14581 1, POST THIS CARD NEAR FRONTOF BUILDINGPERMITNDMBER
Ul
CITY OF CUPERTINO.
14581
YS INSPECTION DIVISION
JOB INSPECTION RECORD Space # 2121 t(
' w �""—'•�T• 4, PERMIT EXPIRATION
10123 N.• WOLFS ROAD, iia',
JOB ADDRESS
NIT# _LOT# `
•' - +` - - PERMIT•EXPIRES IF. WORK
' OWNER DJ°S - CONTRACTORR Burch COIISt . IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSu ':
FOUNDATION - _ ANC. OR 180 DAYS FROM
'NOTE: .M LAST CALADINSPECTION.'.-
UFER - ALL GRADING AND DRAINAGE7SHALL,BE INSTALLED '
PREGUNITE - CU COMPLY WITH THE APPROVED PLANS AND'CITV OF ..PERnnT VALIDATION
CUPERTINO STANDARDS:
_ GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 3—(p_
UNDERGROUND /SLAB w
PLUMBING -- J-{� zvrpf'C
ELECTRICAL 3 ..N,�3- ` ISSUANCEDAre
MECHANICAL 3_vl.` •$7-�L Avj,- I •H1 ELECT PNc, A
rum
DO NOT POUR FLOOR UNTIL'ABOVE HAS BEEN SIGNED EDIA
V, BUILDING PERMIT
' - WOOD FLOOR' - INFORMATION
VALLATION SIFT.
• PLUMBING r - +• '
• ..MECHANICALPERMIT TO
ELECTRICAL
FRAMING - 'f ��'i y,,t„. +w✓,.i:d'.' .
INSULATION - STORIES TYPE ONNSTFL •,
OCC,GROUP - RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.FT PLOOR PRLP TOTAL HCREAGE
ROOF NOTE:IJO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
1 BUILDING USE
ROOF SHEATHINGS - 'Res INO coN Pe oil,.,
APPLY NO ROOFING UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ '❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANN. .
PLUMBING ELECT.ENERGY . I
TRACT NO. PARCEL NO. ll
TUBS BSHOWER PAN• - PLUMBING:ENERGY
MECHANICAL - MECH.ENERGY
ACC DATE �ACC„FILE No.
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
INSULATION - PLUMBING ZONING ENG SITENO_
GAS TEST _ GAS _ •t "
-
MECHANICAL FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' Y ❑ "❑ ` ❑ N[3
EXTERIOR SHEAR - ELECTRICAL RELEASE t FLOOD ZONE A.L U
INTERIOR SHEAR _ - FIRE DEPT. 3 J�j' y Y❑ "❑ Y ❑'. N❑
SHEETROCK - GRADE FEE SUMMARY '
_ EXTERIOR LATH - BUILDING _ ,
INTERIOR LATH- � ' TEMPORARY APPROVALS , BUILDING e„ 1...
SCRATCH COAT ELECTRIC - PLAN CH ED
. - - GAS FEE . .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED.UNTILBUILDING FINALISSIGNED BVBUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY'PHONING 252-4505, ELECTRIC
�* oONE WORKING DAY BEFORE REQUIRED.INSPECTION . ` ' PLUMBING
Z - PLEASE GIVE JOB ADDRESS WHEN PHONING:
- SEE PERMIT FOR EXPIRATION DATE- MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE "§
TOTAL
CALLING FOR FINAL INSPECTION. '`
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _
`
B 1 L PROJECT I DENTI FICATION PERMIT NUMBER
RUIN° O APPLICATION & PERMIT 1
v [AL� zi - BUILDING -ELECTRICAL-PLUMBING-MECHANICAL , ' , r 1 T S1
Il
OWNEWS
NAME �r PLAN CHECK VALIDATION
M�N/7 QTY. ELECTRIC PERMIT FEE
CONTRACTORS /H
Q 33
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00 I ' ,
cD...a j]q�.$�,,,,......,,,��'///��qqq...��, /yE+ PPLIANCES-RESIDENTIAL 4.00
a DDNEs'S,r$7 ,=,!2Z Y. ��p
Y/ fTJT'� Lr PHONE y� �� PANELS 1D.DD DATE OF APPLICAPI N
ABRCNITECT r � PLAN CHC/ 20.00GPANELS IOVER 200 AMP)
-
ENGINEER '
Lica NO, ISIGNS TRANS. 3.00
- M.C.,OR ENO 1-7,zl . SPECIAL CIRCUIT 5.00 PERMIT VALIDATION'
ADDRESS
Snla��G/f $ Z� EIV EMP.METER OR POLE INS. 20,00
APPLICANTS�Zi�r�. D
ADDRESS ✓ /�^ MOTORS SEE FEE SCH.
OIVc�C SERVICE CHANGE 20.00
'02
Oo LICENSED CONTRACTORS DECLARATION
<u u 1 hereby affirm that I on licensed under provisions of Chapter 9 N 11 GATE
y c u (Commencing with Section 7000)of Division 3 of the Be,inessand BLDG. ELECT. PLG. MECH.
Z C)N i Professions Cole, my license is in full force' aU. u ,.y� ❑ ❑
O z v_h 0 Licens'CI H Lie.Number b`
Date Contract.,
a y 3 BUILDING PERMIT
rt rc w OWNER-BUILDER DECLARATION INFORMATION
w ;e - I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
LIC¢ Law for the fallowing mason.(Sec,7031.5,Businessand Professions VALUATION S/FT.
H - w PERMIT ISSUANCE 10.00 ' "
� y 0 Code:Anymolish coontyir any stmehsapeioiltnconsuace,aeq ,�/T�
¢ R Q G improve,demolish,or repair any structure,prior to its issuance,also ELEC.LONTR. UG NQ ELC. , '
La
O¢ requires the applicant for such permit to file,signed statement that TE
OTAL PERMIT TO
u st$ he is licensed pursuant to the provisions of the Contractor's License
i Law(Chapter9(commencin•with Section 7000)of Division 3 ofthe
ic Business 11 Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE /N 76�� ale L
It H m 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 ALTER-DRAIN -WATER IEA.) 5.00
of not more than Ove hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW 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
Cole:'fhe Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 - SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 INC.40UTLETS,6.00
mends are not intended or offered for sale.If,however,the building
x or improvement is Sold within one year of completion,the owner GAS•EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING LIEF
builder will have the burden of proving that he did not build or im- 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 ❑ ❑ ❑ ❑ ❑
licensed contractors to constrlrct the project(Sec. 7044,Business I 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(EA.) 1.00 e
contracts for such ecwith acontructor(s)licensed pursuant to
License
L
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT.NO. PARCEL NO.
❑ lam exempt under See.-,BAP.C.for This WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC FILE NO.
wORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of.consent to self-insure, ZONING
or a certificate of Workers'Compensation I urance,or a certified >< - ENG.SITE NO.
copy thereof ec.3800,Wb.0
Policy No. Compan
O ❑ Certili ropy is hereby anis J. FIRE SPRINK ENERGY T 24
z �J ❑ Cer" is n.dle ci inspection division. MISC.- -' REFER TO ORD. ❑ ❑ ❑ ❑
a Applic' V N V N
CC ti I-RT FICATE OF EXEMPTION F-R M WORKERS' - PERMIT ISSUANCE 10.00 FLOOO ZONE A.L.U.C.
W COMPENSATION INSURANCIi PLG.CONTR. LIC.NO, PLG. Y❑ NE] Y❑ N❑
CL Z (This sect 'n need not be completed if the permit is for one TOTAL
hundred all is IS 100)or less.)
U O 1 cavil hat in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mit is issued,1 shall not employ any person in any manner so as to -
U become subject to the Workers'Compensation Laws of California.w Date-Applicant
Applicant p BUILDING
u ALTER OR ADD TO MECH. 5.00
} to emptio NOTICE *10 APPLICANT: If,alter to the ork Certificate sa fix-
? emptio n you should become subject to the forthwith
Compensation APPLIANCE 5.00 PLAN CHECK
provisions io the Labor Cole, yoedee forthwith comply with FEE
U such provisions of this permit slhall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT(OVER 10MOC.F.M.) 6.00 SEISMIC FEE_
I hereby affirm that there is a consvueti.n 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.) ' 8.00 MICROFILM
3097,Civ.C.).
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and date 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 to building construction, and. BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (OWI,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly 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 whichPERMIT ISSUANCE10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ran ting of this pe 'l. MECH.CONT. LIC.NO:. MECH. '
Y TOTAL TOTAL G3 6 S
o App Ermt/Contractor a
OFFICE COPY
I -