14839 POST THIS CARD NEAR FRONT OF BUILDING,
PERMIT NUMBER
CITY OF CUPERTINO
. . _ 189
INSPECTION'DIVISION
JOB INSPECTION RECORD
.PERMIT EXPIRATION• ;
J JOB ADDRESS 10123 North WorNIT# _LOT# `
PERMIT EXPIRES IF WORK '
OWNER Kinney Shoe Store CONTRACTOR IS NOT STARTED WITHIN `
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. ;
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHM11 VALIDATION
PREGUNITE CUPERTINO STANDARDS. 'GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - q eps
PLUMBING JUN 2 `z logon
ELECTRICAL IssuANCE un TE
MECHANICAL _ BLDG ELECT PLG. MEC.
Of
CRY. Dup"r F]
El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORIVIXION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL � � / �. - 'k
ELECTRICAL PERMIT r0
FRAMING
- STORIES TYPE CONSTR.
INSULATION
�a �w e.
occ,GROUP Res.urvrrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIG EO
SO.IT.aoo«AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE ;
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING " .ES IND CON PB 00", I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN IGNED FINALS DATE INSP. 1:1 ❑ ❑ ❑ ❑
ROUGH SAN.p ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
.TRACT NO, PARCEL NO .
TUBS 8 SHOWER PAN - PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.DATE ACC FILE NO,
FRAMING ELECT.FINAL TEST zoNwc ENG.sIT�No.
INSULATION PLUMBING , ,
GAS TEST - GAS
MECHANICAL FIRE svRIN'r: .ENERGY T2
❑ NEI v [D NE]COVER NO WORK UNTIL ABOVE HAS BEEN SINNED HEATI NE- F
EXTERIOR SHEAR ELECTRICAL RELEE FLOOD ZONE A,L.u.c.
AS
INTERIOR SHEAR FIRE DEPT'. Y❑ N❑ Y ❑ N❑
SHEETROCK - GRADE - FEE SUMMARY
EXTERIOR LATH ILDING
_ INTERIOR LATH TEMPORARYAPPROVALS 'BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE ,
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
;r z PLEASE GIVE JOB ADDRESS WHEN PHONING.'
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL Y
IMPORTANT! . CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT
euu.DlrvG
14839
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14 8 3 9
wrvER's
NAME 'PLAN CHECK VALIDATION
N C GTV. ELECTRIC PERMIT FEE
J ONE
NAMMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No. 3ILIGHTING FIXTURES 10.00/1.00 ,
CCOOO( AV CONTRACTORS S,�.. Or PPLIANCES.-RESIDENTIAL 4.0M0
o / 1404 -ONE a95 PANELS 10.00 DATE OF APPLICATION
OARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
NGINEER
LIC.No, SIGNS TRANS. 3.00
ADDRESS ante. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
➢P TEMP.METER OR POLE INS. 20.00 "
ADDR ESS is - MOTORS SEE FEE SCH. p
SERVICE CHANGE 20.00 D T '�YJn-7
,00 LICENSED CONTRACTORS DECLARATION `�
a o G I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
w a w (commencing with Section 7000)of Division 3 Of the Business and g�p� ELECT. .PLG. MECH.
H y z Professions Co e, d my lice se is in full-lure a fe t. - / ❑ ❑ -❑
z o n - License Class Lie.Number !� - -
9 L� o Date Contractor
a Y E �P� BUILDING PERMIT
E o a o OWNER-BUILDER DECLARATION INFORMATION
X ; I 1 hereby affirm that I am exempt from lite Contractor's License MISC:- REFER TO ORD
w VALUATION $/FT.
FLLNj Law for the following reason,(See.703 t.5,Businessland Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, '
IS ca Q ,O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR., , LIC.NO. ELEC
c u requires the applicant for such permit to file a signed statement that TOTA.L PERMIT TO
m
o. w m m he is licensed.pursuant to the provisions of the Contractor's License M�
z > Law(Chapter 9(commencingwith Section 7000)ofDlvision 3 ofthe -
a Business and Professions Code)or that he is exempt t -herefrom and OTVPLUMBING PERMIT FEE
¢ F the basis for the alleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR.
i5, 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 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 solo 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
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
• mems are throughhisownemployees,for sale.
If,however,
the
improve- GAS-EA.SYSTEM-1 6.00
mems are not intended or offered far sale.If,ed that s [he building
or improvement 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 int- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 -
❑ I,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•(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
the Contractors License Law. TRACT NO. PARCEL NO
❑ Ian,exempt under Sc,.- ,B.&P.C.forthis 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 selbinslm, ZONING ENG.SITE N0.
or u certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3 Lob.C. -
Policy N� puny
O ❑ Certifiedcopyisherebyfurnished. I / FIRESPRINK ENERGYT-24
Z Z A�@ cCCVificd copy is filed will, the city Inspection division. MISC.- REFER TO ORD. y N Y N
p ypli ❑ ❑ ❑ ❑
~ w+ PERMIT ISSUANCE 10.00
� - CERTIFICATE E SATION INS FROM WORKERS' FLOOD ZONE A.L.U.C.
Q. O COMPENSATION INSURANCE PLG.CONTR. LIC'.NO. TPLO
OTAL Y❑ N❑ Y❑ N❑
� Z (This wclars need not be completed if the permit Is for one
hundred dollars($100)or less)
U O 1 certify that in the performance of'the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U nit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California, BUILDING
y[ n Date Applicant ALTER OR ADD TO MECH. '5.00 -
>_ r0 NOTICE TO APPLICANT: If,after making this Certificate of Ex-
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with FEE
CJ 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 10=C.RM.) 6.00 SEISMIC FEE
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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and stale that the aboveVENTILATION 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 '(j S
- ' BOILER-COMP IOVBf 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentionedproperty for inspection purposes. J
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Lranting
gainst liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
way accrue against s 'ty in consequence of the
this permit' MECH.C T. LIC.NO. MECH.
�r T%MP 4190 TOTAL TOTAL o
f Applicant/Contrac - Dat t
OFFICE COPY