14849 .. �S POST THIS CARD NEAR FRONT OF BUILDING
PEiiMIT NUMBER
CITY OF CUPERTINO 14$49
INSPECTION DIVISION'
JOB INSPECTION RECORD
PERMIT'EXPIRATIO
JOB ADDRESS 10123 N. Wolfe Road UNIT# _LOT 0 �� '
- PERMIT EXPIRES IF WORK
OWNER Merksamer Jewelers CONTRACTOR —IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEKN+IT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS / •,,,....—
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - �• f�P �!r b b
ELECTRICAL - ISSUANCE ugre
MECHANICAL 'BLDG. ELECT I PLO. MECH
R1 ❑ ❑ ❑ -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PAID BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING ' 183 VAwarlO" ! SIFT.
MECHANICAL O3UU_�,;; r �,:f'' ,,,.•
ELECTRICAL - IRU PERMIT TO
FRAMING
INSULATION' STORIES, �TYPE COYN`STR
OCC GROUP Res uNlrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "•�' '"'
iROOF - NOTE:NO FINAL INSP,SHALL BE MADE BEFORE -so.rT.FL ou AREA TOTAL Acgegee
DIAPHRAGM
- THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING E RES❑ ❑ IQry ❑ o❑1.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. g55E550R5 PARCEL NO.
ROUGH SAN.# '
PLUMBING j - ELECT.ENERGY
TUBS 8 SHOWER PAN I PLUMBING ENERGY TRACT No. PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL' BUILDING ENERGY ACC DATE ACC FILE No
FRAMING ' /i•36 ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION - PLUMBING
GAS TEST GAS
MECHANICAL FIRESPRINK ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ® "❑ ❑ '"❑.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONE A U.c,
INTERIOR'SHIEAR' FIRE DEPT. �•��f�� °❑' "❑ ° ❑ NE]
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING _
SCRATCH COAT ELECTRIC e . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY .SEISMIC FEE •)
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE.PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! _ CONST.TAX
PLEASE READ REVERSE SIDE BEFORE ' ph•
CALLING FOR FINAL.INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
1 PERMIT NUMBER
1L BUILDING PROJECT IDEN7I FI CATION APPLICATION 4849
emLmac ASOIL� `F O J
ADDRESS
10
/Z3 ` BUILDING-ELECTRICAL-PLUMBING-MECHANICAL "I.a
OWNERS
S PLAN CHECK VALIDATI
t OTY. 'ELECTRIC PERMIT FEE / a �S-
���
•�^i .� CONTRACTORS UTLETS-SWITCHES-RECEP - 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
\/) CONTRACTORS [APPLIANCES'-RESIDENTIAL 4.00 .
A F{ 2T /j�E�1�
(/' P E W PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMN 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
C C y
No. SIGNS TRANS. 3.00
ARCH,OR ENG. IIm✓l /1///t1IT�LTr �/�J' SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS IM' _
Z3ZI 00 TEMP.METER OR POLE INS. 20.00 I
APPLICANTS - MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
Woo
LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
T (commencing with Section 7000)of Division 3 of the Business and
t' D o Prate ions ad J my license is in full fo At� ELECT. 'PLG. MECN.
z O .�/I Llrocensc flL I.E.NOR, 7sJ ❑ ❑
o �F Dale- Contracto _
w a OWNER-BUILDER DECLARATION ILDING PERMIT
o A U MISC.- REFER TO ORD IN RMATION
wg LL m I hereby uRinn lint I am exempt front the Contractor's License ��}} N $/FT.
FUOj Law for the following reason(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 v,
Code:Any city or county whiCtInquiresa Penni,toconslmeL Z
SEQ ¢ 0 Improve,demolish,Or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. TEL G(,(� IX
O SE requires the applicant for such permit to file a signed statement that TPERMIT TO
La m he is licensed pursuant to ilia provisions of the Contractor's License
F z aLaw(Chapter 9(commencingwith Section 7000)o(Division 3 ofthe /A/Te'''C�eR �F9)00"V2!7
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
0,=$ the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant 103 civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ,�'� V_14'of not more than five hundred dollars(5500).):
❑ I,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,AR EA,COND. 5.00
Cade:The Contractor's'License Law does not apply to an owner of
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SOL.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such
improve-ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
, �/. or improvement is sold wittin one year of completion,the owner- GAS•EA.SYSTEM-OVER 4(EA.1 2.00 BUILDING USE
rT builder will have the burden of proving that he did not buil)or ins- RES IND CON' PB Otne,
--�' prove far purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 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 ASSESSO SPARCEL 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 cunlraciogs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
Ilia Contractor's License Law. TRACT NO. PARCEL N0.
❑ I am exempt under Sec. B,&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - [)are WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
( WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(See.3800,Lab.C.). -
Policy Na Company
O Cilie pyo e,hyl' ro"'m . FIRESPRINK ENERGY T 24
Z Z gt�Certif f with the city inspection division. MISC.- REFER TO ORD.
O
Applicant-f-, - Y N� V.� N�
Fy PERMIT ISSUANCE 10.00 .FLOOD ZONE A.L.U.C.
Lu CIiRTI FICOF EXEMPTION FROM WORKERS'
W >_ CC0OMPENSATION INSURANCIi PLG.CONTR. LIC.NO. FLG. I�{
C 0 (This section need not be completed if the permit is for one TOTAL Y N'+a V_ N�
=) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workeri Compensation Laws of California. a0
a
Date Applicant ALTER OR ADO.TO MECH. 5.00 BUILDING .3
} y emptioNOTICE you
APPLICANT: If,after making this Certificate ,a Ex-
FZ envision you shouldbecomeSubject to the Workers Componwith APPLIANCE 5.00 PLAN CHECK
provisions io [he Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be Deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LF:NDINC,AGENCY
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3 D
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. HEATING UNIT(TO 100,000 B.T.U.) 8.001MICROFILM
3097,Civ.0 I, y'I - -
Lender'sName HEATING UN IT(OVER 100,000 B:T.U:)9.50 ELECTRIC
Lender's Addre
I certify that I have read this application and stale 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 100,0008.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby 4unharize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
-� above-mentioned property for inspection purposes.
C (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX t
ma ny way accrue ag:' st said City in consequ ce of the PERMIT ISSUANCE 10.00
anon r iL MECH.CONT. LIC.NO. MECN.
TOTAL TOTAL 78
Signa[ eof Applicant/Contractor D' e • _
OFFICE COPY