14623 (2) POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
. CITYOCUPER100'.
r 146
23
INSPECTION DIVISION
JOB INSPECTION RECORD. "
?.r• _ +:
,,PERMIT EXPIRATION
JOB ADDRESS 21631.7STEVENSCREEK BLVD.,.UNIT# —LOT# '
�. . i,.
'PERMIT EXPIRES�IF WORK
-
OWNER STATE FARM (DEEIJCOr) .'. .' CONTRACTOR DEB COR., IIS'NOT.'STARTED WITHIN
INSPECTION DATE` I INSPECTOR INSPECTION RECORD +: 180 DAYS OF PERMIT ISSu
ANCE'OR-�180 DAYS FROM
FOUNDATION - NOTE: c` `
LAS TCALLED INSPECTION..
I, UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED :•
.-a TO COMPLY WITH THE APPROVED PLANS AND CITY OF veRmq VALIDATION
PREGUNITE' CUPERTINO STANDARDS. - `' ''I ^8
GARAGE SLABS',
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED' �• � ' ®,` w '(.,..•? —
UNDERGROUND /.SLAB qq ,
r,
PLUMBING, _ FEB i 1996 .
ELECTRICAL . - f .ISUANCE.DATE,
MECHANICAL - I ?`Ecr. PLG. MEC..
cls ' o p o .
' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - _ BUILDING PERMIT
INFORMATION
WOOD FLOOR ,' v4LUAT1oN 61FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT To -
FRAMING
INSULATION P - SToama TYPE CONSTH,
OCC,GROW' RES UNITS ,
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - I
y,
50,'T.11-0..AREA 10T.L ACREAGE
'ROOF w - NOTE:NO FINAL INSP.SHALL�BE MADE BEFORE
1� DIAPHRAGM THE CONSTRUCTION TAX'IS PAID .,.
_ ROOFSHEATHING - REs INOUILDING USE
VB o,n,•r
r APPLY NO ROOFING UNTIL ABOVE'HAS BEEN SIGNED FINALS �•,,—.;;s DATE a ,.INSP. 1-1 0 E '❑ 0
ASSESSORS PAHCEL No-
,,. .'ROUGH. - SAN.#
PLUMBING ELECT.ENERGY '
TUBS B SHOWER PAN' - PLUMBING ENERGY - T�+^cT NO PARCEL No
MECHANICAL •MECH:ENERGY r
ELECTRICAL BUILDING ENERGY - ACC DATE aca FILE NO
' FRAMING . ELECT.FINAL TEST,=
].ONING :ENG.SITE,NO.,"
INSULATION ' - PLUMBING -
GAS TEST - GAS -
` MECHANICAL FIRE SPRINK. ENERGY r.aa
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE] 0 NE]
'
.. EXYERIOR.SHEAR • . ELECTRICAL�RELEASE 'j„l�• � FLOOU2ONE . 177777-
- •
INTERIOR'SHEAR, ', .•, - FIRE DEPT. Y ❑ N� vL� -'N�.
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING 2—1-t
,INTERIOR LATH. - - TEMPORARY.APPROVALS BUILDING t I
SCRATCH COAT- , ELECTRIC PLAN CHECK /� • ' f
G
FEE
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - - SEISMIC FEE _1
P - OCCUPANCY OF BU I LDI NG IS NOT PERM ITTED UNTI L I3UI LOINS F INAL IS SI GN ED,BY BUI LDI NG INSPECTOR. MICROFILM '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
1-- ONE WORKING DAY BE FORE.REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE,JOB ADDRESS WHEN PHONING .
Z MECHANICAL
= SEE?ERMIT.FOR EXPIRATION DATE= -
IMPORTANT! CONST.TAX
PLEASE,READ.REVE RSE SIDE•BEFORE ' TOTAL f= J
CALLING FOR FINAL INSPECTION. ,
OFFICE COPY
..
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU14DING PROJECT IDENTIFICATION PERMIT NUMBER
Bm1mNo U�„n APPLICATION & PERMIT A �j�
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL ..
/ NAME S7 A 7 _ PLAN CHECK VALIDATION
/-• QTY. ELECTRIC PERMIT FEE
PHONE G -
NAMEiA TO s OUTLETS-SWITCHES-RECEP 10.00/1.00 IQ
11C.NO 'y ' 7 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
AOORESS 21(12,5- Sfz ✓leV C- ' 131-c PPLIANCES-RESIDENTIAL 4.00
✓ ( " PHONE PANELS 10.00 DATE OF APPLICATION
OR PANELS
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS eel. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 20.00 L..•!'W f�-�
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH. `J
SERVICE CHANGE 20.00
a a z y//L/(��"
F O o 1tC1iNSliD CON'1'RAC"I'CIRS IIISC'LAItAf111N �r a
u u 1 hereby affirm that I ono licensed under Provisions of Cliapler 9 IJ ISSUANCE DATE -
au it, (,onueencmg will, Section 7000)of DmYom 3 of the R sin...and BLDG. ELECT. PLG. MECH.
r Profession Code,and Illy license sin lull fume and of lecl. ❑ ❑
zo zo g.Q .icense Cla Lic.Nunn her d' !_2� ; 0
f N r J ate-2/�Q ,�$'f_.j_Conlraclur_(�¢e]GU)"L.�.�•i^ Of
ir or w u OWNER-BUILDER DPCLARA'FION BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
F.
;e I- hereby al lion 1ha1 I uul exempt Irum the Qnnruol.r's Lic<me VALUATION F u_ D J Law for[Ile following reason.(See 7031.5.Business and Podessiuns SIFT.
Code:Anycityurcounly xIiichmtuirc.0 PERMIT ISSUANCE 10.00 x-�
or m i Ibsib, 1 Penni,In,r nslmeLolreL /✓ V V (/Z
a or ¢ O requires, is applicant
n,'torsi,such
structure,prior to its iatenuan Holo ELEC.CONTII, LIC.NO. ELEC. - ✓ V V
o¢ requires til,aPPlicam for sir=h pennil l.lite r signed tme,ncet Ont TOTAL PERMIT TO
n w m he is licensed Polsuwr Ice Ib,provision of the C o,,Ha,hsr.License
L z }
Law(Cbopter9(mnm+eneing with Section 7000)u1Division 7Of the
4 4 o Business and Prs,ftssiuns Code)of flat be is exengn Ih,r0ront a OTY. PLUMBING PERMIT FEE /N�e=�I�•C ���f�/
arm the basis for the alleged exenplion.Any Oulotio l of Section 7031.5 STORIES TYPE CONSTR.
a 3 .- by any applicant for a Permit subjects the applicant lou civil penny
.fuel noon,than fill,Ilundred dollurs 1S500).1' ALTER-DRAIN& VENT-WATER (EA.) 6.00
❑ I,as owner of the property,or my co,pluyces wish wages its BACK FLOW PROTECT. DEVICE 4.00
rl
their sole cuP,nallO.1.will do the wluk ,u,d Ill,tincture o not OCC.GROUP RES.UNITS
intended ur offered fur sale (Ser. 7044, BW in,ss and Profcsvon, DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'file Comold,ir, License Law dues not apply to.m owner of
properly who builds or inyrnv,s 1hereun,and who don such work F IXTUR ES-PER TRAP 5.00 SQ,IT,FLOOR AREA TOTAL ACREAGE
himself or through his uwo cod,loyces,provided That such improle.
menlsur,not intended or offered for salt.it,,h-wryer lh,huilding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
Or impruv„nenl is sold wilhin one)car of eompleiun, -the owner GAS EA.SYSTEM-OVER 4 (EA.) 2.00
builder will bale the burden of proving Ihw Uc did nn1 build or inn BUILDING USE
prove lar purpmo of all.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe One,
❑ I,a,owner of die property,am exclusively contracting with ❑ ❑ ❑ ❑ 11N,
licensed cunnaelnn 1u cuutmct the ',."la tS,c. 70-14, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PAHCEL NO.
and PO. stmn Code:'file C'Ontranor:License Law dors nol apply
tO an own,r of properly who builds ur i„Braes..I I..reun.:fid who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lar such Projects with a=untneturlt licensed pursuunl to
fine Contractor's License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ Ion cxrngn under S,,.-,B,&I,,c.by this WATER HEATER W/VENT 6.00
on
Owncr Dat`' WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKFRS'CONIPI:NSA'IION UITC'LtItA IION WATER TREATING EQUIP. 5.00
I I",by'allu'll Wal I hose a nen it"col crown to wit-inure.
or =erlilieale of Wurkeri Congmlisaliun Insurance.or a cerni icd ZONING ENG.SITE NO.
co,,lhneol IS,c.3500,Lxb.C'.).
Policy No. Coln Pa,1Y-lr-{-(.j.tlrf}
z Z �❑ Cerlil�eJ,oq)'is hnehy furnsh,d. FIRE SPRINK ENERGY T@4
C'enifi=d ,f y is tiled will, Qu, city inlectim+ division.
FO App lcem �t�,(�Fy.4___GmAys MISC.- REFER TO ORD. Y ❑ Is Y ❑ N❑
KN CERTIIICATIS OFIi hit hill TION FRONI WORKERS. PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
W > . CONII'Lill ION INSURANCE PLG.CONTH. LIC.NO. PLG.
CL O (This section need not be coopicted it the Perillin is Ii)r ono' TOTALY 1:1N❑ Y ClN❑
D Z hundred dollars IS IOUI Or itss.l
U0
I certify dial in the perturnoence Ot the work lot wh0l His per-
LL H ,nil is ssoed, I shall not entPloy any Peoou i, n, nrunner.n m n
l] w be,omc subj,ct to the N'rdori('un+peroat ion Laws Of Cdil'ornia.
a Dan• ,y,pBcant ALTER OR ADD TO MECH. 5.00 BUILDING /7J_
} b NOTICE 'f0 APPLICANT: If,after nuking fill,Cilicwo-I'1.,-
I- ? empli(on,you should became subject to the Workers'Conopenaniun APPLIANCE5.00 PLAN CHECK �� _1
provisions of the Lubar Code, you must forthwith comply will
U lull,Provision to this Perini)shall it,decm,d revnk=d. AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 FEE
C'ONSI'RUCI'DON Ll NDING AGENCY AIR HANDLING UNITIOVER I0,000C.F.M.) 6.00 SEISMIC FEE ,$
I her,hy ainnn But tiler, is a conuOmion lending agency fur EXHAUST HOOD (WITH DUCT) 5.00
file perfuntun,e of the work for which Oil,peunil is issued is,,. MICROFILM
3097,Civ.C.I. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lend,r's Num,
Lendcr,Address H EATI NO UNIT IOVER 100,000 B.T.U.)9.50 ELECTRIC ze
I cell,,)' Alar 111-1c It'd flit]applll1110n 1110 s late Deal file abut, VENTILATION FAN (SIn.00
information is correct. 1 agree m cant Ply will all city and L'Omll)' PLUMBING
ordinances and tate laws relating lir building cuntrucliun, and BOILER-COMP(3 H.P.or 1 .00hereby awhorire n•Pres,nlativn al this city n1 enm, uoIgOOILER-COMP 10 ver 100, SCH.111-11.mentionedpropert,I..i,npcctlun purposesMECHANICAL
., indamily and keel+ ba... ", 11,11'ite fit MISC,- RD.upmmc, a,n,ut liabililics, jwlgm,nls. n+.1.f and expenses whirl, CONST.TAX
nwy in any' way u,crus• againl sad City it, cunw•yuen,= of the PERMIT ISSUANCE .00tling-11h6MLCH.CONT. LIC.NO2ic" TOTAL Zl 37
Signal.!,a I'Appl.I-TiIT n1nu1 One .
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = LISE.BALL POINT PEN ONLY
I • - -
BUI�,DING PROJECT IDENTIFICATION PERMIT NUMBER
PERMIT
ON $'PERMIT
9VIIOtNI]_ aL�a - L 3
AOdfiL55 ' , � 6
_ _ •� ', �� ] BUILDING•- ELECTRICAL-'PLUMBING-MECHANICAL 1.4.6'2
-,
[NA
WN .S „ PLAN CHECK VALIDATION
AAME 579,Tc f 9.RF( ' OTV. ELECTRIC PERMIT FEE
PHONE T
,TR ALTO 'S a l
E OUTLETS-SWITCHES-RECEP 10.00/1.00
�L/� p Lie.No.�'�p �" LIGHTING FIXTURES -10.00/1.00
noo ess TORSn Ir/2� SII_.,e.,P C firms alp ; -' APPLIANCES-RESIDENTIAL 4.00 Y '
GV Q PHONE PANELS - 10.00 DATE OF APPLICATION .
ARCHITECT ' PLAN CHECK FEE P.C.NO.
oR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. ISIGNS TRANS.' 3:00 . '
ARCH.OR ENG, PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT5.00
. CAN I TS 21, TEMP..METER OR POLE INS. - 20.00
AooREss MOTORS,, 'SEE FEE SCH. /`'N/t1•(./,.��r�.�_�.
SERVICE CHANGE 20.00 _
- Foo- LICENSED CON'T'RACTORS DECLARATION.
rt Thereby affine that I and licensed under provisions of Chapter 9 - iISSUANCE DATE
rs a A (commencing with Section 7000)of Division 3 of the llusi ness and BLDG. ELECT. PLG. MECH.
m i 1'rofesslons Code,u d my license is in lull force and effect O
z o y.- .icense Clung_ C..h mvtmr r'r$z�7' � , p1 .,
Q Y f o'. )ate //Q ? Contractar_QQAGQ(�. - .. . . CON ,
a wa OWNER-BUILDER DECLARATioN BUILDING PERMIT
w °' u MISC.- REFER TO ORD INFORMATION
R..LL G. I herebyu0'inn that I am exempt from the Contractor's License
Foo ¢ Law for the following reason.(Sec.703 L5,Business and Professions PERMIT ISSUANCE _ VALUATION $/FT.
Code:An H or 10.00,49-_
y city n pair icy requires Priori to bousec,also r
IF to improve,demolish,Orrepairany structure,prior la its issuance.also ELEGCONTti. "LIGNO.
ne o¢ requires the applicant for such permit to file a signed statement that i TOTAL
he is licensed pursuant to the provisions of the Contractor's LicerSe _ PERMIT TO
Hz >
Law(Chapter 9(commencing with Section 7000)of Division'3 of the'
I z o Business.,,itProfessions Code)or that he'is exempt therefrom and DTV. PLUMBING PERMIT. FEE /�'L 7M��/
M I- o the basis for,lhe alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant torn permit,adQecis the applicant loucivil penalty ALTER=DRAIN& VENT-WATER (EA.) 5.00
- of not more than five hundred dollars($500).):
• ❑ L as owner of the property,or my enl PloyoeS with wages as BACK FLOW PROTECT.. DEVICE 4.00 OCC.GROUP Res.UNITS
Ibelr.Sale compensation,will do Ilse work,and the structure is net
intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs not apply to an owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare:not intended proffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement issold within one year of completion,the owner
builder will have the burden of proving that hedid not buildor int- GAS-EA.-SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
. prove for purpose of sale:). INDUSTRIAL WASTE INTER.. ,30.00 RES IND CON Pa Omar
-" ❑ I,as owner of thmpeOy,e pant exclusively contracting with - ❑ ❑ '❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN'SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and PmfesSema Code:The Contractor's License law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPR IN KLERS-OVER 5:(EA.) 1.00 -
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ lam exempt under Sec. ,B.&P.C.,lor ibis WATER HEATER W/VENT 6.00
rca9ull '
Owner Dale WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WORKERS'COMPF:NSATION DECLARATION WATER TREATING EQUIP: ;5.00
I hereby affirm that I have a certificate ofconsent m selhinsure,.
or a certificate of Workers'Compensalion Insurance,or a cmtil 61 ZONING ENG.SITE NO.
copy thereol'(Set.3800,L.A.C.). _ - -
Policy No. ' - CompanY
O ❑ C¢fliked copy is hereby furnished. RE SPRINK ENERGY TP4
Z Y Certified WY is filed with lire city Jaspemion,ilivision.
Fp A-pp7icant l,2CR6 -• Ap MISC- REFER TO ORD. N❑ v ❑ N❑
CC y CERTIFICATE OF EXEMPTION FRO M'WORKERS' PERMIT.ISSUANCE. . 10.00Ej±ONE A.L.0c.
Lu > COMPF-NSATION INSURANCE PLG.CONTR. - LIC.N0. PLGOWS section need not be coatpletcd if IIIc pe�mil is lit,one TOTAL+ N❑ v❑ N❑
� Z hundred dollars(S100)or less.)
U O '.- 1 certify that in the performance of the work fsir which this perQTY MECHANICAL PERMIT'-' FEE FEE SUMMARY
.LL F, mil is issued,1 shall not employ any person in any manner so as In
Q w become subject to the Workers'Compensation Laws of California. - '
°- Dmc npphcam ALTER OR A_DD TO MECH. : 5.001BUILDING
} W NOTICE TO APPLICAN"1': If,after ranking this Certificate of Es.
.� Z emotion,youshould become subject(I,file Workers''Compensation. APPLIANCE ' ' f,' 5.00 . PLAN CHECK- �� -�
provisions of the Labor Code, you must forthwith comply with - • 'FEE
C.1 such provisions or this permit shell be deened revoked. t AIR HANDLING UNIT(TO 10=QF.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 agmscy for EXHAUST HOOD(WITH DUCT)' - - 5.00 �-
the performance of the work for which this permit is issued'(Sec. - ,MICROFILM
3097,Civ C.). - HEATING UNIT(TO 100,000 B.T.U:) ' 8.00
Lender's Name -
-" Lender's Address - + HEATING UNIT(OVER000,000 B.T.U.)9.50 . - ELECTRIC
I certify that I have read disapplication and state that the above VENTILATION FAN (SINGLE) 4.00inlr -
ordinances is cornu 1 agree In comply coon all construction,
and courtly BOILER-COMP I3 H.P.or 100.000 B.T.U.) 6.001PLUMBING -
+ ordinances and state laws re ((I c in building con.ty and co and
above-hereby enti o ed representatives ins ec This city in enter upon lire BOILER-COMP (Over 100,000 RTU)SEE SCH. MECHANICAL`
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- ' - _ REFER TO ORD. -
-' - -Cupertino against liabilities,judgmenls;costs andmxpcmcs which - CONST.TAX
may in any way accrue against said C�y in consequence of the ; - 'PERMIT ISSUANCE 10.00
ranting ol'ihis permit. MECH.CONT. --LIC.NO. MECH:.
tet, TOTAL TOTAL , zZc37
Signature o nn radar are -
OFFICE COPY
;' s