12664POST THIS CARD NEAR FRONT OF BUILDING' 14? .•. ,.;,
i - -CITY OF CU:PERTINO "
NUMBERX12664
INSPECTION DIVISION
JOB -INSPECTION RECORD'
'
, '%',•PERMIT
JOB ADDRESS /O / �M4' 1L - /I✓Ci UNIT# LOT# �-"
EXPIRATION
' >x
'PERMIT-
EXPIRES IF WORK
INNERTQ�l (/r coNTRACTOR %^ L///
IS NOT STARTED WITHIN
180.DAVS OF PERMIT ISSU•
ANCE OR 180 DAYS.FROM
LASTCALLED INSPECTION.
INSPECTION ATE INSPECTOR
INSPECTION RECOAD
FOUNDATION
'
UFER �7
PR EGUNITE
-
- PERMIT VALIDATION
I •
- ISSUANCE DATE '
OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB.,
PLUMBING
•�,. -
ELECTRICAL. -
MECHANICAL
- BL G.
ELECT.
PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
'«INFORMATION '•
WOOD FLOOR
.VALUATION
_,/ f/}%
^X\PPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON
-
APPLICATION'& PERMIT
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMIT NUMBER
12664
BUILDING /�/1
ADDRESS Imperial A '94 1
O 'S
E
QTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
D E446-1913
-
'
rvrRAc DR's '.
NAME �.
QC) OUTLETS-SWITCHES-RECEP 10.00/1.00 �
LIGHTING FIXTURES 10.00 11.00 ••
Deb COY Corporation, uc.ND.365712'
s
CONTRACTORS 21625 Stevens Creek Blvd
-
APPLIANCES - RESIDENTIAL 4.00ADDRESS
PANELS 10.00
Cupertino, 95014 PRONE 446-1913
DATE OF APPLICATION '.
ARCHITECT,PLAN
DR Sed15. & ASSOC C-1$162
ENGINEER
Stephen Clark LIC. No. c-6382
PANELS (OVERI200 AMP) 20.00 -
CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR ENG.
ADDRESS Seals, Oakland, CA
SPECIAL CIRCUIT 5.00
PERMIT VAlJDL5TION
EMP. METER OR POLE INS. 20.00
Clark Saratoga, CAP
P�1,•`6�ljj
ppp
Tyr f)
L
``�QB1 `(nB
ADrs
ADDRESSDRESS
21625 Stevens Creek Blvd Cupt
MOTORS SEE FEE SCH. -
SERVICE CHANGE p " 0.00
LICENSED CONTRACTORS DECLARATION
, t II U O 1^.�%
I hereby affirm that 1 am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Cod and my license is in full four, oral �feG.
License CAlnjs,.6.-87 con Number 3257 1L
Date 1 Contractor D2}JCOr-0.'bYP
td Cl
159IMNCIE DATE
, U - .. ..
BLDG.
Rr
ELECT. PLG. MECHJR1.
iv
f�
- - „
'' - piy� Of CsurtB[t(B( .
Ul Y
IT
OWNER -BUILDER DECLARATION
I hereby affirm That I am exempt from the Contractor's License
Law forAnythe a Business tocnd Professions
countywhich(Sec.
requires
Code: Any city or county which requires a permit toconsuanc ,also
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licenseddpursuant to the provisions of the Contractor's License
Law(Chapter 9(commencingwith Section 7000)ofDivision 3 ofthe
Business and Professions Code) or that he is exempt therefrom and
IIINFORMATIOUILDINGFER
�xINFORMATION
MISC.- REFER TO ORD
*
VALUATION
T
.18/FT.
•PERMIT ISSUANCE 10.00 �Q�
ELEC. CONTR. ,,LIC. NO.
ELEC.
TOTAL / 5�
PERMIT TO
-
OTY. PLUMBING PERMIT FEE i
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
1
by any applicant fore Permit dollars the applicant to a civil penalty
of not more than five hundred dollars ($5
'1
C; -
•�.
ALTER-DRAIN-WATER(EA.) 5.00
-
employees
❑ I, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec.,7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve.
meritsare not intended or offered dor sale. If, however, the building
1 -
�
,
10 FIXTURES - PER TRAP 5.00
SO. FT. FLOOR AREA
Z3s0
v
TOTAL ACREAGE
GAS •EA. SYSTEM -11NC. 4;O07OTS 6.00 .-
or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or im-
prove for purpose of saled.
❑ l; as owner of the property, am exclusively contracting with
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an.owner of properly who builds or•improves thereon, and who
GAS • EA. SYSTEM -OVER 4 (EA.) 2,00
_
BUILDING USE
RES IND CON PB Othei
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE I TER9,')u' 336.00
-
LAWN SPRINKLERS -N' INC 5 V.B. 6.00
LAWN SPR INKLERS- OVER 61(EA001f1100
ASSESSORS PARCEL NO. "
-'3 Sr7-/q.-QQ_
contracts for such projects witha conlr:mlods) licensed pursuant to
the Contractor's License Law,
❑ I am exempt under Sec. .B.&P.C. for this
SEWER-SANITAR V-STO M EA, 200ft/10.00
TRACT NO.
PARCEL NO.
-
WATER HEATER W/VENT 6.00 -
reason
Owner Date
-
WATER SYSTEM 5.00
ACC. GATE
ACC FILE NO.
WORKERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
'
I hereby affirm that I have a certificate leconsent or set ertifire„ or ,certificate of Workers' Compensation Insurance, or a cerlil ied^
20NING
ENG, SITE NO,
d
copy' thereof (Sec. 3800, I.A.C.). USF & G
Policy No. Company
•
FIRE SPRINK
v® N❑'
ENERGY T-24
v❑ N❑
Certified copy is hereby famished.
Certified o is Bled with file city inspection division.
Applkanl �E�JCOrCOYD
MISC.'; REFER TO ORD. -
CERTIFICATE 017 EXEMPTION FROM WORKERS' t
PERMIT ISSUANCE 10.00' -
FLOOD ZONE
A.L.U.C.
PLG. CONTR. LIC. NO.
PLG.
TOTAL
.COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y ❑ N❑
Y ❑ .N❑
OTY. MECHANICAL PERMIT FEE
f ..
FEE SUMMARY -
hundred dollars IS 100) or ICA.)
I certify that in the performance of the work for which this per.
mit is issued, I shall not ent Ploy any Person in any mmmer so as to
become subject to the Workers' Compensation Laws of California.
DateApplicant
NOTTC-E-1O APPLICANn If, after making this Certificate of fix-
emption, you should become subject to the Workers' Compensation
BUILDING
3
ALTER OR ADD TOMECH.' „_5.00
APPLIANCE Q n 1'',; '� 5.00
PLAN CHECK
provisions of the 'Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (jO40=C.F. VL) 4.00
FEE
AIR HANDLING UNIT(OVER 10, CtF,(YI! 6.00
SEISMIC FEE
q{�
CONSTRUCTIONLENDINGAGENCY
I hereby affirm that there is a construction lending agency, for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
'
EXHAUST HOOD (WITWDUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT (OVER 100,000 B.T.U.19.50
ELECTRIC
/ �
Lender's Name �]��].7a Rank
Lender's Add. r''' A"'"�AEin lYS�.T._S- �T .SIT
I certify that l have read this application and state that the above
VENTILATION FAN (SINGLE)4,00-
inloonation is correct. I agree to comply with all citytand county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER: COMP I3 H.P. Or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
3
above -hereby entiorid representatives ins of this city es enter upon the
above-mentioned property for inspection purposes.
MISC. - REFER TO ORD.
(We) agreeto save, indemnify and keep harmless the City of
Cupertino against liabilities, judgments, costs and expenses which
may in any way seen ,Rains[ said /Ci�ly in consequence of the
Ianting flhis permit , -µ0y
CONST. TAX
PERMIT,ISSUANCE 10.00
MECH.CONT. - - LIC. NO. MECH.'
7-
TOTAL
3�-
TOTAL
) p qsI
/d/V
Signalurcof Applicant/Confrac or Dale
`�' OF FICE Curr
POST THIS CARD NEAR FRONT OF BUILDING
CITT OF CUPERTINO
PFRkIIT NUMBER
:12644
INSPECTION DIVISION
JOB INSPECTION RECORD'
' -
-,PERMIT EXPIRATION
JOB ADDRESS 10`f74 /N/,a' /6L - 14114 UNIT# - LOT#
i.
PERMIT EXPIRES IF WORK
OWNER E' CL a2A_.D c6NTRACTOR
IS NOT 'STARTED WITHIN
-180DAYSOFPERMITISSU-
ANCE OR 180 DAYS FROM
` LAST CALL ED INSPECTI ON.
INSPECTION DATE INSPECTOR
INSPECTIONREC RD
FOUNDATION
-
UFER 7
PREGUNITE -
..
PER MIT VALIDATION
}
-/
P R ftNO UNTIL ABOVE HAS BEEN SIGNED
-
UNDERGROUND/SLAB
PLUMBING
1�
JL
- --
ELECTRICAL.
ISSUAN ATE
GF/b
MECHANICAL
•- -
cit
eLOc.
I IOU
cLgcr.
'11'"
PLG. mecR.
� D
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
' - 'WOOD FLOOR
VALUATION
l':�'v+1'
E/FT.
PLUMBING. xW
��
'+•%✓
MECHANICAL' n'
I'
ELECTRICAL'.
PERmIT To
r
v 1-1
FRAMING:"
INSULATION"
STORIES
TYPE CONSTR.
uRES,
OCC. GROUP
UNITS
IRLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
n ROOF
I '
, I ''
SO. FT. FLOORAREA
TOTAL ACREAGE
E
��;DIpPHRAGNI O
ILDING USEPB Olner
RES INo I
❑ 0,0 ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
` ROUGH
ASSESSORS PARCEL NO.
PLUMBING
GAS TEST '
-
TRACT NO. !
PARCEL NO.
. MECHANICAL _
ELECTRICAL' -
FINALS DATE INSP.
. ACC. DATE,
ACG FILE NO.
'
FRAMING ' ff,
SAN # 02 1
-
ON
INSULATIII-30-8
PLUMBING
ZONING
'
_ . '
ENG. SITE NO.
'
GAS 3
FIRE SPRNK
ENERGY T.]A''
- -
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN GNED ;HEATING
-. ❑ "❑
Y ❑ "❑
LATH–INTERIOR t–,
ELECTRICAL +
FLOOD ZONE
Y'fl NQ
A.L. uC.
YO N❑
LATH–EXTERIOR
FIRE PT,
SHEETROCK { ':� - rf
GRADE'
FEE SUMMARY
SHEAR INTERIOR -
BUILDING
BUILDING
`
-
`t'. , I,
SHEAR EXTERIOR —/y
TEMPORARY APPROVALS'
FIREWALLS
ELECTRIC,
PLANCHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
DCCUPANCY
sElsMlc FEE
OCCUPANCY. OF BU ILDING IS NOTPERMITTED UNTI L BUILDING F INAL IS SIGN ED BY BUI LDING INSPECTOR.
'MICROFILM
t- t
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC .
,:
�_ ONE WORKING DAY BEFORE REQUIRED,INSPECTION.
'
II;
Of PLEASE GIVE JOB ADDRESS WHEN PHONING.
PLUMBING
_
6
MECHANICAL
SEE PERMIT FOR EXPIRATION DATE -
CONST. TAX
�{^,
i �
+
IMPORTANT!
TOTAL''
J)
PLEASE
CALLING FOR FINAL INSPECTIONIDE .
i"64d1l
OFFICE COPY -
,PPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
BU LDI W PROJECT I DENTI FICATI ON
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
12644
BUILDING
ADDREss
10475 IrDerial 8
OWNER'S
'446-.19.13
PLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE I
-
ONE
c NTRAC7014'S
NAME
QQ - OUTLETS -SWITCHES - RECEP 10.00/1.00 d -
ebcor Corporation
uc. No. 385712
LIGHTING FIXTURES 10.00/1.00
'
CONTRACTOR' 521625 Stevens Creek Blvd.
ADDRESS 1
APPLIANCES -RESIDENTIAL .4.00 -'
PANELS 10.00 Q -
Cupertino 95014 I'MONE446-1913
DATE OF APPLICATION
ORSeals& Assoc C-15162
ENGINEER
Stephen Clark LIC. No.
PANELS IOVER 200 AMP( 20.00
PLAN CHECK FEE P.C. No.
SIGNS TRANS. 3.00
ARCH OR ENG.
ADDRESS Seals, Oakland, CA
-
SPECIAL CIRCUIT - 5.00
PERMIT VALIDATION
�
EMP. METER OR POLE INS. 20.00
Clark, Saratoga ' I,
7
jx;;tt
no a ssTs
i
MOTORS ,{')+^ "'rSEE FEE SCH.
SERVICE CHANGE . 20.00
LICENSEDCONTRACfORS DECLARATION
,s;\: 1'
J V
I hereby affirm that I am licensed under pro visions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions s_.[�lnd my licenseLie. in full "OnUd�([�•r�
License Class_A Lia Numher�9DJ 1t._
Vs J ISSUANC9/DATE
�x r)eTLJp+
n:i•1 sx{ Gu.
BLDG.
ELECT.
PLG. MECH.
n-vr,raI
•+•a
Dutc_4/1.6/87 Contrac"Dubcor-Corp-
OWNER-BUILDER DECLARATION
I hereby affirm ngrI am exempt from the Contractor's License
Professions
Lawfertilefollowingreason.(Sec.uires Business to
Code: Any city or county which structure permit to construct. alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe
Business and Professions Code) or that he is exempt therefrom and
,
`
BUILDING PERMIT
INFORMATION
INFORMATION
MISC.= REFER TO ORD
VALUATION
(DOD
$/FT.
,
PERMIT ISSUANCE 10.00!6,1
ELEC. CONTR. 'LIC. NO.
ELEC.
TOTAL /
PERMIT TO
� c [s
QTY. PLUMBING PERMIT FEE
•
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of$ection 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not mole than five hundred dollars (5500).):
C�iyr-'
�� e
ry
-ALTER-DRAIN&VENT-WATER IEA.) 5.00
❑ Las owner at the property, or my employees with wages as
their sole compensation, will (S the work, and Ilse structure is not
L 7044, Business and Professions
intended or offend for License
Code: ty Contractor's License Law docs not apply to an owner of
property who buildsorimproves thereon, and who dots such work
himself re through his own employees, provided that such improvr
merits not or If,however,(liebuildingowner-
BACK FLOW PROTECT. DEV ICE 4.00
OCC. GROUP
.,T
T �3,.
,
RES. UNITS
/
'• DRAINS-FLOOR, ROOF, AREA, COND. 5.00
FIXTURES -PER TRAP ,• 5.00 �-
SG. FT. FLOOR AREA
�3 6
TorAL ACREAGE
I GAS-EA.SVSTEM-1 1NC.40UTLETS 6.00
mens is withinoffered
or improvement is sold within one year of completion, the owner-
one y ar o
builder will have the burden of proving that he did not Build or im-
prove for purpose of sale.).
❑ -1, as owner of the property, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) 2.00
UILOING USE
RES, IND CON PS Ours,
ElEl❑ 1-1licensed
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 1NCr5A" 6.00
LAWN SPRINKLERS• OV ER 5.EA.) 1.00
ASSESS ORS PARCEL NO.
357,.-/e7-d0 /
contractors to construct the project (See. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts far such projects with a contractods) licensed pursuant to
the Contractor's License Law.
'❑ I am exempt under Sec. ,D.&P.C. for This
on
'SEWER-SANITARY-STORMEA.200f1/.10.00 O �"
pTRACT NO.
a9 Q /�
PARCEL NO.
WATER' HEATER W/VENT„ " 6.00 6 •'
Owner - Data
WATER SYSTEM {t6100
.t P,\IOC S
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP; w° 5.00
WORK BRS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of crossent to sal Finsure,
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
4
copy thereof (Sec. 3800, Lab.C.).
Policy No. Company USE &_Gi
-
FIRE SPRINK
V❑ No
FLOOD ZONE
ENERGY T 24
Y❑ N❑:
A.L.U.C.
Certified copy is hereby furnished.
Certtcity inspection division.
A icant�6Ois p
MISC.- REFER TO ORD.
CERTLEICATE OP EXEMPTION('ROM WORKERS'
PERMIT ISSUANCE 10.00 0
• COMPENSATION INSURANCE
(This section need not be completed if the.'permit is for one
PLG.CONTR. LIC. NO. PLG. p
_ "� TOTAL o
�•
Y ❑ N❑
• Y ❑ N
-- y
OTY. MECHANICAL PERMIT FEE
_
FEE SUMMARY
h undyed dollars IS 100) or less.)
I'certify that in the performance of the work for which this per-
mil is issued, 1 shall not employ any person in any manner so as to
become subject no the Workers'Compensalion Laws of California.
Data - Applicant
NOTICE. TO APPLICANT: 1f, after making this Certificate Of Ex-
emption, you should, become subject to the Workers' Compensation
provisions of the Labor Code, you must 'forthwith comply with
such provisions or this permit shall be deemed revoked.
BUILDING
- ALTER OR ADD TO MECH:,
s5.00-
APPLIANCE' of QaQ1?r's•5.00
PLAN CHECK
FEE '
-
-AIR HANDLING UNIT (TO 10,000QF.M.) 4.00
AIR HANDLING UNIT (OVER 10,000 C. F. M.) 6.00
SEISMIC FEE /0-�2
CONSTRUCT ION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00 S
1 hereby affimt that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.-
3097,Civ.CJ. L i
Lender's Name_g:�dZ, rjLH Rh_
Lender's Address•_+ tllut_tuefl Bl1Tt1-SJ_95110
MICROFILMS
1 HEATING'UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT 100,000 B.T.U.0.50
ELECTRIC'
VENTILATION FAN (SINGLE) 4.00 '7-
I certify that I have read this application and slate that the above
information is correct. I agree to comply with all city and copnly
nrdinunces and state laws relating to building construction, ando
hereby authorize representatives of this city IO enter Upon the
above-mentioned property for inspection purposes. '
(1
BOILER•COMP(3 H.P. or 100,000 B.T.U.) 6.001PLUMBING
BOILER•COMP 1 Over 100,000 RTU( SEE FEE SCH.
MECHANICAL
MISC. - REFER TO ORD.
CONST. TAX
(We) agree to save, indemnify and keep: harmless tire City of
Cupertino against liabilities, judgments, costs and expenses whichPERMIT
may in any way accrue against said City in consequcnce'of the
ISSUANCE 10.00 �O .--
g n og 6 his permit.
4/16/87
MECH. CONT. LIC. NO. MECH.
TOTALL, 3/ _.
TOTAL %
/
/
Signsature of Appant Contractor Date
I. �� OFFICECOPY' -
0I