13282 (2) POST THIS CARD NEAR FRONT OF BUILDING
" J r• , _ 1, - PERMIT NUMBER
•C.ITY 'OF;- CUPERTINO 1326
',I_NSPECTION'DIVISION ,
:JOB INSPECTION RECORD
.PERMIT EXPIRATION
21269 STEVENS CREEK ' ,
JOB'ADDR ESS UN #IT -LOT tk
_ t - PERMIT EXPIRES IF WORK
-'OWNER THE . .`' CONTRACTOR 'CAL NEON' IS NOT.;STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORDY 180 DAYS OF PERMIT ISSU-
FOUNDATION. - - ANCE OR'180DAYS FROM
'
UFER LASTCALLEDINSPECTION..
- '
' PREGUNITE -
PERMIT vau DATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING •• ' • ^'!/a'I,'p
ELECTRICAL - - / j - - - - ISSUANCE DATE
MECHANICAL SLOG ELECT. PLG. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR• INFORMATION
VALUATION SIFT.
PLUMBING ' •'ti• - • I"
MECHANICAL
r TTO
ELECTRICAL"^' MI
- 'FRAMING -
Sra+,es + TYPE consTR.
INSULATION .
OCC,Ono UP RES,UNITS.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'SO.FT,FLOOR AREA TOTAL ACREAGE
.ROOF 'I ,
DIAPHRAGM
BUILDING USEd -
RCS •IND CON PR Olhm'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 �' ' O
-ASSESSORS PARCEL NO.
ROUGH'.,.
PLUMBING - r
TRACT NO, PARCEL NO.
GAS TEST
MECHANICAL . . - - -
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #. ZONING F ENG:SITE NO
INSULATION •"` - PLUMBING -
I GAS - ;
MECHANICAL . FIRE SPRINK ENERGY T24
+ a, '•, .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑ N❑ Y.0 , No
LATH—INTERIOR ' " ELECTRICAL ? FLOOD ZONE A.L.00 -
LATH—EXTERIOR FIRE DEPT. .. N0 Y❑ "�
'
r SHEETROCK , ' GRADE - FEE SUMMARY
SHEAR INTERIOR - - BUILDING, , BUILDING'!
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS - ELECTRIC'' - PLAN CHECK y i
GAS' , FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE D
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY'BUILDING-INSPECTOR. MICROFILM ._
ARRANGE FOR,INSPECTION BY PHONING 252-4505, ELECTRIC
H '.,'ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z 4! 'PLEASE GIVE JOB ADDRESS WHEN PHONING '
' i- '. NICAL
a• — SEE PERMIT FOR EXPIRATIONDATE = w ' MECHA
'CONST.TAX
IMPORTANT!-, }•'
PLEASE READ REVERSE SIDE BEFORE+ OWN`' TOTAL 7 t}_'
CALLING FOR FINAL INSPECTION.
. •. - . ' •, OFFICE COPY .
APPLICANT TO FILL IN INFORMATION WITHIN•RED LINES - USE BALL POINT,PEN ONLY
BUILDING PROJECT I DENTIF[CATIONPERMITNUMBER
BUILDING , APPLICATION & PERMIT . ^^ n
AODB�S BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL 3 G G
OWNER'S _ '/'� PLAN CHECK VALIDATION
"A /Y'�`� DTV. ELECTRIC PERMIT FEE
PHONE
co a oR UTLETS-SWITCHES-RECEP 10.00/1.00
N r
.N� LIGHTING FIXTURES 10.00/1.00
CONTRACTOR's
ADDRESS APPLIANCES.-RESIDENTIAL 4.00
a DREss
7 v PANELS 10.00 GATE OF APPLICATION
G
gBH1
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
E R
LIC.NO SIGNS TRANS. 3.00
ARCH. NG. PERMIT VALIDATION
AD s SPECIAL CIRCUIT 5.00 -
zIP FrEMP.METER OR POLE INS. 20.00
APPUP04Tra - MOTORS SEE FEE SCH.
SERVICE-CHANGE 20.00 �
0 ¢z Ji/ 7
F
00 LICENSED CON'I'RACI'ORS DECLARATION. -
�•w I hereb al'rirrn 111n1 I a n licensed under envisions of Cho mrv9 - - .-
y p p ISSUANCE DATE
y a v (commencing with,$ec 00)of Division of the Business and - BLDG. .ELECT. PLG. 'MECH.
r ,A i Professions CO,c/al({I Icenso is in
z 0 0- License Class [_•� Lia Nu - ❑ ❑ ❑, ❑
O z r w Date��• Contractor�/g/-��/��_//�- '
'¢ yrIF "'�' �' -� - BUILDING PERMIT
MIS !OWNER-BUILDER DECLARATION - INFORMATION
o s REFER TO ORD
E:
; u r I hereby uolhcu,ng I am exempt from the Contractor's License MISC.-
F g 0 Low for the city
or county which
e.requires
permit
to construct,
Professions ,PERMIT ISSUANCE ' 10.00 D - VALUATION $/FT.
Code:Any mulish county my whiny structure.
prior
t oconsim alter,
Q Q Q IlnproVe,denlD115h,Or repair any StrnCl Ure,prlOr ro 11515StW 11CC,at,O ELEQ CONTR. . LIC.NO. - ELEC.
O¢ requires the applicant for such permit to file a signed statement that r TOTAL - PERMIT TO
ww . he is licensed pursuant to the provisions of the Contractor's License (7
Fz >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �I
< Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
IS=$ the basis for the alleged exemption.Any violation of Section 703 L5 STORIES TYPE CONSTR.
by anyapplicant for a permit subjects the applicant loo civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500)):
❑ ],as owner of the property`or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not 'OCC.GROUP REB.UNITS
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 re through his own employees.Provided that such improve- - ,
himselfams cacumen his orn0ficEedemplo employees,
or provided that s the building GAS-EA'.SVSTEM-11NC.40UTLETS '6.00
or improvement is sold within one year of completion,the owner - . .) 2.00- GAS EASYSTEM-OVER 4 IEA
builder will have the burden of proving that he did not build or im- - BUILDING USE .�
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 .RES IND CON- PB Omer
❑ I,as owner of the property,am exclusively contracting with '❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business ILAWN,SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Corltmetm'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 sufh projects with a', tracI d0licensedpursuantto - SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
the Contrac rA Liccnse haw.
❑ to a mpt under Sec. ,B.&IpC.for this WATER HEATER W/VENT "6.00 I
naso
• Owner - Date - WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
C - WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I [rave a ce nsati n of co eat to ZONING
or a certifies[•of Workers'Compensation s m critic
-ENG.SITE NO.
copy ereby aff iq ) /�/ - -
Ic
policy NO / -
0 j7/Certified y' r is •d. FIRE SPRINK ENERGY T 24
TO o inspection division. MISC.- REFER TO ORD.
Z O APPlicant- - -Y❑ N❑ I Y ❑ N❑
2 m CERTIFICATE:Oh EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
LU COMPIINSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
I rL O (This section need not be completed if the permit is for one TOTAL Y❑ NE] Y❑ N❑
::) Z hundred dollars(S 100)or less.) - -
'0 O I certify that in the performance of the work I'or which this per DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit irissued hall not employ any person in any manner so as to s�
U become ect to Ole Workers'Compensation Laws of California.
i Date_ Applicant ALTER OR ADD TO MECH.. 5.00 -BUILDING a
} m NOTI . O APPLICANT: If,after making this Certificate of Ex-
F Z emp on,you should become subject to the Workers'Compensation APPLIANCE - _ 5.00 PLAN CHECK'
Provisions of the Labor Code, you must forthwith comply withFEE 94
U such provisions or this permit slm ,000
ll he deemed revoked: AIR HANDLING UNIT(TO 1QOF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE Jb,
I hereby uffinn that ere is a rnnstruction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 -
the performance I I�work for which[his permit is issued(Sec. MICROFILM -
3097,Civ.C). . ) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER100,000B.T.U.)9.50 ELECTRIC 13 -
Lendcr's Addre's
I Certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and.state laws relating to building construction, and BOILER-COMP(3 H,Ror100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL
Amen-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- ' REFER.TO ORD.
CC per' ag inst liabilities,judgmen •cots :urd expenses which PERMIT ISSUANCE 10.001CONST.TAX
in m an a accrue against v' C yin consequence of the
gr [i . I - MECH.CONT. LIC.NO. MECH.- MECH.CONT. LIC.NO. MECH.
TOTAL -1 7 Q�
a--%
TOTAL
Sisnal Ne ol'Appf ant/Con[ractor�Date z
OFFICE COPY - -