16084 POST THIJ&ARD NEAR FRONT OF BUILDING
PERMIT NUMBER '
_
CIllf OF CUPERTINO 16084
INSPECTION DIVISION
JOB INSPECTION RECORD
.la3�'—U PERMIT EXPIRATION
JOB ADDRESS �d�✓ 3 /L' WdLFE � UNIT# LOT#
PERMIT EXPIRES IF WORK
• OWNER CONTRACTOR �Q/L IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD ' 180 DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALm ATTON
PR EGUNITE CUPERTINO STANDARDS. ' "
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL 1p}+.w L r
ISSUANLF.UATF.
MIECHANICALpIO ELECT T%El MEI
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED eCInO BIN ONG PERMIT
WOOD FLOOR Ot 'p VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL '
FRAMING '
STORIES TYPE CONSTR,
INSULATION
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .
$O.FT FLOOR AREA TOTAL ACREAGE
-ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE.
DIAPHRAGM ITHE CONSTRUCTION,TAX IS PAID
BUILDING use
ROOF SHEATHING RES IND CON PB On..•.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING - ELECT.ENERGY
TvaCi NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC.DATE ACG;ILE NO
ELECTRICAL BUILDING ENERGY '
FRAMING ELECT.FINAL TEST '
INSULATION - ZONING ENG.SITE NO.
PLUMBING
GAS TEST - GAS
MECHANICAL
FIRE SPRINK ENERGY T24
- '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - Y L NL Y L NL
EXTERIOR SHEAR ELECTRICAL RELEASE 'L FLOOD ZONE A,LUC
INTERIOR SHEAR FIRE DEPT.' Y NL YL N❑
SHEETROCK. GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - "
TEMPORARY APPROVALS' - BUILDING
INTERIOR LATH '
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING M-4505, ELECTRIC "
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING .
MECHANICAL '
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! coNST:TAX
PLEASE READ REVERSE SIDE 13EFORE 0
TOTAL
CALLINGFOR FINAL INSPECTION,
OFFICECOPY
APPLICANT TO FILL IN IN�RMATION WITHIN RED LINES - US ALL POINT PEN ONLY lS Y`PZ,
BUILDINGPROJECT IDENTI ION -PERMIT NUMBER
Potons. APPLICATION & MIT 16084
- quaffJ
0123 N. Wolfe Rd. #1034Bss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION.
NAME SBARRO INC. - OTY. ELECTRIC PERMIT FEE -
ONE
CONTRACTORS
NAME
_ NgmE L26 OUTLETS-SWITCHES-RECEP 10.00/1.00 41,80
Sprig Electric LIC.No296728C10 14n LIGHTING FIXTURES 10.00/1.00 46-00
ADPRES5 CTOR's APPLIANCES-RESIDENTIAL . 4.00
CORE5
1303 Lick Avenue FRONE 298-3134 PANELS 10.00 DATE OF APPLICATION .
ARCHITECTPLAN CHE CK FEE P.C:NO.
OR PANELS (OVER 200 AMP) 20.00 _
ENGINEER -
uc.NO. 'SIGNS TRANS. 3.00 no I
ADD ESS ENG SPECIAL CIRCUIT 5.08 1 MIT VALIDATION
ZIP 1 EMP.METER OR POLE INS.
ADDRESS
APPLICANT MOTORS SEE FEE SCH.
1303 Lick Avenue SJ CA 95110 SERVICE CHANGE 20.00
F
00 LICENSED CONTRACTORS DECLARATION ' 90 1 KW I (l��
r .
¢ v w I hereby affirm that I am licensed under provisions Of Chapter 9 rj 1 Q HP ISSU NCE DATE
(commencing with Section 7000)of Division 3 of the Business and
¢ w a-O BLDG. ELECT. PLG. MECH.
Hwz ProfessionsCodc,�IsgQylicenseisinlullfrutand�f 2 75KVA' & �15HP El C ❑
Liccnsc class Lic.Nm L7b
Date f 1 -18-88 Contract 1 75KVA o -
¢ y E BUILDING PERMIT
¢ a ¢ OWNER-BUILDER DECLARATION 1 200A.'.Service
w u INFORMATION
wo u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
3 u VALUATION $/FT.
F LLo ¢ Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 12.00
Code:Any city or county which reyuiresa permit to construct,alter,
K Q Improve,demolish,o[repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3 0
oLL requimsthe applicant for such permit to file a signed statement that Sprig Electric 296728C 10 TOTAL �C/ 30 PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's Licenser'
rzi Law(Chapter 9(commencing with Section 7000)Of Division 3 ofthe -
{ i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ F om the basis for the alleged exemption.Any violation of Section 7031.5 1 -STORIES TYPE CONSTR.
n3 - by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).1:
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 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
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
.
himself .1through his ownemployees,for sale,
ho ever,the
improve- GAS-EA.SYSTEM-l 6,00
cents 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 Out build or im- RES IND CON. PB Omer
prove for purpose of sale.). INDUSTRIALWASTE INTER. 30.00 .
❑ I,as owner of the properly,am exclusively contracting with ❑ El ❑ 1:1 F-1
licensedcontractors t0 construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC.5 V.8. 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 thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuaotto
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ [am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM . 5.00
ACG DATE ACO.FILE NO.
WORKERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. - 5.00
I hereby afforn that I have a certificate of consent to self insure, ZONINGENG _
or a certificate o1.Workers'Compensation Insurance,or a certified .SITE NO.
copy there O�(S,e,1 0 '-rLid,C.). -
Policy Nn. Yl:yy$ 18ny-ReHllbliC Lndemni
'Q ❑ Certified is hereby fu...f+C FIRESPRINK ENERGYT-24
z Z ❑ Certifi p is filed wu ly stection division. '
O Applicant ^-Ai� ��w q'_� MISC.- REFER TO ORD. y❑ N'❑ y ❑ N�
F-
CC H PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
S CERTI FICA'I'E OF F.XEMP'fION FROM WORKERS'
_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.-
CL 0 (This section need not be completed if the permit Is for one TOTAL V LJ N❑ Y [-] NEI
Z) Z hundred dollars IS 100)or Iess.)
U O 1 certify that in the performance of lite work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- ntit is issued,1 shall not employ any person in any manner s0 as to
U become subject to the Workers'Compensation Laws of California.
' w Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Iix-
FZ emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 10 FEE
(.1 such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO ,MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name OWNER
Lender's Address ' HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC .2,Ls
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to 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 100,000BTUI SEE FEE SCH. MECHANICAL
- above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep hei'mSxx the City of MISC.- REFER TO ORD.
uperlino against liabilities,judgments, costs and expenses which CONST.TAX
may in my way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ra{n In�in this permitL�<��n• MECH.CONT. LIC.NO. MECH.
�/f�1//IiM. 10-18-88 ', TOTAL TOTAL
Signature of Applicant/Contractor Date -
OFFICE COPY