15755 POST THIS CARD NEAR FRONT OF,BU LDING
PERM IT NUMBER
•Y ��
CITY OF GOPERTINO 15755
INSPECTI ON,DIVISION
JOB INSPECTION RECORD
'*f e7 - PERMIT EXPIRATION .
JOB ADDRESS l6/a•3`-A •WO L4'lq U - _LOT# 'I
- PERMIT EXPIRES IF. WORK
'
OWNER �.',S' " CONTRACTOR. S KEG- &_z_ IS NOT STARTED WITHIN r
INSPECTION DATE I INSPECTOR INSPECTION RECORD '160 DAYS OF PERMIT ISSU. �
FOUNDATION -- ANCE'OR 100 DAYS FROM°•
_ NOTE: LASTCALLED INSPECTION. I
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED •,
PREGUNITE. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERNI T VALIDATION .i
'CUPERTINO STANDARDS. '
GARAGE SLABS'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'/.SLAB
PLUMBING '
ELECTRICAL'•• - ISSUANCE DATE*-
MECHANICAL - uLuc ELECC PLG.` MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING," VALUATION SIFT.
MECHANICAL
'ELECTRICAL: - - PERMIT TO
FRAMING -�
INSULATION , STORIES. TYPE CONST?, i
- - OCC.GROUP RES:UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE. so.Fr,PLooR AREA TOTAL ACREAGE,
�
THE CONSTRUCTION TAX IS PAID DIAPHRAGM - .. ' -
'NUILUI USE
- ROOF SHEATHING RES. IND CON PR Om y
- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
- ` - nsssssoRSPARCEL No
ROUGHSAN.q .
' 'PLUMBING - ELECT..ENERGY' -
TUBS BSHOWER PAN� PLUMBING ENERGY' TRACT NO, PARCEL rvo
MECHANICAL 'MECH.ENERGY {•
' .ELECTRICALBUILDING ENERGY - . . gCC DATE ACC.FILE.NO.
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
INSULATION' PLUMBING' t - v-
GAS TEST GAS '
MECHANICAL - - EIRE SPRINK, ENERGY Ten }
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,Y N Y 0 "
ELECTRICAL RELEASE FLOOD ZONE A.L.0 C.•
EXTERIOR SHEAR - '
N A'Y N
i INTERIOR SHEAR .r'`' FIRE DEPT.; - L- �'
SHEETROCK - GRADE FEE SUMMARY
EXTERIOWLATH, BUILDING .-
INTERIOR-LATH - TEMPORARY APPROVALS - BuILDwG.- "
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. . MICROFILM
ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
•\ z '.PLEASE GIVE JOB•ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE ` j MECHANICAL
IMPORTANT! coAsT.rax
PLEASE READ REVERSE.SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. Lt
OFFICE COPY
,
APPLICI IT T'0 FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMITNUMBER
So LDING APPLICATION & PERMIT 15755��]��
Ap.. 10123 N. Wolfe Rd. #987• BUILDING-ELECTRICAL-PLUMBING-MECHANICAL � I I
OWNER'S Bressler Ce TeBiR PLAN CHECK VALIDATION
NAME - DTV. ELECTRIC PERMIT FEE
Stan Chen PHONE253-1103
NA.M,ERacTORs UTLETS-SWITCHES-RECEP 10.00/1.00
Sprig Electric LID.No. 29672801 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR s - PPLIANCES-RESIDENTIAL 4.00 r.
ADDR E55 -
PHONE 298-35134 � PANELS ' I� 10.00 DATE OF APPLICATION
ARCHITECT. PANELS (OVER ZOO AMPI 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER !1 '
LIC,NO.- SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS . SPECIALCIRCUIT 5.00 PERMIT VALIDATION
zlv TEMP.METER OR POLE INS.
ADMOTORS 07 i-'r) EE FEE SCH.
ADDRESS
OREss •
1303
Lick Ave. - SJ CA 95110 SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION
¢ w HE GATE
¢o U 1 hereby affirm that I am licensed under provisions ofC a h pter 9 nCzfCilrTnRr
ISSUANC
H Z w (commencing with Section 7000)of Division 3 of the Business and 'BLDG. I ELECT. 1 PLG. MECH.
Professions CodL,' lty license is in full forey:PBtFy f�g'I. • ❑ ❑ ❑,
20u� LicenuC ss V Lia Numher�_3F3F ,,UwL1,•..118- �'-"pw� t iC +
2 N w --Cool-Loor
¢ se Z BUILDING PERMIT
¢ a w ¢ OWNER-BUILDER DECLARATION INFORMATION
wDSD MISC.- REFER TO ORD
;w N I hereby affirm that I am exempt from the Contractor's License . _ VALUATION $/FT.
H u o j Law for the following reason.(See.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permitto constricq alter
S <0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIG N0. ELEC.
ID - m a, requires the applicant for such permit to file a signed statement that Sprig Else tYiC 296728010 TOTAL PERMITTO -
n w$ he is licensed pursuant to the provisions of the Contractor's License
Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ OR
o the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not mom than five hundred dollms(5500.)
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 K- 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 Contractor's License Law does not apply to an owner of -
propertywhobuildsorimprovesthereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT.FLOORAREA TOTALACREAGE
himself or through his own employees,provided that such improve t GAS-EA.SYSTEM-1 6.00
ments are not intended or offered for sale.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 have the burden of proving that he did not build or am-, REB IND CON PB Other
• prove for purpose of sale.). INDUSTRIALWASTE'INTER. iv 30.00
❑ 1,us owner of the property,inn exclusively contracting with - - ❑ ❑ ❑ ❑. ❑
. licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-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 Ilicreon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.20011/10.00 TRACT NO. PARCEL NO.,
the Contractor's License Law.
❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 '-
reason
Owner - Date WATER SYSTEM 5.00
ACL.GATE ACC FILE NO:
WORKE,RS'COMPENSAT10N DECLARATION WATER_TREATING EQUIP. 5.00
1 hereby affirm that 1 have a cefif dale of Consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
r copy Us"T a gpp�,{.ab.CA Repo
Policy No 2Cs filnY�`- s'�l C_i11 1IlT1�.
Q C}�Cerlilie c yrshereby furnished FIRE SPRINK ENERGY T-24- '
Z 2 C$Cert ifi y is Rle with t in' ectiosp n division,'
O" Applic;url Y MISC.- • REFER TO ORD. ,Y ❑ N❑ Y N❑
0' in - PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.L.
- CIiRTIFICATEPE EXEMPTION NS PROM WORKERS'
IL > COMPENSATION INSURANCE PLG.LONTR. LIC.NO. - PLG, 'Y
1 O- (This section need not be Completed if the permit is for one TOTAL Y❑ N❑ ❑ N❑
D Z hundred ildlars(SI00)orless.)
L) O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
IL H mit is issued,I shall not employ any person in any mmrner so as m
U become subject to the Workers'Compensation Laws of California.
O m Date M 'Applicant ALTER OR ADD TO MECH. 5.00 FELECTRIC '
} vat NOTICE.TO APPLICANT: IL Aller making this C"Idieme of Ex- _
F Z . emptier,you should become subject to the Workers'Compensation APPLIANCE . . '5,00
provisions of the Labor Code, you must forthwilh comply with -
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT ITO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT IO,000GF.M.16.00 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5:00 -the performance of the work un.which this permit i
s issued(Sec. HEATING'UNIT ITO 100,000 B.T.U.) 8.00 3097,CN.C.).Lender's Name HEATING UN IT IOV ER 100,000 B.T.U.)9.50 r
Lender's Address 5
90
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct. I agree to comply with all city and county.' PLUMBING ordinances and laws relating to building construction, and BOILER-CONTI3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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.
uperdoo against liabilities,judgments, costs and expenses which CONST.TAX •'
ay in y way accrue apainsl said City in consequence of the PERMIT ISSUANCE. 10.00
ria'a flhis permit. MECH.CONT. LIC.NO. MECH. - - �
y_ � 57- TOTAL TOTAL
Sign arc of Applicant/Contractor Date
OFFICE COPY