12044I.,
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
7970 WOODLARK WAY
JOB ADDRESS _ UNIT# LOT#
OWNER STENGEL CONTRACTOR ATLAS HEATING
PF RMITyl16 044
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
UFER
PREGUNITE
PERMIT VALIDATION
(r\ r' f_ ,,;-r
JJj� //
r ` - /
IssuarvcE Dare -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
BLDG,
ELECT.
❑
PLG
❑
MECH.
❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
vnwnnoN
siFT.
PLUMBING '
MECHANICAL
ELECTRICAL
PERMIT TO
_
FRAMING
INSULATION
STORIES
TYPE CONSTR.
OCC GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO I FLOOR WHEW
TOTAL ACREAGE '
DIAPHRAGM
a W LOI USE
HES IND CONPB Other
c) ❑ ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ROUGH
_
ASSESSORS PARCEL NO.
PLUMBING
GAS TEST
-
THACTNO,
PARCEL NO.
MECHANICAL
ELECTRICAL
FINALS DATE INSP.
ACC.OATE
ACG FILE NO.
FRAMING -
SAN * '
INSULATION -
PLUMBING
ZONING
ENG. SITE NO.
GAS
FIRE SPRINK
ENERGY T 24
° � "�
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING __
LATH—INTERIOR
ELECTRICAL
FLOOD zoNE
Y CD No
A.L.0 c.
Yo No
LATH—EXTERIOR
FIRE DEPT.
SHEETROCK -
GRADE
FEE SUMMARY
SHEAR INTERIOR
BUILDING
f
BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS
FIREWALLS,.
ELECTRIC
PLAN CHECK
FEE
•
AS.
NO TAPE 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 252.45051
HONE WORKING DAY BEFORE REQUIRED IMPECTION.
0� PLEASE GIVE JOB, ADDRESS WHEN PHONING.
Z
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
'C
'CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION
-
APPLICATION&PERMIT
PERMIT NUMBER
aUILGING
ADDRESS
UILDING -ELECTRICAL- PLUMBING -MECHANICAL
12044
OWNEP'a
NAME � �/\!�
`/ PHONE 6
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
CONTRACTOR _
ld� If
LIC. NO, Iw
UTLETS-SWITCHES-RECEP 10,00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRA t--r//il•1
ADDRESS RS eJ-� ala_ JAPPLIANCES
-RESIDENTIAL 4.00
PANELS 10.00
AlWi PHOrvE
DATE OF APPLICATION
ARCHITECT
OR
ENGINEER
LIc, No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.L. NO.
SIGNS TRANS. 3.00
ADDRESS ervo.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
rrEMP. METER OR POLE INS. 20.00
ZIP
APPucaNrsJ,�-^_ � � -
ooREss-�✓V�1
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
g
E
77
LICENSE 'ON'TRACTO SDECLARATIONh4��
1 hereby affirmthat I am licensed under provisions ofChapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Codi. and my license is in full fort ) d c
License Class y:epi .(J_- Lic. Numberlltill
IS
BLDG.
❑
ELECT.
❑
PLG. MECH.
❑ ❑
Date Contractor
BUILDING PERMIT
INFORMATION
OWNER -BUILDER DECLARATION
Contractor's License
I hereby affirm that 1 ng so C%empl from the Business Professions
Law finny city
Code: Any city or county which requirese permit to construct alter,
countywhchn. e. requires permitto
improve, demolish, or repair any structure, prior to its issuance,statementalso
requires the applicant for the permit to file a signed ctor'siThal
he is licensed pursuant the provisions of the License
MISC.- REFER TO ORD
VALUATION
$/FT.
PERMIT ISSUANCE 10.00
EIEC. LONTR. LIC. N0.
ELEC.
TOTAL
PERMIT TO
DTV. PLUMBING PERMIT FEE
oC Division 3 of the
en WI'Division
Law (Chapter 9 (commencing with Section is exempt therefrom and
Business and Professions Code) or that he is
GTORIE
TYPE CONSTR.
tion of
the basis for the alleged exemption. Any violation of Section 703malty
by any applicant for apenre dollatsthe 1500).licunl One Civil penally
of oat more than Clva hundred dollars(1500).):
ALTER-DRAIN-WATER(EA.) 5.00
O I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended or offered for sale (Sec. 7044, Business unit Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds Or improves thereon, and who does such work
himself or through his own employees, provided That such improve-
ments are not intended or offered for sale. If, however, the building
F IXTUR ES - PER TRAP 5.00
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS-EA.SVSTEM-1 6.00
or improvement is sold within one year of completion, Dse owner.
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.),
❑ 1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM -OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB Cuba,
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
l0 an owner of properly who builds or improves thereon. and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS - OVER 5 IEA.) 1.00
ASSESSORS PARCEL NO.
contracts for such projects with u contractors) licensed pursuant to
file Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C. for this
Eason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKF.RS'COMPENSAT10N DECLARATION
1 hereby affirm thus I have a certificate of consent In self -in sure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereof S�ec.� Jj80ff,� Lab.C.). O _F•Cd�
c }'S
Policy Nza"3 MRPany
O Certified copy ishereby furnished.
entified co1ly is fled with the city inspection division.
pplicant qg
FIRESPRINK
Y❑ N❑
ENERGY T-24
Y N❑
MISC.- REFER TO ORD.
CERTIFICATE OI' EXEMPTION FROM WORKIiRS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.u.C.
PLG,CONTR. LIC. NO.
TPLO
OTAL
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y❑ N❑
V❑ N❑
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per-
Mit is issued, I shall not employ any person in any manner so as to
OTV. MECHANICAL PERMIT FEE
FEE SUMMARY
,
BUILDING
become subject to the Workers' Compensation Laws of Culiforniu.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Ex.
emption, you should become subject to the Workers' Compersullon
APPLIANCE 5.00
PLAN CHECK
provisions of the Labor Code, you must forthwith comply with
such provisionsor this permit shall be deemed revoked.
AIR HANDLING UNIT (TO 10MC.F.M.) 4.00
FEE
AIR HANDLING UNIT (OVER I0)000C.EM.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that There is a construction leading agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued Our.
3097, CN.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
HEAT[ NG UN I T(OV ER 100,000 B.T.U.) 9.50
ELECTRIC
Lender's Address
I certify that l have read this application and stale thin iha above
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER• COMP (3 H.P. Or 100',000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
3 �O
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD..
CONST. TAX
(We) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in ny way accrue against said City in consequence of the
PERMIT ISSUANCE 10.00 .
grantin (his ermiL
ECH. CONT. LIC. NO. MECH.
TOTAL
3 ao
Signature of Applies n Contractor Uutc
OFFICE COPY