10937 POST THIS CARD NEAR FRONT.OF BU iIV,G ..
.. �t• - - �.J PFRMIT NUMB[II
CITY OF" CUPERTINO '' ' q 7
INSPECTION DIVISION' 1093
J 4 JOB,INSPECTION RECORD
•vz
1'' PERMIT EXPIRATION
i. 7524 LEEDS AVENUE
JOB ADDRESS -UNIT# LOT# ' PERMIT,EXPIRES IF WORK
OWNER JACK ROSENTHAL CONTRACTOR GRANT GUSTAVSON IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION Dj-LI - 8 hOC- Q e'cccp V U^ ANCE OR 180 DAYS FROM
LIFER 7 S�{-O-IMSv '„' g4va9r QrY' COYrec��bN AST.CALLED INSPECTION.,,
PERMIT VALIDATION•
PR EGUNI7E � - - - � ,qq
X7.06
POUR NO CONCRETE UNTIL ABOV HAS BE SIGNED
UNDERGROUND /SLAB c �Y"
PLUMBING
ELECTRICAL Clfissunnc'€!b �6nn'
MECHANICAL - BLOG. ELECr. PLG.'-• MECH.
❑ . ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING -
MECHANICAL � - - - -
. \PERMIT TO
ELECTRICAL -
FRAMING' -2 eKC-e DS ' '
Q��y $tOR1E5 TYPE CONSTR..
INSULATION ,� ,�IL I'�"'� -l'
' OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SG.FT.FLOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM - -�Z- - -BUILDINGUSE
RES fIND CON PB 00",
W
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED D ❑ ❑ 0
ASSESSORS PARCEL NO.
ROUGH
PLUMBINGj [AL _ iYv 5�1�'i /-/9 SFr
TRACT NO. PARCEL NO.
GAS TEST '
MECHANICAL -
ACC.OATE ACC.FILE NO.
ELECTRICAL' 2- FINALS DATE INSP. .
FRAMING ..�, r . IYA5 _ SAN.# ZONING eNa SITE NO.
INSULATION _ PLUMBING ,3-
r 11
7ta 313-ow tab GAS �8
FIRE SPRINK ENERGY T 24
I - MECHANICAL '-3 Y ❑ NC] Y ❑ NE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING .
LATH-INTERIOR '-p-d L ELECTRICAL FLOOD ZONE A.L.0 c.
LATH-EXTERIOR FIRE DEPT.' III
v NE] Yo NE]
SHEETROCK ,.1 - GRADE FEE SUMMARY I
SHEAR INTERIOR+`^y, -12-$$ BUILDING '
BUILDING - 4
SHEAR EXTERIOR UAtN 5-12"8Qj TEMPOR RY PROVALS
FIREWALLS ELECTRIC PLAN CHECK
' GAS1(2 S FEE -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE'FOR INSPECTION BY PHONING 252-4505, ' ELECTRIC
1 ` F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
jC Z MECHANICAL SEE>PERMIT"FOR EXPIRATION DATE ='
IMPORTANT! CONST.TA /l3
PLEASE READ REVERSE SIDE BEFORE TOTAL 7
CALLING FOR FINAL INSPECTION. /I OFFICE COPY
1\LICANT TO FILL IN INFORMATION WITHIN RED LINI���-.USE BALL POINT PEN ONLY
�. BUILDING PROJECT IDENTI FICATION - �-' �� PERM IT NUMBER
\G 4NILOING APPLICATION & PERMIT
ADDRESS �uDn•V£ . a BUILDING-ELECTRICAL-PLUMBING-ME
MECHANICAL
10937
OWs CHECKPLAN
VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
Soi RosrN mL PHONEa4 -;l3
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAM4E n Y-- /6 'I
115 ✓ AJtrC.NO, J,S LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
' ADDREss
' Jet PHONE"4-3(V� PANELS 10.00 DATE OF APPLICATION
ARCHITECT
` J_( �(�Cc PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR 7,,4 V GJ JCr
ENGINEER P n
LIC.NO. SIGNS TRANS. 3.00 ,/
ADDREss ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ztR EMP.METER OR POLE INS. 20.00 X71 l t I
rl
AP
ADDRESS
rS- MOTORS SEE FEE SCH.
Ess s
SERVICE CHANGE 20.00 �- t upeltino
O. Z.o o LICENSED CONTRACTORS DECLARATION '
¢o U I hereby affirm that 1 am licensed under provisions of Chapter 9 LANCE GATE
t- z a (commencing with Section 7000)of Division 3 of the Business and
BLD ELECT. PLG. MECH.
F m" Professions s-I- yW my license is id(ell for •yn ([FSty.. " ❑ ❑ ❑
z D m ;License ass_ C Lin.NumbContractor . fo
Q y q Date Ff1j^I'�1-86 Contractor- _
¢
w3: ¢ •OWNER-BUILDER DECLA ATIO BUtL DING PERMIT
a,
OAU MISC.- REFER TO ORD INFORMATION
wa.I- I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
u O a Law for the following reason(Sec.703 t.5,Business unJ Professions PERMIT ISSUANCE 10.00 Q
E � 0 Code:Anyclty orcounty whichrequiresapermiuownstmet,alteq
¢ ce f¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /y Is �`v r
C e, requires the.applicant for such permit to file a signed statement that TOTAL 3(// PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License _
Ha 'e Law(Chapter 9(commencingw'ith Section 7000)of Division 3 of the �+
i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE S%
it I-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES
by any applicant fora permit subjects the applicant o a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than fisc hundred dollars(S500)J:
❑ I,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 the work,and the structure is not
intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:'him Contractor's License Law docs not apply loan owner of -
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALALREAGE
himself or through his own employees,provided that such improve-
mentsamnotintendedoroffered for sale.If,however,the building GAS-EA.SVSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 2.00 UILDING USE
builder will have the burden of proving that h . .
e did not build or int- RES IND CON PR Omer
prove lot purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the 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
contracts for such projects with a contrzetorts)licensed pursuant to
me Comractor s License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL N0.
❑ l am exempt under Sec. ,B.&P.C.fix this WATER HEATER W/VENT 6.00 -
reasmr
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE ND.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm 11,21 I have a cenilice,of consent to odfminsum. - ZONING ENG.SITE NO.
/ or a certifeam of Workers'Compensation Insurance,or 2 certified
�C copy there-�n(f��{Fc.30, ab.C.).��
Policy Nosiilf.71. pry--- l
O ❑ Certnfieddd copy ish r yfurnished. FIRE BPRINK ENERGY 24
a4 Certified copy is filed with the cit inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
p1� Afipbcant Y N Y N
� N CE TIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UL.
LU > COMPENSATION INSURANCE PLG.CONTR. .LIC.NO. PLG.
d a (This section need not be completed if the permit is for one TOTAL YE] N❑ Y ❑ N❑
Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any mdnner so as to
U become subject to the Workers'Compensation Laws of California. (` .XJ��{
U w
Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING G(6r
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex.
Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK y
provisions of the Labor Code, you most reHlo,ith comply with FEE a
U such Provisions or this permit shut[be deemed revoked. AIR HANDLING UNIT(TO 1QODOCF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.EM.) 6.00 SEISMIC FEE 3e
i
I hereby affirm that there is.a construction[ending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued fSee. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that 1 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
infonnxtion is correct. I 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 of this city to enter upon ate BOILER-COMP rover,100,000 BTU)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 CONST.TAX
may in any way accrue against said City in cons] uence f the PERMIT ISSUANCE 10.00
granting of this permit
MECH.CONT. LIG NO. MECH.
TOTAL, TOTAL
ore o pplic Contrac or to
OFFICE COPY -