14191 POST THIS CARD NEAR FRONT OF BUILDING _
PERMIT NUMBER
CITY OF CUPERTINO 14191
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS - 10123 N WOLFE ROAD UNIT#2021B LOT#
PERMIT EXPIRES IF WORK
OWNER ARRIGONI BOUTIQUE CONTRACTOR PACIFIC UNION BLDRS IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECOR5 180 DAYS OF PERMIT ISSU-
FOUNDATION vL 'ANCE OR 180 DAYS FROM
LIFERLAST CALLED INSPECTION...
PREGUNITE - - PERMIT VALIDATION
I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL '�,_ ISSUANCE DATE..
MECHANICAL a}oa(; ELECT. PIA. MECH.
f
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $IFT.
PLUMBING !
MECHANICAL- ' '
ELECTRICAL „ � ` PERMIT TO,
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•� �� ROOF SO.FT,FLOOR AREA TOTAL ACREAGE
/a-9
DIAPHRAGM I�fI•
\Q �/ BUILDING USE
HES IND CON PB Diner
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED [:1 F-1 0 1:1 (__1
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST - - TRACT No, PARCEL No:
MECHANICAL
ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC,FILE NO:
FRAMING L,- SAN # zoNlNc ENG..SITE No.
INSULATION PLUMBING ..2 —w
GAS
Y L
MECHANICAL FIRE SPRINK ENERGN - _
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �
LATH—INTERIOR ELECTRICAL S. FLOOD zorvEA.L.U.c. -
-2S'-�
LATH—EXTERIOR FIRE DEPT. 114g-10❑ "� v 0 IN
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR, BUILDING ^� BUILDING --
SHEAR EXTERIOR ' TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505,
t ELECTRIC
Lu
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING. } ,
~ Z MECHANICAL f
- SEE PERMIT FOR EXPIRATION DATE -
I IMPORTANT!; CONST.TAX
PLEASE READ REVERSE SIDE BEFORE 7° ,'; "M TOTAL '• %f`gid
CALLING FOR FINAL INSPECTION.
OFFICE COPY -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
oR
�BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
ADILDING „ APPLICATION & PERMIT 14191
AoEss K�
,O o z V/c Ila"�O jl BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S � ^s` PLAN CHECK VALIDATION
. NAME1 QTY. ELECTRIC PERMIT FEE_
&f-_f74"g1I1.N3_7CP-tW0
CONTRACTORS
NAME 2 JA OUTLETS•SWITCHES-RECEP 10.00/1.013,
C_ N 10N&DO.J Lt.,No. L/12 Z LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S - PPLIANCES-RESIDENTIAL 4.00
ADDRESS
_311,1O all PRONE PANELS 10.00 DATE OF APPLICATION
ARCRITECT
oR N Q PANELS (OVER 200 AMP) 20.00 PLAN CHECW7 P.C.NO.
-
ENGINEER ,W !
OC Tic.No, SIGNS TRANS. 3.00
Ao0R'Ess ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
4vig^ � z,P lG^I TEMP.METER OR POLE INS. 20.00
APPLICANTS
AMOTORS SEE FEE SCH.
ODREaS
7j� E i*zm � SERVICE CHANGE 20.00 (;
Foo LICENSED CONTRAFfORS DECLARATION r
t u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 I �' 1ISSUANCE DATE
H<a (commencing with Section 7000)of Division 3 of the Business and . . BLDG. ELECT. I PLG. MECH.
F Hz Professions Code, my license is in full for e' t ❑ ❑ ❑U ❑
O�' Ls icense I Lic.Number �i•
O y F O
z Date Contractor
a m I!� '• � ^( �l'�.:I�II BUILDING PERMIT
¢ Or w BUILDER DECLARATION INFORMATION
w 3 A I- 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Fa-0w VALUATION $AFT.
< Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 U�
m� Code:Any city orcounly which mquiresa permit to construct,alter,
7S'oo-e
Se a¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D 5 requires the applicant for such permit to file a signed statement that TOTAL Q' PERMITjP
6yw m he is licensed pursuant to the provisions of the Contractor's License
y(� �
F z¢ Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe ,fL/QdZL.
f i c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
ag_ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00
of riot more than five hundred dollars(5500).): d
❑ 1,as owner of the property or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP RES.UNITS
their 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
Code:The Contractor's License Law does not apply G an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 d SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
} ments arc not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 200 BUILDING USE
builder will have the burden of proving that he did not build or im- . . .
RES IND CON PB Osner
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 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 1.00
contracts for such projects with a contractods)licensed pursuant to SEWER-SANITAR V-STORM EA.20011/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Data 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, �11�eC�ll'r`. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation In su D
cc,or a certified
copy[hereof fSec.3800,Lab.-
Policy ere Company
Certified copy is hereby furnished. FIRE SPRINK ENERGY TZA
Z Z Certified y s BI d wisp the city inspection division.
p Applicant . YI MISC.- REFER TO ORD. Y ❑ IN v ❑ N❑
CC I,] it PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
Q: CERTIF CATS E EXEMPTION RAN WORKERS'
W COMPENSATION INSURANCE, PLG.CONTR, Tic.No. PC
Q' O (This section need not be completed if the permit is for one TOTAL 30- Y❑ No v C] N(]
D Z hundred dollars(S IOO)or less.)
0.0 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to _
U become subject to the Workers'Compensation Laws of California.
i Date Applicant -,ALTER OR ADD TO MECH. 5.00 tf BUILDING
} W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER IQOOOC.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 f r which this permit is issued(Sec. MICROFILM
3097,CN.c.). HEATING UNIT(TO 100,000 B.T,U.), 8.00
Lender's No - HEATING UNIT(OVER 100;000'B.T.U.)9.50 ELECTRIC Add, 940
Oe
�-
� I certify that I have read THIS application and state that the above VENTILATION FAN (SINGLE) 4.00 D'L
information is correct.1 agree to comply with all city and County PLUMBING ,3O
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the B01 LER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
• above-mentioned properly for inspection purposes.
(We) agree to save, indemnify unit keep harmless the City of MISC.• REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue,against said City in consequence of the
PERMIT ISSUANCE 10.00 Q•--
gmn g of this r it. I MECH.CONT. .LIC.NO. MECH.
/ N r}�� TOTAL /S-!�' TOTAL �9� _
Si Tire of A pp lican�/ConfTactor nate
OFFICE COPY