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15526 POST THIS CARD NEAR FRONT OF BUILDIN y G , *' PF,RMITNUMSER r CITY OF CUPERTINO . . '15526 INSPECTION DIVISION JOB INSPECTION RECORD, • S �� PERMIT EXPIRATION, 10123 North Wolfe Road JOB ADDRESS ` UNIT# _LOT# ' - PERMIT EXPIRES IF WORKy I NEE Thin 5 Remembered CONTRACTOR - IS NOT STARTED WITHIN , INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSLI FOUND_ ATIONANCE OR 180 DAYS FROM'` NOTE: - LASTCALLED INSPECTION.'; ' 'UFER - ALL GRADING AND DRAINAGE SHALLBE INSTALLED PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF: •PERMIT VALIDATION CUPERTINO STANDARDS. + GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED y UNDERGROUND /SLAB PLUMBING ELECTRICAL - " ISSUANCE DATE MECHANICAL - ., aLOG eLEcr. vLc. MECR - - ❑ ❑ ® .❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION SIFT. PLUMBING - MECHANICAL _ PERMIT TO ELECTRICAL FRAMING STORIES INSULATION STORIES TYPE-CONSTR. • pAD. CC�GROUP RES.UNITS a ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1 .92 PT FLOOR AREA TOTALACREACE • ROOF NOTE:NO FINAL INSP.SHALL BE MA5E ,R�,�BEF 110 DIAPHRAGM - THE CONSTRUCTION TAX IS'PAID P1t1 ', - 1 ROOF SHEATHING auILO usE ' 'RLS INION oN P D S '00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO, TUBS&SHOWER PAN PLUMBING ENERGY i - MECHANICAL - MECH.ENERGY - ELECTRICAL- ' - ACC.DATE ncc.PILE No. BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING EwG.SITE NO.' ! INSULATION PLUMBING GAS TEST GAS _ FIRE SPRINK ENERGY T,24 - ' - - MECHANICAL .Y .IN Y ❑ •. NE] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE AL,U C' EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR - FIRE DEPT:` - YEl H11 ❑ IN SHEETROCK GRADE - FEE SUMMARY EXTERIOR.LATH BUILDING BUILnwc INTERIOR-LATH TEMPORARY-APP ROVALS - - SCRATCH COAT ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM • ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1-- ONE WORKING DAY BEFORE REQUIRED INSPECTION. .� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING �Iv Z - MECHANICAL - SEE PERMIT FOR EXPIRATION DATE IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ° TOTAL CALLING FOR FINAL INSPECTION. i OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY ' BUT LDING PROJECT IDENTI FI ATION .PERMIT NUMBER _ WGIL.INI aj - APPLICATION & PERMIT ADDRESS Q .� 1552 6 ��<c /�� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S Y NAME PLAN CHECK VALIDATION / • t QTS'• ELECTRIC PERMIT FEE V S Pr�ivn/t� NF COHAD OR NAME ' •� OUTLETS-SWITCHES:RECEP 10.00/1.00 p A(ic.No. dV LIGHTING FIXTURES 10.00/1.00 nooeess TORS O PPLIANCES-RESIDENTIAL 4.00 o /,/ is. 141714/' PANELS 10.00 PATE OF APPLICATION aRCNITECT - oR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. ENGINEER LIC.No. SIGNS TRANS. 3.00 ;: C E'SR ENG. ADDRESS SPECIAL CIRCUIT $,QQ PERMIT VALIDATION APPLICANTS ZIP EMP. METER OR POLE INS. 2000, - aD REss MOTORS SEE FEE SCH. co/1J/q9 /'P� �P SERVICE CHANGE 20.00 '02 LICENSED CONT RACTORS DECLARATION <i cI hereby aftirm that 1 am licensed under provisions of Chapter'I A a (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H o i Professions Co e�ay1D license is in full forµµ•'gqnd el a BLDG. ELECT. PLG. MECH. z0 C 2 o License lass J Lic.Number d0 d� /C ,A El ❑. ❑ �_w late Contractor. QIS E ¢_ IS ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION u o j Law for the following reason.(Sec.7031.5,Business and Professions VALUATION '- — PERMIT ISSUANCE 10.00 s/Fr. ¢ w� Code:Any city or county which requiresa permit to conslnwt,idler, Q a o improve,demolish,or repair any structure,prim to its issuance,also ELEC.CONTR. LIC.NO.to ELEC. O u requires the applicant(or such permit Io file a signed smtemem that TOTAL N w N Ile is licensed pursuant to IhC pmv1510ns Of IIIc CanlraCloi a LiCeuse _ PERMIT TO _ rzQ Law(Chapter 9(commencingwilh Section 7000)af Division3of the 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE X10'lY ¢r the basis for the allege,exemption.Any violet ion of Scotion 703 L5 STORIES TYPE CONSTR. n; by any applicam fora permll subjects the applicant lnucivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundreA Dollars(5500).1: ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and[he sUuclure is at OCC.GROUP RES.UNITS intended or offered far sale ISec. 7090, Business and Professions DRAINS-FLOOR,ROOF,Afl EA,CON D. 5.00 Code:The Contractor's License Law does not aPply to an owner Of . properly Who hulllsor lmmooes limmon,all,w1odoCssuell work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or'im. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for 1.as ownerose of theJ. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Ohm ❑ L is owner of the property,am exclusively contracting with 0 0 D 0 licensed contractors to construct 0m project(Sec.7049,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Conmucmr s License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 emlrecls for such projects with u eontraclor(x)licemad pursumn In the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under See. ,B.&P.C.for this reason WATER HEATER W/VENT _ Owner Uate WATER SYSTEM 5.00 ACC.DATE ACC FILE NO. WORKFRS'COMPI:NSATION DECLARATION WATER TREATING EQUIP. .00 I hereby Infirm that I have a certificate of consent lu elf-insure, - or a certificate of Workers'Compensation Insurance,or a cert..... ZONING ENG,SITE NO. copy thereof(Sec 3500,LAC.), policy No. Company JUN O ❑ Cerli fi��sss is hereby turn ed. FIRE SPH ENERGY T-Z9 z.O plctoel � py Isv Bled tNhe city 1 lion division. F L c MISO.- A U Y ❑ N❑ V N[D cc CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE ,1QtB0 FLOOD ZONE q,Lu.C. LU O COMPENSATION INSURANCE PLG.CONTR, ❑C.NO. PLG. '1//II db fL Z (This section need not be completed if the permit is for one TOTAL OC(J Y❑ N❑ Y ❑ N hundred dollars IS 100)or less.) V 0 d certify that in the performance of the work Or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.I shall not employ any person in any manner so as ro O W become subject to the Workers Compensation Laws of California. y Duro Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } as NOTICE TO APPLICANT: If,after making this Certificate of Ex- F 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Libor Code, you must forthwith connply with U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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 Lenders Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application:md state Ihet the have VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city,and county PLUMBING Q ordinances and state laws relating to building construction, and BOILER-COW H.P.or 100,000 B.T.U-) 6.00 hereby mrtimcd reprasenforins inspection this City to enter upon the BOILER-COMP IOv,l 100,000 BTU)SEE FEE SCH. MECHANICAL above-merilioncd property tarvesp of purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD. upertum against liabilities,judgments, costs and expenses which CONST.TAX ay in " y way accrue against id City in consequence of the PERMIT ISSUANCE 10.00 m of Is p,rmlt. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL gnalure of A pplicant/C ntractor Date OFFICE COPY