14136 `• POST;THIS CARD NEAR FRONT OF BUILDING
• PERMIT NUMBER
CITY OF CUPERTINO ' 41 �
INSPECTION DIVISION
JOB INSPECTION RECORD
-• +
PER EXPIRATION
JOB ADDRESS 101,23 N WOLFE ROAD UNIT# LOT# - 2018
PERMIT EXPIRES IF WORK
OWNER -CLASSIC, KIDS , CONTRACTOR 'AMCOE SIGN ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT(SSU
+ FOUNDATION - ANCE%OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PREGUNITE 1 _ PERMIT VALIDATION.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
r
PLUMBING -
ELECTRICAL - ISSUANCE DATE '
BLDG. ELECT. PLG7 MECH.
MECHANICAL '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR " ' VALLUATION
PLUMBING - - _ ✓-•- /.
MECHANICAL '
' PERMIT TO
ELECTRICAL -
FRAMING -
STORIES TYPE CONSTR.
.INSULATION
DCC.OR CUP RES(UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$0 FLFLOORAFEA JOTALACREAGE
I ROOF
DIAPHRAGM -
BUILDING USE
•
RES IND CON PB O,ner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Cl ❑ ❑ ❑ '❑
ASS E SSO R S PARCEL NO.
ROUGH
PLUMBING -
TRACTNO. PARCEL NO.
GAS TEST _
MECHANICAL - - -
• ELECTRICAL• FINALS DATE INSP. ^cc.DATE acc.FILE No.
FRAMING SAN # • '
!ZONING ENG.SITE NO.
INSULATION I PLUMBING,
GAS
_ FIRE SPRINK ENERGY T.ZG
- - MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING r❑ No Y E-1N❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. -
LATH—EXTERIOR • FIRE DEPT, r v❑ N❑ Y.❑ N❑
SHEET80CK GRADE + FEE SUMMARY
SHEAR INTERIOR • BUILDING /! - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS - ELECTRIC- PLAN CHECK .
GAS FEE -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu ONE WORKING DAY BEFORE' REQUIRED•.INSPECTION. 0�I
0' PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
Z = MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
' CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE a TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LD1 NG PROJECT 1 DENTI FIC/RTION PERMIr NumeER
BUILDING loraa r APPLICATION & PERMIT 1. 4136
-/ ADDRESS , �C /
71 DZpl IQ bLL�� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
NAMER's PLAN CHECK VALIDATION
NAME c / DTV. ELECTRIC PERMIT FEE -
LIURS I PHONEm_aNTt
NAME croRs UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
M LOC' AIIIIIIv LIC.NO. LIGHTING FIXTURES 10.00/1.00
ADORE sroRs APPLIANCES-RESIDENTIAL 4.00
(.O AP0 PANELS 10,00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No. . i SIGNS TRANS. 3.00
ARCHON ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ADDRESS
ZIP rrEMP.METER OR POLE INS. 20.00
ADDRESSTs - MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
'02 LICENSED CONTRACTORS DECLARATION
¢U U I hereby affirm that I am licensed under provisions of Chapter •
a 01 (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
F N i Professions Cod- a license is 10 full f c aryl e((e BLOC. ELECT. PLG. MECH.
zo 0 m License Class Lie.Number (SSI
w I_ Date��r ContractorCA
❑ ❑ ❑
¢_ to w a OWNER-BUILDER DECLARATION BUILDING PERMIT
D MISC.- REFER TO ORD INFORMATION
w ;' w I hereby affirm that I am exempt from the Contractor's License _
HLLO¢ Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION $/FT.
PERMIT ISSUANCE 10.00
fay Code:Any city or county whichrequiresaperminomns[real,alteq to o ¢Q Improve,demolish,or repair any structure,prior to Its IssuanCe,also ELEC.CONTR. LIC.NO.
A. ELEC.
E m to requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
r z r
Low(Chapter 9(commencing with Section 7000)of Division 3 oftbe ('s�
E o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE U
to I- $ the basis for the alleged exemption.Any violation ofSeclion 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant t..civil penalty
of not more than live hundred dollars ISSOO)J: ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner at the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will property,
the work,and the stwith w i5 not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
properly who builds or improves thereon,and who docs such work FIXTURES-PER.TRAP 5.00
himself or Through his own employees,provided that such such
improve-
66 FT.FLOOR AREA TOTALACREAGE
mentsare But intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 .
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND -CON PB Onor
❑ I,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 N0.
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(EA.) 1.00
contracts forsuch projects with a contractoHs)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200tt/10.00 TRACT NO. PARCEL NO.
❑nl am exempt under Sac..,B.&P.C.for this
re WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 PCC.DATE ACC.FILE NO.
WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificare oferment to self-insure, -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereof(Sec.3800,Lab.C.)
Policy No. Com ny } _ MG
O Certified co h yfum¢hed FIRE SPRINK ENERGYT-24
Certified ed t tion division.
F 0� Applicant �slj MISC.- REFER TO ORD. Y � N� Y N[]
CC y CERTIFIC TE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLO0o 2oNE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
CL O (This section need not be completed if the permit is for one TOTAL
::) Z hundred dollars IS 100)or less.)
L) O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,I shall not employ any person in any manner so as to
O Ubecome subject to lire Workers'Compensation Laws of California.
UJ n Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with L
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 . FEE 3a-�
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.NL) 6.00 SEISMIC FEE tra
I hereby affirm that there 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.L 1 HEATING UNIT ITO 100,000 B.T.U.) 8.00 -
LendersName
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I 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
ordinances and state laws relating to building construction, and
hereby authorize prepresentatives of inspection purposes.this city to enterabove-mentioned roperly for inspecer upon the BOILER-COMP IOvar 100,000 BTUI SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,j Seats, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may i BY
wa true xg et s Cit i onsequence of the
ganli f is a it. MECH.CONT. LIC.NO. MECH.
TOTAL
of pplic omaaor ate TOTAL LJ
OFFICE COPY