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13036POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS 10050 N. Wolfe Road UNIT# LOT# OWNER Wells Fargo CONTRACTOR Pettibone Signs PERN11T NUMBER 13036 PERMIT EXPIRATION pERM1T EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE PERMIT VALIDATION PAID -` n qC�1 l' 11 SOANCE uATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL C; BLDG. R]C ELECT. u'110 PLG. ❑ MECH, ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL ELECTRICAL PERMIT To S/�n / FRAMING INSULATION STORIES TYPE CONSTR. OCC. GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. TL FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RE$ IND CON P9 Olhm El ❑ El Q APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC. FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG SITE NO, INSULATION PLUMBING GAS FIRESPRINK YE] No ENERGY T 24 Y ❑ NE] MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE v� N� AL.0 Y I] N❑ LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE SHEAR INTERIOR BUILDING BUILDING - SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRICFEE PLAN CHECK GAS ' SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCEUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL CONST. TAX ' IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL �c '` 2- —" OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 13036 BUILDING ADDRESS �� OL� /3r' M. OWNER 'S rvaME/ ��[ LEiE�V `� PHDrvE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION GATE OF APPLICATION CONTRACTORS NAME NAME ` OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS /', S"C-0 W&L -y aooREss `�� !zx'A J /ti PROrvE (� (J APPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 A CHITECi PANELS (OVER 200 AMP) 20.00 PLAN LHECK FEE P.C. NO. OR ENGINEER uc. rvo. SIGNS TRANS. 3.00 ARCH , OR ENG. ADDRESS ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION 1D�(l/ S�y�/ 7 }} EMP. METER OR POLE INS. 20.00 APPLICANT rs A - 4/ r MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 P LICENSED CON 'I'R ACTORS DECLARATION all 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and (1 Iv'.i I IBSUAN E DAT Q. BLDG. ELECT. PLG. MECH. Professions Code, and my license is in full force and effect License Class Lic. Number D ) ❑ ❑ ❑ /s t C11Y �1 Date Contractor BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affrin that I 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 permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also INFORMATION MISC. - REFER TO ORD FVjA��UATION t S/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO, ELEC. requires the applicant for such permit to file a signed statement that TOTALMIT T he is licensed pursuant to the provisions of the Contractor's License LBW(Cllapler9(commeDBing with Sect rs 7000)o fDivision 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of5ection 7031.5 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars (5500).1: DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. gLTER-DRAIN&VENT-WATER (EA.) 5.00 BgCK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ❑ I, as owner of the property. or my employees with wages as 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 docs such work himself or through his own employees, provided that such improve- mems are not intended or offered for sale If, however, the building FIXTURES - PER TRAP 5.00 50. FT, FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM- 1 INC.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 im- prove for purpose of sale.). D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's License Law dues not apply to an owner of property who builds or Improves thereon. and who contracts for such projects with a contmetorts) licensed pursuant to the Comractor's License Law. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 20011/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 L]I am exempt under S,,,-, B &P C. for this reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORK ERS'COMPENSA'IION DECLARATION WATER TREATING EQUIP. 5.00 1 herehy affirm that I have a certificate of consent to self -inane. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (Sec. 3800, Lab.CJ. Policy No. Com Pany 0 Cenific 'opy ish re furnished Certified 'y�s//3 lie i 1 III,ci� inspection division. AP licant- K YY CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE section need not be completed if the permit is for one FIRESPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 -FLOOD ZONE Y N ❑ a. L. U.L. Y [:] N E] PLG. CONTR. LIC. NO.PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or III hundred I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workeri Compelumion Laws of California. Date Applicant : IC after making This Workers' sa Ex- NOTICE TO shout become Compensation emption, you should become subject to the Workers Compensation provisions the Labor Code, you must forthwith comply with such provisioio ns or this permit shall be deemed revoked. such BUILDING fi 0 ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE �99 S_ AIR HANDLING UNIT (TO 10,000 C.F.M.1 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.16.00 SEISMIC FEE S� CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 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.). ' HEATING UNIT (TO 100,000 B.T.U.) 8.00 EATING UNIT( OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's NameH Lender's Addre I certify that I have read this applicmion and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction. and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER - COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (WC) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any ay a against said City in consequence of the granting thisp 1 q0 1 4,l O I Ai �• t.5 'ZI -Cd' MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIG NO. MECH. TOTAL TOTAL 5 nature of Applicant/ Date firma: carr