14064 _�!►^ POST THIS CARD NEAR FRONT OF BUILDING RMTNDMRER
CITY OF CUPERTINO 14064
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 10123 N WOLFE ROAD UNIT# 2109 _LOT#
PERMIT EXPIRES IF WORK
OWNER ZALES CORPORATION CONTRACTOR DUBLIN CONSTRUCTION IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - AWE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE PERMIT vn ylDnnoN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 1
PLUMBING '
ELECTRICAL „�•,"
---•,1.r ISSUANCE DATE
• MECHANICAL - BLDG, ELECT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION $/FT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING `
INSULATION STORIES TYPE CONSTR.
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
RES IND. CON PB Olney
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ 0 El
ROUGH
ASSESSORS PARCEL NO.
. '
PLUMBING
• GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ACC,DATE ACF FILE NO.
' ELECTRICAL ' RGAS
DATE INSP. -
FRAMING
ZONING ENG.SITE NO.
INSULATION
FIRE SPRINK ENERGY T-j4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED "� "�
LATH—INTERIOR ELECTRICAL _� FLOODZONE A.L.uc.
LATH—EXTERIOR FIRE DEPT. v N� v I] N❑
SHEETROCK GRADE FEE SUMMARY
i
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING
FIREWALLS - ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGN EU-1 OCCUPANCY SEISMIC FEE �!
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
1
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC moi' V
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. ;;R, r PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
PLEASE READ REVERSE SIDE BEFOREAga W TOTAL
CALLING FOR FINAL INSPECTION.
'OFFICECOPV ,
APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE, BALL POINT PEN ONLY
--%LriiLDINGPROJE7 I DENTI'FICA ON � � PERMIT NUMBER
9AUDIDLDI55' - , N� APPLICATION & PERMIT
C�Zing 7 Q.i CO MM �I BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 14064
OWN R'S
NAM PL AN CHECK VALIDATION
�0.1eS /' r OTY. ELECTRIC PERMIT FEE
LUN I CA
PHONE
NAME O
CTORS
NAME P q OUTLETS-SWITCHES.-RECEP 10.00/1.00 -
&J1011 11 aP'6� LIC.No.Z94 Z98 LIGHTING FIXTURES 10.00/1.00CONTRA
ADDREScro R's ��6Q$4 ry g/$ - APPLIANCES-RESIDENTIAL 4.00
ADDRESS
QP/A Ln PHorvF -7 700 PANELS 10.00 GATE OF APPLICATION
ARCHITECT
oR „ PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEARCH.OR ER
LIC,NO, SIGNS TRANS. 3.00 • '
ADDRESS ENG. SPECIALCIRCUIT 5.0D PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 -
ADDRESS Ts MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
,09 LICENSED CONTRACTORS DECLARATION
a v I hereby affirm that I am licensed under provisions of Chapter 9
H 2 w ISSUANCE DATE
4 A (commencing with Section 7000)of Division 3 of the Business andProfes _ BLDG. ELECT. PLG. MECH.
H i Licensse ns s de my license is in full forq®Aaf{ecYO ❑ ❑
2 2 v'i G License Class Lin.Number G 7(oL 70
'_o y r J Date Q- �$,Z_Contractor ,•_,
5 Q a - OWNER-BUILDER DECLARATION - BUILDING PERMIT
w0, D INFORMATION
; H 1 hereby affirm that I am exempt from the Contractor's License 'MISC.- REFER TO ORD
a.0 Lewforthe fGllowingreasoa(Sec.7031.5,Business and Professions VALUATION $/
FT.
r - PERMIT ISSUANCE 10.00 Q'-
'
�.wiy Code:Any city or county which requiresapcnnit toconstrucl,alter,
C ¢ G O improve,demolish,or repair,any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 01
o u requires the applicant for such permit m file a signed statement that S TOTAL 6 3
n w$ he is licensed pursuant to the provisions of the Contractor's License )
,t PERMIT TO
- .f z a Law(Chapter 9(commencing with Seel ion 7000)of Division 3 of the �•v/GI�L�/Oif ' E
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
rc F.$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,t
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.40UTCETS 6.00 .
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or he- GAS-EA.SYSTEM-OVER 4(EA:) 2.00 BUILDING USE
prove for purpose of sale.). RES INDUSTRIAL WASTE INTER. _ 30.00 ❑ IND❑ ❑N PB 1:1 El❑ 1,as owner of the property,am exclusively contracting with
licensed'contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to - -
theContractor'sLicenseLaw. • SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner - Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
Or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy therea�j�$ee��....3,�00,Lab.CJ.C ,,D
Policy No.m.24 Company r -
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. ❑ N❑ r❑ y❑
CC CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 12001 FLOOD ZONE A.L.U.C.
LL 1 COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
d O (This section need not be completed if the permit is for one TOTAL Y❑ No Y E] tN❑
rD Z hundred dollars($100)or less.)
) O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
0 y Date Applicant ALTER OR ADD TO MECH500 BUILDING
} N . .
NOTICE TO APPLICANT: If,after making this Certificate of Ex- '
Z. 'i
I empton,you should become subject to the WorkersCompensation - APPLIANCE- 5.00 PLAN CHECK
provisions
- U such provisions
the Labor Cade, you must forthwith comply with FEE
ns or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M) 4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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. .M ICROFJLM
3097,Civ.C.L S. - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 'ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct.1 agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives ec this city es enter upon the BOILER-COMP (Own,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 PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
granti g this per!11U. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL A/�� .
Sig Store of Applicant/Contractor Date
OFFICE COPY