14031 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14031
INSPECTION DIVISION '
JOB INSPECTION RECORD
Sok", PERMIT EXPIRATION
JOB ADDRESS /��s �' ��ah'h ��-`UNIT# - LOT# PERMIT EXPIRES IF WORK
OWNER `--'�'R�"L'6 �L v-. CONTRACTOR 'O IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
,FOUNDATION _ ANCE OR 180 DAYS FROM.
LIFER
LASTCALLED INSPECTION.
�.
PREEGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL-ABI)IIII ,QSJBE ,;SIGNED 1, r p iD '
'UNDERGROUND /SLAB pR,� Ile'
PLUMBING - 1n�,1 . A
ELECTRICAL •JQ I $UANCE PATE
MECHANICAL (LyIPp Or PO MH.
City "LWJ5
DO NOT POUR FLOOR UNTIL ABOVE HAS-BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUAnoN
PLUMBING /4r... •,�r 0
MECHANICAL
ELECTRICAL - � PERMIT TO
G) ,C_
FRAMING
STORIES TYPE CONSTR.
INSULATION I .y !' �4,•,;
OCC.GROUP RE%UNITS
..
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•
50.FT.FLOOR AREA TOTAL ACREAGE ROOF a r r;
DIAPHRAGM BUILDING USE
HES IND CON PB Omer
APPLY,NO ROOFING UNTIL ABOVE HAS BEENSIGNEDEl El 1:1
ASSESSORS PARCEL NO.
ROUGH yy
PLUMBING ,21,d' `�'Z -�/�-
GAS TEST TRACT NO, PARCEL No.
.;;
MECHANICAL
ACC.DATE ACF FILE NO.
• ELECTRICAL _ ^. FINALS DATE INSP. II
FRAMING SAN
ZONING ENG.SITE NO.
INSULATION � /f PLUMBING - -
GAS
IIQ� MECHANICAL FIRE SPRINK ENEE] rN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "'� []
FLOOD ZONE A.L.U.C.
LATH-INTERIOR 7'Z, V,� ELECTRICAL
LATH-EXTERIORFIRE DEPT. vo N0 Yo N❑
SHEETROCK , GRADE FEESUMMARY '
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR' TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL'.ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC -
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING f
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
• Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICALIMPORTANT! - CONST.TAX
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
BUI LDI NG PROJECT IDENTIFICATION *..IT'`�- PERMIT NUMBER
BUILDING APPLICATION & PERM14031
ADDRESS
_ 9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
_a ow ER'S Y 'ID LANE, 1-QT PLAN CHECK VALIDATION
NAME GERARll DEVELOPMENT ''""
d• f ELECTRIC PERMIT FEE
CORP. 415 PHONE 941-4141OT,V..: _
s NAMERAcroRs .� /�.� OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC,NOF4V-re LIGHTING FIXTURES 10.00/1.00 36 -
CONTRACTOR'SlI�' v� dL
ADDRESS APPLIANCES-RESIDENTIAL 4.00
` A
L,QS• PHTO,�NE 4 PANELS 10.00 /0- DATE OF APPLICATION
-ARCHITECT y N r PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER ARCHITECT LIC.NO.C13629 SIGNS TRANS. 3.00
AGGRESS EN 1 AVE. SPECIAL CIRCUIT S.00 RMIT VALIDATION
LOS GATOS f CA. 2,,9503C TEMP.METER OR POLE INS. 20.00
APPLICANT'S
-ADDRESS MOTORS SEE FEE SCH. � f,e/'�-N
141 FIRST ST. SERVICE CHANGE 20.00 G�j
w
00 L D ORS LAR Of clj `IDyFF sy�a O
<u w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
vaoi i Professions Code,and my license is in full f0r�gypsyRffgrj.� Imo} fQ.
i o w- License Class Lic.Numbed(.. 11��''1IS�J.9:C�.�7--
o o Date 1-7&- Ho1fb. Contract.,
J --- �
Q y f J BUILDING PERMIT
r a w < OWNER-tl UILDF.R DECLARA ON INFORMATION
woAca MISC.- REFER TO ORD
;u. I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
Fu.04 Law forthe following,eason.(Sec,7031.5,Business and Professions PERMIT ISSUANCE 10.00 01
Code:Anycily orcounty which requires a permit to construct,alter,
S, Q O Improve,demolish,or repair any structure.prior to its Issuance,also ELEC.CONTR. LIC NO. ELEC. o
D ¢ requires the applicant for such permit to file a signed statement that TOTAL o0� PERMIT TO -
wm LL he is licensed pursuant to the provisions of the Contractor's License - a
rZ > Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and DTV. ,PLUMBING PERMIT FEE -
(c the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ban' ofnot morre than five hundred dolllars(1he$500)P)cant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00
❑ 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
r ti intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 P-3
j OIIl. 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 S SO,FT.FLOOR AREA TOTAL ACREAGE
, }lf himself or through his own employees,provided that such Improve-
h menta are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-1
�' or improvement is Said within one year of completion,the owner- GAS•EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that he did not build or im- . . .
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with [vRtPpII
Y- _❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply q
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for Soch projects with a contmetor(s)licensed pursuant to / SEWER-SANITARY-STORM EA.200ft/10.00 Q
the Contractor's License Law.' �� TRACT N0. PARCEL N0.
711am exempt under Sec. ,B.&Poco for this
WATER HEATER W/VENT 6.00 '� 8Qb>�
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.fconsenl to self-insure, - ZONING ENG.SITE NO.
Or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sce.3800,Lab.CJ.
Policy No. Company
-
0 ❑ Certified copy is hereby furnished. FIRE SPRH,K ENERGY T-24
Certified coy Is will, tile e yfL�inspection division.
Z p pplicant pr� MISC.• REFER TO ORD. Y[:] N❑ v ❑ N❑
Hy PERMIT ISSUANCE 10.00 Q� FLOOD ZONE A.L.U.C.
LU CERTIFICATE F EXEMPTION FROM WORKERS'
CL COd not ATION,NSU if tale PLG.CONTR. LIC.NO. PLG. //a p'Q Y❑ N❑ v ❑ N❑
1 O (This section need not be completed if the permit is for one TOTAL
//01
Z hundred dollars(5100).,less) ..-
U O I certify that in the performance of the work for which this Per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
u. F mil is issued,I shall not employ any person in any nsanner so as to .
U become subject to the Workers'Compensation Laws of California.
O w 'Date Applicant - BUILDING
a ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after mu Ring this rs'Comps,of lix-
F ? eruption,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 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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,CN.CJ, /-.��xp�►-� 1 HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NamIrASLl3.1'/1 `NQ �'d•T 1-- ' HEATING UNIT(OVER 100,000 B.T.U.)9.50 AP
CZ
Address ELECTRIC 0CJ
�- I certify that I have read this applicationand ante that the above VENTILATION FAN (SINGLE) 4.0 0
v information is correct. I agree to comply with all city and county PLUMBING �d
ordinances and state laws relating to building construction; and BOILER•COMPI3H.P.or100,000B.T.U.) 6.00
,M` •.4' hereby authorize representatives of this city to enter upon the 3
above-mentioned property for inspection purposes. BOILER-COMP IOvar t00,00087U15EE FEE SCH. MECHANICAL �.�
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino,againsl liabilities,judgments, costs and expenses which CONST.TAX p
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 o- CP
anting
8�gtt$[ure.f Applicant/Contractor Date
MECH.CONT. LIC.NO. MECH.
_ -2fo P� TOTAL �3Or TOTAL d7B '�S
OFFICE COPY