14526 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
` BDIIOING/ /� 1,' c['' Q APPLICATION & PERMIT
ADo By 000
WO LFE Y R D
1` �pBUILDING - ELECTRICAL-PLUMBING-MECHANICAL 14526
OWNER'S F_� Af PLANCHECK VALIDATION
y NAME AC 447-
NAME
w P QTY. ELECTRIC PERMIT FEE �-
PHONE 7 7 9J"
NANTRAc7ORs UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00
CADDRESS 0Rs APPLIANCES-RESIDENTIAL 4.00 '
ONTRA
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
uc.No SIGNS TRANS. 3.00
ADDRESS ENa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
APPLICArvr's MOTORS SEE FEE SCH. .
ADDRESS
SERVICE CHANGE 20.00
EE
o LICENSED CONT RACTORS DECLARATION '/-/
a i w I hereby affirm that 1 am licensed under provisions of Chapter 9 SSUANCE DATE
a a (commencing with Section 7000)of Division 3 cu use Businessund L ELECT. PLG. MECH.
F m z Profnslons Code,and my license is in full force and effect. ❑ ❑
oi m w License Class Lie.Number f.
m _ Uam Contracmr
F
y F BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARA'I ION afiftWTION
aoa MISC.- REFER TO ORD
w g N I hereby affirm that 1 ren esempt from the Contractor's License A ON $/FT.
F a m j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city Or county which requires a permit to construct,alter,
EE ¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. TE Fr. /
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w$ he is licensed pursuant t0 the provisions ol'the Contractor's License
Fit Law(Chupterl(conunencing with Section 7000)of Division 3 ofthe
4 Business and Professions Code)or that lie is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢H p the basis for the alleged exemption.Any violmi00 of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toe civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(SS00).):
Cl 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 Jo the work,and the structure is not
intended or offered her sale (Sea 7044. Business and Pmfcssions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code The Contractor's License Law does not apply to an owner OI'
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
menu are not intended Or offered for sale.IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or imprm,ement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will hove the burden of proving that he did not build or ire RES IND CON PB Other
.rove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,en,exchhxivdy contracting with ❑ ❑ ❑ ❑ ❑
licensed contructors to construct the project(Sec.71744,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law dries not apply
to an owner of property who builds or imposes thereon,unit who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for Nath projects with a contmnod s)licensed pursuam In SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's Fr),rri License Law.
11 anh cxe p under a _ .&' is WATER HEATER W/VENT 6.00
euson
Owner �, 1) _ _ WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPEN'SAI`ON DECLIRA ION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate W consent to sell-insure.
or a certificate of Workers'Conpsensalioo Insurance,of a cerlillal ZONING ENG.SITE NO.
cop,thereof(Sec 3800,Lab.C.).
Policy No. Company
0 O Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z Z Cl Certified copy is filed with the city inspection division. REFER TO ORD
MISC.- .
O Applicant v ❑ NE) v ❑ NC]
N CERTIFICATE OF FXEMVI'ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AT.U.C.
UJ >_ COh11'IiNSATION INSURANCE PLG.COMP. LIC.No. PLG.
1 O ('Phis section need not be completed if the permit is for one TOTAL Y E) N❑ Y C3 ❑
2 hundred dollars IS 100)or less.)
L) O 1 ecnity that in lire Pedorromare of the work I'Or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit isissued,I shall not employ any person in any manner so as to
U
0 bee ne subject In the Workcrs'Compensation Laws.1 Calif ern ia.
a m
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
Y m NOTICE 'f0 APPLICANT: If,after making this Certificate oI Es- �7
? empron,you should become subject bah the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of Lire Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall by deemed revoked. AIR HANDLING UNIT(TO IOPMC.F.M.) 4.00 p
CONS"fRUCIION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 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 MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I cCddy that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. 1 agree to Comply with all City and county PLUMBING
mdiarceS and state laws relating to building construction, end BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP hover 100.000STUI 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
ay in any way accrue against said City in consequence of the
ran' I'this permitMECH.CONT. LIC.NO. MECH.
I'j�[4n- 1-Z1-gB TOTAL TOTAL
31greffule of Applicanticontractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
' CITY-'OF CUPERTINO 14526
INSPECTION DIVISION,
I � JOB INSPECTION RECORD
BLDG. PERMIT EXPIRATION
JOB ADDRESS 11000 WOLFE ROAD UNIT# _Lor# 42
PERMIT EXPIRES IF WORK
OWNER HEWLETT PACKARD CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - sunrvcE DATE
.LECT PLG. MECH
MECHANICAL
AW
El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED JEII PERMIT
WOOD FLOOR INFOIiMATI ON
w "SIFT.
PLUMBING Ik). t)
MECHANICAL '
(I TO
ELECTRICAL
FRAMING
STORIES TYPE CONSTR
INSULATION
Oca GHOUL RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT ILOOIi AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
• DIAPHRAGM THE CONSTRUCTION TAX IS.PAID
BUILDING USE
ROOF SHEATHING Hes CON
El 0
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑
ASSESSORS PARCEL NO .
ROUGH - SAN.# -
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 3 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECR ENERGY
ACC DATE ACG FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING EVG.SITE NO.
INSULATION PLUMBING 3—f d8' oW
GAS TEST GAS
FIRE SPRINA ENERG'/,T?G
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING V N❑ y N�
FLOOD ZONE A L U C
EXTERIOR SHEAR ELECTRICAL RELEASE — _ �� N� r L7 N❑
INTERIOR SHEAR FIRE DEPT..
SHEETROCK - GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEES'`
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
LEI
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING;
Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE I TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY