14622 'POST THIS CARD NEAR FRONT OF BUILDING;
PERMIT Numeerv'
CITY OF CUPERTINO
INSPECTION DIVISION 14622
JOB INSPECTION RECORD
PERMTEXPIR ON� �o3 / / D �.RDJOB ADDRES �
UNIT# -LOT#• '
PERMIT EXPIRES IF WORK'
OWNER , A� coNTO CTOR C,^/1 CO '7U O . IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD 1110 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM .
FOUNDATION •�
NOTE: LAST CCALLED INSPECTION. '
LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED -I 41
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERb+IT-VALIUA T'ON
—
CUPERTINO CUPERTINO STANDARDS. "' ^T
GARAGE SLABS - y. h. r -"'"
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED• " ^ lf,'•
UNDERGROUND /SLAB ,f'. .I1,
PLUMBING
ELECTRICAL - ' ISSUANCE DATE
MECHANICAL - nLOG. ELe CT, ,PLG. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR
P INFORMATION
' � � nnoN siET.
PLUMBING - - ' '
MECHANICAL
�p PENMH i0
ELECTRICAL rk + F
FRAMING
INSULATION' - TORIES l 'TYPE CONSTR ;
^UCC
GROUP . RES.UNITS
I
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa Lr.PLoon Asea TpTAL ACREAGE -
- DIAPHRAGM THE CONSTRUCTION TAX IS PAID 4•.� i;
ROOF SHEATHING Hci" IND ILDcory usiPe Do—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. � ❑ ❑ ' I❑ '
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY -
TUBS 8 SHOWER PAN - - PLUMBING ENERGY TRACT No PARCEL No
MECHANICAL MECH.ENERGY, Acc.DATE Acc,TILE No
ELECTRICAL - - Fwk
BUILDING ENERGY
FRAMING ' ELECT.FINAL TEST -
INSULATION PLUMBING
ZONING ENG.SITE NO. "
' - -
GAS TEST GAS
MECHANICAL. FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " N[]
FLOOD ZONE 'A,L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE v� N� Y ❑ .N❑
INTERIOR SHEAR - FIRE DEPT.
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR-LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK -
GAS
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED. OCCUPANCY - SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLL7MBINc
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coasT.Tnx ,
PLEASE READ REVERSE SIDE BEFORE TOTAL � !Z
CALLING FOR FINALINSPECTION.
OFFICE COPY
III. —
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALLPOINT'PEN ONLY '
„.•.. BUILDING PROJECT IDENTIFICATION -PERMITNUMBER
yu DRESS APPLICATION & PERMIT 14622^ ^^
ADORLN6 204'4 VALLCO FASHION .PARK L�b G G
. CUPFJLTINIU - CA_ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S l�ls� _ ` PLAN CHECK VALIDATION,
uAME S, M46NlAl - /` CITY. ELECTRIC PERMIT FEE
REP% WiLLIRM Ci}ARO(dA5 PHGNE.-765- 106• - �Q� ••
CONTRACTORS
OUTLETS-SWITCHES-RECEP, 10:00/1.00NAAME
,C.4 6. do. Lac, CAPE 2 LIGHTING FIXTURES 10.00/1.00
7 -
'CONTRACTORS
ADDRESS - APPLIANCES-RESIDENTIAL 4.00 _
PHONE 4w PANELS .10.00 DATE OF APPLICATION
ARCHITECT - - PLAN CHECK FEEPG,NO.
OPANELS (OVER 200 AMP) 20.00
ENGINEER 'M'N PARtNeRSH(P C-14921 -LIC.NO, ISIGNS TRANS. 3.00
ADDRESS END. NINTH Sir ,g0.4A - - PERMIT VALIDATION
-1 9 SPECIAL CIRCUIT . 5.00
SAN FRANyco, CA. , ziP941D3 EMP.METER OR POLE INS. '20.00 /\�//��\\1� „ �•
APPLICANT'S \•I�xtA ./�Pv' - peNe•- `."
ADDRESS I1j5 Be1xaY S? RIM �j0� MOTORS SEE FEE SCH. '
=*- I ' C14 4A BASIAL S.F. CA. 141o7 SERVICE CHANGE 20.00 I
aa O o LICENSED CONTRACTORS DECLARATION / rI
v u I hereby affirm that 1 am licensed under provisions of Chapter 91
y ¢ N (commencing with Section 7000)of Division 3 of the Business mtd a' ISSUANCE DATE
H o 2 Professions Code nd my license is in full fo an of e '
BLD ELECT.' PLG. MECH.
zQ z = Licens CI Ss
Lic.Number ��E� - �„
m J me Contractor '`
Q E J
Y +
• - {p'GILDING PERMIT
w'u OWNER-BUILDER t`I TNFORMATION
K
a. a.w 1 heretiy affirm that I am exempt from the Contractor's License . MISC.-i •REFER TO ORD
u. oj Law forthe following reason.(Sec.7031.5,Business and Professions LVALUATION $/FT.
- PERMIT ISSUANCE• 10.00
Code:Any or county which structure permit totsi construct,alter, li/O �O
SR a Q improve,demolish,or repair structure,prior to its issuance,also ELEC.CONTE. - LIC.NO. ELEe. ((_ '+
, requires the applicant for such permit to file a signed statement that TOTAL
u w m hers licensed pursuant to the provisions of the Contractor's License PERMIT T0- y
F i Q
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe dA rel a�-yOG
-y o Business and Professions Code)or that he Is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ r m the basis for the alleged exemption.Any.violation of Section 703LSce 5_6 STORIES TYPE CONSTR. .
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred de ltars($500).):
❑ I,as owner of-the property,or my employees with wages a 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 Profession, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to on owner of -
property who builds or Improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 50.FL FLOOR AREA TOTAL ACREAGE
\� himself or through his own employees,provided that such improve- -
r menta are not intended or offered for sale.l L however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
Or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4"IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND' CON PB Other .
❑ 1,as owner of the property, INDUSTRIAL WASTE INTER.' 30.00 ;1
p p y,he exclusively contracting Bu with -
anensed colons ode:The
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 owner of property who builds improves thereon,and who - _ LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts
m
for such projects with a ntralmctolor(S)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT No. PARCEL No.
❑ I am exempt under Sec. -,B.&7..C.for this
reason WATER HEATER W/VENT, 6.00 ,
-
Owner Date WATER SYSTEM 6.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPEMATION DECLARATION WATER TREATING EQUIP. 5.00 '
1 hereby affirm that I have a certificate of consent to self-insure, ZONING .ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified _
copy thereof fSec.3800,Lab.( ,�E",,
Policy No. CompanY+^O tIi�C
O ❑ Certified copy is hereby furnished.�- - FIRE SPRINK ENERGY T2A
Z Z ❑ Certif d coy is file with the city inspection division.'
H ❑ ❑O' Applicant - MISC.- REFER TO ORD. v N ❑ ❑v N
LO C-ft HCATE OF 17XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.D.
LU 0 COMPENSATION INSURANCE _ PLG.CONTE. LIC.NO., PLG. y 'N�' V N
(This section'need not be completed if the permit is for one TOTAD
D Z hundred dollars($100)or less)
L) O I certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY*
LL U mit is issued,1 shall not employ any person in any manner so as to
become subject to the Workers'Compemation Laws of California.
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 13.
"
,} W NOTICE TO APPLICANT: If,after making this Certificate of F.x-
F. emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C) such provisions or this permit shall be deemed.revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.RM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) - 5.00
3097. performance
C.)nce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state 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 lo-building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
t, hereby authorize representatives of this city to enter lipon-the BOILER-COMP(_Over 100,000 BTU)SEE'FEE SCH, MECHANICAL _
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of f/ MISC.- REFER TO ORD. t
Cupertino against liabilities,judgments, costs and expenses which .CONST.TAX
may in any way are a against said CI
in consequence of the PERMIT.ISSUANCE 10.00
•ranting ofinds perm' MECH.CONT. - LIC.NO. MECH:
TOTAL TOTAL
S' afore of App Iant/Contractor' - Date -
OFFICE COPY