16691 r'px
APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT.PEN ONLY
i_ BUILDING PROJECT IDENTIFICATION PERMIT NUMBER,,-
man-OPNG APPLICATION & PERMIT y 16691,
-• TO g+ I U J
470' Ainsworth Dr, _ :BUILDING-ELECTRICAL-PLUMBIN- -G--MECHANICAL ,
OWNER'S. PLAN CHECK VALIDATION
NAME, t OTY. - ELECTRIC PERMIT FEE
Judv Waters PHONE 737_g0 n
CO TRACTORS
=CO T • I OUTLETS-SWITCHES-
RECEP 10:00/1.00
Dial One BUffalowas • 961-7b50 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDRESS III APPLIANCES-RESIDENTIAL 4.00
' 1245 Space Park PKSEv 961U PPU PANELS 10.00 DATE OF APPLICATION
ARCHITECT — -- — -- PLAN CHECK FEE I P C.NO
oR PANELS (OVER 200 AMP) 20.00
ENGIry EER a +A .
• uc NO' SIGNS TRANS. . 3.001
ARCH OR END --- — -
ADDRESS I SPECIALICIRCUIT 5.001 PERMIT VALIDATION
(TEMP. METER OR POLE INS. 20.001 8L.
' APPLICANT'$ / I 'j
ADDRESS MOTORS' ESCH.
- ISERVICE CHANGE 20.00
'00 I .
�,o o LICENSED CONTRACTORS DECLARATION- � (!j 1�` �'
a u w 1 hereby itftnn that I am Lcen+ed under pruvrsmn,of Chapter') � � U ISSUANCE DATE -
y a m (commencing with Section 7000)of Division 3 of the Business and - - ,dLDG. ELECT PLG. MECH.
w z Pmfcssions Cod}•.anJtyY liccnu Ia In full Iwrq; 4.eLLct I, - rs. _ ❑ ❑ ❑
'z o w- License Cing+�r'- Q._—lac,Numher<3 7 7 O
2 w °0 Date L tl tl 9 Contractor '"
_r
a m L ` °BUILDING PERMIT
¢ ¢¢ a OWNER-BUILDER DECLn AA-� `
°x O.6 I here,, (�e6 ,"� MISC.— n . REFER TO ORD i INFORMATION
w ; y uollo i g I am cxee 7 fn.5 file Contractor's Lm sc
LO ¢ Law for the following reason.lSec.7031.5,Business:mA Pn,fesvons VALUATION I, $/FT
r ; -L Code An cif or count which rei ntresa construct, I PERMIT ISSUANCE 10.00
j Y Y Y I permit .aIP,also 'ELEC CONTR LIC.NO
'� ¢ a o improve,demolish,ur for such Perrot 1.11 poor n its statement also I ELEC I .
K LL requires wreg the applicant for such permit to file a signed statement that " TOTAL
he
Law is hcvosed pursuant to the provisions of the Contractors I'cenr • P�E`RM)TITO,
i r t
BusiBusiness ndProfessions e
Col f
Code)or that he is exnpt tlicmfromanJ OTY. PLUMBING PERMIT * FEE •!1N`J lM I L +/�,E��'I
¢ H$ the basis for the alleged exemption.Any violation of Section 703 LS - I STORIES TYPE CONSTR.
y ?� � by any applunint far a permit]RbjLoS file ap plicallt lOa civil penally ) gLTER-DRAIN -WATER IEA.L 5.001
of not more than five hundred dollus($500).) I.
- ❑ L as owner of the property,or my employees with wages as ggCK FLOW PROTECT DEVICE 4.00 - 77
(heir Sole compensatio .n,will do the work.and the structure is not ` OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Profession+1 11+ t •- *I:
Curie.The Contractor's License Law does not apply m an owner of DRAINS-FLOOR,ROOF,AREA,COND. 5.001
y who builds or improves thereon,and who does such worA ' FIXTURES PER TRAP .5.001.;
propCri p SO FT FLOOR AREA TOTAL ACREAGE
4� himself or through his own employees,provide)then such improve-
^-'11 mcut,me not intended ar'ol @red f..sale.I f,huweveq the building) GAS-EA.SYSTEM,:I INC.40UTLETS 6.001'r�- •r
nr improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM OVER 4 TEA.) 2.001
\ ..-../ builder will have the burden of proving that he did nnf build or um iBUILDI NG USE
prove for purpose of,.I,) INDUSTRIAL WASTE INTER. 30.00 • REST.+IND „CON PIS ,Omar
❑ I,as owner of the property,am exclusively contracting with I '❑ +' ❑ ❑ ❑- ❑
I¢ensed contract.,, to construct the pmlect ISee 7044,Busums+I ILAWN SPRINKLERS-1 INC 5 V.B. 6,001 q'El 4R$PARCEL NO.
and Professions Code:The Contractor's License Law dues not app)
_and
an owner of property who builds or anprovsihcrcon.and who1 ILAWN SPRINKLERS-OVER 5(EA.) 1.001 'd
contracts for such pmje<b with a enntractorw Ileensed punuanl lu - • .. '• -
file Commct.r's License Law. 1 SEWER-SANITARY-STORMEA.2001t/10,001' ;"1 I ',TRACT NO. PARCEL ND.
❑ Ium exempt under Sec ",N&P C.ter Dos WATER HEATER W/VENT 6.001
Owner Dnic WATER,SYSTEM' 5.001 Ace.DATE ? ACC.FILE NO
N'ORAflRS'COMPIiNSA'I'ION DECEARA'I'ION' ,WATER TREATING EQUIP. " 5.001 't ,•
J hrrchy affirm that I have a certdicah of consent to self-insure,
or a eeridicale of Workers'Compensation Insurance,or a caridmd • - ZONING ENG,SITE NO. '
Copy ule"G' Si tbacific Com
Cohcy No. ny P
p Ceri ilied p hereby nisheJ.
Z 2 �] CerniO ti file h tit y rR n division. I FIRESPRINK " ENERGY T 24
CC Onpplicam MISC.- I REFER TO ORD. v❑^„N❑ v ❑ 1 N❑I
CERTIFICATE OF EXENIr I-RO� RS' PE RMIT ISSUANCE - 10 00 1i FLOOD ZONE'' A.L.U,C.
W COMPFNSATION INSURANCE PILE.CONTR, LIC.NO PLG.
CL O This section need not be completed If Ihr permit is fur one I I TOTAL i Y❑ N❑ Y ❑'. N❑
hundred dollars 151001
U O or less 1 r
I certily that in the performance of the work for which tiis•per' QTY '' MECHANICAL PERMIT FEE FEE SUMMARY ' • _ �I y
LL'I- mit is issued, 1 shall not employ any person In any manner sit as to _
U become suhlen In thu Workers'L'unlpen+a InNn Laws of Cuhfnrma,
O n De Applicant BUILDING
} 00 NOTICE TO APPLICANT' If,after making this C,,t,rcafe.,,is (ALTER OR ADD TO MECH. 5.00 i
Z e n turn, oa should hecone sub
I— , P Y met n most I..th it CCo p ly stn '(APPLIANCE 5.00 I PLAN,C-1
provisions of Ole Labor Code, you muss drevoke comply wv
, U such pmnvods or this permit shall he Jecmee revoked I AIR HANDLING UNIT(TO 10,000 C.F.M.) 4,001 FEE
CONSTRUCTION LENDING AGENCY' . 1 AIR HANDLING UNIT(OVER 10f WC.F.M.) 6.001 , SEISMICFEE —� • 'I
I lmrchy alhun that there is a construction landing agency Tor EXHAUST HOOD(WITH DUCT) 5.001 I
the performance of the work for which this perms is issued(Sec MICROFILM
30g7,Civ,C.). , J HEATING UNIT(TO 100,000 B.T.U.) 8.001, o-0 I
Lender's Nx••• I I---
LedersAaar•• ' 1 TREATING UNIT(OVER 100,000 B.T.U.)9.501 ELECTRIC,
1 ccruty that I have read this uppllcatL n no late Ihaf the uhndc I VENTILATION FAN (SINGLE) 4.001 _
t
,Of. nation is "Rest. I agree to comply with all city and county
oNlnances and state laws relining to budding c.ni ruction, and I- BOILER H.P.Or 100,000 B.T.U. 6.o0I ' PLUMBING
Y hereby authorize representatives of this city to enter upon the I BOILER-COMP (Over 100,000 BTU(SEE FEE.SCR, i MECHANICAL
` above-mentioned property for inspection purpous - Q
.(Wc) agree In save, allemmfy nil keep,hairnloss the City of ` 1 MISC.- REFER TO ORD.
Cupertino agains iah I to Judgments, costs and expenses which I CONST.TAX,
may in any w' accrue gains[ said Qty m conse9 uencr of the I PERMIT ISSUANCE 1 10.00 1�QC
granting,, t permit. MECH.CONT - LIC.NO MECH,
TOTAL TOTAL I O V
Srgna r of Applicant/Con r c ,,7 Date ✓, ��. II OFFICE-COPY
a
' POSTTHIS'CARD NEAR'.FRONT•OF-BUILDING-
PERMIT NUMBER''
j' CITY OF CUPERTINO 1,6691 '
INSPECTION.DIVISION"
fy' ',LOB INSPECTION RECORD _
'A .p/, '• PERMIT EXPIRATION'
JOB ADDRESS.JJ(Lf " -"" YrV POq D., UNIT# _LOT#' '
(lr : PERMIT EXPIRES IF WORK 11.
OWNER �� � Y. \N��L�r)-. CONTRACTOR .n •x�Idiv IS NOT STARTED WITHIN
I ,INSPECTION DATE INSPECTOR INSPECTION RECORD I 180 DAYS OF PERMIT ISSU-
I FOUNDATION _ - ANCE OR 180 DAYS FROM
NOTE: LAST CALLEDINSPECTION..;,
I UFER '+' ;•j, ,. 'I ALL GRADING AND DRAINAGE SHALL BE'INSTALLED I • ' ' . '
Iu COMPLY WITH THE APPROVED PLANS,AND CITY OF PERMIT VALmgiION
• I GARAGE SLABS - `I CUPERTINO STANDARDS.
. I GARAGE'SLABS '. . I!•':,r: .'. - :: '. ., +,, . .+: 1 " (....--�,... L•�''•
]PLUMBING
NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
"
UNDERGROUND,/,SLAB
6
ELECTRICAL
'-JAN. 1989 `'
ISSUANCE DATE
IMECHANICAL . •. ' •' --_ J c I
uy.ut Cupertino I OLOC ELECT I PLC I M�,
❑ ❑ ❑
I 'DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '" BUILDING PERMIT
INFORMATION
I WOOD FLOOR I. .
PLUMBING VALUATION I SIFT
^I
IMECHANICAL
IELECTRICAL I ' PEHr.IT TO
IFRAMING ;' .. . `
INSULATION. ,I _ I - snn+It TYPE CO1vsrR"
L.
• �I I I ,• -I OCC GROUP TIES UNITS
/y. I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ''• I IO
SO FT.FLOOR AREA TOTAL ACHEAGE
�� I •- _ .ROOF �', � INOTE:NO FINAL INSP SHALL BE MADE BEFORE '� I
" -•I DIAPHRAGM I I HE CONSTRUCTION TAXIS PAID
IROOF SHEATHING ewl.DlNC USE
' I' .I ., , r+ES INO cON PB Ono•,
P; APPLY-NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS DATE I' INSP.- I ❑ ❑ ❑ ❑ ❑
'SAN
ROUGH
I ASSESSORS PARCEL NO
I ; .#
'• IPLUMBING . PELECT.ENERGY ' . I I
TRACT NO PARCEL NO.
' ITUBS&SHCWER.PAN, -'I PLUMBING ENERGY
IMECHANICAL - I MECH.ENERGY
ELECTRICAL ,; ' ' ' , BUILDING ENERGY I ACC DATE ACC FILE NO
L' I
IFRAMING : . I • I ELECT.FINAL TEST 'I
INSULATION I ZONING ENC.SITE NO J�
GAS TEST •. I '. IGAS f 1
IMECHANICAL I I i r IRE SPRINK • ENERGY T 54
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ❑ N❑
EXTERIOR SHEAR_', "UnN ZONE AL.UC '
- I I, � � ', ELECTRICAL RE I .. ,
I INTERIOR SHEAR .I ' (FIRE DEPT. I I Y❑ N 1 L N❑
ISHEETROCK I IGRADE I I .I FEE SUMMARY
IEXTERIOR,,LATH I ' IBUILDING .I
' BUILDING ' —�I INTERIOR LATH .I TEMPORARY APPROVALS I.
(SCRATCH COAT I" I . (ELECTRIC I PLAN CHECK r•'
I 1. ' ,T I I IGAS ( 'FEE I.
'I NO TAPE OR PLASTE R'U NTIL ABOVE HAS BEEN SIGNED OCCUPANCY I •'. + SEISMIC FEE '
IOCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR.( MICROFILM. :. I_�—
BAR RANGE;FOR INSPECTION BY PHONING_ 252-4505, I ELECTRIC
Z ONE WORKING DAY BEFORE R11QUIRED INSPECTION. I PLUMBING '
1 ;a' PLEASE GIVE JOB'ADDRESS WHEN PHONING,
�,! . 60
— SEE PERMIT MECHANICAL FOR EXPIRATION DATE = I +��
IMPORTANT! ' CONST. TAX
PLEASE READ REVERSE SIDE BEFORE ' T
• •-' _ •`. CALLING FOR FINAL INSPECTION. ' TOTAL :OIy1 I ',
OFFICE COPY, 111