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14871 POST THIS CARD NEAR.F,RONT OF BUILDING..' L� PERMIT NUMBER CITY OF . CUPERTINO 14871 INSPECTION DIVISION . JOB INSPECTION RECORD `+ - - PERMIT EXPIRATION JOB ADDRESS 10123 N. WO1fe ' ROad UNIT# `'LOT# .. - PERMIT EXPIRES IF WORK OWNER AT & T CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD -180DAYS OFPERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM NOTE: -LAST CALLED INSPECTION. LIFERALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PerinuT VALIDATION _ CUPERTINO STANDARDS. GARAGE SLABS, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6/-.21-"- k-L-4 UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE MECHANICAL. - - BLUIl ELECT I PLG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR " O NFORMATION VALUATION SIFT, PLUMBING MECHANICAL - PERMIT rO ELECTRICAL FRAMING Si DRIES TYPE CONSTH. INSULATION - OCC.GNOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ® BUILDING USE ROOF SHEATHING" - RES IND CON PB om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ...DATE INSP. El ❑ 0 ❑ 13 ASSESSORS PARCEL NO, ROUGH SAN.a PLUMBING ELECT,ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ' ELECTRICAL -j , ACCDATE ACC FILE NO BUILDING ENERGY. �� • FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING ' GAS TEST GAS MECHANICAL FIRE STRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICALRELEASE q--7T-_W FLOOZZONE ALUC. INTERIOR SHEAR _ FIRE DEPT;- Y❑ NO YL N❑ SHEETROCK Z GRADE - - FEESUMMARY, 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 IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM_ -ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRICIJU n' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING •' z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! 'CONST.rnx 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 I QENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT t /� ADDRESS 14871 p q 0 I D i iL,3 S• L. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,.. OWNER'S OT"' T^ .�N,� PLAN CHECK VALIDATION N//AME��,,��II�Z^�//11�� yam- QTY. ELECTRIC PERMIT FEE "` \qL S I V`av, PHONE CONTRACTORS C�10 3 UTLETS-SWITCHES-RECEP 10.00/1.00 NAME Lw WVpkW uc.No. (� gg TING FIXTURES 10.00/1.00 CONTRACTOR'S 1190 Dlu,pN otvNF Ntr•/4 APPLIANCES-RESIDENTIAL ADDRESS C�L PHONE 740 PANELS 1D.DD GATE OF APPLICATION ARCHITECT PANELSIOVER 200 AMP) 20.00 PLAN LHECK FEE P.C.NO. Dq ENGINEER LIC.NO. SIGNS TRANS. - 3.00 ARCH.OR ENG. a SPECIALCIRCUIT 5.00,75 - PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANT'S ,'MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 0 0 O LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ' y<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH., '030. Professions Code,and m license is in full , ( eL-T- ❑. ❑ Z, o u- Licen ^las C. Number ❑ 9 Dale Contractor L!'H/� 'pQLC, �,1`1 • BUILDING PERMIT w u OWNER-BUILDER DECLARATION - INFORMATION X 3 a- N I hereby affirm that I am exempt from the Contractor's License MISC.- REFE O ORD VALUATION $/FT. F u.NJ Law for the following reason (Sec,7031.S,Business and Professions pERMIT ISSUANCE 10.00 O 'er Code:Any city or county which requires a permit to construct,alter, ¢ a, improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ...c LICee.NO. ELEC. R? a 0 a, requires the applicant for such permit to file a signed statement that LNA$.�p� KG,yp 97p I TOTAL PERMITTO Z m he is licensed pursuant to the provisions of the Contr:Itmr's License H z i Law(Chapter 9(commencingwitls Section 7000)of Division 3 ofthe z a Business and Professions Code)or that he iscxempt therefrom and DTV. PLUMBING PERMIT FEE ¢Ii-0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 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,AREA,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 FIXTURES-PER TRAP 5.00 sD.Pr.FLOOR AREA TOTALACREAGE himsclfortimm,li his own employees,provided that such i nmrov, GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 ments are not intended or offered for wee.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will'Ihave the burden of proving that he did not build or int. RES IND CON . PB onuo prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ �' Cl licensed Contractors to construct the project(Sec.7044, Business LAWN SPRINKLERS-1 INC 5 V.B: 6.00 ASSESSORSPARCELNO. 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 IEA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL N0. ❑ I am exempt under Sec.-,b&P C.for this WATER HEATER W/VENT 6.00 reason Owner - Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION 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(Sec.3800,Lab.C.L ' Policy No. Company Cl (lied copy is hereby furnished. - FIRE$PRINK ENERGY T44 Z Z Certified copy is filed with the city spedtion division. 0 ApPicunl.Nl.LM.1TIzWV ''''"�""'� MISC.- REFER TO ORD. Y NE] VC] NE] CERTIFICATEPERMIT ISSUANCE 10,00 FLOOD ZONE A.L.u.C. LU > COMPENSATION EXEMPTION FROM WORKERS'INSURANCE: PLG,CONTR. LIC.NO. PLG. V� N� Y [:] N� CL O (This section need not be completed if the permit is for one - TOTAL D Z hundred dollars IS 100)or less) - U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O Ubecome:subject tO the Workers''Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } on NOTICE TO APPLICANT: If,offer making this Certificate of f- ? Ex- 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 (� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.)' 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOC.F.M.) 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 I Lender's Ad dress HEATING UNIT(OV ER 100,000 B.T.U.19.50 ELECTRIC 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 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 (Over 100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property 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 whiclhpERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City a ante of the ranting Of this permit. MECH.CONT. ❑L.NO. MECH. TOTAL TOTAL Signature of A pplicant/Contractor OFFICE COPY