13629POSTTHI RDNEAR''FRONTOFBUILDING; •
'CUPERTINO
PERMIT. NUM8ER
CI .OF .Q
13629'
INSPECTION DIVISION ' '
JOB INSPECTION RECORD
+
•' "' - ,' ... e•
-- PERMIT EXPIRATION''
JOB ADDRESS -21255 STEVENS CREEK '. • uNl7#- -Lor# -
PERMIT; EXPIRES IF WORK'
OWNERHAMNER /.JUST FRESH CONTRACTOR. RAGO NEON
JS NOT STARTED WITHIN
•180 DAYS OF PERMIT ISSU-'
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
-
-�,
- -
LIFER
PREGUNITE '
- ,.
PERMIT VALIDATION }}
.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,'
;.
'
-UNDERGROUND'/SLAB,
Gia
Y
'1 f , -
Y• J
PLUMBING
I }
-
ELECTRICAL'
ISSUANCE DATE
. MECHANICAL
.. -
piI
eLac.
e.
ELECT,
Bt 1;1)
PLG, . MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
.WOOD FLOOR..
vnwnnoN-
Sod
aIPT.
PLUMBING
'
MECHANICAL -
ELECTRICAL -
-
ERMIT TOw
•�-•�
FRAMING-
INSULATION - -
- i TOHIES /
TYPE CONSTR.
.
OCC; GROUP
HES, UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- -
ROOF
SO. FT. FLOON FRET
+ V
TOTIL ACREFGE
.DIAPHRAGM -
BUILDING USE
.RES! IND, CON ,PB O+he,
❑ ❑ ❑ ❑ '0
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
. .
ASSESSORS PARCEL NO,
ROUGH
..
PLUMBING -
GAS TEST
+ -
TRACT NO
PARCEL NO.
`
MECHANICAL
ELECTRICAL- -
FINALS DATE INSP. '•
ACC. DATE ,.
ACC FILE N0.
FRAMING - e,
SAN
INSULATION i
-
PLUMBING
ZONINGENG.
SITE NO. '
. ., _ ..
GAS
MECHANICAL -
FIRE SPRINK
❑ "❑
'. ENERGY T-20
Y NC]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING"
LATH-INTERIOR -
ELECTRICAL f A- -2 -�
FLOOD zorvE
Y❑ , N❑
A. L.U.C.
-.,Y0 N❑.
LATH-EXTERIOR'. .' I -
FIRE DEPT.
SHEETROCK
GRADE -
FEE SUMMARY
SHEAR INTERIOR
BUILDING-' -
BUILDING
PLAN CHECK
FEENO
1
ylal
SHEAR EXTERIOR;
TEMPORARY APPROVALS `
FIREWALLS
ELECTRIC
p
GAS" ..
TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
p.�U
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
•"
MICROFILM.
'ARRANGE FOR INSPECTION BY PHONING 252=4505,
�R;:`,
ELECTRIC •• '
13.UQ
F� ONE WOR KING.DAY BEFORE REQUI'REDJNSPECTION.
PLUMBING'
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.:
.
MECHANICAL
'
Z I
=SEE PERMIT FOR EXPIRATION DATE =
r`�
CONST. TAX
-
IMPORTANT! ..
; ' A; '
PLEASE READ REVERSE SIDE BEFORE
TOTAL
7
CALLING FOR FINAL INSPECTION.
• - � '� � � • OFFICE COPY - -
APPLICANT TO FILL, INANF RMATION WITHIN RED LINES — USF LL POINT PEN ONLY
BUhLDING PROJECTIDENTI FI N'
APPLICATION &.PERMIT
BUILDING — ELECTRICAL=PLUMBING—MECHANICAL
PERMIT NUMBER
-
1,.3629 -
sDILDING -
ADDRESS-rF.�r,.-,1
SlIz 'S_ S\c1fcNQ* `C�/� '���,
OwNEER'S ,
N(AJME/� �' /,�/-� .1 1,x..,'�y� �6o -01b%
P_k CAAM1Z4'�MV�=Ir' PHTONE II ••l '
I
QTY. *' ELECTRIC PERMIT " FEE
- PLAN CHECK VALIDATION
'
p: '
. �•
q'
DATE OF APPLICATION '
CONTRACTORS.
1I11. p'
AGO N C. t '
LIC. NO. r.
OUTLETS - SWITCHES?RECEP 10,00/100
P.. LIGHTING FIXTURES 10.00/100'
CONTRACTOR'S --- q
ADDR sS I�D''-Ici09
2S .L VRft 14vb 7
! APPLIANCES 400'
-
PANELS 1000
ARCHITECT f - -. ""
on 84341
ENGINEER
'LIC.NO.=
PANE ,(OVER ZOO AMP) 20,00 -
PLAN CHECK FEE P.C. NO.
, .
• ,
Y
� SIGNSTRANSY" ''' - "3,00
ARCH. OR'ENG.;'. -
ADDRESS x "_
' zip : 'rr
SPECIALCIRCUIT 5.00
- P.E PMIDV ALIDATION. .
-
AUG3f
"
f1r rf
'`a' ¢ Cr.pa1 qr -
t EMP?MET,ER'OR_ POLE INS:. 20.00
APPLICANT'S ' t
aoDR s
Z LyUCiG-L iW6 IF{Eoyt~Agt2n 94541
t
MOTORS SEE FEE SCH. "
5 RVICE^CHA`NGB' 20.00
LICENSED' CONTRACTORS DECLARATION
Ihereby, affirm that 1 am licensed under provisions of Chapter 9
ISSUANCE DATE
(conimebclvg with Section ]000) of Division'3 of the Business and
Professions Cor 1� gr'M1wM�icense is in full f<+ID1�0
License C s s - Liu Number.?s.�s.f�U,
Date ' - Contractor- ---
, -
- - '- i
BLDG.
vl
CT.
- ❑
PLG. MECH.
, ❑ ❑
r -
+ - rt
BUILDING PERMIT
'
OWNER -BUILDER DECLARATION 1"
I hereby, uffirm'[bat 1 am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code. Any, city or county which requires a permit to construalter,
ct
improve, demolish, or"repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Conlmet6r s License
INFORMATION
'—' -
MISC. REFER TO ORD
VALUATION
s
$/FT.
'
,PERMIT ISSUANCE r - 10.00 rOQ�
'ELEC. CONTE. _ LIC. NO:.
1 :
EL��((
TOlOfJ
ERMIT TO - '
_ -
QTY. PLUMBING PERMIT . FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and,
STORIES
TYPE CONSTR..
the basis for the alleged exemption. Any violation of Section,7031.5
by any applicant fore Permit subjects the applicant to a civil penalty
ofnot nice, than five hundred dollars($500).)',
L
ALTER -DRAIN -WATER (EA.) 6.00'
'❑I, as owner of the property, or my employeeswithwages as
-their sole compensation, will do the work, and the Structure is not
- K BACK FLOW PROTECT. DEVICE 4.00
oeQ GROUP
RES. UNITS
DRAINS -FLOOR; ROOF, AREA,COND. 5.00
intended or offered for salcHSce, .7044, Business and Professions
"Code: The Contractor's License Lowdoes not apply loran owner of
property,who builds or improves the reoq and who does such work.
himself or through his'own employees, provided that 'such improve-.
ments are not intended or offered for sale. It, however, the building
FIXTURES- PER TRAP .5.00
SQ. FT. FLOOR AREA
-
TOTAL ACREAGE
'
- -
- GAS-.EA.SYSTEM-1'INC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner -
builder will have the burdemof proving that he did not build or an-
prove for purpose of sale.).' �" --
❑ 1, as owner of the property,. am exclusively contracting with
GAS, -'EA. SYSTEM -0 VER 4 (EA.) 1 .2.00 t'
BUILDING USE .
RES IND CON PBS 'Omer
❑ ' ❑ ❑ ❑ ❑ -,
INDUSTRIAL WASTE INTER. .30.00 s
- -
LAWN SPRINKLERS -'I INC5 V.B. -;6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
;ASSESSORS PARCEL NO.
'+
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 witch contractors) licensed pursuant 10
the Contractor's License Law. -
SEWER-SANITARY"STORMEA.200ft/10.00 "
TRACT NO.
PARCEL NO.
❑ 1 tun exempt under Sec. ,BAP.C.Orthis
-
WATER HEATER W/VENT 1 '- 6.00
reason
owner Date
WATER SYSTEM _ 5.00
- ACc+DATE
ACC, FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSA'PION DECLARATION
"
I hereby affirm that I have a c'ertificaterofconsent to self-insure,20NING
o`r a'certificate of Workers' Compensation Inearanc,, or cetlified
ENG. SITE NO.
- ' - -
Copy there of(Sec R00 Lab C.) q.:•. 1'I•rlJ
folic o."pant
'CertiBe copy is hereby furnished rob Ili _
❑ Certified eop 19 fIJ�d Wlth'the city Inspection dlvlsen.
Applicaltl_(—{[s7d(�
FIRE SPPINK
Y❑ N❑
ENERGY TY4•
'
I v❑ N❑
MISC.- REFER TO ORD;
CI!RTIPICATEOFI'-XEMPTIONI'ROMWORKERSI
PERMIT ISSUANCE 10.00 -
'FLOOD ZONE
A.L.U.C.
PLG.CONTR. - LIC. NO. -
PLG.
TOTAL
COMPENSATION INSURANCE.
' (This section need not be completed if the permit is for one
Y ❑ r N ❑
Y ❑ N ❑
- r - -
QTY. MECHANICAL PERMIT FEE
a
FEE.SUMMARY
hundred dollars (S100) or It..)
'-I,certify that in the performance of ale work for which this per-
mit is issued, I shall not employ any person in. any manner so as to
_
BUILDING'
become subject to the Workers'Compensation Laws of California.
Dale '- 'Applicant
NOTICE TO. APPLICANT: If, after making this Certificate of Ex
ALTER;OR ADD TO MECH. - 5.00
APPLIANCE 5.00
PLAN CHECK�oT'
emplion, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall he deemed revoked
FEE
'-
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIO.FEE
"CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
EXHAUST HOOD,(WITH DUCT). 5.00
the performance of the work for which this permit is issued fSeC.
3097, Civ.CJ.
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) X8.00
HEATING UNIT IO VER 100,000 B.T.U.)9,50
ELECTRIC' `
t300
Lender's Name
- -
Lender's Address
I certify that I have read this application and state that the above
information is correct.) agree to comply with all city and county
ordinances and stale laws relating to building construction, andBOILER-
VENTILATION FAN (SINGLE) 14.00 -
PLUMBING
COMP (3 H.P. Or 100,000 B,T.U.) 6.00
BOILER -COMP (Over100,00o BTU)SEE FEESCH.
MECHANICAL
hereby aulhorizeattresenlalives of this city to enter upon"Jhe
abovennenlioned property for inspection purposes. '
MISC. - REFER TO ORD.
-
CONST. TAX
(We) agree to save, indemnify and keep barn alms the City of
Cupertino against Babllities, judgments, costs and expenses which
may m any way acerue,againsl said City in consequence of the
'PERMIT ISSUANCE -10.00
MECH. CONL• .LIG NO.
gra o permit. -
-
TOTAL
TOTAL
�6
Signature of Applicant/Contra, r JJare
OFFICE COPY
wn
od.
J_