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13631 (2) POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER CITY OF CUPERTINO 13631 INSPECTION DIVISION JOB INSPECTION RECORD 'PERMIT EXPIRATION JOBADDRESS 10923 N. WOLFE ROAD UNIT# LOT# PERMIT. EXPIRES IF WORK OWNER VALLCO VILLAGE (QUEE9NTR,ZF,b' OTSEN s,irNS, IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1!IO UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE ECR. MECHANICAL , . RLUc. ELEcr. PLc. M DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED C`ty Of '1�IN OIRMATIONT WOOD FLOOR VALUATION $/FT. PLUMBING -'7/y./ MECHANICAL /K/• PERMIT TO ELECTRICALvv FRAMING STORIES TYPE CONSTR. INSULATION, OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF - SO FL FLOOR AREA -TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PR Ober 1 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 El El ❑ 1:1ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST MECHANICAL ACC DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # INSULATION PLUMBING ZONING ENG.SITE NO. GAS FIRE SPRINK ENERGY T24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ N❑ v E:] "� I FLOOD ZONE A.L.U.C. LATH—INTERIOR" ELECTRICAL LATH—EXTERIOR FIRE DEPT. v❑ N❑ v C] NE] SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR IBUILDING , SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING ' FIREWALLS ELECTRIC 7 PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — '" IMPORTANT! CONST.TAX . PLEASE READ REVERSE SIDE BEFORE TOTAL A 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 ADDRESS/(9/TGF/ �WoL BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 13631 owrvEfA:e;� NAME/\(WC// PLAN CHECK VALIDATION DTV. ELECTRIC PERMIT FEE HONE CONTRACTOR'S. NAME©?'�, ^•'/� '. OUTLETS-SWITCHES-RECEP 10.00/1.00 ! �/�-N CJ/(G' IC.NO"' IS LIGHTING FIXTURES 10.00/1.00 nooA¢acr;0- APPLIANCES-RESIDENTIAL' 4,00 PHOrvE ` PANELS 10,00 DATE OF APPLICATION on - - ' PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.NO. ENGINEER LIC,ND. SIGNS TRANS. 3.00 ADDRESS ARCH.OR ENG. ' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ��nII APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE 7�- CHANGE 20.00 022 ' 02 LICENSED CONTRACTORS DECLARATION a Z w I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE < (commencing with Section 7000)of Division 3 of[he Business and - BLOGS kB LECT. PLG. MECH. H in i Professions Code 'cense is in full f fe El 1:1ZO i w � 'W Licens lass Lic.Number w Contractor < x BUILDING PERMIT Ic s,a OWNER-BUILDER DECLARATION o a v INFORMATION I'xu ; LL�r 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD N VALUATION $/FT. F O,g Law for the following reason(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, - O '�)jY'� Q�r 2 R Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC NO. %LEC. / a wDLL requires the applicant for such permit to file a signed statement that TOTAL I3- PERMIT O sew he is licensed pursuant to thee provisions of the Contractor's License �r`� rz > Law(Chapter 9(commencin with Section 7000)of Division 3 of the J' 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ' w r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a 3.- by any applicant for a permitsubjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($5000.): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 ' Cade: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 s0.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. eildats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 - r improvement is sold within one year of completion,the owner- 0o' EASYSTEM OVER 4 IEA) 200 - Briar w - . - . . ill have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ 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 to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sac.-,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00' ACC.GATE ACC FILE N0. WORKERS'COMPENSATION DECLARATION WATER,TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation tion InifZONING ENG.SITE NO. copy thereof(Sec.3800 parry)f IA Policy No, ompany -/"(O/ - 0 ❑ Certified is hereby FIRE SPRINK ENERGY T49 Z Z §f Cert ifie c i 1 ci Y mi Division. O A¢plicanl s MISC.- REFER TO ORD. y � NEI v ❑ IN[3 ~ H 10.00 UJ - CE I KATE OF E PTION ROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. CL COMPENSATION INSURANCE PLG.CONTE. LIC.NO. I.G.P •Y NE] V [:] N[] Z El (This section need not be completed if the permit is for one 'TOTAL hundred dollars(S100)or less.) L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. III. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �3 } N NOTICE TO APPLICANT'. If,after making this Certificate of F.x- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply withFEE V such provisions or this permit shall'be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER10AMC.EM-) 6.00 SEISMIC FEE a� 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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UN IT ER 100,000 B.T.U.)9.50 �. Lender's Address ELECTRIC 1 certify that I have read this application and state that the above VENTIL TION FAN (SINGLE) 4.00 information is correct 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives ec[his City to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpbscs. (we) agree to save, indemnify and keek harmless the City of MISC.- REFER TO ORD. Cupertino a had liabilities,judgments, costs and expenses which CONST.TAX may in way acer gains[ said City in consequence of the PERMIT ISSUANCE 10.00 grant g this porta. ) MECH.CONT. LIC.NO. MECH. TOTAL TOTAL �95" n o Ap b ontrael Date " OFFICE COPY