14026 (2) POST THIS CARD NEAR FRONT OF BUILDING
,. • - PERMIT NUMBER
CITY OF CUPERTINO 4026
INSPECTION DIVISION
JOB INSPECTION RECORD
-• '. PERMIT EXPIRATION
JOB ADDRESS "Ls� /f/J' ��IXi+ LL `L rl• UNIT# LOT.# '
-- PERMIT EXPIRES IF WORK
OWNER �R Q�d �G V - CONTRACTOR �?�-��L L(, IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD180 DAYS OF PERMIT ISSU
FOUNDATION _ AWE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
� � y � - -
PREGUNITE " , P ERMIT VALIDATION
POUR NO CONCRETEUNTIL A OVE HAS BEEN IGNED
UNDERGROUND /SLAB
PLUMBING ELECTRICAL CDATEMECHANICAL s
2j%1m.*,E
LECTPLG. MECN.
DO NOT POUR FLOOR UNTIL ABOVE HAS'BEEN SIGNED BUILING PERMIT
WINFORMATION
WOOD FLOOR
_ VALUATION SIFT.
PLUMBING -
MECHANICAL _
PERMIT TO
ELECTRICAL -.`}ko 4,
FRAMING �(
INSULATION STORIES TYPE CO STR.
" OCC.GNOUP RE NITS
- .• � � - 1. r i
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT.FLOOR AREA TOTAL ACREAGE
,l 77
DIAPHRAGM CO' BUILDING USE
I HES IND . CON PB ONe,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 D ❑ 11
RO GH ASSESSORS PARCEL NO,
q
GAS TEST ' - 0�7— - .- TRACT N0. PARCEL NO
' MECHANICAL" .$$ ' '
ACC.DATE ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
-. MECHANICAL FIRE SPRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "o ° "o
LATH-INTERIOR' UAgCl, ELECTRICAL - FLOOD ZONE A.L.u.c,
LATH-EXTERIOR FIRE DEPT. Y❑ N[] l Yo No
_ SHEETROCK GRADE FEE.SUMMARY '
BUILDING
SHEAR INTERIOR _I BUILDINGt %••^
SHEAR EXTERIOR �I(o- TEMPORARY APPROVALS '
FIREWALLS ELECTRIC PLAN CHECK _
GAS FEE
,NO TAPE OR PLASTER UNTIL ABOVE HAQ B „N,4!13RED. OCCUPANCY SEISMIC FEE ; I
OCCUPANCYOF BUILDING IS NOT PERM ITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC / �
w ONE WORKING DAY BEFORE REQUIRED INSPECTION.
F PLUMBING
0�• ' PLEASE GIVE JOB ADDRESS WHEN'PHONING.
Z MECHANICAL 'z f
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL • ' /'
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
14026
ADDRESS�s
OZ/{< OMILLARll BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
MER' s,
S ., . .11 +. PLAN CHECK VALIDATION
NAME GERARD DEVELOPMENT PTV: ," ELECTRIC PERMIT FEE
CORP. ( 415 HONE 941-414
corvE TRAcroRs
NAMft UTLETS-SWITCHES-RECEP 10.00/1.00 /a, -
�A/��
_641'A F+ 0.1071 '0 ' �-+ � LIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR'S 14� �1� 'L- PPLIANCES-RESIDENTIAL 4.00
ADDRESS 1 T .
PHONEc3k- PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLANCHECK FEE P.C.NO.
OR 7,T
ENGINEER GREG W. BEN^{I,9%, SIGNS TRANS. 3.00
ARCH.OR EN
" SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
wooREss
513 MONTEREY AVE 21P rrEMP.METER OR POLE INS. 20.00
APPLICANTS F MOTORS SEE FEE SCH. Q
ADDRESS '141 .F-'RST ST. `SERVICE CHANGE 20.00 .s/• pp
woo LICENSED CONTRACTORS RAT IN
�N Qi 9i1 eY i�0 0
¢U v I hereby affirm that I am licensed Under provisions of Chapter 9 TE
w <n Iconmencing with Section 7000)of Division 3 of the Business and gLp� PLG. MECH.
H N z Professions Code,and my license is in full for eGg' e e
z o m License Class Lie.Num be,
o I- w Date�_�/ CO Incl,
.Fm-� Y--snv `-v
a y BUILDING PERMIT
¢ ¢;
OWNER-BUILDER OF:CLARATI
a o e. O - MISC.- REFER TO ORD INFORMATION
K"3 1 hereby affirm that I am exempt from the Contnmlor's License VALUATION $/FT.
'u a o 4 Law fertile following reason.(Sea 7031.5,Business and Professions PERMIT ISSUANCE 10.00 /O'•- "
t ,Am Code:Any city or county which requires a permit toemstruct,alter, ea--n�, y-D-a-� .I
2 ¢ Q p improve,demolish,or repair,any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. y py. /,
.a g C u requires the applicant for such permit to file a signed statement That I TOTAL /0 7 PERMIT TO
X$ he is licensed pursuant to the provisions of the Contractor's License
Fzi Law(Chapter 9(commencing with Section 7000of Division3 ofthe
5 4 o Business and Professions Code)or that he isexempl therefrom and PTY. j PLUMBING PERMIT FEE STORIES q
CQNST
Be H$ the basis for the alleged exemption.Any violation of Seelion 7031.$ y" .
d ; by say applicant for u permit subjects the applicant to a civil penalty
ALTER-DRAIN&VENT-WATER (EA.) 5.00 "/Aof not more than five hundred dollars(1500)):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do Be 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 Conttncmr's License Law does not apply to on owner of
Property who builds or improves thereon.and who does such work 14, FIXTURES-PER TRAP 5.00 SD.FL FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- / GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 307
meals are not emended 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 not build or im- RES IND CON PB Oma,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
CI 1,
rryyeB
1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct tire project(See.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
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3�1; _t�E/ '
contracts for such projects with a contractor/sl licensed pursuant to
(he Contractor's License Law. SEWER-SANITARY-STORM EA.200t1/10.00 O TRACT NO. T PARCEL NO.
r
❑ lam exempt under Sec.-,BAP.C.for this / WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate ofconwnt to self-insure,
or a certificate of Workers'Compensation Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lub.C.).
Policy No. Company
O ❑ Certified copy is hereb rnished. FIRE SPRINK ENERGY T-24
Z Z Certified copy I wllh Ole,rft�,ra�eclrun division.
O Applicant dam-/ MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC CER ICATIi OF EXEMP�TION PROM WORKERS' PERMIT ISSUANCE 10.00 o-- FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG,
0. 0 ('This section need not be completed if the permit is for one TOTAL 46 7 SO Y❑ N❑ Y❑ N❑
:) Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of Ore work for which this per- PTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. /
ED Date - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING (O
} M) NOTICE TO APPLICANT: If,site,making this Certificate of Ex-
? empticn;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 Shull be deemed revoked. AIR HANDLING UNIT(TO 10POD C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY " AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 S�
the performance of the work for which this per V is issued(Sec. MICROFILM
3097,Civ.0 I a HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nam, Pa KIATL 51.1L_ HEATING UNIT(OVER 100,000 B.T.U.)9,50 p
Lender's Address ELECTRIC 1I ../
I certify that 1.have read(his application and stale that the above VENTILATION FAN (SINGLE) 4.0
information is correct. I agree to comply with all city and county PLUMBING /Q
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 100,000 BTU)SEE FEE SCH. MECHANICAL 1
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. �pr
Cfipertioo against liabili(ies,judgments, costs and expenses whichCONST.TAX �kOU s
may in any way eccrye against wad City in consequence of the PERMIT ISSUANCE 10.00 �-
granting of thisper f. MECH.CONT. LIC.NO. MECH
i .
� _ 7P-1/__� _ TOTAL 1G, TOTAL 30�/S
Sigl�,e of Apple Contractor 1 LDatteee
OFFICE COPY