13055 POST THIS CARD NEAR FRONT OF BUILDING
PF R MIT NUMBER
CITY OF CUPERTINO
• INSPECTION DIVISION 13055
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 10123 N. Wolfe Road UNIT,'*2137 LOT#
• .. PERMIT EXPIRES IF WORK
OWNER Lady FootLocker (Kinney Shoe's NTRACTOR Brite Litd Neon IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
PLUMBING
UNDERGROUND /SLAB
ELECTRICAL - A E(DATE
MECHANICAL BLDG. a CT, PLO ECR.
`oLrtJO ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BWI DING PERMIT
I FORMATION
WOOD FLOOR VALUATION SBFT.
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING \✓ E�/�'
STORIES TYPE CONSTR.
INSULATION
?cc.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT.FLOOR AREA TOTAL ACREAGE
• ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB Orn"
❑ El ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PAE NO.
GAS TEST
MECHANICAL
ELECTRICAL FINALS DATE INSP. ^cc.UnrE Acc. NO.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS _
FIRE SPRINK ENERGY h24
MECHANICAL ``~_.j Y ❑ N❑ Y ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE AL.O,C.
LATH—INTERIOR ELECTRICAL f - `7
LATH—EXTERIOR FIRE DEPT. '-rr—� ` j Y❑ N Y ❑ N
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
r
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL i
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
lfUI LDI NG PROJECT I DENTI FICATI ON APPLICATION PERMIT NUMBER
`
BUILDING
ADDRESS , 13055
//-��./.� 3
Z) BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER
Ra AMEd -0 �14i PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
XIVAIP PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 Q
NA.EE
J,JiQ/J'E� /]-L�A�9.) LIC.No A// LIGHTING FIXTURES 10.00/1.017
CONTRACTOR S
ADDRESSPPLIANCES-RESIDENTIAL 4.00
T
//�� /7 J
I' PHONE��p'/�j" PANELS 10.00 DATE OF APPLICATION
ARCHITECT /NU" Cq f1601 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR (�
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
AR. ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ss
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE SCH.
ADDRESS ((�ffttp�
SERVICE CHANGE v AAVED •, P Il JV
nl p
�
'02 LICENSE[)CONTRACTORS DECLARATION
4 o u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 s r V
N z
(commencing with Section 7000)of Division 3 of the Business and Y1r, BLDG. MECH.
F N Oz professions Cq nA 1'cen se is in full fore n f
z o m - License las L� L2b Lic.Number S��f5� ( ❑ ❑ ❑ ❑
Dat< Contractor. City of Cup
BUILDING PERMIT
Q ce u OWNER-BUILDER DECLARATION INFORMATION
o T MISC.- REFER TO ORD
w 3 m 1 hereby affirm Ihat I am exempt from the Contractor's License VALUATION S/FT.
H u o ac Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 �f
Code:Any city of County which requires permit to construct,alter,
a¢ p improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O /
iL 0, requires the applicant for such permit to file a signed statement that TOTAL -fe PERMIT T
a w m he is licensed pursuant to the provisions of the Contractor's License
H z a Law(Chapter 9(commeneingwith Section 7000)of Division 3 ofthe
f i 0 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;_ by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not mole than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do Bre work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
• properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
mentsare nolintended oroffered for sale.If.however,the budding GAS-EA.SYSTEM-I INCA OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have lire burden of proving that he did not build or Do- RES IND CON PB Other
prove for purpose GO sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the properly,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 pmfil,oiuns Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lin such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ lam exempt under Sec..,Of&RC fur this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy therey'9��see.3 00,Lab.c.).S,7gTL•"F/xJD
Policy NmgfI CmnP'ny
O ❑ Certiliad copy I. herebyf nished FIRESPRINK ENERGY T-24
Z ❑ Certify rlh City inspection division. v❑ N❑ v ❑ N❑
O Applicant MISC.- REFER TO ORD.
(r0 PERMIT ISSUANCE 10.00 OOD ZONE A.L.U.C. `I
� ) CERTI PICA'I'li Of EXEMPTION I'ROhI WORKERS'
LOU (70M14-NSAT'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
d 0 tThis Section need not he completed if the permit is for one TOTAL v❑ N❑ v❑ N�j
� Z hundred dollars IS 100)or less.)
U O 1 certify that io the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P mit is issued,I Shall not employ any person in any manner so as to
O0 become subject to the Workers'Compensation Laws of California.
Date npptirm ALTER OR ADD TO MECH. 5.00 BUILDING a O
} tdn NOTICE '10 APPLICANT: If,alter making this Certificate of Ex-
F Z_ cmption,YOU should become subject to the Workers Compensation APPLIANCE 5.00N CHECK 3 Z
provisions of the Labor Code, you must forthwith comply with FEE /
z Ll
CJ such provons or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,00011F.M.) 4.00 �n
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE "a
I hereby affirm that throe 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 C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT ER 100,000 B.T.U.)9.50 ELECTRIC C>,)Lender's Address
1 certify that 1 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordimnceS and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP Ouno 100,000 BTU)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 CONST.TAX
May in any way accrue gain t wid City in consequence of the PERMIT ISSUANCE 10.00
goat flhi - MECH.CONT. LIQ NO. MECH.
Z TOTAL TOTAL G O 31
I nalur t/ onunctor Date
OFFICE COPY