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13251 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 13251 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10123 NORTH WOLFE ROAD UNIT,0LOT# PERMIT EXPIRES IF WORK OWNER MIKE BLANC CONTRACTOR BELL ELECTRICAL SIGN IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER PREGUNITEE�I�s.1gAuoanoN n^k POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I, -• ,-�•' UNDERGROUND /SLAB PLUMBING Df�,UA8S11p0 ELECTRICAL Clty ISSUANCE DATE BLDG. ELECT. PLG. MECH. MECHANICAL ❑ 0 010 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUNFOING PEION RMIT WOOD FLOOR VALUATIONsiFr. PLUMBING -. ) MECHANICAL ELECTRICAL PERMIT,ro V C- J TYPE FRAMING STORIES COrvSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT FLOOR AREA TOTAL ACREAGE • ROOF DIAPHRAGM BUILDING USE HES IND CON PB Olnw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ Cl ❑ ❑PAR ASSESSORS CEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACG FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # TONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPHINK ENEHGV L24 MECHANICAL r ❑ N❑ ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.0 C. LATH—INTERIOR ELECTRICAL v ❑ N[_LATH—EXTERIOR FIRE DEPT. ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARYAPPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE ' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC uJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING • 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL \ - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL J CALLING FOR FINAL INSPECTION. J_ OFFICE COPY . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUIL I G P OJECT I NTI F ATI PERMIT NUMBER OUILDING APPLICATION & PERMIT il aooRey� �7,I� 1/�e4� // BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 1325 OwNElIR'S '�/ w ZfU y `lf' PLAN CHECK VALIDATION • NAM �J /7/ C TV. ELECTRIC PERMIT FEE CONTRACroR OUTLETS-SWITCHES-RECEP 10.00/1.00 NA LIGHTING FIXTURES 10.00/1.00 TRA D ADcro R's ( APPLIANCES-RESIDENTIAL 4.00 CONTRA r HONE y-L3 PANELS 10.00 DATE OF APPLICATION ARCHITECT 5-4,* PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER L10.NO, SIGNSTRANS. 3.00 ARCH.OR ENG. 5.00 PERM IT VA LI CATION ADDRESS SPECIAL CIRCUIT ZIP EMP.METER OR POLE INS. 20.00 ADDRESrvr's MOTORS SEE FEE SCH. ADDRESS I` SERVICE CHANGE 20.00 wce o LIC17NSED CONTRACTORS DECLARATION a 0 U 1 hereby affirm that I um licensed under p.,,ions(,I Chapter 9 Ant I ® Is DANCE DATE H<w (Commencing with Section 7000)of Division 3 of the Business and L .� x. BLDG. ELECT. PLG. MECH. D'A" Professions Codr n e is in full fore auU ••1k �a o OR License CI7 s G Lic.Number b ❑.. ❑ ❑ ❑ o H W' Date_/�yL��Contructor tl__.!L " ,g 3 J'cLL't r Tt\n� s• •• - {+ 'eK - ii tvxl Q BUILDING PERMIT s w¢ OWNER-BUILDER DECLARATION 0 / ' [INFORMATION u MISC.- - REFER TO ORD LILY UT . 0. , ;u vHi I hereby aflinn that I am exempt from the Contractor's License VALUATION $/FT. r- .. oj Law for the following reawn.ISec.703 t.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires s permit to construct,alter, ar . 40 Improve,demolish,or repair any structure.pllOr IU Its 65nanCe,aISV ELEC.CONTR. LIC.NO. ELEC. /.-r �. le O u requires the applicant for Such permit to file a signed statement that TOTAL l"l( pERMI TO A w m he is licensed pursuant to the provisions of the Contractor's License F z i Law(Chapter 9(commenciagwith Section 7000).(Division3.fthe 4 Business and Professions Code)or that he is exempt therefrom and DTV. r 0 the basis for the alleged exemption.Any violation.l Section 7031.5 STORIES TYPE CONSTR. i ; to by any applicant I'..a permit subjects the applicant to civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00 of not more It an five hundred dollars(SSOOE) ❑ Las owner of the property,or my employees with wages as ggCK FLOW PROTECT. DEVICE 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 properly who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 so.vT.RLooR AREA TOTALACREAGE himself or through his own employees,provided that such improve- reentsarenetintendedoroffered for are.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or impolvenhe"t is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or in* RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with Iiccowd contractors to construct the project ISec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL 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 IEA.1 1.00 contracts forsuch projects with a contruetot(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10,00 TRACT NO, PARCEL NO. the Contractor's License Law. ❑ Iamexemptunder Sec. ,B.&P.C.for Ibis WATER HEATER W/VENT 6.00 reason Owner Dam WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPHNSATION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm th t 1 have a certificate olconsenl to self-insure. ZONING END.SITE NO. o))pp��clt�fis'pt4ytf L.�`�a cnsatj.n InsuTuncc,or a ccrtificJ d�1(/Iher• -1SU8 pa dd).�T//j�'V^L///b I 0 No. Company 0 ❑ Certified copYilerehy furnished, FIRE SPRINK ENERGY T.24 Z Z, ❑ Certified s f • with t cit i p MISC.- REFER TO ORD. v ❑ Np v ❑ N❑ applicant I" y GIiR'I'IIe1GA1'E OE IiXCh1YTION FROM RK S' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. � - � LU > COMPENSA'T'ION INSURANCE PIA.CONTR. LIC.NO. PLG. v❑ N❑ V❑ N❑ d 0 This section need not be completed if the P' it is for one TOTAL Z hundred dollars(S100)or less.) U O 1 certify that in the pedbnnance of the work her which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to OtU become subject to the Workers'Compensation Laws of California. BUILDING J _' y Date Applicant ALTER OR ADD TO MECH. 5.00 } In NOTICE'1'0 APPLICANT: If,alter making this Certificate of Es- I.. Z creation,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK / provisions of the Labor Code, you "lust forthwith comply with FEE b u^ U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10/)ODC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that then is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.06- ... .00 MICROFILM 3097,Civ.CJ. 1 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC �J Lender's Address I certify that I hove read this implication and stutc that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Conor 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 ol,U st liabilities,judgments, costs and expenses whic CONST.TAX may illi any ay ac ria a•ainst 'it�C' wnsequenc of I PER ISSUANCE 10.00 grant g hf IIs t. ECM.CONT. LIC.NO. MECH. ? r 7 7 TTA TOTAL 7S Signature of Applicant/Contractor Date OFFICE COPY