15440 (2) ---mss.
POST THIS CARD,NEAR, FRONT OF BUILDING. ,J
RMiTNDmEER
CITY OF CUPERTINO ' 15440
INSPECTION DIVISION,
JOB INSPECTION RECORD. ;
'r.�. • PERMIT EXPIRATION
JOB ADDRESS 10123 :North Wolfe SP 2106 UNIT# � -LOT#
PERMIT EXPIRES IF WORK
'OWNER V3llCO .:Pdrk/,Daug AllOt.O coNTRacToa .IS lNOT STARTED WITHIN
INSPECTION DATEINSPECTOR INSPECTION RECORD ISO DAYS OF PERMIT ISSU- .
FOUNDATION - - ANCE OR.180 DAYS FROM
NOTE: - LAST CALLED INSPECTION. .
UFER F ALL•GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF �:PERMIT VAi IDATION
PR EGUNITE o CUPERTINO STANDARDS. -
.GARAGE SLABS I - ` - •
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. ,UNDERGROUND /SLAB
PLUMBING L": .i ,,,:" ';•
ELECTRICAL _ -
ISSUANCE I tE
MECHANICAL - FIN.. f J BLDG. .ELECT PLc MECL.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR . - - a ' INFORMATION
PLUMBING - - _ } VALUATION SBFT.
!'�"5 I ✓I
' ,.• MECHANICAL; '
ELECTRICAL - PER^^IT To
FRAMING - . . z.0 l.C.
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -\:, '• . -
• -
: .
- 50 IT,FLOOR AREA TOTAL.ACREAGE
. 'ROOF 'NOTE:NO FINALINSpSHALL
BE MADE BEFORE
DIAPHRAGM ,• , THE CONSTRUCTION TAX IS PAID
BUILDING USE
RODFSHEATHING - FRES IND CON_ •PR ,0,11"
APPLY NO ROOFING.UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INS P,.-*
-0 ASSESSORSPARCEL NO.
❑- 1:1 ❑' El. ROUGH � ' � - SAN.N � • -
PLUMBING . - - ELECT.ENERGY -
TRACIPU5 "PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL -ACC DATE ACC,FILE'NO
BUILDING ENERGY .
FRAMING ' - ELECT.FINAL TEST -
INSULATION - - ^ PLUMBING - ZONING ENG SITE NO.
i.
GAS TEST GAS " - .
FIRE SPRINK" ENERGY T,Z4
' MECHANICAL' '
No [] NF]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .HEATING:.' Y
.EXTERIOR SHEAR ELECTRICAL RELEASE - FL000 zoNE A.L u.c.
INTERIOR SHEAR FIRE DEPT. .. Y'❑ "❑ v L. "❑
r. SHEETROCK • •• GRADE - . - - FEESUMMARY
" EXTERIOR'LATH BUILDING
INTERIOR LATH TEMPORARY APPROVAL .BUILDING a� 1
SCRATCH COAT ' - ELECTRIC' PLAN CHECK
' GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. SEISMIC FEE
OCCUPANCY OF.BUILDING ISN OT PERMITTE D UNTI L BUI LDING F INA LIS SIGN ED BY BUI LDING I NSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ' ONE WORKING DAY BEFORE REQUIRED,INSPECTION. .PLUMBING`.
.; z PLEASE GIVE JOB ADDRESS WHEN,PHONING.
—
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL."
IMPORTANT!
CONST.
PLEASE READ REVERSE SIDE BEFORE-
CALLING FOR FINAL INSPECTION. - TOTAL
OFFICE COPY - —
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES -LSE BALL POINT PEN ONLY
'PERMIT NUMBER
.BUILDING PRO E T ID NZI FIcAtlo - APPLICATION & PERMIT
BDII.DIN _ 15.4,40,
aDDRES
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNS PLAN CHECK VALIDATION
• NamDTV. ELECTRIC PERMIT FEE
bb O PHONE
,( rvame ACTOR
OUTLETS-SWITCHES-RECEP -10.00/1.00 ^
LIC.NO LIGHTING FIXTURES '10.00/1.00 . .
- ADDRESS oRs APPLIANCES-RESIDENTIAL' '4.00 -
PHONE PANELS 10.00 DATE OF APPLICATION" -
ARCHrtE PLAN CHECK FEE P.C_N0.
OR C. PANELS (OVER 200 AMP)" '20..
ENGINEE
LIC.NO. SIGNS TRANS.' 3,00
ARCH:O E G. - PERMIT VALIDATION
Ajq�G (��nj- " SPECIAL CIRCUIT - 5.00
ZIP 1((���bEMP..METER OR POLE INS.' 20.00 .
APL ANTS - MOTORS '` ' SEE FEE SCH.
aD .
SERVICE CHANGE - 20.00
o 2 LICENSED CONTRACTORS DECLARATION' /�?
a z w 1 herehy affirm that I am licensed under provisions of Chapter 9 SSUANCE DATE _
G Pe (commencing with Section 7000)of Division 3 of the Business and , 'BLDG. ELECT. PLG.., MECH.
E]
H w i Professions Code,and my license is in full force and effect. - _ ...�� El ' 0
O
z O m - License Class Lic.Number _ p- I
9 z r'w Date Contractor
P m f - - - BUILDING PERMIT
ic e .OWNER-BUILDER DECLARATION - A h 1, m r,
MISC.- REFER TO ORD "^-If` INFORMATION
E,
LL N I hereby affirm that 1 am exempt from the Contractor's License - VALUATION ,-S/FT. .
r u O J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE "' 10.00 �, ,
ave Code;Any city or county which reyuiresa permit to construct,alter, � -
ImPI, improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. % LIC.NO, ELEC. WI-3 (4r
i D OM requires the applicant for such permit to file a signed statement that - -• TOTAL PERMIT TO
K m u he is licensed pursuant to the provisions of the Contractor's License '
r z r
Law(Chapter 9(commencingwilh Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES' t TYPE CONSTR.
s- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN, -WATER (EA) 500 -
of not more than five hundred dollars($500).): . . -
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 -
their sole compensation,will do the work,and the structure is not . . ,OCC.GROUP- 'RES.UNITS
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 to an owner Of -
- property who buildsorimproves thereon,and who does such work "F IXTUR ES-PER TRAP 5.00 - SO.FT,FLOOR AREA, TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mems are not intended or offered for sale.If,however;the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA) 200
builder will have the burden of proving that lie - . - . . .
_e did not build or im- BUILDING USE
firfor purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB .' Other
V1,as owner of the property,am exclusively contracting with _ ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the projecl'(Sea 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 s chpmjec s with a contractorTRACT NO.
s)licensed pursuant to SEWER-SAN ITAR V-STORM EA.200ft/10.00 „PARCELNO.
the Contract Lice aW. •
❑ Ia mptu Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
19 son
Owner Dat WATER SYSTEM' - 5.00 ACC.OATE ACC.FILE NO.
WO 'RS' MPENSATION DECLARATION WATER TREATING EQUIP. 5.00
,1 hereby affirm that 1 have a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
,VX copy thereof(Sec.3800,Lah.C).
Policy No. I Company-
0 ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24
- z Z ❑ Certified copy is filed with the city inspection division. "
H O 4.s Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
T PERMIT ISSUANCE - - 10.00
CC CERTIFICATEONSATIOTINS FROM WORKERS' FLOOD ZONE a.L.0 C.
W � COMPENSATION INSURANCE PLG.CONTR. - u0.NO. 'PLG.
0. Z I (Th his'section need not be completed if the permit is I'or one _ TOTAL - Y❑ N❑ Y❑ N❑
handred dollars IS 100)or less,)
U O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
W F mit is issued',I'shall not employ any person in any manner so as to
Q w . become subject to The Workers'Compensation Laws of California.
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING as�
} r�li• NOTICE TO APPLICANT'. If,after making this Certificate of Ex--
emotion,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
Provisions of The Labor Code, you must forthwith comply with - FEE - '
U such provisions or this permit shall be deemed revoked 0D
AIR HANDLING UNIT(TO 1Q0C.F.M.) 4.00 .
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,WDC.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. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.)' 8:00 t
Lender's Name
Lender's Address HEATI NG UNIT(OVER 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 is correct. I agree To comply with all cityand county - -PLUMBING
`
ordinances and state laws relating to building construction, and BOER-COMP(3H.P.Or100,000B.T,U.) 6.00
hereby authorize representatives of this city to enter upon the BOI LILEO-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-menti ed property f spection purposes.
(We) a to save, i e fy and keep harmless the City of MISC.- REFER TO ORD. -
upe n ainst'liddli es dgments, costs and expenses which - CONST.TAX
ay In way,sec. last said City in consequence of the PERMIT ISSUANCE 10.00
ra it f i permit. n MECH.CONT. LIC.NO. 'MECH.
t Ay 123-0
- TOTAL aS V s+
V TOTAL „
at a p to Co oto Date
i
OFFICE COPY