14053 ~ z
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT NUMBER
+ 14053
INSPECTION DIVISION -
. JOB INSPECTION RECORD
PERMIT EXPIRATION
10123 N WOLFE ROAD K-24
JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER FLOWERS FOR YOU coNrRAcroR JOSEPH ANNUZZI IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB —
PLUMBING
ELECTRICAL PAOISSUANCE DATE
MECHANICAL -
EGG. E PLG. MECH.
;: ,
11 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDg�y�ryµp PERMIT,
WOOD FLOOR GuYPVRMATION
PLUMBING - vALunTION $/FT:
MECHANICAL
ELECTRICAL - PERMIT TO
-FRAMING • '
INSULATION STORIES TYPE CONSTR. +
.
OCC.GROUP RES.UNITS
Mw PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
O SO.FT,FLOOR AREA TOTAL ACREAGE
D'
e
� �r DIAPHRAGM BUILDING USE
RES IND CON PB Om«r
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ❑
_ ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO ' PARCEL N0.
MECHANICAL - - -
ACC.DATE ACC.FILE NO, '
ELECTRICAL FINALS DATE INSP.
FRAMING SAN u ZONING ENG'SIT E NO.
, INSULATION PLUMBING ,
"• GAS
FIRESPRINI( ENEEl T"Na
MECHANICAL ❑ N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NCI
ZONE.. ❑AL.U,L.
LATH—INTERIOR ELECTRICAL 3 1.03,
v� '"N� vl] N❑ '
LATH—EXTERIOR - - FIRE DEPT. -
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY'APPROVAL! eulLDwc,
ELECTRIC PLAN CHECK
FIREWALLS " F '
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /
OCCUPANCY OF BUILDING IS NOTRERMITTED UNTIL BUILDING FINAL:IS SIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION' BY PHONING 252-4505,' ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o� PLEASE''GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
`
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT!
CONST.rnx
I PLEASE READ REVERSE SIDE BEFORE' TOTAL 1
CALLING FOR FINAL INSPECTION. ✓
OFFICE COPY ,
� 01"LICANT TO FILL-IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BUILDING PROJECY'I DENTI FICATION
am LOIrvG BUILDIAPPLICATION & PERMIT
AOORESs -'ELECTRICAL-PLUMBING-MECHANICAL 1 4 0 5 3
oia3 NG
wolf PLAN CHECK VALIDATION
OWNER'S, _
NAME CITY. ELECTRIC PERMIT FEE
flowEa foo SNc ON&r)311'$3e3
corvTRACTDRs - 'UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
Ni)) + uc.NO.$ 7r LIGHTING FIX TURES 10.00/1.00
roNTRA oes Cys, APPLIANCES-RESIDENTIAL -4.00
. AooREss. // p - .
(t 4'aPHONE PANELS 10.00
- . pCHEOF•APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
�( OR - PANELS (OVER 200 AMP) 20.00
w EN NE g / UC.NO. SIGNS TRANS. 3,00
ARCH.09eNG/1. - - - 5.00 PERMIT VALIDATION
ADDRESS
��/ p SPECIAL CIRCUIT
DDRES f' N/0 CA' zIP] 30 EMP.METER OR POLE INS. 20.00 n
( APPucnrvrs MOTORS SEE FEE SCH. _ C
ADDRESS-
0) A) O SERVICE CHANGE 20.00
w O O LICENSED CONTRACTORS DECLARATION r - _ kJ
r a u u I hereby affirm tml I am licensed under provisions of Chapter 9
S N
so a N (commencing with'Section 7000)of Division 3 of the Business and BL MECH.
H Z Professions Code,and my license is in full force and effect. DID
Z 0 L License Class Lic.Number
0 z. Date Contractor -
H !2t BUILDING PERMIT
a o w OWNER-BUILDER DECLARATION INFORMATION
X r I hereby'affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VAL�U.ATq�ION $/FT. '
a.0 a Law for the following reason.(Sec.7031.5,Business and Professions 'PERMIT ISSUANCE 10.00 ye�
�S
�yw Code:Any city or county which requires a permit to construct,alter, U
P
41)- E prior t0 its issuance,also ELED.CONTfl. LIC.NO. ELEC. /
. a¢ 0 improve,demolish,or repair any structure,p -
0 is threquires the applicant for such permit to file a,signed statement that
a' _ TOTAL , -/ PERMIT TO
2 he is licensed pursuant to e'provisions of the Contractor's License •t(/ O�.
w < Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
E '
4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ,STORIES. TYPE CONSTR.
the basis for the alleged.exemption.Any violation of Section 7031.5
6;m by anyapplicant fora permit subjects the applicant loo civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).): -
❑ 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 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 5.00
r property who builds or improves thereon,and who does such work FIXTURES PER TRAP so.PT.FLOOR AREA TOTAL ACREAGE
himself Or through his own employees,provided that such improve- 6AS-EA.SYSTEM-11NC.4 OUTLETS 6.00
ments are not intended or offered for sale.If,however,the building
1, or improvement is "sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00' BUILDING USE
-y builder will have the burden of proving that he did not build or im- RES IND CON PB Other
pro efor purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ E] ❑-
eI,as owner of the property,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 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.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM.EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law. -
❑ I,arp.eXemptunderSec. ',B.&P.C,for this WATER HEATER W/VENT 6.00 ,
reason - s_
Owner- 11 11 A D a / " WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO.
WORKS S'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, " ZONING ENG.SITE NO.
I or a certificate Of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). '
Policy No. Company - -
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified Copy is Filed with the city inspection division. MISC.- REFER TO ORD. y ❑ N❑ -:y FNEI
Applicant
W CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00/Q'�; FLOOD ZONE A.L.U.C.
Cr 9LU1 - COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLI
TOTAL (�� 'Y❑ N;❑ v❑ N❑
1 O (This section need not be Completed if the permit'is for one
� Z hundreddollars 1$100)or less I FEE SUMMARY
U 0 1 certify that in the performance of the work for which this per- OTY. - MECHANICAL PERMIT FEE
F- mit is issued,I shall not employ any person in any manner so as to -
O IU become subject to the Workers'Compensation Laws of California.
BUILDING
Date Applicant - ALTER OR ADD TO MECH... 5.00 17U
} SO NOTICE TO APPLICANT: If,after making this Certificate of Ex- 5.00 PLAN CHECK
F.. ? emption,you should become subject to the Workers'Compensation APPLIANCE
provisions of the Labor Code, you must'forthwitlh comply with FEE
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT(OVER IQOOOC.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for. EXHAUST HOOD(WITH DUCT) 5.00 MICROFILM
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00
3097,Civ.C.).
Lender's Name - HEATINGUNIT OVER 100,000B.T.U.)9.50 ' ELECTRIC
Lender's Address - - -
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - -
information is\correct.l agree tocomplywith all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000 B.T.U.) 6.00
hereby authorize,representatives of this city to enter upon file BOILER-COMP(Ovne100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for.ospection purposes. 'REFER TO ORD.
(We).agree to save, indemnify and keep harmless the City of MISC.- CONST.TAX
Cupe ino against liabilities,judgments, costs and expenses which PERMIT'ISSUANCE 10.00 '
ma in way accrue against said City in consequence of.the
gran i g Of hi arm _ MECH.CONT. LIC.N0. TOTAL
TOTAL 0,
Sign lu of Ap licanl/Contractor
OFFICE COPY ,