12175 l
i POST THIS CARD NEAR FRONT OF BUILDING
+ PERMIT NUMBER
CITY ,OF CUPERTINO 'j �175
INSPECTION DIVISION
/ JOB INSPECTION RECORD
space 2121 PERMIT EXPIRATION
JOB ADDRESS 10123 North Wolfe Rd UNIT# LOT# A
PERMIT EXPIRES IF WORK
OWNER D.J' S CONTRACTOR IS NOT STARTED\WITHIN
180 DAYS OF PERMIT ISSU-
INSPECTION DATE INSPECTOR INSPECTION RECORD
ANCE•OR 180 DAYS FROM
FOUNDATION', LASTCALLED INSPECTION.
UFER
- PERMIT VALIDATION
PREGUNITE \
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING •. .. -�'�,.1'1, a C \
ELECTRICAL ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
MECHANICAL _ 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vnwnnoN s/FT.
PLUMBING
MECHANICAL '
PERMIT TO
ELECTRICAL4��..11+�
FRAMING sTORIEs TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -TOTAL TOTALACREAGE
SO.FT.FLOORA EA
ROOF
!tti DIAPHRAGM BUILDING USE
\ 'HES IND CON PB O,hu
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED � ❑
ASSESSORS PARCEL NO.
ROUGH,
PLUMBING TRACT NO. PARCEL NO.
GAS TEST I ,
MECHANICAL
I ACC.DATE ACC.FILE NO
ELECTRICAL FINALS DATE INSP.
FRAMING SAN ____ZONING ENG.SITE NO.
INSULATION IPLUMBING .
GAS F
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .�?� N� ❑ NEI
ZONE A1.U,C.
LATH—INTERIOR ELECTRICAL
Y "
LATH—EXTERIOR FIRE DEPT, � v I] "�
SHEETROCK _ GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS BUILDING ,
FIREWALLS ELECTRIC PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRAN::=BY PHONING 252-4505, ELECTRIC
w ONE WOE REQUIRED INSPECTION.
PLUMBING
0' PLEASES WHEN.PHONING.Z MECHANICAL— XPIRATION DATE —
CONST.TAX
IMPORTANT! xw
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY
ICAN4rTO F LL I I FO MATION WITHII�TRED LIINErll BA DINT PEN ONLY
BUILDING PROJCLT I DENTI FICATION gppLICATION & PERMIT PERMIT NUMBER
BUILDING 1�
ADDRESS N.Wol£ul�pre Rd S c 2 ' 12175
ILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S•i
NAME {� PLAN CHECK VALIDATION- .
T .
yJ.'y.r S _ PHONE QTYELECTRIC PERMIT FEE
CONTRACTOR'S
NAME 0UTLETS-SWITCHES-RECEP 10.0011.00
Cal-Air ConditiOLBn ND. 137195 -2 IGHTING FIXTURES 10.00/1.00
ADDRESsrolls ppLIANCES-RESIDENTIAL 4.00
1775 So: 1st. 'San JoONE / PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
ENGINEER.
OR PANELS (OVER 200 AMP)' 20.00
- -
ARCH.OR
LIC.NO, SIGNS TRANS.
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP- EMP.METER OR POLE INS. 20.00
nooriess Ts MOTORS SEE FEE SCH. ^
•_ SERVICE CHANGE 20.00
'02
LICENSED CONTRACTORS DECLARATION gf €
rto 0 1 hereby affirm that I am licensed under provisions of Chapter 9
H a n (commencing with Section 7000)of Division 3 of the Business and IS UANC DATE
r 7 Professions Code, nd my license is in full fore ¢ffcL.� BLDG. . ELECT. PLG. MECH.
z O - License lass - - Contractor r j � � \`L ❑ ❑ ❑ �V
O w H w Date Contractor
ac 2 w OWNER-BUILDER DECLARATION BUILDING PERMIT
X g w H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
u o ¢ Law(or the following reason.(Sec.7031.5,Business and Professions VALUATION
- -+ PERMIT ISSUANCE 10.00 S/Fr.
Code:Any city ,or county which requires a permit to construct,alter,
Jso rt <0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
O u requires the applicant for such permit no file a signed statement that TOTAL PER T
v w m he is licensed pursuant Wine provisions of the Contractor's License f
�zQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe z(I/,a•.if.
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ' `C�•�'�
s- o the basis for the alleged exemption.Any violation of Section 7031.5' STORIES TYPE CONSTR.
a ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN of not more than five hundred dollars($500)): (EA.) 5.00
O 1,as owner of the property,or my employees with-wages as BACK FLOW 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 F IXTUR ES-PER TRAP 5.00
` . himself or through his own employees,provided that such improve. So.PT.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.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. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. RES IND . CON PB Omer
O 1,as owner of the property,am exclusively contracting with 1:1 1:1 licensed colons Cors de:The Contraconstruct clietor's
project(Sec. 7044,does not apply LAWN SPRINKLERS-11NC6 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:The Contractor's License Law docs not apply
to ancontracts
owner of property who builds tl improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) ` 1.00 the
Co is actor's h projects with a wntracmgs)licensed pursuant to
the Contractor's License Law.' SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. NIA ,B.&P.C.for this
reason ' WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM - 5.00
ACC.GATE ACC,FILE NO.
WOfirm that
CI have a ATIOMDECLARAT ION NPERMIT
TER,TREATING EQUIP. - 5.00
I hereby affirm or I have a certificate In consent or self-insuid
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C�m7� 1
Policy Ceti
i ed __is In !D y Li}d., 1151 -
- Ceslified cop is
reby furnished. FIRE SPRINK ENERGY T$4
Z Z �[ Certified ll d wit a inspection division.
F O pp ptjNC'Lr � C.- REFER TO ORD. Y IN V ❑ NE '
Cr y CERTIFICATE OF EXEMPTION FROM WORKERS' ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
WCOMPENSATION INSURANCE . . LIC.NO. PLG.
CL ❑ (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N
Z) Z hundred dollars($100)or less)
U O 1 certify that in the perform n I'the wo
e. f which his per- OTY. MECHANICAL PERMIT'" FEE FEE SUMMARY
LLQ H mit is issued,I shall not emplo Pelson in anne so as t
Q w bewm s t �{qI�¢Worke a
. r 4 Date�LICA 1c g ALTER OR ADD TO MEC Ha�{ v.) X5.00 DL BUILDING
m NOTICE TO APPLICANT: I ,aftermakingthis Certificate oEx-
2 emption„you should become subject to the Workers'Compensation APPLIANCE 5.00 „ PLAN CHECK
provisions of the Labor Code, you must forthwith comply wit
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F,tM)Or;'4�00 V FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I6)000C.FM.) 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 wo k o which this permit is.issued(Sec. MICROFILM
3097, 's,Na . /��'� HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Named p
Lender's Address 7 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1.certify that l 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 m building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereauthorize representatives of this city to enter upon the BOILER-COMP lOvar 100,000 BTU)SEE FEE SCH.
above enlionedpropert for inspection purposes. MECHANICAL
( agree to save in Truly and,keep harmless the City of MISC.-
up REFER TO ORD.
[' o against iia lilies judg cots, costs and expenses which CONST.TAX
a any way e a a ind aid Ci yin consequen a of he - PERMIT IS 10.00 e.0 -"-'
o .per L MECH.CONT. LIC NO. MECH.
/0� ��/� -HJ--
T. TOTAL
gnature of Applica t/Contractor Uat `, / /3
OFFICE COPY