15972 POSTTHISCARD NEAR FRONTOF BUILDING
\:' - - • PERMIT,NUMBER 4'�
CITY, 'OF CUPERTINO
INSPECTION DIVISION 15972
'JOB INSPECTION RECORD
.. - ,/ PERMIT,EXPI RATION
JOB ADDRESS /O/d-3 ,V
-3 • WOCF4 �7b UNIT# _LOT#
^^ - PERMIT EXPIRES IF WORK
OWNER yv�}L{�-y 8p4 CONTRACTOR w� L' Wj L IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION ECORD 180 DAYS OF PERMIT ISSU;
FOUNDATION, - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL' BE INSTALLED
PR EG UNITE" TO COMPLY-WITH THE APPROVED PLANS AND CITY OF PERMIT.VALIOATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - �•3 /, " ;
UNDERGROUND /SLAB
PLUMBING - - L. '��• "
ELECTRICAL ISSUANCE DATE
MECHANICAL' - eLOc ELEcr. PLG. MECR,
❑: ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
PLUMBING
WOOD FLOOR VALUATION SIFT.
-
MECHANICAL -
ELECTRICAL - - PERMIT To
FRAMING -
INSULATION - - STORIES TYPE CONSTR.
• - OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO ET FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE .
ROOF SHEATHING RCS IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
• " ROUGH SAN.N ASSESSORS PARCEL NO.
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO., PARCEL NO
MECHANICAL MECH.ENERGY '
ACC.UATE ACC.FILE NO. 1
ELECTRICAL BUILDING ENERGY
FRAMING ELECT,FINAL TEST
,ZONING '•6NG.SITE NO.
' INSULATION � PLUMBING
I. GAS TEST GAS
MECHANICAL EIRE SPRINK ENERGY T,24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ Y F, '"❑
EXTERIOR SHEAR
ELECTRICAL`RELEASE FLOOD ZONE A,LW,c.
INTERIOR SHEAR' FIRE DEPT. - Y ❑ "❑ Y ❑, N❑
SHEETROCK ' GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH- TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK ;
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IUCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, k ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION: ° SrN
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. ' PLUMBING ' a'
Z - '�yl MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! • ' ++}} CONST.TAX'
PLEASE READ REVERSE SIDE BEFORE 411 ia4''" TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
- BUILDING PROJECT lDENTI FICATION • - .PERMIT NUMBER
APPLICATION & PERMIT `
ADDRESS 1 C 97 2
ADDRESS
N. .WOLFE ROAD SPACE- 100 "' I J J
BUILDING -'ELECTRICAL-PLUMBING-MECHANICAL � '
OWNER'S
NAME PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE 1
WAACTOR S OKS PHONE
NAME ACTOWS UTLETS-SWITCHES-RECE_P 10.00/1.00
W.L. HICKEY .SONS, .1XG.K1: 961 " LIGHTING FIXTURES 10.00/1.00
moo ESS TORS APPLIANCES-RESIDENTIAL 4.00 '.
P.O. .BOX 61209. — SUNWVALE PANELS 10.00 DATE OF APPLICATION
ARCHITECT . PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMPI 20.00
ENGINEER .
SIGNS TRANS. 3.00
ARCH.OR
DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP ITEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS - SEE FEE SCH.
ADDRESS
P.O. BOX 61209. — SUNNYVALE, CA SERVICE CHANGE 20.00
uH0'
00 LICENSED CONTRACTORS DECLARATION / E
a u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE GATE
y Q n (commencing with Section 7000)of Division 3 of the Business and —EEG. ELECT. I PLG. MECH.
H O
professions a Cod e�,a�pp,spp��-�Dyyy�license is in fall force and fE�cC{{-- s '
. O-.E O License C/ 2rJ-80 Lic.Num64r.� ,11 Y- NS ❑
Date -2f2S Contractor WW�^LL 1lll.:n P,
F
BUILDING PERMIT
OWNER-BUILDfiR DECLARATION
o a u INFORMATION
E
; u y I hereby affirm that I am exeropt from the Contractor's License MISC.— REFER TO ORD
u he following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
O a Law for t
cem 02 Code:Any city or coo my which Structure permit m construct,alter, PERMIT ISSUANCE 10.00
QQQD improve,dtmOhr11,0flepalr amy,IrI1CWlB,prior to lir issuance,8IS0 ELE0.CONTR. LIC.NO. ELEC.
LL requires the applicant for such Permit to file a signed statement that ^ TOTAL
w $w he Is licensed pursuant to the provisions of the Contractor's License
z La. 9(commPERMIT TO
H encingwith Section 7000)of Division 3 ofthe
i a Business and Professions Code)or that lie is exempt therefrom and QTY. PLUMBING PERMIT FEE
le I-m the basis for the alleged exemption.Any violation o'Section 7031.5 STORIES 1 TYPE CONSTR.
by any applicant for a permit subjects the applicant loa civil penalty DRAIN&VENT-DRAIN —
of not more than five hundred dollars($500).1: ALTER- — M)
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions 1 DRAINS-FLOOR,ROOF,AREA,COND.=S:a& 2,
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work 2 F IXTUR ES-PER TRAP E;8a q, $D.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS.&G&
or improvement is sold within one year of completion,Die owner- GAS-EASYSTEM OVER 4 IEA) -.Sk
builder will have the burden of proving that he did not build or im- . - . BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. RES IND CON Pa Other
El 1,as owner of the property,am exclusively contracting with ❑ ❑ . ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS'-OVER 5 IE
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. 1 SEWER-SANITARY-STORM EA.;200bR*0N TRACT NO, PARCEL NO.
❑ [am exempt under See. ,B.&P.C.for this, WATER HEATER W/VENT 0
reason
Owner Date WATER SYSTEM Cz 0
ACC.DATE ACC.FILE,NO.
` WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP,
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
l occo �tF �impanY�IOBTHBRUGK�'RA']�_
❑ Certified copy is hereby furnished. FIRESPRINK - ENERGY T 24
Z 2 XX Certified copy is filed with the city inspection division. MISC.- REFER TO ORD
F O Applicant—W..-L�—HICKEY—.SON$,--F .
NC - . Y❑ N.❑ Y ❑ N❑
CC w CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 12. FLOODZONE A.L.U.C.
LU > COMPFNSATION INSURANCE PLG.CONTR. LIC.NO.' PLG. e
CL a (This section need not be completed if lila pcomll is for one W.L. HICKEY TOTAL 29. V❑ N❑ V❑ N❑
hundred dollars(%100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F' mit is issued,I shall not employ any person in any manner so as to
Q W become subject to the Workers'Compensation Laws of California. BUILDING
a Date Applicant ALTER OR ADD TO MECH. 5.00
} Ge NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
proviAIR HANDLING
of the Labor Code, you must forthwith comply with - FEE
V such provisions or this permit shall be deemed revoked; ANDLING UNIT(TO 10XDC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.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,Ci,
.C.). - HEATING UNIT(TO 100,000 B.T.U.)' 8.00 '
Lender's Name Uss HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) ' 4.00 Op
information is correct. I agree to comply wish all city and county PLUMBING
ordinances and state laws $mating-lo buildinµ construction, and BOILER-CUMP(3 H.Ror100,000B.T.U.) 6.00
,• hereby autho ve representatives of this city to to ler upon'the BOILEN-COMP 10ver 100,000BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Sas., indemnify and keep harmless the City of MISC. _ REFER TO ORD '
upertmo against liabilities,judgments, Costs and ex Purses which - CONST.TAX'. -
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 -
granting ofthis permit. MECH.CONT. LIC.NO. MECH Q0
TOTAL 25 —
Siluno TH. n at r Da '
OFFICE COPY