18416 APPLICANT TO•FILL IN INFORMATION WITHIN RED (LINES - USE BALL POINT PEN ONLY
' •'�;. BUILDING PROJECT IDENTIFICATION -
- PERMIT NUMBER
BUILDING. APPLICATION & PERMIT RLA�
ADDRESS /J /� ♦ • 1.8
BUILDING — ELECTRICAL—PLUMBING —MECHANICAL
"1� OWNER'S j PLAN CHECK VALIDATION
,'/!I P}.{4 NAM .J��e j '-
„f `533 /yam�/� • OT 1. a ELECTRIC PERMIT - FEE
I��v CDNTRACTOR S //
NAME UTLETS,-SWITCHES-RECEP 10.00/1.00 /1/31 / v.'.
uC NO LIGHTING FIXTURES - 10.00/1.00
ADDRESS roll's APPLIANCES-RESIDENTIAL 4.00 e
PHONE PANELS 10-00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE PC NO
on PANELS (OVER 200-AMPI ' '20,00
ENGINEER
LAC No. SIGNS TRANS._ .". '3.00 '
ADDRESS ENG. SPECIAL CIRCUIT „ 5.60 PERMIT VALIDATION
TEMP.METER OR POLE INS.16
ADDRESSTS MOTORS SEE FEE SCH. _
�Q�•f/�J .JiJ rYLYR./ SERVICE CHANGE 20.00
woo LICENSED CON'TRACI'ORS DECLA RA'IfON
a U . 1 hereby affirm that 1 am licensed under Fmvisunis of Chap4•r 9.1 x ISSUANCE
art H -1 commencing with Section 7000)nf Division 3 of the Business and I BLDG ELECT. PLG. MECH.
F w z Professions Code,and my hccnse Ism full force end effect
o i m o L'te a Class Lm Number - s � 'I 'I
Hate Lic Nu Contractor V V M'Y
< " a OWNER-BUILDER DECLARATION Rn'11ON BUILDING PERMIT
m ° MISC.— �9 JAD ORD _ INFORMATION
w °' H 1 hereby ull'irm that 1 am exempt Gall the Contactor's License VALUATION $/FT.
uo J Law forthe folfowingnason (Sec.7031.5,Businessand Pndessaons
Code Any e;ly nr C"my which reymmsupennittoconstnict,alter, PERMIT ISSUANCE 10.00 �z 1
Q improve,demolish,or repair any structure,prior to its issuance,also ELEC:CONTR. LIC.NO ELEC. �r7J
n w m LL requires the applicant for'Such Period to file a signed state...cot that I TOTAI i3O PE T Tp-�
he IS licensed pursuant tothe provisions of the Contractor's License '�/'M„ yJ4 341
or i o Nbsim v mul 1§olcso(commencing Co )o1r that he isyscmpt thercl'n mf End
QTY. PLUMBING PERMIT FEE T///'( v l{�/
in h $ the basis for the alleged exem Pllom Any violation of86ction 7031.5 STORIES TYPE CONSTR.
a by any applicant for a Pcrad subjects the applcant to civil penalty .
of not more than five hundred dollars(8500)1. ALTER-DRAIN&VENT-WATER'(EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE r 4.001
I heir sole compensation,will do the work,and the structure is not .- OCC.GROUP RES UNITS
intended or offered for sale (Sec 7044, Rusincss and ProfeSsmns DRAINS-FLOOR,ROOF,AREA,COND, 5.001
Code: The Contractor's License Law does not apply m in owner of
iMi�xP'fU progeny who builds or uupmves thereon,and wl.o does such work FIXTURES-PER TRAP 5.001 $o.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve
m -
entserenotiNCnde d or titlercd for sale mld
If,however,the hmg GAS-EA.SYSTEM-1 INC.4 OUTLETS 6,001
•>xj Or Improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.001
builder will have the burden of proving that he did not build or im- BUILDING USE
s
prove lot purpose of sale) RES IND CON PB Other
INDUSTRIAL WASTE INTER. 30!001 ` �' ❑ ❑ ❑ ❑ E]. ❑ I,as owner nee of the property,am exclusively contracting with
licensed cold...lors to construct the Protect tSec 7044,BOShICSS I (LAWN SPRINKLERS-1 INC 5 V.B. 6.001 ASSESSORS PARCEL NO.
and Pmfih.0 ns Code.1 he Contractor's License Law does not apply -
to an owner of property who builds or homioves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.001
contracts far such projects with a contractors)licensed pursuant to B EWER-SANITARY EA.'200f1/10 001
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l an,enenmt under Sec It&P C.ITT this WATER HEATER W/VENT 6.001 TRACT
Owner Date WATER SYSTEM 5.001
I ACC.OATE ACC FILE NO.
WORK HRS'COMPE.NSATION DECLARATION WATER TREATING EQUIP. 5.001 11y
I hereby aIfum that I have a cenda'ate of consent to"I&lo'n", ZONING ENG SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified 1 1
copy Ihereot(Sec.3800,Lab,C.l. „
Policy No. Company
O ❑ Certified opy is hereby furnished.. FIRE SERINK ENERGY T-i4
Z Z ❑ Certified copy a filed with the co ti
y' inspecon division
O Applicant 1MISC.- REFER TO ORD. Y ❑ N❑ Y 'NF]~ �? PERMIT ISSUANCE 10,00
LU CERTI FICCOWIPU EXEMPT ION FROM WORKERS' FLOOD ZONE I A L.0 C.
W � COh11'fiNSATION INSURANCE. PLG.CONTR. LIC NO PLG,
CL O This section need not be completed if the permit is for one I I TOTAL Y❑ N❑ t Y ❑ N❑
::) Z handled dollars IS 100)nr less l I r
U O 1 certify that Ia the performance of the work for which this per- CITY MECHANICAL PERMIT FEE I FEE SUMMARY
LL F mo iJissueA,1 shall not employ any person in any manner so as m - -
U -become subject to the Workers'Compensation Lawn of Qdifo o....
0,W Date Applicant - I"BUILDING' : al '
} to NOTICE TO APPLICANT,If,utter making it...Certificate of fin. (ALTER OR ADD TO MECH. ' 5.00 '
2 empllAon,you should hecmne subject to the Workeri Compensation APPLIANCE .5.001 1'P CHECK
1)ov Ions of,the Labor Code, you must forthwith comply with
U such provisions or thus permit shall be deemed revoked AIR HANDLING UNIT(TO 10MC.F.M.) 4.001 , I FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.16.001 , SEISMIC FEE '
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.001 I ' ,
the performance of the work for which this perms Is issued(Se... MICROFILM
3097,Ce C.) 1 ' HEATING UNIT(TO 100,000 B.T.U.) 8.001 I'
Lender's Names HEATI NG UN IT 100,000 B.T.U.)9.50I ELECTRIC ..
Lender's AAdrv` � '
.�.iiIV,;F I .easy that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.001
Information is correct I agree to rimply will, all City and county PLUMBING
!; ordinances and state laws relating to building construction, and BOILER-OCMAP I3 H.P.Dr 100,000 B.T.U.1 6.001 +I
i hereby authorize representatives of this city to enter upon the above mentioned property for inspection purpaus. BOILER,COMP IOVer 100,000 BTU)SEE FEE SCH.1 I MECHANICAL
e..n^
"(We) agree to save, indemnify and keep harmless 0.c Oty of 1 MISC.-'• - REFER TO ORO.1' -
Cupertmo against liabilities,judgments, costs and expenses whmh CO NS_
.TAX
may i any way ace ue against said Qty in consegaaa}}}ttrace the
PERMIT ISSUANCE 10.001
Er_yin of tlu en /.q '� /� �� MECH.CONT LIC.NO. MECH }
Z/(/w/G—(x / TOTAL TOTAL
S.gnalure ol'App lcanl/L'ontractor Uute
OFFICE COPY
POST THIS CARD NEAR FRONT-OF BUILDING PERMIT NUMBER
:'CITY OF CUPERTINO .
INSPECTION'DIVISION 16416 ;
+JOB-INSPECTLON.RECORD
`I
PERMIT EXPIRATION
JOB ' -•UNIT# _LOT# ,1
PERMIT EXPIRES IF WORK
OWNER - S/ �C/�f-�"`�/�0�� �-CONTRACTOR IS I,NOT STARTED WITHIN
I . INSPECTION DATE' INSPECTOR I ' , INSPECTION RECORD 180 DAYS OF PERMIT ISSU
(FOUNDATION NOTE:' - ANCE OR 180.6AYSEFROM
_
. ' I UFER' - ' '- ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE _ .. . ,.� TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT va.mn Wool
CUPERTINO STANDARDS. '
i I GARAGE SLABS
I POUR NO CONCRETE UNTIL ABOVE HAS B :EN SIGNED
UNDERGROUND /SLAB
':IPLUMBING'
!ELECTRICAL -
.ISSUANCE AT
(MECHANICAL _ .uuD I _°LUG I fL.F.r.�i ^P�' PLC .I n+ecR
I • I ❑ L�1 I ❑ ❑
100 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 'JAU'U 0 6-17V3 BUILDING PERMIT —
I ° INFORMATION
' I "WOOD FLOOR �: "' (y "'��ry� vnlunno SiEr.,
,IPLUMBING 'I I g � „ I'')/a -
' IMECHANICAL I . . I'�/• 'C. ��!ry I -�
!ELECTRICAL G///V•' �o,V'U/.��
' (FRAMING
INSULATION „ I STORIES Tv PCCONSTR
UCC,GROUP, RES.UNITS
! PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I ,I -
� I ROOF I NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO FT I LOOR AREA -TOTAL ACREAGE
I. IDIAPHRAGM, I HE CONSTRUCTION TAX IS PAID ,
BUILDING USE.
(ROOF SHEATHING - l I: • • LIPS IND CON PB on.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ., _ •DATE . INSP. I 0 I] 0 ❑
-ASSESSORS PARCEL NO
I . ROUGH SAN'.#
'I PLUMBING ` I I ELECT.ENERGY - " - I
i + TRACT NO. PARCEL NO
••ITUBSBSHOWER PAN - I . IPLUMBING ENERGY'
` I ME-CHANICAL -I MECH.ENERGY - 1 R'
('ELECTRICAL I ' I BUILDING ENERGY I - I i ACC OnrE„ ncc.FlLe No
I FRAMING , I ELECT.F.INAL.TEST
. I i
,
INSULATION i I IPLUMBING TE NO.
., I � _ I•
ZONING ENG.SI
GAS TEST ' ',. I I - IGAS I I I 1
(MECHANICAL I ,I .,. FIRE SPRINn ENERGY r 24
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED (HEATING I . • ' Y � ' N❑ I " Y ❑ Np
ALUC
(EXTERIOR SHEAR' FLOOD ZONE
(ELECTRICAL RELEASEI , I I ,
(INTERIOR SHEAR. (FIRE DEPT. Y.0 ' "� I' S ❑ ."❑
ISHEETROCK " (GRADE' I I FEE SUMMARY +�
.. IEXTt'RIOR.LATH .,,-, - IBUILDING ,
INTERIOR'.LATH �` ' BUILDING'
- � - I ' , TEMPORARY APPROVALS '
SCRATCH COAT,' I I (ELECTRIC I PLAN CHECK
- I - ' •I'' IGAS' is _ -'FEE
NO NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY I SEISMIC FEE
OCCUPANCY-OF BUILDINGISNOTPERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,,. I ELECTRIC
F ONE WORKING',DAY BEFORE REQUIRED,INSPECTION. . ^ I ,PLUMeINC
;C) PLEASE GIVE JOB'AODRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE - I MECHANICAL
IMPORTANT! I coNST.TAX
PLEASE.READ REVERSE SIDE BEFORE
CALLING"FOR FINAL INSPECTYON. TOTAL��
OFFICE COPY ' 4