14500 (2) POST THIS CARD NEAR FRONT OF BUILDING
' - PERMIT NUMBER
A CITY OF CUPERTINO 14500
INSPECTION DIVISION
JOB INSPECTION RECORD.
PERMIT EXPIRATION
JOB ADDRESS 10923 N WOLFE ROAD UNITst _Lor#
PERMIT EXPIRES IF WORK
OWNER VALLCOPARK LTD CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITi PERMITVAIA>ATION
GARAGE SLABSCUPERTINO STANDARDS.
'
POUR NO CONCRETEUNDERGROUNDABOVSLAB E HAS BEEN SIGNED ,AN. 4�gB1
PLUMBING ��tU110JJi 01"] ,
ELECTRICAL Wr
ISSUANCE DATE
MECHANICAL BLOC ELECT. PLq, I MECH
❑ El ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR' INFORMATION
VALUATION
PLUMBING
MECHANICAL -
ELECTRICAL PERMIT TO
• FRAMING
INSULATION STORIES T PE CONSTR.
.UCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• .ROOF � NOTE:NO FINAL INSP:SHALL BE MADE BEFORE SOFT FLOOR Al I A TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
ROOF SHEATHING RES IND ILDCON usEP9 On.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ .❑ ❑
ROUGH SAN.q ASSESSORSPARCELNO
PLUMBING ELECT.ENERGY -
'TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECK ENERGY I
1
ELECTRICALACC DATE ACC.FILE NO
' BUILDING ENERGY
FRAMING ELECT,FINAL TEST '
INSULATION PLUMBING ZONING ENG SITE NO.
T
GAS TESGAS
MECHANICAL - FIRE SPUNK ENERGY T-14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ° ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE . FEE SUMMARY
EXTERIOR LATH BUILDING .
INTERIOR LATH TEMPORARY APPROVALS 'sulLowG
SCRATCH'COAT ELECTRIC (,� PLAN CHECK -
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY . SEISMIC FEE "
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
LU ARRANGE FOR INSPECTION BY PHONING 252-4505,. .
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. j
PLUMBING
z
PLEASE-GIVE JOB ADDRESS WHEN PHONING. '
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! t CONST.TAX
PLEASE READ REVERSE SIDE BEFORETOTAL
CALLING FOR-FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ..
Rn'LCHIN /O APPLICATION & PERMIT 14500_
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S 'MO^�.x'K^ PLAN CHECK VALIDATION
NAME !�(�J C/Ml/(YpU(/ GTV. ELECT RIC PERMIT FEE
,• RA T�(P•� 7Q, PHONE
NAMERAcions UTLETS-SWITCHES-'RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION
ncRrtEci PANELS (OVER 200 AMP)'. 20.00 PLAN CHECK FEE P.C.NO.
o
On
ENGINEER
' uc.rvo. SIGNS TRANS. 3.00
PERMIT VALIDATION
ADDR.SS ENC. SPECIAL CIRCUIT 5.00
aoor Ess � '
.ZIP TEMP.METER OR POLE INS. 20.00 ' - vG.feL•f/'�-F'�
APPILI MOTORS SEE FEE SCH. ✓�
ADDRESS
SERVICE,CHANGE 20,00
ro o LICENSED CONTRACTORS DECLARATION
a U U I hereby affirm that I am licensed under provisions of Chapter 9 ISS ANCE DATE -
y< a. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.-
F w z Professions Code,and my license is in full force and effect. ^ ❑ ❑
' 0. - License Class Lie.Number-
2
umber 9 z r D Dare Contractor
Q y f J A� BUILDING PERMIT
¢ ¢ m a OWNER-BUILDER DECLARATION - INFORMATION
oAu MISC.- REFER TO!?
E:
;u w I hereby affirm that I am exempt from one Contractor's License VALUATION 5/FT.
uoa Law for the following reason.(Sec.7031.5,Businessand Pro@scions PERMIT ISSUANCE 1
L• HmJ Code:Anycity orcounly which requires a permit to construct,alter, 'v
2 ¢ Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
6 c LL requires the applicant for such permit to file a signed statement that , TOTAL oV PERMIT TO
w
S. m he is licensed pursuant to the provisions of the Contractor's License �.
w, Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe
a Business Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ = $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i by any applicant for a permit subjects the applicanuo a civil penalty ALTEWDRAIN&VENT-WATER (EA.) 5.00
allot more than five hundred dollars(55001.):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.caouP 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 Contractors License Law does not apply to an owner of
properly who builds or improves thereon,and who docs such work F IXTUR ES-PER TRAP 5.00 So.Pi.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 budding GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im• RES IND CON Pe Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed mmormors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
toan owner of property who b ilds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contacts for
such projects with contractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
[lief ors License Law. TRACT NO. PARCEL NO.-..
ClI mexc le ,BAP.C.for it WATER HEATER W/VENT 6.00
carers
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
W RKE "COMPEN ATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm wt I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.). „
Policy No. Company _
O ❑ Certified Copy s silently furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
0 Applicant MISC.- REFER TO ORD. y [3N❑ y C] N[]-
0: CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLG.
�
Z (FIRS section V clidn need not be completed if the permit is for one ❑ NE] V❑ N
❑
hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which"i's per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of Califomia.
U y Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of lix.
H ? 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
U
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.1110 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.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.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
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 city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING.
ordinances and stale laws relating to building construction, and
hereby authorize represenativ of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for it pection purposes,
e) agree to save, Inde fy and keep harmless the City of MISC.- REFER TO ORD. '
per ainst liabilities, gments, costs and expenses which CONST:TAX
in any accrue a in t said City in marc ence f the PERMIT ISSUANCE 10.00
IN
i I this / /'/�� MECN.CONT. LIC NO. MECH. TOTAL
y TOTAL
Signature Applicant/Contract r ate
OFFICE COPY