14795 POST THIS CARD•NEAR'FRONT•OF BU I LD I NG' :1 PFRhIIT"NUMBER
CITY OF' CUPERTINO
• � : 14795 ,
INSPECTION,DIVISION
I, "tI JOB'INSPECTION RECORD
71
. �•: ,i• E ' PERMIT EXPIRATION - e
JOB ADDRESS 20,195. STEVENS' CREEK BLVD. uNIT# 265
•" . - - PERMIT'.EXPIRES IF WORK
OWNER '•W D T . COrTRACToH THERMAL DESIGN •SYSTEMS. IS NOT'STARTED WITHIN.; '
INSPECTION DATE - INSPECTOR INSPECTION RECORD -1110 DAYS of PERMIT ISSU.
' FOUNDATION i; +_ " .c " '� • , ANCE OR`-180 DAYS FROM
.NOTE: LASTCALLED INSPECTION, '
UFER - ALL GRADINGIAND DRAINAGE SHALL BE INSTALLED ,
`
TO COMPLY WITH THE APPROVED PLANS AND CITY OFVAl tf jLIOn
AoN
�. PREGUNITE ,?I 'CUPERTINO STANDARDS. . & LL,J!
GARAGE SLABS. -
'POUR NO-CONCRETE-UNTIL ABOVE HAS BEEN SIGNED - - - MAR+ ,7U`
UNDERGROUND /SLAB,
• . . '' PLUMBING, -;• ' ,A - City of Cupertino
ELECTRICAL .'FT - : ISSUAN&DATE 1 '
• MECHANICAL • ,. • : ..' 'BI ua . ELECT. Pic. -.me ;c
❑ 7 ❑ 0
DO'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD=FLOOR `- IS VALUATION aiFT.
PLUMBING '
MECHANICAL'
ELECTRICAL . " „ PERMIT TO
FRAMI NG',x 7 - 1 `�=��I 1�••..
'- INSULATION - - - ,STORIES TYPE CONSTR. I
OCC.GROUP RES UNITS .
.i ♦
e PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'ROOF - - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sq_FT,aao,+nl+eA *o*n�nu+t neE-,I
DIAPHRAGM THE CONSTRUCTION TAX IS•PAID �.
BUILDING USE.
ROOF SHEATHING - ' L 'RESIND „ CON PB om.'
APPLY NO ROOFING,UNTIL ABOVE HAS BEEN SIGNED FINALS• DATEINSF '• El-, El0 0
nSSESSOR5P AHCEL NO
ROUGH SAVII -
'PLUMBING ` ELECT.ENERGY -
TUBS&SHOWER PAN PLUMBING ENERGY rRnc*No. PARCEL No
- MECHANICAL � � �j MECR ENERGY'
'. ELECTRICAL , • - ACC.DATE ACC.FILE No ,
BUILDING ENERGY ,
FRAMING : " ". ELECT.FINAL TEST.- - -
INSULATION ' PLUMBING Co"'"C ENG.SITE NO....'
i,
GAS TEST GAS - - - `'I -
MECHANICAL FIRE SPRINK ENERGY T2A
'COVER NO WORK UNTIL,ABOVE HAS BEEN SIGNED HEATING .� Y ❑ "� r 11 "Ell
,
EXTERIOR SHEAR ��- ELECTRICAL RELEASE FLOOD zDNE n.L.0c '
{ INTERIOR+SHEAR, FIRE DEPT. - Y 0 .No - Y C] Np
SHEETROCK•.'.- `, - GRADE I FEE SUMMARY
EXTERIOR LATH BUILDING ' '-
' INTERIOR LATH-` - - TEMPORARY APPROVALS 'BUILDInIG '
SCRATCH COAT" GELECTRIC PLAN CHECK,`
AS ' FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN.SIGNEO OCCUPANCY ' SEISMIC FEE _
OCCUPANCY;OF BUILDING ISNOTPERMITTEDONTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
.;ONE WORKING DAYBEFORE REQUIRED INSPECTION' ` PLUMBING
0 PLEASE'GIVE:JOB ADDRESS WHEN'RHON,I_NG �I.
MECHANICAL ' 1{J
— SEE PERMIT TOR EXPIRATION DATE =;
IMPORTANT! • wu coNsr.TAX .
PLEASE.READ REVERSE SIDE BEFORE '
TOTAL !i .
"CALL-ING�FOR FINAL INSPECTION `) 4i-
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES = USE-BALLPOINT PEN'ONLY
BUI LD1 NG:PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADUREss CT14.795
.
Ol�r, c�-r�V•Eµs G.��^Z.�s BUILDING - ELERICAL-PLUMBING -MECHANICAL �, -
OWNER'S' J - PLAN CHECK VALIDATION
NAME UTY. ELECTRIC PERMIT . .FEE
D1. PHONE , f
CONTRACTOR'S - ,... .
. rvaME • .yx r � . OUTLETSiSWITCHES=RECEP- 10.00/100
H ' r�LSICGN uc.N Q LIGHTING FIXTURES 10.00/100 ' t'
CONTRACTOR', $ A
ADDRESS. APPLIANCES-RESIDENTIAL ' •4.00
- � pQ •' A. r :(4•
L•_ A� PHONE �QQVOUp' ' PANELS 10.00 ' .1 DATE OF APPLICATION '
OgcHITECT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.c:No.
ENGINEER
' sec.ND. SIGNS TRANS. - 3.00 _
ARCWOR ENG. . Dv PERMIT VALIDATION'
` ADDRESS - . SP,ECIAL CIRCUIT ' 5.00
ZIP TEMP.METER OR POLE INS. '20.00
APPLICANT'S '• - 11 {f
ADDRESS MOTORS ' SEE,FEESC
Alamo AVE R{LTA' G lL1R SERVICE CHANGE ,, ,. 20 00
0 0 LICENSED CONTRACTORS DECLARATION " ` p2ttI11O. ,
' Q 2 U I hereby affirm tial I:an licensed under provisions of Chapter 9 ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and
G.
D� P'.1c.mus Co Lp1 an n a .,cis in full fu r f ct.
z o y2 0 License Class-Cb Ly Lic.Nmmb r 1 l-y_yp d
O ,�„ t Dmc Contractor
BUILDING PERMIT
¢ a, w OWNER-BUILDER DECLARATION _ INFORMATION
w ; A H 1 hereby affirm that I am exempt front the Contractor's License MISC.- REF.ER TO ORD
uoa Law fogthc following reason.(See.703 L5,Businessand Professions VALUATION '
H _ w PERMIT ISSUANCE '_ 10.00
m � Code:Any city orcounly which'rcquiresapermittoconstrucl,.INr, '
p tt a iOlpr.vc,demolish,or oc,l,r':my Vtrmtu,c,prior to its isstmnf4,also ELEC.CDNTR. - LID,NO.II ELEC,
a
d,o ¢ r luires the applicant for such liennit to file a signed statement that ^,' - TOTAL PERMIT TO
a. he Is licensed pursuant to tile provisions of the Contractor'sLicense -
H z aLow(Chapter 9(commencing with Section 7000)of Division 3 oftho
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE''
¢ r o the basis for the'alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ;m by any applicant for a peril subjects the applicant to a civil penalty - ALTER-DRAIN& VENT-WATER (EA.)-5.00 - s
- of not more than five hundred dollars(x5001.): -
- '❑ 1.as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 - Oce.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered.for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
- - Code:'rhe Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-P.ER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
hint II or through Ills own cmpl aY P v'ded that such unprove •. -
ants nalntnded o,oper.1f -I If,however,the huddinl, GAS-EA.SVSTEM,-11NC.4OUTLETS 6.00 -
-� f' t Prov erne at is id svII in one y u' f completion,the owner GAS-`EA.SYSTEM-OVER 4'(EA.) 2.00
bu'Ider will have it,,hard mt of powro,that he did not huild or Inn- _. BUILDING USE
prove for purposc'of Sole.). RES IND CON. PB Other '
❑ I,as owner of the properly;am exclusively contracting with INDUSTRIAL WASTE INTER, 30.00 ❑^ . ❑ ❑ ❑ ❑.
' licensed contract.,, m 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 n .
ot amply -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.)• 1.00 - -
contracts for such projects witla it contractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 'I am exempt under Sec.-,114P.C.for this WATER HEATER W/VENT 6.00 '
reason
owner Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPHNSA'IION DECLARATION WATER TREATING EQUIP. 5.00
I h noby'aft rni chat 1 have a Of111 me of epnsent to self inw e,
v or.a certificate of Workers'Conrpenadinn Insurance,or it codified ZONING. ENG.SITE NO.
copy Ther�-pf��g�e�y}�f�0,Lab.Cl, - f
Policy NtOS�C ullpaly'F`A CAMP - .• .d ,. ,
. O C Certified copy is hereby famished.. FIRE SPRINK', ENERGY TY4
Z Z X Certified copy is filed with Om city inspection division.
O Applicant IMISC.- t REFER TO ORD. YQ NO Y ❑ 1v0
~ y - PERMIT ISSUANCE 10,00
LU CERTIFICATIiTNIA:ON IDONNS FROM WORK 1: FLOODZONE a.L.U.C.
W > CO.M I'IiNSATION INSURANCE PLO.CONTR. - LIC.N0. PLG.
Z ('this section need riot be completed if the permit is for one TOTAL Y❑ ,'� N❑ Y E], N[3
huadred dollars(S WOu.,less.)
U O 1 certify that in flit performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I ,bill not employ any pcnon i&any manner sD a to
_. O ° becont,subject to the W.,kcrs C p uatmn Laws of California. ' r
y Date Apphc. at.- 'I ALTER OR ADD TO MECH. 5.00 S.00 BUILDING
} y NOIICE r0 APPLICANT 11, I'1 r.taking this CertiUcalc of fix- - '
�.? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you'nmst forthwith comply will :FEE -
U . such provisions or this permit shall be deemedrevoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 -
CONSTRUCTIONLIiNDWGAGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency flit EXHAUST HOOD(WITH DUCT)' 5.00
the performance of the work fix which this permit,is issued fSec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) .8.00 -
Lender's Ndde HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify (hal l have read this appLeation and state that the above VENTILATION FAN,(SINGLE) 4.00 -
i I f C is err cl Arce to cotoply with all unta and county _ 3 H.P:or 100,000 B.T.U.) 6.00 PLUMBING
r lin, and tate laws rclattocotao , and BOILER-COMPI ,
hr 1 y m tltorme represcrithitives or flib.city to enter upon [Ira
a bum mentioned prperty for'n:p tion purposes - BOILER-COMP I0ver,100,000 BTU)SEE FEE SCH. MECHANICAL
(WO agree to save, indemnify send keep harmless the City of MISC:- REFER TO ORD.. -
Cupertino against liabilities,judgments, costs andexpenses which PERMIT ISSUANCE .10.00 I17,QQ CONST.TAX
accrue '
may in any way against said City in consequence of the
•rentingofthopermit. MECH.CONT. ' LIC.NO. MECH.
.»� =$g -r D.S. 31-7 c6 TOTALS OV - TOTAL 6�
Signatureof Applicant/Con actor Date
a
OFFICE COPY