13448 (2) POST THIS CARD NEAR FRONT OF BUILDING
PFRMIT NUMBER
CITY OF CUPERTINO 13448
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10851 N WOLFE ROAD UNIT# - LOT#
PERMIT EXPIRES IF WORK
OWNER ATLANTIC FINANCIAL CONTRACTOR AMERICA SIGN & LIGHTING IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PR EG UNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB PAI /,,
PLUMBING (!/
ELECTRICAL r IS 'p NCE DAT
LQG. EL CT- PLG, MECH.
g1liMECHANICAL ❑ ❑ El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED LOING PERMIT
INFORMATION
WOOD FLOOR
VALUATION SIFT.
PLUMBING .1
MECHANICAL
ELECTRICAL Flu/ER/mlr�ro1
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- $O.FT.FLOOR PNEA TOTPL PCREAGE
ROOF
DIAPHRAGM
BUILDING USE
RES IND CON PB Oma
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - - ❑ ❑ El ED ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO
GAS TEST
MECHANICAL
ACC.OATE ACC.FILE rv0.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY T 2
MECHANICAL Y ❑ N❑ yo NC]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE ALuc.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR FIRE DEPT, v N� Y I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
• O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. `
OFFICE COPY
I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13448
ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S -PLAN VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Ao
HONE
TRACTDR's UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
No LIGHTING FIXTURES 10.00/1.00
roN RAcroR's ! PPLIANCES-RESIDENTIAL 4.00
ADDRESS �✓.Aijw e,4 . lyes)
O/ PHONE PANELS 10.00 DATE OF APPLICATION
ARCH( ECr PANELS (OVER 200 AMP) 20.00 PLAN CNECK FEE P.C.NO.
OR
ENGINEER LIC.NO, SIGNS TRANS. 3.00
PERMIT VALIDATION
ADR. ENG, SPECIAL CIRCUIT 5.00
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS ^`ryC
SERVICE CHANGE 20.00 I
Hoo LICENSED CONTRACTORS DECLARATION ,] A r
¢ is 1 hereby uflinn but 1 .,,I licensed under provisions of Chapter 9 ISSUANCE DATE
r¢ w' (commemmng with Section 7000)of Division 3 of the Business and C.
es" D w Professions Codc.:InA n�license is in full fill d ,feA.� tyl P T PLG. MECH.
z o m - icenss'CJns L/ Lie.Number LI I� ❑
g F UatcX j.[�tp�Contmctof �.
a Y s ,/ BUILDING PERMIT
ma,w u OWNBR-BUILDER DECLARATION 2'i� INFORMATION
W3 u y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u. o J Law for the following reason.(Sec.7031.5,Businessand Professions vALUAn ON S/FT.
Code:Any city or county which sequitur a permit to is issuance,
act,alter,
PERMIT ISSUANCE 10.00
Q Q Q MO require,'.demolish,or for n any structure,no pa Si ID Its statement
also ELEC.CONTR. LIC.NO. ELEC.
- O¢ require,the applicant for such permit l0 file a signed sraor's Li that TOTAL PERMIT TO
wLL he is licensed pursuant to the provisions of the )ofDicmr's License Cly
Hzi Law(ChapterProfessions
ode)with Section 7seseni D therefon ooRhe V
a Business and Professions Codes or that hu is ezennp(therefrom and QTV. PLUMBING PERMIT FEE
E t O STORIES TYPE CONSTR.
¢ H$ the basis for the alleged exemption.Any violation of Section]03 L5
n 3 of noimoreicant for five a permitdubjectsthe
dollars a applicant to a civil penalty' ALTER-DRAIN& VENT-WATER IEA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCG.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for Sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 S.OB SQ.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees.provided that such improve-
Bents are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-11SIC.4 OUTLETS 6.00
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 Other
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 El ❑ El El 1:1CII,as owner of the property,am exclusively contracting with
licesed ncontractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCELNO.
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 IEA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ rum exempt tinder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORKERS'COMPCNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
cm ificute of Workers Compensation Insurance,or a certified
copy thereof(Sec.3000,Lab.C.I
Policy No. Company rp.G /aVc
O ❑ Cctliticdcopyislncrebyfurnrsbed. FIRESPRINK ENERGY T 24
Z Z ❑ Certitied�copy i�Isd W 1, the sty inspection division. MISC.- REFER TO OR D. y ❑ N❑ Y ❑ N❑
FyApplicant�4✓/�ill L
PERMIT ISSUANCE 10.00 FL000 ZONE A.L.U.C.
M - C17RT1171CA'1'E OF EXEMPTION FROM WORKERS'
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 ❑ ('Phis section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars IS 100)or less)
U O 1 certify that in the performance of the work for which this per, QTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
O L) become subject to the Workers'Compensation Laws of California.
Dale Applicant BUILDING
} rasa NOTICE TO APPLICANT: If,after making this Ce rifietne of Ex- ALTER OR ADD TO MECH. 5.00
F Z caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK �J
provisions of the Labor Code, you must forthwith comply with FEE /7 r
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work dor which this permit is issued(Sec. HEATING UNIT(TO 100.000 B.T.U.) 8.00 MICROFILM
3097,Civ.C.).
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC
Lender's Address
. l certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
infonnalion is correct.I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to emer upon the BOILER-COMP (Over 100,000 BTUI SEE FEE 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,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
granting of this pennit. MECH.CONT. LIC.NO. MECH.
/ .�" el!- r.��.Ji t�- TOTAL TOTAL �cG.x2
S�gnamre of hcunljConlr Ume -
OFFICE COPY -