16082 POST THIS,CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF-CUPERTINOgpg
INSPECTION DIVISION
JOB INSPECTION RECORD
119., ,�/ I,VUV, /0L� PER EXPIRATION
/
JOB ADDRESS .J OI A3 /V e OLFC �D UNIT# LOT# •'�
PERMIT EXPIRES IF WORK
OWNER 3i$- - Ny i G CONTRACTOR S Q/ -! STI' . x r C I IS' NOT.STARTED WITHIN."
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU,
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
LIFER 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
UNDERGROUND /SLAB
PLUMBING / " r
ELECTRICAL - I ISSUANCE DATE
MECHANICAL BLDG ELECT T PLO %ECR.
I El7 El13 ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED s BUILDING PERMIT
INFORMATION
WOOD FLOOR ` VALUATION $/FT.
PLUMBING ,y0 "
MECHANICAL QV `N
PER M1IIT TO
ELECTRICAL
FRAMING
STORIES TYPE CONSTR
INSULATION -
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.IT.FLOOR AREA TOTAL ACREAGE
" ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
. DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES No CON PB 0m1–
El E3
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ElEl
ASSESSORS PARCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO. PANCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY- - - "
ACC DATE ACC.FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING - ELECT.FINAL TEST ZONING END SITE NO.
INSULATION - PLUMBING ..
GAS TEST GAS
FIRE SPRINK ENERGY T"'$4 ,
MECHANICAL Y NY E] Nn
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE aLuc.
EXTERIOR SHEAR ELECTRICAL RELEASE '
INTERIOR SHEAR FIRE DEPT. Y [j ND Y ❑, N❑
SHEETROCK- - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING,
SCRATCH COAT
ELECTRICPLAN CHECK
GAS01 FEE
NOTAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALI SSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC _
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLumelNc
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
• Z. MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION:'
OFFICE COPY
IA PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
( BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER ,
9 LL"No a co.: .ar APPLICATION & PERMIT: 16082
ES
AD10123 N: Wolfe Road 411033
BUILDING-ELECTR ICAL-PLUMBING-MECHANICAL
NAME s __ rL e . PLAN CHECK VALIDATION
III r� OTV. ELECTRIC PERMIT 'FEE
Cl
NAME air's Boutique,�;�,E.In
NAE Ta R's 67 UTLETS-SWITCHES-RECEP 10.00/1.00
-
Sprig Electric LIC,No 296728010 IGHTING FIXTURES 143 10.00/.1.00
crrRs
ADDRESS PPLIANCES-RESIDENTIAL 4.00
OORES �x
1303 Lick Avenue PRONE 298-3134 1 JPANELS 10.00 DATE OF APPLICATION I
ARCHITECT PANELS (OVER 200 AMP) 20.0
R0 PLAN CHECK FEE P.C.NO.
O „
ENGINEER '
LIC.NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDR1303 Lick Avenue SS CA 95110
SERVICE CHANGE .00
o o LICENSED CONTRACTORS DECLARATION
a u U I hereby affirm that I ant licensed under provisions of Chapter 9 - ISSUANCE DATE
Na e. (commencing with Section 7000)of Division 3 of the Business and 1` � BLDG. ELECT. PLG. MECH.
r H i Professions Code,C`ltm license is in full for,2f%798. I WIR HTR '21>W Js Q ❑ ❑ ❑
Z,o L.; License as Lic.Numb&OTi�.fri C I�
O z LDale - 9-88 Contractor_-
'' m BUILDING PERMIT
w u OWNER-BUILDER DECLARATION INFORMATION
K
5 LL m 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION $/FT.
Fc. OJ Law for the following reason(Sec.7031.5,BusinessundProfessions PERMIT ISSUANCE 10.00 12,00
m Code:Any city orcounty which requires a permit to construct,alter,
atK¢0 improve,demolish,or repair any structure,prior to its issuance,aIW ELEC.CONTR. LIC.N0. ELEC. / l-
n
S c , requires the applicant for such permit to file a signed statement that TOTAL ( /U PERMIT TO
w m he is licensed pursuant m the provisions of the Contractor's License
Fzi Law(Chapter 9(commencing with Section 7000)of Division 3 of the �L-�"tf
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE -
r$ the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant-too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
minor more than five hundred dollars($500).): 1 _
❑ I,as owner of the Property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.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
property who builds ar improves thereon,and who does such work FIXTURES-PER TRAP 5.01) sD.FT FLOOR AREA TOTAL ACREAGE
himself or thr
oughtende own employees,
red forsle.If,howevsuch improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
mems are not inthn dad or offered for sale.If,ed that s the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving t .hat be did not build or im- - REB IND CON .PB Omer
prove 1for,as owner
of sale.). INDUSTRIAL WASTE.INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ d as owner of the Properly,he exclusively contracting Bu with
licensed contractors to hconstructe Contra for project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codec The Contractor's License Law docs not apply -
to tr owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contmdods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamexemptumder Sec. ,B.&P.C.faith's WATER HEATER W/VENT . 6.00
reason
Owner- Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION' WATER TREATING EQUIP. 5.00
I'hereby affirm that I have a certificate(;I consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
spy theSGpp( s qqpp,,Lab. -te ldblic Indemnit
Policy N4,(+ Ur8ltPany'-
Q ❑ Ce[tified c Py is hereby furlfsh'd. _ FIRE SPRINK ENERGY T 24
Z Z �1 Cert' +y is tole w h 't speclion division. 'REFER TO ORD.
O APPllcilnt MISC:- V ❑ N❑ V ❑ IN
� 9 CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC.
LU > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. ' PLG. ,
CL o (This section need not be completed if the permit is for one TOTAL Y❑ IN[:J Y ❑ IN F]
:) Z hundred dollars IS 100)or less.) '
U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U subject to the Workers:Com enation Laws of California.
become su lLLl P BUILDING
Do Date ApplicantIa. - - ALTER OR ADD TO MECH., 5.00
} 00 NOTICE TO APPLICANT'. If,after making this Certificate of Ex- _ - .
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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 issue(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 'ELECTRIC
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is street. I agree to comply with all city and county BOILER-COMP(3 H.P.Oi 100,000 B.T.U.) 6.00
tPLUMBING
ordinances and state laws relating m building construction, h -
hereby authorize representatives of this city to enter upon the
BOILER-COMP oa.r 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.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
ma in ny way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
a ti of this per MECH,CONT. - LIC.NO. MECH.
i� TDTAL TOTAL
Signature of Applicant/Contractor Date '
OFFICE COPY