14244 POST THIS CARD NEAR FRONT OF BUILDING
• PFRMIT NUMBER
CITY OF CUPERTINO 14244
INSPECTION DIVISION
JOB INSPECTION RECORD
:.`, PERMIT EXPIRATION
JOB ADDRESS 10253 N PORTAL UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER APPLE COMPUTER CONTRACTOR JACK & COHEN IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION / 1,fjrcr,e 04✓I ANCE OR 180 DAYS FROM
LIFER LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION 7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DATE
MECHANICAL BLDG. ELECT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
+}y ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
•> ,�^ DIAPHRAGM
RES
USE
ES INDCON PB 00.u'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO,
ROUGH
PLUMBING
GAS TEST TRACT NO, PARCEL NO.
MECHANICAL
.
ELECTRICAL FINALS DATE INSP. ACCDATE ACC FILE NO.
FRAMING SAN *
ZONING ENO.SITE NO.
INSULATION PLUMBING '
GAS
F IRE SPRINK ENERGY T2E
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v N v"❑ NE]
LATH-INTERIOR ELECTRICAL FLOOD ZONE A U.C.
,
LATH-EXTERIOR FIRE DEPT. v❑ NEI Yo NEI
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING �,/O-
SHEAR EXTERIOR. . TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
I,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY F SEISMIC FEE j
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2KA505, ELECTRIC
LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
1
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! I
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
— ""BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 14244
ADDRESS O
lipf VA_ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER' - PLAN CHECK VALIDATION
`v NAME OTY. ELECTRIC PERMIT FEE
CONTRA PHONE —
ss OUTLETS-SWITCHES-RECEP 10.00/1.00
wins
JAI fillLIC.NO. a D LIGHTING FIXTURES 10.00/1.00
poNTEq$A�/CTo 61 f' APPLIANCES-RESIDENTIAL 4.00
� (/ Y PHONEY PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
NGINEER
LIC,NO.A SIGNS TRANS. 3,00
ARCH.OR ENG. PERMIT VALIDATION
ADDRE t SPECIAL CIRCUIT 5.00 7
PS zIP 6 EMP.METER OR POLE INS. 20.00
A°Pu E ; MOTORS SEE FEE SCH.
OREsS ) 1
(/ SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION
a v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
to Q y (commencing wit Secllon 7000)Df Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H O z Professions Code sit my license is in full fort ✓f ❑ ED
❑
License Clas Lic,No mber G
0 z h w Dale Contractor
r sBUILDING PERMIT
¢ ¢ w et WNER-BUILDER Df;CLARAT 0 INFORMATION
iz ;.� I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
w u O a Luw fur the following reason.(Sec.7031.5,Business anA Professions VALUATION SIFT.
FNN� Code:Any city or county whichrequiresepermil to construct,alter, PERMIT ISSUANCE 10.00
Q a ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
u — O ¢ requires the applicant for such permit to file a signed statement that TOTAL MIT TO
whe is licensed pursuant to the provisions of the Contractor's License
Fii Law(Chapter9(commeneingwith Section 70000of'Divisicn3oflhe
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
I ¢O STORIES TYPE CONSTR.
¢r$ the basis for the alleged exemption.Any violation of5ection 703 L5
ii — by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not mom than five hundred dollars($500).);
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEV ICE 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
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 are
or ugh intends own employees, le.If,ed ever,hat the
improve- GAS-EA.SYSTEM-1 6.00 .
mems are nor intended or offered for sale.If,however,the building
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 Omer
� . prove for purpose ofsalcJ. INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the properly,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: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.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
lire Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,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 I have a certificate of Consent to self-insure• ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy thercof(Sec.3800,Lxb.C.).
Policy No. Company
❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T"24
Z Z ❑ Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
O Applicant Y C] N❑ Y C] No
frLo CF.RTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
0' 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
D Z hundred dn11ers(5100)or less.)
U O 1 certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY
IL I— mit is issued,I shall not employ any person in any manner so as W
U become subject to the Worked Compensation Laws of California.
CL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} M NOTICE TO APPLICANT: If,after making this Certificate of Ex-
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 3,�f„�
U such provisions or this perr/Iit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNITIOVER 10MC.F.M.) 6.00 SEISMIC FEE °Sv
1 hereby affirm thin there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,0008.T.U.)9.50 ELECTRIC
Lender's Address
4/1
I certify that I have read this application and state(hat the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city anti county PLUMBING
ordinances and state laws relating to building Construction, and BOILER-OOMPI3 H.P.of 100,0008.T.U.1 6.00
r hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
i above-mentioned property for inspection purposes.
(We) agree ve, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ag t iabilities,judgments, costs end expenses which CONST.TAX
may in an acerae n at id City in conseyuen a of the PERMIT ISSUANCE 10.00
granting of s er MECH.CONT. LIC.NO. MECH.
�/ TOTAL TOTAL ,n
Signature of Ap ¢a t onlract r Da -0V
OFFICE COPY