13224 POST THIS CARD NEAR FRONT OF BUILDING
'•'��'� <�;' - - Pfi HMITNUMBEN
CITY OF . CUPERTINO 13224
INSPECTION.DIVISION
JOB INSPECTION RECORD
• ' - PERMIT EXPIRATION
10501 N. TANTAU AVE. T•FT r-r '
C.�✓ JOB ADDRESS UNIT# 'LOT#
PERMIT EXPIRES IF WORK
OWNER TANDEM COMP. CONTRACTOR RUDOLF ANn ST,T'TTBN IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE•OR .180 DAYS FROM '
UF,ER
LASTCALLED INSPECTION.
-
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING /� �'
ELECTRICAL rhV Q Y' ISSUANCE DATE
B G.
MECHANICAL ELECT. PLG. MECH.
-
❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION '
WOOD FLOOR VALUATION SIFT.
PLUMBING . )-w..�E
MECHANICAL �u V V
PERMIT TO
ELECTRICAL ,,pp
FRAMING - / STORIES ,�0R L
TvpE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O,Fi.iLOOR AREP TOTALACREAGE
ROOF
J- DIAPHRAGM cp
BUILDING USE
f
RES IND CON PB Orn.r
- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING - TRACT NO, PARCEL NO,
GAS TEST
MECHANICAL
ACC.DATE ACC.FILE,NO.
ELECTRICAL - FINALS DATE INSP.
FRAMING SAN n -
ZONING ENG.SITE NO.
INSULATION PLUMBING
W. GAS
FIRE SPRINK ENERGY L]<
MECHANICAL Y E] N[:] YE] N❑
COVER NO WORK UNTIL ABOVE HAS BE IGNEO HEATING
FLOOD ZONE A:L.u.c.
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR - FIRE DEPT. -•�!- Y NC_ Y ❑ No
SHEETROCK GRADE FEE SUMMARY.
SHEARINTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS - ,. ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
UJ
4ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
M PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX
IMPORTANT!
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 r
BUILDING PROJECT 1 DENTI FICATION PERMIT NUMBPR
ar,EDBU APPLICATION & PERMIT 13 2 2 4
�G Ap6Ey, ,y ' n BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
y. OWNER'S N /1cn f.S - PLANCHEVALI TION
QTY. ELECTRIC PERMIT FEE9U
C TRattons :J UTLETS-SWITCHES-RECEP 10.00/1.00 r0 J
E.trOiPl�f j1 La uc.N LIGHTINGFIXTURES 10.00/1.00
1. - �
r,Drvrnacroa�sL (/�71/C APPLIANCES.-RESIDENTIAL 4.00
Oby1o37 , PHONEt')1✓✓ PANELS 10,00 DATE OF APPLICATION
.� o"W_'rS', rte.,( Iz � � Q,s q PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.c.rvD.
r�fd-7`E'e Llc.N..CIV SIGNS TRANS. 3.00
AR H.on E.G. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
55 r,
C� C)b4lI U �. rev 9 O- EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS s _
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a v w I hereby affirm that I am licensed under provisions of Chapter 9 CISSUANCE DATE
2 (commencing with Section 7000)of Division 3 of the Business and - IBCDG. ELECT. PLG. MECH.
D i Professions Co an my license is in full 10, e 1 et. sJ�
o v - Lice yy au Liu.Numbe //� ❑ )10 ❑
0 m DmenSComndor�Ja�
ams ,`BUILDING PERMIT
¢ ¢ c Q OWNER-BUILDER DECLARATION INFORMATION
wN I hereby;(firm that I am exempt from the Contractor's License MISC.- REFER TO ORD
uog law for the following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ,za.- TION S/FT.
y'r+ Code:Anycity orcountY which rc9uiresa permit to construct,alter, 7TZ7//
S ¢G FO improve,demolish,or repair any stractu¢,prior to its issuance,also ELEC.CONTR. LIG NO. ELEC. / -
In G u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division3 of the INTER/QaQ /ytw.G
- < Bushiness and Professions Code)or that he is exempt therefrom end QTY. PLUMBING PERMIT FEE
� xD
¢ r $ the basis for the alleged exemption.Any violation of SeClion 7031.$ STORIES TYPE CONSTR.
a ; - by any applicant for a permit subjects the applicant to a civil penalty
ALTER-DRAIN (EA.) 5.00
of not more than five hundred dollars($500).):
Cl I,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 es not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law al.not apply to an owner of
property who builds or Improve,thereon,and who does such Wort( FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such Insprove-
mentsare not intended or attend for sale.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
r 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- RESIND CON PB O,ner
Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contraction to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. ,6.00 AS5E550HS PAHCEL 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 contnetons)licensed pursuant to
the CDntmctors License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O l am exempt under Scc. ,B.&P.C.for this ' WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 `I
I hereby affirm that I have a certificate of consent to self-insure. ZONING
or a certificate of Worker'Connsur t pensation Icu,or a certified ENG.SITE NO.
copy thereof(Sec.3800,Lab CJ. 1a
Policy No. Company llr.�af
0 ❑ Certifse qpy lshe toy furnished. FIRESPRINK ENERGY T-24
Z Z ❑ Certif opy is filed i ny sp ti on. MISC.- REFER TO ORD.
Applicant Y ❑ N❑ v ❑ ,N❑
Fri �JU�ON�� PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc.
Cc: CERTIFICATE OF EXEMPTION FROM WORK.R. S
DJ _ COMPENSATION INSURANCE PLG.;CONTR. LIC.NO. PLG,
ITY❑ N❑ Y❑ N❑
d Tis section need not be e perm
completed if the is for one TOTAL
Zi Z hundred dollars($100)or co.)I
U O 1 certify that in the perbommnce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,1 shall not employ any person in any manner so as to
V become object to the Workers'Compensation laws of Califomu. Q'p
0 w Date Appliciul BUILDING �� 3
a ALTER OR ADD TO MECH. 5.00 i
} rn NOTICE TO APPLICANT: If,after making this Certificate of Ex..
.F2 emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the labor Code, you most forthwith comply with FEE
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 10,000CEM.) 6.00 SEISMIC FEE.
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 HEATING UNIT(TO 100,000 B.T.U.) 8.00 - MICROFILM
3097,Civ.CJ.
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
J Lenders Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'b. information is correct. 1 agree to comply with all city and county PLUMBING
-) 'ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (on,100,000BTU)SEE FEESCH. 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 cx,omws which 10.00 CONST.TAX
ma any way accrue ��arr .Ca sjd City 'n ru scyuc}�ce of the PERMIT ISSUANCE H.
W ti g Of this permll� /r �a �� / MECH.CONT. UG N0. MECH.
/ .r///L(7g/ a / TOTAL TOTAL
Signature of Applicant/Contractor Date
OFFICE COPY -