17683 A APVL'ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY u
BUI LD1 NG PROJECT I DENTI FICATION '- ^ t
PER
NUMBER •'
BUILDING APPLICATION & PERMIT +„ 17 1',6 83
AODREs - - BUII-DING- ELECTRICAL='PLUMBING-MEC+NANICAL - .I ('.0
0,93 ?" � a �d
.k OWNER'S _ - :Y' PLAN CHECK VALI DATION '
- NAME -1• 733'0NI OTV. ELECTRIC`PERMIT JEFF",a • _ ' '
'r ( NlY `• ..PHONE t M
Names•TORs r ' ' •a^��C�'1.�> - ,OUTLETS=SWITCHES-RECEP� 10.00/1.00 -fid-p„
F� C
'�SSlov (�. ttL.No.iry',5 � LIGHTING FIXTURES - 10.00_/1.00
CONTRACTORS; C --- APPLIANCES-RESIDENTIAL 400
ADDRESS
PANELS 10.00 DATE of APauCATION
tc. ARCHITECT P)
PANELS (OVER 200 AM ' , .2000 . PLAN CHECK FEE . P.C.NO..I
ENGINEER, - - ,
tll
- 'tic.NO. SIGNS TRANS. L 3.00
' ARCH.OR END I .. r PERMIT VALIDATION
ADDRESS - r'y SPECIAL CIRCUIT . ;500 >.g
;.
ZIP EMP.METER OROLE'INS 20.00
'P
APPLICANT:S - '/ MOTORS SEE FEE SCH
c ADDRESS / r '.1 •' "
SERVICECHANGE .2000
Doo N LICENSED CONTRACTORS DECLARATIO
< o�y I hereby affirm that I am licensed under Pru Is ons of Chapter 9 or - f t ISSUANCE DATE-
.H,Q jmanumcinwithSecto 7000)of Dlvlslona3 bthpe��Businessand BLDG ELECT' PEG. MECH.
H.� z'. 1 olessions Cod y my ncen e l In full Co(ee a- "9 19 "i
z o Lieenv C�n Lic Number- _ i �-
1' o H Date Contractor
.¢ � � + ' 'y ,b' + - BUILDING PERMIT,'
Ix_Ace OWNER-BUILDER DECLARATION - ,r, INFORMATION
-x 3'LL-I- '1 hereby affirm that l um.exeD t fron.s[heC Imctor's License MISC {�-t - R _ D e a -
' VALUATION $/FT
F o¢ Law f'Any city oriounty which re 7011:5 BnIofto on Professions PERMIT ISSUANCE' 10.00 �Za
e Code'Any city or wumy which requiresa permit to construct,alter, '
.Q R Q,O,. Improve,demolish,or repair any structure,prior to is issuance also ELEC.CONTR. LIC N0. µe: FLED.
E
D¢ requires the applicant for such per n Cto file a signed statementtla[ . ,' - n'� t TOTAL l?( PERMIT TO
X " he s licensed ph rsh ant to the pro isions of the C> tri tors License _ -
H,z a Law(Chapter9(commeneingwth Section 7000) fD son3ofthe + '"k = 4 i,xd
�a o Bines,and.Professions Codel or that he is exempt-therefrom.and OTV.- .,r PLUMBING PERMIT_- }• :FEE,.}"
- ¢ H S' - the basis for LI a alleged exemption,Any violation f Stctiom7031^5' _ +"- �' + -t _ 'A STORIES i TYPE CONSTR.
ag hy'anyapplicant for a permit subjets the applicant Ci a civil penalty �' gLTER-DRAIN&VENT-WATER (EA.) '5.00 '
of not more than five hundred dollars($500).) n= A. I '
❑ 1,as owner chthe property,or my employees with,wages as .BACK FLOW PROTECT.DEVICE '4.00 OCG GROUT? RES.UNITS
their sole compensation,will do the,work,and the structure is not - - -
intended or offered for salc�(Sec.,7044, Business andProfessions DRAINS-FLOOR,ROOF;AREA,COND. 5'.00-
Code'The Conti icto VLicense Law does not apply ly to an owner of - - "
property who builds or improes thereon,and.who docs such work FIXTURES-PER TRAP _ r 5.00 7--'0 Sa FT.FLOORAREA..TOTAL ACREAGE
..
himself or through his own employees,provided that such improve _ .
' mems are not mtunded proffered for sale if,howccr,the building „GAS-EA.SYSTEM,-I INC.4 OUTLETS 6.00 '
` or improvement is sold within one year of completion,the owner-
GAS-EA SYSTEM-OVER 4 (EA.)�" 2.00
builder will have the burden of proving that hedid not build or Inti - _-- ,_ - - BUILDING USE
prove for parp wofsale). �- RES IND CON PB Other
❑ I;as owner of the properly,am x9uslvely.contracting with
INDUSTRIAL''WASTE INTER •.,3000 ❑ ❑, ' ❑. ❑ ❑;"
license is In construct tire project(Sec.'7044,Business LAWN SPRINKLERS-1 INC 5 V B 600 ASSESSORS PARCEL NO.
a e and professions Code:The Contactors LicenseLaw does not apply +' L.
x 1
to an owner of"property who builds or improv6s tlicrcon:and who LAWN'SPRINKLERS-OVER'5'(EA.).' 1.00
contracts torso hprojecls with a'contactorts)licensed pursuant to SEWER-SANITARY-STORM EA.;200ft%1000
the Contractors License Law. ,V TRACT NO PARCEL NO.
❑ I am exempt ander Sec. 11&P.C.for this -
reason WATER HEATER W/VENT 600
`
Owner . a ACC FILE NOWATER S5.0ACC.DATE
. ^
t WQWORKCRS'COMPNSATION UICLARAfION 0WATER'TREATING EQUIPr 50 ,
1 lieaby affirm that I have a Certs Ci ate of Consent to wit insure,
D;a certificate,of Workers'Compensation Insurance,or a certified ZONING •ENG SITE N0.
4 - copy thereof(Sec 3800,Lab.C)
Policy No! � Company
. .Et b
Certified'copy is hereby urnishe v + `' FIRE SPRINKR 'ENERGY T-24
ZiZ ❑ Certified co f wit ityil spa.' di Lion. MISC. '; REFER TO ORD,
O Applieali`.:. . YO NO Y ❑'':NE] '.
'~ w' - PERMIT ISSUANCE 10:00 •�
n 27 -CERTIFICATEOI EXEMPTION FROM WORKERS'- �`O FLOOO ZOrvE
LU J COMPENSATION INSURANCE PLG.CONTR. t - ,LIC.NO. PLG.1i
-r . ,.. TOTAL dU Y 'N- V N
. 1.O his section need not be coniplcted if lite permit Is for one.- '" - _ ❑ ❑ ❑ ❑
�.Z! hundreddollnn($100)or less) -
.0,'O I ci3rtihytliat in the performance of the work for Midi this per- CITY: MECHANICAL PERMIT '- FEE .FEE SUMMARY,
_ LL'H mit is issued,1 shall not enhploy any person in any manner sir es to _
bac me Subject to the Workers Ccurn,ematimi Laws of California. ^ ` -
O w;-' Date,- ^- Applicant BUILDING
mALTER OR ADD TO MECH. "5.00 .
w NO]ICL.TO,'APPLICANT', If,ufter'nwking this Certificate of F.x- ' �' ' 1�'�
enddion,you should become subject to the Workers'Compensation APPLIANCE - _ 5.00 PLAN CHECK .
- -. provisionsof the Labor Code, you must forthwith comply withFEE
such provisions or this permibshall be deemed revoked. ' AIR HANDLING UNIT(TO lO,ODDGF.M.) 4.00 I _
CONSTRUCTION-LENDING AGENCY^ AIR HANDLINGUNIT(OVERIOPWC.F.M.) 6.00 SEISMIC FEE•�� 1,70
. t I hereby affirm that there is a Onstraction lending agency for EXHAUST HOOD(W ITH_DUCT) .5.00
C the perfoon.ore.of the worly for which this motor is issued(Sec.NmMICROFILM Y
3097 Civ.C.) �/jT - HEATING UNIT(TO 100,000 B.T.U:) 8.00 "
Lend, ', ae-' HEATING UNIT(OVER100,000B.T.U.)9.50
+y Lender's Address - ELECTRIC e
i' (certify that lhave read this application and state that the above VENTILATION'FAN'(SINGLE) =.,v. 4.00
ml rmatim is corrccL I agree to comply with all city and countyPLUMBING.
ordinan es and state laws relating to building construction and 'BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 fVO
hereby authorize representatives of this city to enter upon the - ,.,BOILER-COMP(Over 100,000 BTU)SEE FEE SCH.- 'MECHANICAL
'
lz." above-mentioned property for inspection purposes.
q ' (Wej'agree to save, indemnify and keep harmless the City of i y MISC,' REFER TO'ORD. - - -
+ Cupertino against liabilities,judgments, costs and penses whuAh 'PERMIT ISSUANCE '3" 10.00 .�' CONST.TAX ,
may In any way alter a o'amsat i YAP quo ce of the
t rdnting of this MECH CONT - LIC NO:. MECH. -
TOTAL (,U D TOTAL ("
P Iggature of Apph t/Contmotor Date. t �2,IirW
OFFICE COPY ?
POST THIS CARD NEAR FRONT,OF BUILDING
PERMIT NUMBER
CIT OF CUPERTIN0 17683
" IN SPECTION,'DIVISION
• JOB INSPECTION RECORD
`PERMIT-
EXPIRATION
JOB ADDRESS �10�'� � UNIT LOT,W
.; PERMIT EXPIRES IF WORK
°'CONTRACTOR $,;(O.(/r'dy(. 6p�'`' IS .NOT STARTED,WITHIN '
101PECTIOW DATE, INSPECTOR" INSPECTION RECORD ` 180 DAYS OF PEAMIT Issu-
FOUNDATION. ''N `NOTE .«,' ' J- '. ANCE OR'�180'DAYS FROM
LAST CALLED INSPECTION. '
UFER -S ` ALL�GRADING,`AND'DRAINAGE SHALL BE INSTALLED; -
r,., TO COMPLY WITH+7HE AP,PROVED,PLANS AND CITY OF -PERMIT VALIDATION
P.R EGUNITE ° . UCUPERTINO STANDARDS. t 's
GARAGE SLABS , :,. ?. _ 7 r , ✓
i° POUR NO.CONCRETEUNTIL ABOVE HAS BEEN.SIGNEO
t'UNDERGROUND /SLAB
-;: IF,
-'i PLUMBING s, .: < . :,T, l','-t V'• f t; IA LST. f.
r
ELECTRICAL ^' ' '-ISSUANCE DATE
MECHANICAL 7 .BLDG.'TE,LECT PLG MECR
is y d
DONOT-POUR'FL_OOR;UNTIL'ABOVEHAS BEEN SIGNED , ' '•; BUILDING PERMIT,'
INFORMATION,
,. ..' _. ' 'WOOD FLOOR .VALUATION S/FT.� 2
PLUMBING i - - a
MECHANICAL •,..t., _ T,.._d.,+•- r . .I.' <' L�j'
�} PERMIT
TO
ELECTRICAL",:' E . r+ '^ .e ,y,., .•• �.LC�MD�Yf'l "" 1
., 'FRAMING
,INSULATION . N'. +,i' ' - sraRlEs TYPE coNBTR
Occ,GROUP . RES UNITS
PLACE NOSUBFLOOR'UNTIL•ABOVE�HAS BEEN SIGNED
E
ROOF, NOTE"NO FINA INSP.SHALL BE MADE BEFORE
EwnB ABeA �TaTAL Aa+Face
DIAPHRAGM p, THE CONSTRUCTION TAXIS PAID.
BUILDING USE
lA �)
ROOF SHEATHING r .�`` a' 'Res IND .CON PB -Om.•, '
k:-APPLYAO;ROOFIN GUNTIUABOVE:HAS.BEENSIGNED', I `FINAIN'Ra 1DATES,T; dlINSP.-
ASSESSORS PARCEL NO.
'
: :ROUGH (' SAN.#.,r"',
,PLUMBING • 'r ELECT:ENERGY;�
r -TRACT NO PARCEL NO.
• TUBS 8`SHOWER PAN _ PLUMBING ENERGY"' ...
MECHAN•ICAC _y ,ty, - - 'Y:, '°' MECHrENERGY.
ELECTRICAL z ACC DATE ACC FILE NO.
�L ,' BUILDING ENERGY i' r
'FRAMINGa' _ - ,(�• �^' ,ECECT..'FINAL,TEST' .:
ZONING - '.ENG.SITE NO.•.
INSULATION q 5 " PLUMBING -
GASTEST. I.e„r.' ,. >. ..,.,..: GAS ...Y•., , � .
� ' - t "”' '•"' MECHANICAL EIRE BPRINK '" ENERcv T;Za'
o
COVERAO WORK UNTIL A
BOVE HAS BEEN'SIGNEO ,HEATING - °e -
'• _ - ELooO ZONE-:ALuc
,EXTERIORSHEAR. $ r ,� ELECTRICAL RELEASE + '
INTERIOR'SHEAR P ' K" FIRE;DEPT :'•��, ;v 0•.4N 0• r v L7- NE]'
1 .ti 'SHEE-T,ROCK y - : GRADE FEE SUMMARY
EXTERIOR LATH ti' ` i •!' BUILDING T:'p
+ T - BUILDING''
INTERIOR LATH �. �,y a TEMPORARY APPROV',ALS - • '.
.1 SCRATCH'COAT `r'.`' ELECTRIC PLANSCHECK
GAS '.A 'FEE
NO;TAPE OR PLAST,ER�UNTIL•ABOVE HAS,BEEN SIGNED, OCCUPANCY '�,.` " SEISMIC FEL re 7t
OCCUPANCY OF BUILDING ISNOT PERMITTEDUNTI L BUI L'DINGF INAL IS SIGN E D BY'B U I LD I NG I NSP ECTO Ry - M,1
,r `+., is MICROFILM
ELEDTRIC
uJARRANGE FOR INSPECTION BY:PHONING•2524505, +S�
'ONEWORKINGDAY'BEFORE REQUIRED INSPECTION }
-
Z PLEASE GIVE'JOB ADDRESS WHEN PHONING PLUMBING LUMBING Roo • ,
;y 'SEE.FERMIT,FOR EXPIRATION DATE nnecHANIDAL dy1j, r,
, + „ CONST TAX
x IMPORTANTI
PLEASE READ REVERS'E`SIDE BEFORE
T CALLING FOR FINAL"INSPECTION. , TOTAL � 1r'
IT-
OFFICE COPtl G