12652 P•,OST THIS CARD NEAR FRONT OF BUILDING ;
'• Y PERMIT NUMBER
CITY OF COPERTINO 12652
INSPECTION DIVISION ;
•� 90 ho
RECORD.,,
//`1 PERMIT EXPIRATION
'JOB ADDRESS Cl� /0 ,/ /CQ �Q� //1'PiC1N IT# I LOT# '
ERMIT EXPIRES IF WORK
OWNER - - . CONTRACTOR -PIS NOT STARTED WITHIN
INSPECTION . DATE INSPECTOR INSPECTION RECORD ! 180 DAYS OF-PERMIT ISSU-
FOUNDATION, ' ANCE OR 180 DAYS FROM ,
UFER
LAST CALLEDdNSPEC710N.-. ,
, 7.-ST7' U -
I,PREGUNITE fLPMIT VALIDATION
Pa d71/
UR WCONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB _ I' 1 ` ✓
.,, 1PLUMBING.. i ' - . .
Gf y cf SSUAN E DATE
� - _ I � •• �
Il ISSUANCE GATE'
m� ELE❑C*,. PL❑G
1 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT
WOOD FLOOR [
11 (I INFORMATION
[ PLUMBING. juvawnnoN S/FT.
[MECHANICAL ' 7 L�..w CC�' l�j� I - ' 'r E•',:•.,( .r�,,.)
[ELECTRICAL [• I I ,iERMII TO
'[FRAMING ,- :7l1/ I '.r - �. 6'✓.,.+ .
INS SIV LATIGN, I [ - -,� STOHIES TYPE CONSTH
_dtivt. / n . �I/D-
.+„ - / OCC CHOUP .RE UNITS �.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEO • "
q� ROOIF I „ G -T FLOOII AREA TOTAL ACREAGE
1 DIAPHRAGM Moo F,.rH(f�'IN/.11G . I '
BUILDING usE„
RES IND CON PR 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED [ 2 '❑ ' ❑ ❑ ❑
ASSESSORS PARCEL NO
I ROUGH:
, . '[PLUMBING �,TOPON7�
.. 1 GAS TEST �. -.➢'S! 11G�d I ' - I TRACT No, PARCEL No,
[MECHANICAL I _ 5/^ [ �11,• '�'
L,^ ACC,DATE ACC.FILE.NO.
' ,[ELECTRICAL � [ !/.¢./ ! FINALS DATE INSP. ! _
[FRAMING ed 9.y P7 ISAN # '�.� l.'�/ '• '_, ! • I .
ZOwNG' ENG.SITE NO
[ INSU CATION _ _ [PLUMBING ' � ,'.z _ I
l� [GAS ' I' n
+. ,[MECHANICAL - I I�-//rJ/, 1/ii ;I
Fl SPR INK ENERGY T 24
I COVER NO WORK NTIL ABOVE HAS BEEN SIGNED IIHEATING [ E P I ❑ "❑ e Y ❑ "O
F LOOUZDNE - A.L U.0 91 V[LATH-INTERIOR„s �Q-o�D.� IELECTRICAL _ �1; y- IF-7- fib
[LATH,EXTERIOR ,I: (FIRE DEPT. I _ v❑ "❑ rI] N❑
1SHEETROCK 4 T [GRADE” [ I' I FEE SUMMARY
,'I SHEAR INTERIOR � J _ [BUILDING - J
BUILDING EXTERIORk *+ ;-1 TEMPORARY APPROVALS PLAN-CHE C,K I FIREWALLS• [ELECTRIC
-
I I I 1GAS FEE
I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY I I SEISMIC FEE
[OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL'IS SIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION'SY-PHONING 252.4505, ELECTRIC
H� ONE WORKING DAY BEFORE.REQUIRED INSPECTION. . LUMBING
,ECTION. .
PLEASE GIVE JOB ADDRESS WHEN PHONING. l
,�J Z AL
— SEE PERMIT FOR EXPIRATION MECHANIC
',DATE —' '
CONST.TAX I'^
IMPORTANT! ,
PLEASE'AEAD REVERSE SIDE BEFORE TOTAL
CALLING FORE FINAL INSPECTION.
— -- — — --
,. OFFICE COPY _, ., —
APPLICANT TO FILL IN INFORMATION WITHIN RED.LINES - USE BALL POINT PEN ONLY
. t PERMIT NU!ABER
BUILDING PROJECT IDENTIFICATION, APPLICATION & PERMIT
ACHORPS NICAL 12652
vVL71690 Alcazar A BUILDING - ELECTRICAL-PLUMBING-MECHA
S OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
PJcm,"446-1913 F
CONTRACTOR S
NAME OUTLETS-SWITCHES-RECEP 10.0011.00
Debcbr Corporation�11C.NO. 38-9712 1@3 LIGHTING FIXTURES 10.00/1.00 A3
CONTRACTOR`21625 Stevens Creek Blvd .1 ,q APPLIANCES-'RESIDENTIAL 4.001
ADDRESS
Cupertino. 95014 IROSIE,446-1913 1 . PANELS s DATE OF APPLICATION
1000
ARCHITECT PLAIN CHECK FEE PC NO,
.OR Seals & Assoc' . . c-151 PANELS (OVER 200 AMP) 2
ENGINEER
SteDhen' Clark LIC NO C-6382 SIGNS TRANS.
ARCH.OR EN% 5.001 PERMIT VALIDATION
ADDRESS eals, Oakland' CA SPECIAL CIRCUIT
Clark. qaratocra. CA zu, TEMP.METER OR POLE INS., 20.001
APPLI ANT'S
ADDACESS MOTORS SEE FEE SCH.1,1
SERVICE CHANGE
_2lk9q qtesveans Cre k Blvd. Cunt M. 20.001 L.
0.�0 LICENSED CONTRACTORS DECLARATION I
CSSJAI �E-
I hereby ftT ri that I inin Im,C.d order pamOs.....S at Chapter 9 1 9 1 IS DATE,,-
z w (commencing with Section 7000)of Division 3 of the Business and BLDG ELECT. PUG. - I PASCH.
Pa.fiExsmnSC.dc1nd my license ism full fare T
0,o - L RS�Q LIE Mellr!`
so
I__ c
Date Car �t!orty— 2— z. a
31 1 1 1 City Of CLI,,C tir"o
M� g m�< OWNER-BUILDER DECLARATION BU DING PERMIT
E: 0 W Er I I FORMATION
X i: a_ I hereby J6.... that I.,,I exenn,pt Ron, the Contractor's License misc.- REFER TO ORD _1 _7
to a. Cr. Law for the following reason (Sec.703 1.5,Business and Professions ;PERMIT ISSUANCE VALUATION
s- < 10.00 /0 —
i � 0 ` Code�Any cayoecounty which requires a permit to construct,alter. ELEC - -ev
Sa � , improve,demolish,or repair any structure,prior to its isstuince,also ELEC.CONTE. LIC NO
. <0 1W -0
a. TOTAL 13s�
S_ requires the applicant for such permit to file a signed statement that
X a- -he is licensed parsuant to the provisions of the Contractor's License PERMITTO
a, �0 Law(Chapter 9(commencing with Scchod 7000)of Division 3 of the
Bitsiness and Professions Code)or that he is exempt therefroun and OTY PLUMBING PERMIT FEE
W the basis for the alleged excurption.Any violation ofSeclion 7031 5 1 STORIES TYPE CONSTR,
by any applicant for a permit subpects the applicant loacivil penalty ALTER-DRAIN&VENT
of not mom than tive hundred dollars 1$500),). 1 2, .
0 1,as owner of the property,or my employees BACK FLOW PROTECT.DEVICE 4.001 OCC.GROUP RES UNITS
their sale compensation,will do the work,and the st
intended or offered for sale (See 7044, Business an DRAINS4LOOR,ROOF,AREACOND. 5.001
Code The Contruclor's License Law does not apply to an owner at
property who builds a,improve,thereon,and who does such work F IXTUR ES-PER TRAP SO I SO.FT.FLOOR AREA TOTAL ACREAGE
houself or through his own employees,provided that such impro -- -1 1.NC. 72
merits are not intended or offered for sale.It,however,the budihng I IGAS �EA.SYSTEM 4 OUTLETS S:0", .2(04
or improvement is said within one year of completion,the ower'. IGAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder Will have the burden of proving that he did Out build or in-I BUILDh G USE
prove for purpose of sale.) JINDUSTRIALWASTE INTER. 30.001 RES IND CON PB Othar
0 1,as owner of tire property,am ex,d'I contracting with I 'm 0
liecinted contractors to construct the IT...met(S,,.7044,Business I ILAWN SPRINKLERS-I INC 5 V.B. 6.001
and Professions Code:The Contractor's License Law does not Apply ASSESSORS PARCEL NO
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.001
contr cis for such piqccts with a contructoga licezised pursdan -3,S-'7
tire Contractor's License Law. �SEWER-SANITARY�:STORM EA.200ft/1 O.00VO TRACT NO. ;ARCEL NO,
D I am exempt under See B&PLC'fv' WATER HEATER W/VENT 6.001 P0 le
m.som
Own., Date
I I WATER SYSTEM.1 91 ....../ ACC.DATE ACC,FILE NO,
WORKERS'COMP�,NSAI[ON 6ECLARATION WATER TREk T ING EOUIP. 5.00l
I hereby affirm that I have a certificate ofconen if one 5 1 _#* r, I
or.certificate —_T__ ZONING END SITE NO.
copy thereof(See 3800 L.b C I G
Policy No_C.�p.nyL'_U,5P & an-
of Workers'Compensation In
0 Coached copy sherchy furni,led, city nalm FIRESPRINK, ENERGY T 24
z z Ce�tdfily ,�gc�_fi�i with the �hon division.
P: 0 Aolican Es orn I IMISC.- REFER TO ORD' YE3 N[
CC T CERTIFICATEOFEXEMPTION FROM WOkKl:�S' PERMIT ISSUANCE 00 , 0 FLOOD ZONE A.I_U.C�
Lu > CO�PEN�ATION INSURANCE PLG.CONTE. LIC.NO LG
DEAL Y E] N
.(This Section need not be completed if the I �7,
0 IT Y [:] N 0
z hundred dollars($100)or less)
2 1 cenif,that in the pi,rVor-Arince of tire work for which this per. (ITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t our is ksamd,I shall not employ any person in any manner so as to
0 Ed become subject to the Wericrs'Compensation Laws of California I BUILDING
> Date 6 * , * A,plmaml I ALTER OR-ADD TO MECH. 01
' IT) APPLICANT. If,alter making this Certimate at his
W NO I PCE 5.0
Z empire"you should become subject to the Workers'Compensation APPLIANCE 5.001 1 PLAN CHECK
provisions of the Labor Code yen most torthovith mordy .,I I FEE
such provisioa�or this pennit shall be deemed revoked AIR HANDLING*UN&(TO iO=C.F.M.) 4.001
- . �ONSTRUCTION LENDING AGENCY 'AIR HANDLING UNIT(OVER 10MC.F.M.) 6.001 SEISMIC FEE
I hereby affum, that them is a Linaltourtim leading agency far EXHAUSTO-,10013-MITH DUCT) .4 5.001ss�
the performance of the work for which this Permit IS issued(Sec.
3097.CY.0 I HffATiNG-UNIT(TO 100,000 B.T.U.) 8.001 d I MICROFILM
Leader's Name n a FnA
Lcrudv,'SAddmSsWA1ma t J=�Sjj=_d I HEATING UNIT MVER 100,60013.T.U.)9.501 I ELECTRIC
I ertrry that I hu,,emad thc,.pd;,,.tma ad state that the admvi: VENTILATION FAN (SINGLE) 4.001-5Z
information Is correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and IBOILER-COW(3H.P.orlOO,000B.T.U.) 6.001 �'7
lurreby EUmrim nepies6noarces of this city 1. enter amn.the '(0vai 100,000 BTU)SEE FEE SCH. MECH 7
above-mentioned property for inspection purposes I I BOI LER�COMP I
(We) agree to Save,' Indemnify �rd keep hamI 114 City of misc. REFER TO ORD.1
Cupertino against liabilities,judgments, costs'and expenses which I 6ONST.TAX
may in tiny vXty acerm, against said City in consequence of the PERMIT ISSUANCE 10.001/6
t IF in C, At CONT. LIC.NO. MECH
C TOTAL OS
4416/87 TOTAL
Signature plicant/Contoclor ',[)are
OFFICECOPY