15289 POST THIS NEAR''FRONTOF BUILDING''
- PERMIT NUMBER :'''
a CITY OF ".CUPERTINO 15289
INSPECTION DIVISION
JOB INSPECTION RECORD
:10123 North Wolfe "RoaGl PERMITrE XPI ATION
JOB ADDRESS. - UNIT# _LOT#
+ PERMIT EXPIRES IFWORK.,
OWNER AthletlCEXjJre55. CONTRACTOR IS NOT 'STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU '
ANCE OR 180 DAYS FROM.
+ FOUNDATION NOTE: • - -LAST CALLED INSPECTION. I
UFER' - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - - -. . - TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
CUPERTINO STANDARDS, ,•,,,�,;,:r
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED7•$S•C`�.�'�'Q,' - C'
'UNDERGROUND /SCAB - 7— =
PLUMBING U •�'' r
ELECTRICAL - U - ISSUANCE DATE
MECHANICAL —75777 I—E—C T PLG. MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'BUILDING PERMIT
WOOD FLOOR INFOR TION
. V UATION' n .$/F T.
PLUMBING
8
0
9
MECHANICAL ,
P ERMIT�TO
ELECTRICAL.:; '- ''CVQCMID.5 f;
FRAMING rA
INSULATION - STORIES ry CONSTR.
'OCC.GROUP, YRES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ` - '_
$U,FT FLOOR AREA TOTPL PLH FACE
s .. ROOF., NOTE:NO FINAL INSP:SHALL BE MADE BEFORE -
- DIAPHRAGM THE CONSTRUCTION TAX IS PAID r
_ BUILDING USE
V ROOF SHEATHING - RES IND CDN FIT D '�
APPLY NO ROOFING UNTICABOVE HAS BEEN SIGNED FINALS, DATE INSP. El ❑
ED
ASSES50RSPARCELNO.
ROUGH SAN.# _ -
PLUMBING ELECT.ENERGY
uACT NO. NO
' TUBS&SHOWER PAN • . � � PLUMBING ENERGY ' .. - TR ,- '
MECHANICAL MECR.ENERGY e -
ELECTRICAL _ BUILDING ENERGY Acc DATE ACC FILE NO
FRAMING - , ELECT.TINAL TEST zoNlNc., ENG.sIrE No
INSULATION. - PLUMBING
GAS TEST GAS.
MECHANICAL FIRE SPR INK_ .ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING a Y ❑ "'EJ ` ❑_ "O
ELECTRICAL-RELEASE FLOOD ZONE A.L.uc:,
EXTERIOR SHEAR ��/
INTERIOR'SHEAR FIRE DEPT.'^ - Y I] N❑ r ❑ •'N Q,
SHEETROCK - - i. GRADE - FEE SUMMARY
BUILDING BUILDING
EXTERIOR LATH
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ' ' " ELECTRIC - PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY .. SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDINGINSPEOTOR. �ICROFI_LM.
W-.' I
ARRANGEFORINSPECTION BY PHONING 252-4505ELECTRIC� ONE WORKING DAYBEFORE REQUIRED INSPECTIzPLEASE•GIVE JOB ADDRESS WHEN PHONING: P�uMBiNc
—SEE PERMIT FOR EXPIRATION DATEMECHANICAL
•!MPOR-TANT! covsr.rnzPLEASEREAD REVERSE SIDE BEFORE TOTAL'CALLINGTOR FINAL INSPECTION.
OFFICE COPY ,
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
"_':'BUI LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
" BUILDING APPLICATION & PERMIT
ADDRESS oma, 15289
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S l _ PLAN CHECK VALIDATION
"AM QTY. ELECTRIC PERMIT FEE
PHONE /r O9
zeagI
CONTRACTOR'S
NAME_'7^ OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00 -S
NTRACroRs
ADDREAPPLIANCES,-RESIDENTIAL 4.00
COT `
IS/� AONE�J d^ PANELS - 10.00 DATE OF APPLICATION' S
aRCHITECT , PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 .
ENGINEER
g' Ic.NO. SIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
A REssr � SPECIAL CIRCUIT 5.00 '..
ZIP
ADDRESS EMP.METER OR POLE INS. 20.00
A71
MOTORS SEE FEE SCH,
ADDRESS
I jr/ SERVICE CHANGE - 20.00 N
.w o o LICENSED CONTRALTO DECLARATIO N�/' L.0 4 -
rt u u I hereby affirm that 1 am licensed Linder provisions of Chapter 9 0 1 SUANCE DATE
yz w - (commencing with Section 7000)of Division 3 of the Business and
Q'> LDG. ELECT. PLG. -MECH.
H H z Professions Code P d my license is in full forcq,an`re��
z O m ---� License lass _Lia Number 3 IY`b"
O w H w / Date �- - Contractor
a,yE o LDING PERMIT
o: wu OWNGR-BUILUHR DECLARATION INFORMATION
o a MISC.- REFER TO ORD
E:
; 0 y I hereby affirm that I um exempt from the Contractor's License V N - $/FT.
LL o j Law for the followin reason. Sec.7031.5,Business and Professions
H _ g ( PERMIT ISSUANCE
Code:Any City or county which requires a permit to construct,alter, -
ce¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC. O� / r+�OO
O ac requires the applicant for such permit to file a signed statement that TOTAL o S�i - PERMIT TO
e. ,e m he is licensed pursuant to the provisions of the Contractor's License
,n _ � LR/0
Busi(Chapterand
Professions
ode)or Section is7000)
exempt theref o and .Q �F- D/20(�'
a Business and he alleged
Code)or that he is exempt therefromandDTV. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
' aS� by any applicant to,a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 '
of not more than five hundred dollars(8500)J: '
❑ 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
Code:The Contractors License Lew does not apply to an owner of _
! • properly 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-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLET$ 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving t . . .
hat he did not build or im- RES IrvG CON PB Omer
prove for purpose of Safe.). INDUSTRIAL WASTE INTER. - 30.00
❑ I,as owner of the property,am exclusively contracting with _ Q. ❑. ❑ - ❑ ❑
licensed contractors to construct the project(Sec.'7044,Business LAWNSPRINKLERS-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 concretions)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ I am exempt under Sec. ,W&P.C.for this WATER HEATER W/VENT 6.00 �O
reason
Owner Date WATER SYSTEM S.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate fin Certified
consent to s su - '
' or a certificate of Workers'Compensation Insurance,or a certifiedre ZONINGENG.SITE NO.
-,w copy thereof jS; ru Lony o _
Policy No.em o,a . �tJ�
O ❑ Certifi p Ish by furnished FIRE SPRINK ENERGY T-24'
Z ZO� ❑ Cer' le co Blcd with lh• y, inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
Applicant v N v N
~ �+ PERMIT ISSUANCE - -1$00 FLOOD ZONE ' A.L.U.C.
� T � MI'TION FROM WORKERS' •
L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. qD r-• Y❑ N❑ Y❑ N❑
CL 0 (This section need not be completed if the permit is for one - - TOTAL .J
=) Z hundred dollars IS 100)or less.) '
U O 1 certify that in the performance or the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
L H mit is issued,I shall not employ any person in any manner so as to -
OU become subject to the Workers'Compensation Laws of California.
w BUILDING
y Date Applicant ALTER OR ADD TO MECH. 5.004411 L_
} W NOTICE TO APPLICANT:Jf,after making this Certificate of 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
t.0 such provisions or this permit And be deemed revoked. AIR HANDLING UNIT(TO 10 p00QF.M.) • 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C-F.M.) 6.00 ' SEISMIC FEE, &b
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.CJ. ., HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's AdH EATI N G UN IT(OV ER 100,000 B.T.U.)9.50 'ELECTRIC
dress
I Certify that l huve read thisapplicaticn ondstate bat the above VENTILATION_FAN (SINGLE)' 4.00 S
Information Is correct.I agree to comply with all city and county PLUMBING, 3 a •!
• ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 -
hereby authorize representatives of this city to enter upon the BO
hereby (Over t00,000BTU)SEE FEE SCH. MECHANICAL '027 S�
ahove-mentloned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
uperti run t liabi' judgments, costs and expenses whichCONST.TAX '
a n any y against C' n consequence of the PERMIT ISSUANCE - 1660 /eZ,
ntih s I MECH.CONT. LIC.NO. MECH. �x
TOTAL ''2Z7` i TOTAL
i 1c on for Dace
OFFICE COPY