13937 POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 13937
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10133 S. Portal Ave UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER Berends CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
- FOUNDATION Al.., OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PERMIT VALIDATION
PFEGUNITE -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE'
BLDG. ELECT. PLG. ECH,
MECHANICAL El G-.l. ElME]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING u' o�'I iL}c iL 9LG VALUATION s/Fr.
MECHANICAL diL c� «L .44,- 'LY
PERMIT TO
ELECTRICAL ��i)'I 6,r A •A r/vL k � �4�
FRAMING
STORIES TYPE CONSTR.
INSULATION .
GCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF S0,FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND. CON PB Ott,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ � ❑ ❑ ❑ El
ASSESSORS PARCEL NO,
ROUGH
PLUMBING - -
TNACTNO. PaHCEL NO.
_GAS TEST
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
MECHANICAL
FIRE SPRINK ENERGY T 24
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r [] N(] 'v [] NC]
FLOOD ZONE Al U.C.
LATH-INTERIOR ELECTRICAL
d' -
LATH-EXTERIOR FIRE DEPT. Y❑ N[] l Yo N0
SHEETROCK GRADEFEE 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 BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC t�
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
" Z
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL
IMPORTANT! _ CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL _201
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
r' mhDING /� ` APPLICATION & PERMIT
GREaa so or 13937
�Q/33 I�LtI il'l� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S PLAN CHECK VALIDATION
"AME /yyy)6 /xY QTY. ELECTRIC PERMIT FEE
V&re"aS H°NE/ 3V!
CONTRACTOR 3O OOrI
NAME UTLETS-SWITCHES-RECEP 10.00/1.00'
LIC.No. LIGHTING FIXTURES 10.00/1.001-
ADDRESS CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.001 DATE OF APPLICATION
ARCHITECT PANELS(OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.N0.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00 '
noo Ess ENa. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
Q
SERVICE CHANGE 20.00 I g RA
0
,02 LICENSED CONTRACTORS DECLARATION
<u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
N <w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F 0 z Professions Code,and my license is in full force and effect. ❑ ❑ El
O= — License Class Lb.Number
9 Z w Date Contractor
BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DECLARATION
o a 0 MISC — REFER TO ORD INFORMATION
w ; n y 1 hereby affirm that I am exempt from the Contractor's License .
u 0 a Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
ryw � Code:Any city or county whichrequiresa permit to construct,alter, ��
¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Q
O
0¢ requires the applicant for such permit to file a signed statement that TOTAL• PERMIT TO
u w $ he is licensed pursuant to the provisions of the Contractor's License
tit Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE e
ce 1- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN (EA.) 5.00
Of not more it...five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not occ.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM•1 IPIC.4 OUTLETS 6.00
Gr improvement 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 int BUILDING USE
RES IND CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑
licensed contractors to construct'the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License I.S.does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.—,IL&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKI?RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00
1 hereby alfrm 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(See.3800,Lab.C.L.
Policy No. Company
O Ell copy is hereby famished. FIRE SPRINK ENERGY T24
Z Z ❑ Certified copy is fled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y ❑ N I] Y [:] N❑
H y PERMIT,ISSUANCE 10.00
LU CIiRTIPICAT POF ENSAIEON INSUROMCWONKERS' FLOOD ZONE A.Lu.C.
W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z tThis section need not be completed if the permit is for one TOTAL Y 11 N El Y N 0
hundred dollars(S 1001 or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W 1- mit is issued,I shall not employ any person in any manner so as to
OW becon],�suh��ec��try�,t��e Workers C ipensalion LawY_nf Ca omb
Date.? Applicants�I_^PATALTER OR ADD TO MECH. 5.00 BUILDING
NOTfCE TO�AAPPLLICAN'P: If,after making this Cer Ificate of Ex-
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 FEE
U such provisions or this permit shall he 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
I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC p—
.v
1 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 PLUMBING
ordinances and state laws relating to building construction, and BOILER•CORM(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city 10 enter upon the BOILER-COMP(Over 100,000 BTUI SEE FEE SCH. MECHANICAL
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 10.001CONST.TAX
may In ny way accrue against said City In conscqucnce of the
rof its permit. MECH.CONT. LIC.NO. MECH. OQ
I -/./ TOTAL TOTAL r
Si stare of Applicant/Con rector Dole
OFFICE COPY