11606 POST THIS CARD NEAR FRONT OF BUILDING. •
PFRMIT NUM1IBFA
CITY. OF CUPERTINO 11606
I INSPECTION DIVISION '
JOB INSPECTION RECORD',
PERMIT EXPIRATION
JOB-ADDR
ESS GZ I
UNIT#
PERMIT EXPIRES IF;WORK
OWNER F\QY.I�N W�S.� , , CONTRACTOR ,p�407$j(-'� • ��]y(e—, - IS,NOT STARTED WITHIN
• -. I INSkafiON DATE INSPECTOR ( INSPECTION RECORD,` I • iBO DAYS of PERMIT lssu-
FOUNDATION 1 '+ - UAST AL 180 DAYS
PE FROM,
I t., V ��/ ? C✓ �/J! 6- .L�� I CAST CALLED INSPECTION.,
LIFER l`O E? ✓`/.-�°�*�l
ER
IPREGUNITE Pnnlr VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 2f-r3-gb �y�Q- -6a� i�(:� n C.0 I�
UNDERGROUND /SLAB •
(PLUMBING 11A 1'Q f�I/0 �f
ELECTR I CAL I 'f SSUANCE GATE
•,IMECHANICAL BLDG ELECT.' PLC IMECR.
( L'V\ 1- . .0'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUDDING PERMIT
r - INFORMATION
I
WOOD FLOOR I
I � � � VALUATION VALUATION Jjo)N
PLUMBING $/FT-
ELECTRICAL- - - I PERMITTO
I. .f'�ieQO r p ' Rr--H�Il2,
- (FRAMING
INSU CATION 1 STORIES TYPE CON
!TR.
I OCC,GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I
ROOF ,I , SO FT.FLIOORARIFA TOTALACHEAGL
DIAPHRAGM, I ' BUILDING USE
' DES IN 'CON' PDOthiv
APPLY NO ROOFING LINT L ABOVE HAS BE IGNED �'
ASSESSORS PARCEL NO
ROUGH
•,;I PLUMBING I TRACT ND, PARCEL NO,
GAS TEST I I 1
IMECHANICAL
ELECTRICAL I FINALS DATE INSP. ! ncc•DnrE. ACC.FILE NO
FRAMING '(SAN # 1 I zoNlNC INC.SITE NO
INSULATION .. IPLUMBING I - -
..I IGAS,
(MECHANICAL I FIRESPRINK ENERGY T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ;('HEATING I Y - "� ND
• ILATH=INTERIOR ,' (ELECTRICAL FLOOD ZONE, ALUX
—/4—r� CS� i I
` ILATH-EXTERIOR' - (FIRE DEPT. I O ! ; Yo N[] Y NI]
ISHEETROCK IGRADE . - I I FEE SUMMARY
• ISHEARINTER IOR _ - IBUILDING . ,�^-I Y=Y I I BUILDING•"
I Y -
ISHEAR EXTERIOR I TEMPORARY APPROVALS ('
IFIREWALLS ' (ELECTRIC; ` PLAN CHECK
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY : I I SE SMIC FEE ,
•- OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - I
ARRANGE FOR INSPECTION BY,PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMewG
0 PLEASE GIVE-JOB ADDRESS WHEN PHONING.
Z
.— SEE PERMIT FOR EXPIRATION 'DATE '-
IMPORTANT! coNST.TAX
PLEASE READ REVERSE SIDE.BEFORE TOTAL ,
CALLING FOR FINAL INSPECTION.
.,OFFICE'COPtl .. -
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION _ PERMIT NUMBER
BUaOING APPLICATION & PERMIT
ADORES s—
BUILDING AL
OWNER'a� PLAN CHECK VALIDATION
NAME �F� OTY. ELECTRIC PERMIT FEE
P, K lzi gvia1 PHGNEzs3 a2/?/
CONTRACTORS
` E �J it) OUTLETS-SWITCHES-RECEP. 10.00/1.0016 —
CM!lv,lit { /lQ�1C LIC NO 213.7V. LIGHTING FIXTURES 10.0011.001
ADDRESS CroRs APPLIANCES-RESIDENTIAL 4.00
ONTITA
PANELS 10.00 DATE OF APPLICATION
•
ARCHITECT ECT 1 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE PC NO.
ENGINEER
LIC NO SIGNS TRANS. 3.00
ARCH,OR ENG PERMIT VALIDATION
AOOREss SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE.INS. 20.00 A.>
APPLICANTS MOTORS SEE FEE SCH. /j /�I "f'�•
ADDRESS S
' - SERVICE CHANGE 20.00 Q
�00 LICENSED CONTRACTORS DECLARATION �4a1n Er-7l
Gr
.Q v w 1 hereby.(Finn that I am licensed under provisions of Chapter 9 I ISSUANCE DATE
yz' (commencing with Section 7000)of Division 3 of the B ioness anJ
< y I BLDG, I vii-T, PLO I'MECH
r N z Professions de, d my license Is in full forelyJUd�fCecb Z' A }(y f`
g`QI 7 S 4 4 6 1 10 'I M n r!
o i m W License CI s —LS--Co Number
Uate 4,._Conlrautor
F N H J
• ¢ o OWNER BUILDER DIiCLA RATION - yp,iv .�• OsrY,y NIAR){RrT
w ;.. N I hereby afOnn that I am exempt from the C...rmctor's License MISC.-- , FE��`r'i IIVFV Rrurr
H m w j Law for the following reason.(Sec.703 1.5,Busmessand Professions I PERMIT ISSUANCE 10.00 �d VALUATION $/FT.
Code:Anycity orcounty which requires a permit to construct, µ '� / a
K ¢4 0 improve,demolish,m repay any structure,prior to is Issuance;also I ELEC CONTR LIC NO. I ELEC n_ /
o uc requires the applicant for such permit to file a signed statement that TOTAL Ou✓ PERMIT TO e
ca w$ he ra licensed pursuant to the provisions of the Contractor's License
io Burin ssaantdrProfessio Professions that li is exempt therefromfanid IQTY. PLUMBING PERMIT I FEE j
¢ 1, pm the basis for the alleged ascription.Any violation of Section 7031 5 STORIES TYPE CONSTR.
ag _ by any applicant for a permit subjects the applicant to a civil penalty) ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(8500).1.
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.001 OCC GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale ISec. 7044, Busaes5 and 1rofcssio.E DRAINS-FLOOR,ROOF,AREA,CONO. 5.001
Code;The Contractor's License Law does not apply m an owner of
• properly who builds or improves Ili ere on and who Jnes such Work FIXTURES-PER TRAP 5.001 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,fronded that such improve- 1
merle are not amended or offered for sale.I(,howevcL the huddmg GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.001 71
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.001 j auaO(NG USE
budder will have the burden of-proving that he did not build or im- RES IND CON PB oiM1ar
prove for purpose of sale.). 11NDUSTRIAL WASTE INTER. 30.001 I RE ❑ ❑
❑ I,as owner of the property,am exclusively contracting with L1 0
licensed contractors to construct the project(Sec.7044,Business (LAWN SPRINKLERS-1 INC 5 V.B. 6.001 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-OV ER 5(EA.) 1.00
Lontracts for such projects with a contractors)licensed pursuant L. (SEWER-SANITARY-STORM EA.200(t/10.00
the Contmuksrs License Law. 1 TRACT NO. I PARCEL NO.
❑ Iamexemptunder Sec ,B&P.C.for this (WATER HEATER W/VENT 1C]']
reason
Owner 'Date WATER SYSTEM 5.001 ACC,DATE ACC.FILE NO.
WORKERS'CONIPENSATION DECLARATION I I WATER TREATING EQUIP- 5.001
I hereby affirm Thal I have n certlt scale ofcmocut to Self-ii, 1 ZONING I ENG.SITE NO.
or a cerlifitate of Workers'Compensation Insurance,o,a certch,
copy thereof(Sec.3800,Lab.C.).
Policy No Cnmpanv
0 ❑ Certified Copy is hereby furnished. - I FIRE SPRINK ENERGY T 24
Z 2 ❑ Certifed copy R. filed will, the my mspecr ron division
O ApphcaM , (MISC.- REFER TO ORD.1
I Y p N I Y I] N]
M t2 CERTIFICATE 017 EXEMPTION PROM WORKERS' I PERMIT ISSUANCE 10.001 1 FLOOD ZONE AT.U.C.
LU > COMPENSATION INSURANCE PLED.CONTR. LIC.NO. IPLG. ❑ ❑ ❑ ❑
n' ,. IT his'secNno need nom be 'candeted d the permit is for one TOTAL Y N Y N
Z huhd,cd dollars IS 1001 or Icss.)
O _ 1 certify that In the performance of the work for-which this per SUMMARY
arLL F' mit I issu I all not employ any person m any manner so its vs QTY. MECHANICAL PERMIT FEE
„O Lb"nm'S jet he WI ken'C e i now aIy'[o_r�a r
Date APPlicam tea(!!-!L ALTER OR ADD TO MECH. 5.00 BUILDING
-NOTI 1'O API'LICAN'f If,utter mukmg this Ccrtificua al'E-
F Z_ capita ,yn should becomes to the Workers'Compcmauo^I I APPLIANCE 5.001 PLAN CHECK
provisions of the Labor Code, you must 10011W Ell comply with
U such provmmns of this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=r.F.M.) 4.001 FEE
CONSTRUCTION LENDING AGENCY I AIR HANDLING UNIT(OVER 10=C.F.M.) 6.001 ! SEISMIC FEE
'I hereby affirm that there is u'constructum lending agency for 1 EXHAUST HOOD (WITH DUCT) 5.001 I
the performance of the work for which this permit is issued IS, MICROFILM
3097,CY.C.). - 1 HEATING UNIT(TO 100,000 B.T.U.) 8.001 •I
Lender's Na, HEATING UNIT(OVER 100,000 B.T.U.19.50 r
Lenders Addres= I I ELECTRIC
1 certify that 1 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 I BOILER-COMP 13 H.P.OF 100,000 B.T.U.) 6.00 I PLUMBING •I
ordinances and state laws relating to budding construction, and
hereby authorize representatives forryes of this city es enter upon ihcl 1801 LER-COMP (Over 100,000 BTU)SEE FEE SCH I MECHANICAL
hereby property for lnsp of this
purposes.to.
(We) agree to save, indemnify and keep harmless the City of I I MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, casts and cap see whit.. PERMIT ISSUANCE 10.00 CONST.TAX
yym Apt e •most s old City m co s'eq ncc f the MECH CONT. LIC.NO. MECH f ToTA` TOTAL
Cons actor / D to
` OFFICE COPY