15969 POST THIS RD NEAR FRONT OF BUILDING
PERMIT NUMBER
CI-M OF CUPERTINO 15969
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS ZO/-3 Ali 0L-�d 9,6 UNIT# LOT*t
11''`` T PERMIT EXPIRES IF WORK
[-
OWNER Ess �(^ g ' SO U2 y
P ,a CONTRACTOR y,L, �t IS NOT STARTED WITHIN
11 SP CTION DATE INSPECTOR INSPECTION CORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
UFER._ NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT vauoanoN
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
MECHANICAL
ISSUANCE DATE '
BLDG'- ELECT 1 PLG. MECR.
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PER IT
WOOD FLOOR INFORMATION
PLUMBING VALUATION SIFT,
MECHANICAL
ELECTRICAL PERMJT TU
FRAMING
INSULATION STORIES rvPE.coNsrR.
y. OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF 'NOTE:NO FINAL INSP.SHALL BE MADE BEFO F. GT.FLOOR AREA TOTAL ACR PACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID �!'�
ROOF SHEATHING M1 BUILDING USE
IND CON
Po G,nri
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE I ❑ ❑ ❑ ❑ '
ROUGH SAN. �"� $ORS PgRCEL NO
PLUMBING - - ELECT, ENERGY -
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PANCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY Acc DATE Acc.EB.E No
FRAMING ELECT,FINAL TEST
INSULATION PLUMBING zowmc ENC.517E No.
GAS TEST GAS
MECHANICAL FIRE SPR INK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v❑ "❑ ` ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD tome A.LUc1
INTERIOR SHEAR FIRE DEPT. - v❑ N❑ v ❑ N❑
SHEETROCK IGRADE
EXTERIOR LATH BUILDING FEE SUMMARY J
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH
AT ELECTRIC PLAN CHECK
GAS FEE'
NOTA OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR.
' - MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING0`II
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
,CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE LL POINT PEN ONLY
' BW LDI NG PROJECT I DENTI FIC - PERMIT NUMBER
BDILDING _ APPLICATION &.PE T15969:
ADDRESS N .WOLFS.ROAD PAC
BUILDING — ELECTRICAL—PLUMBING—MECHANICAL �`
<�
NAME
OWNER'S PLAN CHECK VALIDATION', -
ar: QTY. ELECTRIC PERMIT FEE
^+ � VOLUME SHOE.CORPORA7D,T6aNN
NnmenncrGRs - OUTLETS-SWITCHES-PIECEP 10.00/1.00
W.=aICKEY SONS,,.INCa.H0. .95122. LIGHTING FIXTURES - 10.00/1.00
CONTRACTORS -
ADDRESS - APPLIANCES-RESIDENTIAL 4.00
qTZM�MATPANELS 1008
ARCHITECT GATE OF APPLICATION. .T
PLAN CHECK FEE
' OR 11 PANELS (OVER 200 AMP) 20.00 P:C.NO.
ENGINEER _
uc.NO. SIGNS TRANS. 3.00
ARENG. PERMIT VALIDATION
ADDRESS
Ess SPECIAL CIRCUIT 5.00 -
ZIP TEMP.METER OR.POLE INS. 20.00
APPucnrvr's - ' SEE FEE SCH.
ADDREss MOTORS
P.O. .BOX 61209, — SUNNYVALE CA I. SERVICE CHANGE 20,00 �" 16-
1-
6-
0 0 o LICENSED CONTRACTORS DECLARATION - (J
¢u w I hereby affirm that I am licensed under provisions of Chapter 9 '
vHi Q f (commencing with Section 7000)of Division 3 of the BusiISSUANCE DATEness and BLDG.
H w z Professions Code my license Is in full force u f -
ELECT. PLG. : MECH.
Q i L o' License ass - Lic.NumbgI El ❑ ❑
H ur Date C.atmc;l ��S NS
a m J BUILDING PERMIT
a,¢ w
OWNER-BUILDER INFORMATION -
w ; a-y I hereby affirm that 1 am exempt from the Contractor's s License MISC.— REFER TO ORD
u
04 Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
� — Code:Any city orcounty which recluireso permit to construct,after, PERMIT ISSUANCE 10.00
¢ 2 G 0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO:.
ELEC.
ce _¢ requlfe5 the applicant for such permit to file a signed statement that TOTAL PERMIT TO
m rn he is licensed pursuant to the provlslohs of the Contractor's License -
HZQ
Law(Chapter 9(commencing with Section 7000)of Division 3 of the Z—A 6— -
4 0 Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ H o the basis fertile alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant fore Permitsubjeclsthe applicant loacivilpenxlly ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,asowner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400
their sole compensation,will do the work,and the structure is not . . OCC.GROUP RES.UNITS -
intended or offered for sale (Sec. 7044, and
and Professions 1 DRAINS-FLOOR,ROOF,AREA,COND. S! -
/ Code:Tire Contractor's'License Law does aol apply to an owner of L.
property who builds or improves thercom,and who does such work FIXTURES-PER TRAP �2 'p• SQ FT.FLOOR AREA TOTAL ACO SAGE
himself merits re through his own employees,provided that such Improve-
orimprovemenotnntendedwithinoffered
oneyeasale.If,however,the the o ner- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement Is sold rd Olin 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 purpose of sale.). INDUSTRIAL WASTE INTER. REs INo CON PS Other
El 1,as owner of the property,am exclusively contracting with 0 11 D
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 . ASSESSORS PARCEL NO. -
and Profession,'Code:The Contractor's License Law does not apply
town owner of property who builds or Improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.0 `
contracts for such projects with a contractorts)licensed pursuant toQ
the Contractor's License Law.- ], SEWER-SANITARY-STORM EA.3 TRACT No. PARCEL No.
❑ I am exempt Linder Sac. ,B.&P.C.for this 1 WATER HEATER W/VENT
reason
Owner—Date 1 WATER SYSTEM 2. ACC.OATS ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby'ufllrrn Oml'I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy ` ' ')
y��6b4J1 � Northbrook Prop
Q .
Certified
copy is hereby furnished. FIRE SPRINK ENERGY T
z bled with the city inspection division. 24,
Applicpnt.W:..L.,yZ1Cyy_SODN1LS-s—INr MISC.- REFER TO ORD. YE)
Cr ti CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE fUi3O 12., FLOOD ZONE
LU COMPENSATION INSURANCE P .VONT �y NO. PLO
CL O (This section need not be completed if the permit is for one "`•"• MICKEY .901 , .INC TOTAL $29.. Yo No Y C] NF
0 Z hundred dollars($100)or Ices.)
U O I certify that in the performance of tele work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is Issued,1 shall not employ any person in any manner so as to
became subject to the Workers'Compensation Laws of California. -
i Date Applicant BUILDING
} 0 NOTICE TO APPLICANT': If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
2 emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most forthwith comply with U 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 I0,000C.FM.) 6.00 SEISMIC FEE
. I hereby affirm that them 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
Lender's Name NONE
Lender's Address 0 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that 1 have read Otis application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct..l agree to comply with all city and county PLUMBING p
ordinances and state laws relating t0 building construction, and BOILER-COMP(3 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 representatives
of
purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upImUma against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00
ranting of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL 29 e.e
nota can C � D to —
OFFICE COPY