15800 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF. CUPERTINO • 15800
INSPECTION DIVISION
',. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS � 0/_Vsr y UNIT# LOT 4t PERMIT EXPIRES IF WORK
OWNERv�'7!'Fr p r Tr CONTRgCT.,, �/ L g� L•,pn//� - IS NOT STARTED. WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 100 DAYS OF PERMIT ISSU-
FOUNDATION '• - ANCE OR 180 DAYS FROM
NOTE: - LAST CALLED INSPECTION. '
UFER - ALL GRADING AND DRAINAGE SHALL BE 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 \ s + L .�
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG ELECT PLG. MECH,i
F-1 ❑ ❑ 0
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION VFT,.
PLUMBING '
MECHANICAL
HMII TO
ELECTRICAL ,,..pp
FRAMING - / Gl`+
INSULATION _ STORIES TYPE CONSTR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SD fT FLUOR ANEA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFQw -
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ES IrvO CON PB O,I,_
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 1 SE - SF
ASSESSONS VANCELNO. 1
ROUGH SAN,N '
PLUMBING ELECT.ENERGY
iHALT NO. PARCEL NO
TUBS&SHOWER PAN - PLUMBING ENERGY "
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINALTEST ZONING ENG.SITE NO.
INSULATION- PLUMBING , -
GAS TEST GAS
FIRE SPRINK ENERGY T"7G
- - MECHANICAL Y L NL v L NO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L UC. ,
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT. YL NL 'YL .NL
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC .PLAN CHECK "k
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIREDINSPECTION. PLUMBING
. o� PLEASE.GIVE JOB ADDRESS WHEN PHONING.
z ' MECHANICAL
.- SEE PERMIT FOR EXPIRATION DATE
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE.SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDING PROJECT I DENTI FICATION -PERMIT NUMBER
BUILDINGN
APPLICATIO & PERMIT C p o 0
ADDRESS 10123 Wolfe Road 1035oREss BUILDING —ELECTRICAL—PLUMBING—MECHANICAL . JO
'
OWNER'S
NAME - PLAN CHECK VALIDATION,
f�
Petite Shisticate OTY. ELECTRIC PERMIT FEE .
' P„oNE
CON
NAAMERAciGRs OUTLETS-SWITCHES-RECEP 10.00/1.00
Cal7khY CbriditioningIc.No, 137195. LIGHTING FIXTURES 10.00/1.00
ADDRESSTDRs PPLIANCES=RESIDENTIAL 4.00
1775 S. lst St.. SJ PHONE 947-0155 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on PANELS (OVER 200 AMP) 20.00 -
1 ENGINEER -LIC.NO, ISIGNS TRANS. 3.00
ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 -
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
-1775 S. 1St St. Bldg. 66 San Joe SERVICE CHANGE 20.00
X.o LICENSED CONTRACTORS DECLARATION
a v u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 �” ISSUANCE GATE
w Q A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.-
H O Z Professions Cod-, -suss Is in full force a e bt.
o i = o Licensc„ly Lic.Number_ _
•w H w , Date Contractor O..
a m m a OWNIi R-BUILDIiR DECLARATION BUILDING PERMIT
o d ° - INFORMATION
w 0; H 1 hereby affirm that 1 am exempt from the Contractor's License MISC.— REFER TO ORD
u O¢ Law for the following reason.(Sec.703 L5,Business and Professions VALUATION $/FT.
� — Code.Any or count which re PERMIT ISSUANCE 10.00 .
GEwj Y Y Y structure,
riot ttamnsuance,also
R ef O improve,demolish,or repair any slmcturc,prior to its issuance,also ELEC.CONTR. LIC.N0. _ ELEC.
O ¢ requires the applicant for such permit to file a signed statement that TOTAL
PERMIT TO
d w$a` he is(Chapter
9(copursuant to(commencing
provisions of the Contractor's License
r Z i Law mis and Professions
Code)orth Scalae is exempt
th eien 3 of the
q a Business for
Professions Code)or that he is exempt Sectio 70 and OTY. PLUMBING PERMIT FEE
r$ the basis for the alleged exemption.Any violation tto action malty .STORIES TYPE CONSTR.
n , by any more tha fora permit subjectsthe$500).licant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(my em'
❑ 1,as owner of the property,a my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the slrucf are is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's Licensa 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.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended or offered for sale.If,however,the building GAS-EA,SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.)' 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE-
prove for purpose of.sale.). INDUSTRIAL WASTE INTER3000 • RES IND CON PS ` Omer
❑ I,as owner of th . .
e property,am exclusively contracting with O ❑ ❑ Q - ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 .. ASSESSORS PARCEL NO.
and nProfessionswnof Calle:The Contractor's License Law docs not apply
to tr owner of properly who hullos tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such censeprojects with u contractoR%)licensed Pursuant to
the Contractor's am exempt
License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under Sac.—,BARC.for this WATER HEATER W/VENT 6.00
AI reason -
Owner
Data WATER SYSTEM z 5.00 -
ACC.OATE ACG.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP.• 5.00
1 hereby affirm that I have a certificate of consent to self-insure, -
or a certificate of Workers Compensation Insurance;or a certified ZONING ENG.SITE NO.
copy therct*(Sce.3800,Lab.C.I �
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY T 24
Z Z Cerfi dco�yv Is fit .wit t city inspection division.
F O AnPlicunttaL—HT n. 11'1CJ—CO-- MISC.- REFER TO OR � N� v � • N�
Tft6
IrXP q �7R—Q�� PERMIT ISSUANCE 10.00
El
cc y CERR A E ? 1' WORKIiRS' FLOO ZONE - A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC!NO. - PLG. ` AV _
CL Cl (This section need not be completed if the permit is for one TOTAL y. No YE
.N�
hundred dollars(8100)or less.)
U O 1 certify that in the performance of the work for which this per- DTVMECHANICAL PERMIT ,CLI % FEE SUMMARY
.
LL F mit Is Issued,I shall not employ any person in any manner so as to V1,
U w become sybje�[to he Workers'Cron ensullon Laws of California.
a Uutc "//[rjLlicuntT1-i_ (+And-i_b- 'ALTER OR ADD TO MECH. . 5.00 BUILDING
>- W NOTICE' APDL NT: If,a lar mii ng his erh¢a
F.,Z emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with /-411
FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4:60 6
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.RM.) 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.CJ. / HEATING UNIT,(T0100,000 B.T.U.) 440 47
Lender's Name HEATING UN IT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) . 4:80' -�
. information is correct.I agree to comply with all city and county PLUMBING
ordinan and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
bench a Ihoriae representatives of this city to enter upon the
abo t boned prope rinspection purposes. BOILER-COMP(Over 100,000 BTU)SEE FEE 9CH. MECHANICAL 31k -a
agree tosave i in ify a d keep harmless the City of MISC.- REFER TO ORD.
u no against Iia it S udgme Is, costs and expenses which PERMIT ISSUANCE CONST.TAX
m y wa�'ac u a Inst S. City in consequence o the
tis r EL H.CONT. LIC.NO. MECH.
Dfy ^ TOTAL 3460, TOTAL
Signature of Applicant on[ractor ate C &J
OFFICE COPY