13916 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
�Tt BLd LDING PROJECT IDENTIFICAI . APPLICATION & PE PERMIT NUMBER
"�oRELING 13916
ss �� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OZ�oO v�
OWrvEH'a � PLAN CHECK VALID ION ,
NAME 1 /yam w QTY. ' - ELECTRIC PERMIT FEE 7
GI W -t •c3 PHONE, -
coNTRACTo s UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
LIC.No. LIGHTt NGFIXTURES' 10.00/.1.00
CONTRACTORS
ADDRESS .APPLIANCES-RESIDENTIAL - 4.00
ADDRESS ^ -
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.N0,
DR PANELS (OVER 200 AMP) 20.00
ENGINEER
' LIC.No. SIGNS TRANS, 3.00
AARCH,09 DDRESS ENG SPECIAL CIRCUIT . 5.00 PERMIT VALIDATION -
ZIP TEMP.METER OR POLE INS. 20.00 '
APPLI
ADORE - - MOTORS' SEE FEE SEH. ¢2(a
-
2- p C.I SERVICE CHANGE 20.00
o o a LICENSED CONTRALTO S DECLARATION _ - - (n ���15 1
G o w I hereby affirm that 1 am licensed under provisions of Chapter 9 169 ANCE GATE
� (commencing with Section 7000)of Division 3 of the Business and eLDGp 1ELECT}L PLG. MECH.
r z Professions Code,and my license is in full force and effect. C`i p LD N VL'R ❑ ❑ 1
z o y - License Class Lic.Number '1
O w Date Contractor
a m IS=+ BUILDING PERMIT.
¢ OWNER-BUILDER DECLARATION"
E m wu INFORMATION'
w ;.- N I hereby affirm that I am exempt from tie Contractor's License MISC.- t' REFER TO ORD
Lo ¢ Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00 - VAWnJTT ON $/FT.
E Code:Any city or county which requires a permit to construct,alter,
IS
Q ¢ Q, improve,demO11S11,Or repair any structure,p110r to its issuance,aI50 ELEC.CONTE. LIC.NO.
ELEC.
a w m u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO r
he is licensed pursuant to the provisions of the Contractor's License
rzi
POST THIS D NEAR FRONT OF BUILDING •
CITF CUPERTINO
PERMIT NUMBER
INSPECTION DIVISION
13916
• JOB INSPECTION RECORD f (
f x
10260 ANTHONY PLACE PERMIT EXPIRATION,
JOB ADDRESS UNIT# LOT# "
, PERMIT EXPIRES IF WORK
OWNER STEPHEN WEYER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
�W ANCE OR 180 DAYS FROM
FOUNDATION •LASTCALLED INSPECTION.
UFER r
PERMIT VALIDATION
• PREGUNITE -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED W
UNDERGROUND /SLAB (1(• ( '�- I l-
PLUMBING -
ELECTRICAL CtIY D�- t OQBlf!RO
ISSUANCE DATE r
MECHANICAL - BLDG. I ELECT. I PLG. MECR.
❑ •❑ 0 ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITw
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
- �
MECHANICAL
ELECTRICAL - PERMIT TO.
- FRAMING '
INSULATION - STORIES TYPE:CONSTR,
OCC.CROUP RES.UNITS
PLACE NO SUBFLOOR UNTILABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE ti
DIAPHRAGM
BUILDING USE
RES IND CON PB Umar I
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 0 ❑ ❑ ❑
ASSESSORS PARCEL NU.
ROUGH '
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL -
ACC DATE ACC.FILE NO.
FINALS.. - DATE .INSP.'
FRAMING SAN * -
ZONING ENG.SITE NO.
INSULATIONPLUMBING
GAS
MECHANICAL FIRE SPRINK ENERGY T-24
'COVER NO.WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y-[-] NE] Y ❑ N0
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.LU.C.
LATH-EXTERIOR FIRE DEPT. Y NE] Y.0, N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING. /LCJG I j-- _
SHEAR EXTERIOR TEMPORARY APPROVAL
BUILDING
FIREWALLS - ELECTRIC " PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE J
OCCUPANCY OF BUILDI NG ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING'
O PLEASE GIVE JOB ADDRESS WHEN PHONING:
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY