12971 POST THIS CARD NEAR FRONT OF BUILDING
- j CITY OF CUPERTINO Y PERA,IT NUMBER .
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10435 N.Tantall- UNIT# LOT# PERMIT-EXPIRES IF WORK
OWNER Tandem CONTRACTOR Valley Electric IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 7_�. Y /v ANCE OR- 180 DAYS FROM
LASTCALLED INSPECTION.
UFER - 6=67 L.a 2i AR,C-7 -/ 94-
PR EGUNITE D' ev PERMIT VALIDATION
7
s ARS 'a1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f-2 A p ,
UNDERGROUND /SLAB P;9>5 2,1, 3 <<
PLUMBING
ELECTRICAL 9-F187 - 'Z�/¢6� /P45'J'A•H'/�L�E ISSUANCE DATE
MECHANICAL /V-JL-$7 LKF �''� 1Gew-5ac BLDG. ELECT. PLG. MECH.
A -G if A✓J ❑ ❑; ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED m_'25- •b"7 /Q 414 f(LC EF e SUT7 BUILDING PERMN IT
INFORMATIO
WOOD FLOOR z�JF VALUATION $/FT
PLUMBING I14 11'4 u2 -
MECHANICAL
PERMIT TO
ELECTRICAL L{^/ 'C67/L/'"f" L t z
FRAMING RLQ - �' � fi�Y sroRlEs ry PE coNSTR.
INSULATION' U'-2P1"Yk e-IZ/L! L&-d—/
cwzsT- '
n G GST OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �.
50,FT.FLOOR AREA TOTAL ACREAGE
.�, ROOF
DIAPHRAGM
F BUILDING USE
HES IND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ` ❑ ❑ ❑ ❑ ❑
ROUGH
'ASSESSORS PARCEL NO.
�-/v-$� `� -`�JL' /EL-
PLUMBING jzr, _ '
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL
1PCC.GATE ACG FILE NO,
ELECTRICAL FINALS DATE INSP. -
FRAMING SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING ,
GAS
FIRE SPRINK ENERGY T�24
MECHANICAL Y ❑ NO Y ❑ NO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.uc.
LATH-EXTERIOR - FIRE DEPT. Y NO Y D NO
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS - ELECTRIC - PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY 'SEISMIC FEE '
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY.BUIL•DI NG INSPECTOR. MICROFILM
I
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
FW ONE.WORKING DAY BEFORE REQUIRED INSPECTION:, PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
r Z - MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE — -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
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 12971
ADDRESS LJ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
DINNER'S � PLAN CHECK VALIDATION
NPNE 3 7 ELECTRIC PERMIT FEE
T
PHONE
CONT E RACTOR_S OUTLETS 10.00I1.00
NA
Ic.No. IZ LIGHTING FIXTURES 10.00I1.00 12
CONTRACTORPPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE _ b hJ f5 .ANELS 10.00 DATE OF APPLICATION'
ARCHITECT •7 PANELS (OVER 200 AMP) 20,00 O PLAN CHECK FEE 1.0.NO.
uR
E NEEP
Ic.No. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS4IX) ZIP TEMP.METER OR POLE 20.00 ^
APPUCANT'S CrsT MOTORS 4 TRANS FEE SCH. Z
ADDRESS�f ^ \
�ai'ZS /V SERVICE CHANG .00
a 0 LICENSED CONTRACTORS DECLARATION fs,,Y
<U. 1 hereby affirrn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
z ea (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
ri Professions Code,a d4my license Is in full forcrl eiff ❑ ❑ ❑
z O v� - License CI s �� Lid.Number 1
o z �_ °w Dete "-Z- Contractor BUI D NG PERMIT
Q y J
2 re u OWNER-BUILDER DECLARATION INFORMATION
X
I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
A Y VALUATION 5/FT.
ar Law for the following reason.(See.7031.5,Businessand professions PERMIT ISSUANCE 10.00 IQ.
Code:Any city or,county which requires a perosit to comtruct,alter,
rt ¢ 2 improve,demolish,or repair any structure,prior to its issuem o,also EC NTR. LIC.NO. ELEC.
C u requires the applicant for such permit to file a signed statement that ` TOTAL IZIq -
PERMIT TO
w$ he rs licensed pursuant to the provisions of the Contractor's License /CIJyL--•
z i Law.(Chapter 9(commencing with Section 7000)of Division 3 of the
a Busness and Pmfessiom Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE CONSTR.
se by any applicant for a permit subjects theapplicamt toe civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more then rive hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW 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 (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractors License Law does not apply to an owner of
e property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 SD,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00
or Improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of salt.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am 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 Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improve thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant m.
the Contmctor's License Law. SEWER-SANITARY-STORM EA.200ft110.00 TRACT NO. PARCEL NO.
❑ I an,exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6600
reason
Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certifcale of consent to self-insu¢. ZONING
or a certificate of Workers Compensation Insurance,or a cerlifeJ ENG.SITE N0.
cop 4c,p ,Sec.]800,LA.C.I
Polio Nsi.L2V=.repinY C�ls'1�
O ❑ Certified Copy is hereby fumished. FIRE SPRINK ENERGY T-24
Z Z v (7viOed ep(�yD ifi1W with the,cit nsptction division. MISC.- REFER TO ORD.
O Applicant _ CAILL Y ❑ N❑ Y ❑ N❑
CC a CF R I F-ICATE 01:Ii X EM PT 10N Ir ROM WOR K1:RSPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. ❑C.No. - PLG. V❑ NC] Y ❑ N❑
CL O (This section need not he completed if the Ipermit is fee one TOTAL
Z) Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Califomia.
O w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ tan NOTICE '1'0 APPLICANT: If,after making this Certificate of fix-
Z emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 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 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 AddHEATING UN IT[OVER 100,000 B.T.U.)9.50 ELECTRIC /
rtss
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply.wlth all city and County PLUMBING
ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.or 1 DOXID B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over too,"STU)SEE FEE SCH. MECHANICAL
above mentioned property for inspection purposes.
(We) aero to save �tlderanify and keep h.l. the City of MISC.- REFER TO ORD.
LIZtirm against litdib ,judgments, costs and exposes which PERMIT ISSUANCE 10,00 CONST.TAX
may a y way rue aimt said City in comsegcamm of the
gremlin Ibis L MECH,CONT. LIG NO, MECH,
ae> TOTAL TOTAL
Signaru o A lieenl Co frac Date
OFFICE COPY