15382 POST THIS RD NEAR FRONT OF BUILDING . PERMIT NUMBER
CIivOF',CUPERTINQ 4 '
INSPECTION DIVISION 1 382
JOB INSPECTION RECORD
• ' - 1'PERMIT EXPIRATION "
10123
oB''aooREss .North Wolfe Road uNlTtt SP 201-5.
- PERMIT EXPIRES IF WORK.
owNER Berman' s CONTRACTOR - - IS NOT STARTED WITHIN• '
INSPECTION DATE INSPECTOR INSPECTION RECORD 180.DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM -
' .
UFER - .AALLLLG &GRADING AND DRAINAGSHALL BE INSTALLED; LASTCALLED I INSPECTION.,
PR EGUNITE' TO COMPLY�WITH THE APPROVED PLANS.AND CITY OF
PER
nuT VALIDATION STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. .UNDERGROUND /SLAB J
I - PLUMBING
ELECTRICAL - I
ISSUANCE DATE
M _
ECHANICAL - > SLUG. ELECT. PLC, MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
'WOOD FLOOR
INFORMATION
. nnD ' S'
PLUMBING 'VALUATION SIFT.
� � - L � � �
MECHANICAL ` „ ✓ ' h
,PERMIT
ELECTRICAL � � - rev " - TO + '
FRAMING � fu: �'i •f..,�'.? •. r-�,x:r, tr�
-' INSULATION - - STORIES TYPE CONSTR.
OCC.GROUP RESSUNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.
' ROOF, � NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT,FLOOR AREA TOTAL`ACREAGE i
�i, •. DIAPHRAGM' THE CONSTRUCTION TAX IS PAID,'
.BUILDING USE
ROOF SHEATHING - - - RE's IND CON .PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . FINALS DATE INSP. El ❑' E. "❑ El '
ASSESS ORS PARCEL NO.
ROUGH SAN.# - -
PLUMBING ELECT.ENERGY
TRACT NO. PARCELNO,
TUBS&SHOWER PAN, PLUMB'NG ENERGY
MECHANICAL - MECH..ENERGY
BUILDING ENERGY. ACC.Dnre - Acc,FILE No.
ELECTRICAL �. � ,
FRAMING ELECT.FI NALTEST
ZONING ENG.SITE N0.
INSULATION PLUMBING ..
GAS TEST GAS
' MECHANICAL - FIRE SPRINK ENERGY T24 -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING'' Y,El N.❑ Y'❑ �N❑
ELOOO ZONE A L.U.C.
EXTERIOR SHEAR• ' • ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT. .`''❑ 'N❑ Y ❑ N❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH. - ;. TEMPORARY APPROVALS eui�Dwc s
ELECTRIC SCRATCH COAT. C C PLANCHECK
GAS
FEE-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ''"O
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING-FINAL 16SIGNED BY BUILDING INSPECTOR. MICROFILM
,
" ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY. BEFORE,REQUIRED INSPECTION: PLUMBING
z PLEASE'GIVE JOB ADDRESS.WHEN PHONING.
'SEE PERMIT FOR'EXPIRATION DATE - MECHANICAL
IMPORTANT! coysT.TAX
PLEASE READ REVERSE SIDE BEFORE °
'CALLING FOR FINAL INSPECTION. ' TOTAL 4.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE,BALL POINT,PEN.ONLY
BUI LDI NG'PROJECT I DENTI FIC -PERMIT NUMBER t
amLDINCy - APPLICATION &;PE T
AppREss /',
Q/d3N• 'yf/0LtCC^ ;D .�' Z;O/,S UILDING-
ELECTRICAL-PLUMBING-MECHANICAL 15.382
OWNER'S
NAME '� .' � .� ' PLAN CHECK VALIDATION
`• 1 CITY. ELECTRIC PERMIT FEE % t
N RA.H. PHO- • ]dao r,
CGNTRACTogsOUTLETS-SWITCHES-RECEP 10,00/1.00
NAME "x
ER X13 LIC.No. - - LIGHTING FIXTURES 10,00/1.00 '
CONTRACTOR'S / 6vA
-
ADORE ss !. - APPLIANCES'-,RESIDENTIAL 4.00 '
J• KM 1�'PHory _y2j�h0 PANELS - :..10.00 DATEOFAPPLICATIOFI-
ORcgrtEc -
Oq PANELS.IOVER 200 AMP) - 20.00
PLAN CHECK FEE P.C.NO.
ENGINEER ,. r "•
Lid No: SIGNS TRANS. 3.00 -
ARCH.ORENG, - _ _
AopRE55 SPECIAL CIRCUIT 5.00 . PERMIT VALIDATION
zm EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS ' SEE FEE SCH. )
AOOR EA
C ys�/Z SERVICE CHANGE 20.00
,02 LICENSED CON, RACTORS DECLARATION /• / '
I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H < H (commencing with Section 7000)of Division 3 of the Business and �, BLDG. ELECT. PLG. MECH.
t- y z Professions Code,and my license is in full force and'effect.
o 0 w o License Class Lic.Number ,� 1:1 ❑ -
m H w Dale Contractor
a x g BUILDING PERMIT
R 0 w OWNER-BUILDER DECLARATION ., '
R
;at I hereby affirm that I am exempt from the Contractor's License- MISC.- REFER TO ORD INFORMATION
u o ¢ Law for the following reason.(Sec.7031.5,Business and Professions ,' - VALUATION $/F T.
fw > J Code:Any city or county which requires a permit to construct,after, PERMIT ISSUANCE 10.00 [[ y -
r[ ¢ ¢ improve,demolish,or repair any shucture,prior to its issuance,also ELEC.CONTR. - LIC:NO. ELEC. rd B Y.
�LL requires the applicant for such permit to file a signed st5temem that TOTAL .it I,•f PERMIT TO
o. w m he is licensed pursuant to the provisions of the Contractor's License - lar
Hz >
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe ,
g 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE MaL�f,,f!/tim�lo�
X r- the basis for the alleged exemption.Any violation of Section 7031.5
T 3 $ by any applicant for a permit subjects the applicant to a civil penalty - .r Vrsl I TORIES TYPE CONSTR,
of not more than five hundred dollars($500l): ALTER-DRAIN Si VENT-WATER (EA.) 5.00 ;111 °a Y
❑ I,as owner at the property,or my employees with wages as - BACK F LOW PROTECT. DEVICE - ,4.00 OCC.GROUP RES.ON ITS
their sole compensation,will property,
the work,and ye 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 3 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employeesprovided that such intprnve-
memtsarermtotendedorofferedforsale.If,however;the building GAS-EA.SYSTEM-i INC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2,00
builder will have the burden of proving that he did not build or im- BUILDING USE
PXfor purpose aside). '" -. INDUSTRIAL WASTE INTER. 30.00 - RES IND CON PB Other
fp�d I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
Ii a sed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ,6.00 ASSESSORS PARCEL 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 u codtrnetons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. - PARCEL NO.
❑ Inner.
reason empt under Se C. ,B.&P.C.for this WATER HEATER W/VENT 6.00 `
Owner - 74NV - WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO. -
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 41 5.00
hereby affirm that Finite s certificate o(cousent to sell'-insure,
or S certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab C.), - -
Policy No.-Company
-
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T44
Z Z ❑ Certified copy is fled with the city inspection division.
I" 0 Applicant - MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
= T [. CERTIFICATE OI°EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 'FLOOD ZONE a.L.U.C.
W > COMPENSATION INSURANCE PLGCONTRLIC.NO. PLG.
1 . .0 (This section.need not be completed if the permit is for one TOTAL _ Y❑ N❑ .Y❑ N❑
D Z hundred dollars(S 100)or less.)
L) O I certify that in the performance of the work for which this per QTY MECHANICAL PERMIT FEE FEE SUMMARY -
U, F mit is issued,I shall not,empluy any person in any manner so as to
0U.1 become subject to the Workers'Compensation Laws of California.
IS.
Date Applicant -BUILDING L!
} W NOTICE 1'0 APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH: 5.00
F _ emptied,you should become subject to'the Workers'Compensation APPLIANCE ,. - 5.00 PLAN CHECK'-
. provisions of the Labor Code, you must forthwit f comply with V FEE'Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING-AGENCY AIR HANDLING UNIT(OVER IQOOOGEM.) 6.00 SEISMIC FEE �f'D
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH_DUCT) 5.00
the performance of the;wark 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 UN IT(OVER 100,000 B.T.U.)9.50 4 ELECTRIC'
. I e,lify In, hzve read this application and stole[hat the above VENTILATION FAN (SINGLE) 4.00
information is correct. I'agree to comply with all city and county gO1LER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and -
hereby authorize representatives of this.City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEESCH. MECHANICAL`
above-mentioned property for inspection of
Flcity to
(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
may in any way accrue against said.City,igconsequence of the PERMIT ISSUANCE - 10.00 _
ttanti Of this p¢rmi MECH.CONT. LIC.IN - MECH.sTOTALTOTALature of Applicant/Con[mctor Date
OFFICE COPY.