14453 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
IBUI LDING PROJECT I DENTIFICATION - - PERMIT NUMBER -
BUILDING �A APPLICATION 8i PERMIT q j� A ��.
ADDRESS���� I-'-'�T�` 144
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER a PLAN CHECK VALIDATION
9C To, �-!•G7) TY. ELECTRIC PERMIT FEE '
I l - PHONE //O
d 2•
CONTRACTOR'S /(
OUTLETS-SWITCHES-RECEP 10.00/1.00
NO. LIGHTING FIXTURES 10.00/1.00 '
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
ADDRESS
`'•� -PHOrvE"�p 3 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.O.NO.
OR
ENGINEER
LIc.No. SIGNS TRANS. 3.00
AARCH.Do DDRESS ENG. - $PECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE SCH.
ADDRESS
'
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION D
mu 1 hereby affirm Ilial I am licensed under provisions of Chapter 9 - �[.,�ti'7 ISSUANCE DATE
z w (commencing with Section 7000)of Division 3 of the Business and
< vAi B D ECT. PLG. MECH.
H N z License
Cls Cod- and license is in full fo vW elle t -
z o,.,•, License Class Lia Number
O H r Oate_i_ Conlmdor ' e
If
06 ` WNER-BUILDER DIiCLA RATIONT
FORMATION
X
; u N I hereby affirm that I am exempt from the Contractor's Lice se MISC. REFER TO ORD
Huo J Law fur the following reason.(See.7031.5,Businessand Professions pERMIT ISSUANCE 10.00 // VALUATION $/FT.
- Cade:Any city or county which requires a permit In construct,alter, /" ��'oo„
rt2 Q improve,demolish- a repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. 31�� / 0
G LL requires the applicant for such permit to file a signed statement that TOTAL f-
a W m he i5 licensed pursuant to the provisions of the Contractor's License f's PERMIT TO
F z a Law(Ghapter9(commencing with Section 7000)of Uivision3ol'Ihe S40/0y A,,
E 4 0 Business and I'rofuasions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE d V v
It H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a 3 by any applicant for a permit subjects the applicant toa civil penalty "
of not more than five hundred dollars 155001.1: ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITSnd
their sole compensation,will do the work,and the structure is not -
inteed or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property Who hUlldS or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTALACREAGE
himsoll'or Ihongh his own employees,provided that such in0rovo
menu are oat intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
J or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that lie did not build it am. - . BUILDING USE
RES IND CON PB , Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. •30.00
- ❑ d as owner of the property,nm exclusively.contractingBo with -0 EL -
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions of Coop:The Contractor's License Law does not apply
to ancontraownerfor
of propertywhob a contor rimproves lhereon,andsua who LAWN SPRINKLERS-OVER 51EA.) 1.00 33-Z`�-O�f-
theCoutsfo�sucLcenecLwithamntr:mmrl s)liccnscd pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 /
the Contractor's License Law. TRACT N0. PARCEL NO.
❑ lam exempt under Sec. ,B.&PLC.for Ibis WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC'FILE NO.
WORKIiRS'COM PI!NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofeonsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a cert it ieJ. '
copy thereof(S•• 3
Policy Noted p f,L
0 D Certified copy is hereby furnished. ���� - FIRE$PRINK ENERGY TZ4
Z z ❑ Certified co Is file 1 h city insp�ec'Ilondivision.
F O Applicant MISC.- REFER TO ORD. Y E] N❑ Y ❑ No
CCN CERTIFICATE OPE ! TION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPE ONINSURANCE PLG.CONTR. LIC.NO. PLG. N� Y N
�
d O This section need n re completed if the permit is for one TOTAL
V
� 2 hundred dollars 18100)or Icss.l
U O 1 eertify that in the performance of Illi work lir which IIIN per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY '
LL U mit is issued,I shall not employ any person in any manner so as to
become subject 10 the Workers'Compensation Laws of California.
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /�0
} W N011CIi TO AI'I'LICANT, It,after making this Cellibof Ex-
? emption,you should become subject In the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of tlm 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.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 14000 C.EM.) 6.00 SEISMIC FEE 7�
1 hereby affirm that there is x 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's.Nurn
Addr HEATING UNIT(OVER 100,000 B.T.U.)9.50 .L3
Lender's Address ELECTRIC I
I certify that l have read this application and slate that the above VENTILATION FAN,(SINGLO 4.00
ini'mmmion is correct. I agree to comply with all city and county PLUMBING .
44 ordinances.and state laws «lating to building Construction, and
BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby toed representatives of this city enter upon the BOILER-COMP(Over .
above-mentioned property lot inspection Purposes. 100,000 BTU)SEE FEE SCH. MECHANICALpt �'
(We) agree.to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertimo against liabilities,judgments, costs and expenses which PERMIT ISSUANCE' 10.00 CONST.TAX'
may in any way "cc a ugui [ sa' Cily.in consequence of the' U "�
rand is pernii MECH.CONT. LIC.NO. MECH. .'
1 f10 TOTAL �i�% TOTAL dS
I nature of Applicant tractor I to C.V - --y/
OFFICE COPY /
POST THIS CARD NEAR FRONT.OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14453
INSPECTION DIVISION '
JOB INSPECTION RECORD
' . a c
- PE RMIT,;EXPI RATION
JOB.ADDRESS ✓/633 ASTER LANE : UNIT9 LOT#
PERMIT EXPIRES IF WORK
OWNER TOM CONTRACTOR ANTHONYPOOLS. 'IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE 70 COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAIVRATION -
CUPERTINO STANDARDS. ' 1.
GARAGE SLABS 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �.y3 y R� tae W p pi4�C o Lv .0,; '
UNDERGROUND /SLAB p /LGA/(rG
PLUMBING
ELECTRICAL ,��� -Fj' - s'A\, ISSUANCE UArE
MECHANICAL �tyy BV01:� 'PLe. Mer,R ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR
INFORMATION
'VALUATION
• PLUMBING
MECHANICAL -
ELECTRICAL - PERMIT TO
FRAMING „CLJ '1 I—/-, G�
INSULATION STORIES TYPE CONSTR
OCC-GROUP RES UNITS
EP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
' ROOF . SO.Fr.FLOOR Am.A w.AL AGIEAGE
NOTE:NO FINAL'INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILOING USE
ROOF SHEATHING .. "Es IND EON PB O✓,n
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 7, DATE INSP.,' 0 '❑ ' ❑ -El ❑
ASSESSORS FARCE
ROUGH SAN.N L NO
:r `: =..,w..� {.; �.
PLUMBING ELECT.ENERGY •'I
TRACT NO PARCELNO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL - - MECH.ENERGY ' le 1-
ELECTRICAL 200,
BUILDING ENERGY / L'. ACE.DA TE -ACG.FILE NO
. FRAMING _ ELECT.FINAL TEST
' ZONING ENG.SITE N0.
INSULATION ..� - PLUMBING
GAS TEST - GAS
MECHANICAL -
FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ( Y ❑ NO 1 Y ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE A.I..0 C.
INTERIOR SHEAR - FIRE DEPT. Y❑ "❑ Y ❑ NO
SHEETROCK. GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
.INBUILDING {; a ',•�,.
.INTERIOR LATH TE PORARY APPROVALS '
SCRATCH COAT ELECTRIC - - PLAN CHECK'
GAS . - - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANUT SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERM ITTEDLNTI L BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING. Y
Z` = SEE PERMIT FOR EXPIRATION-DATE — MECHANICAL
IMPORTANT! coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE " i
CALLING FOR FINAL INSPECTION. TOTAL,tj . •;
OFFICE COPY # }F