBING PERMIT FEE
E
$ the basis for the alleged exemption.Any violation of ScCtion703l.5 STORIES TYPE CONSTR,
TR by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500)J:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00OCC.GROUP NITS
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 FIXTURES-PER TRAP .5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mes are not intended or offered for sale.If,however,the building GAS•EA.SYSTEM•1 INCA OUTLETS 8.00
nt .
or improvement is sold within one year of completion,-the owner. GAS•EA.SYSTEM•OVER 4 IEA,) 2.00 BUILDING USE
builder will have the burden of proving that he did not build Or im- RES IND CON PB Dow,
for purpose ofsaleJ. INDUSTRIAL WASTE INTER. 30.00
121,as 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 Cade:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS•OVER 5(EA.) 1.00contr .-
theCoctsfor ctar'shcenects Lwithacontracrortsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Seg ,B.&P,C.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 hereby affirm that 1 have a certificate of consent to self-insure, -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereofwkc.3800,Lab.C.l. , -
Policy No. Company T i 1wT-l-Tv MnYsia l-_
0 ❑ Certified copy is I b ,furnisheJ.
FIRE SPRINK ENERGY L24
Z Z X Certified copy . 1 J s the city inspection division.
MISC.- REFER TO ORD.
D Appl'c'n1lAy�� (� -��sp7(1 (1�'7V❑ No V F] NC]
HLYt�I'IFIC7'OF°EXfiR1PITON'F'12UM W KERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one T TAL Y❑ N❑ Y ❑ N❑
7 Z hundred dollars($100)or less.)
V O 1 certify that in the performance of the work for which This per - FEE SUMMARY
LL Umit is issued,I shall not employ any person in any manner so as to PTV. MECHANICAL PEAfNfIT." R FEE
U become subject to the Workers'Compensation Laws of California.
i Date Applicant ALTER OR ADD TO MEC 5.00 5� BUILDING
>_ m NOTICE TO APPLICANT: If,alter making this Certificate of Ex-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 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 ) .00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10 DFM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) - 5.00
the performance of the work lot which this permit is issued(Sec. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Na11pp�p
Lender's AdtlkHEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
s
. I certify that I have read this application and ,are that the above VENTILATION FAN (SINGLE) 4.00 At i -
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building.construction, and BOILER•COMP 13 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL W
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 PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
g tip o(lhis permit. MECH.CONT. LIC.NO. MECH.
TOTA` ll" TOTAL
signature o ppllcant/Contract 3788— Cal—Air - 137195
OFFICE COPY