15648APPLICANT TO, FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN -ONLY
BUILDING PROJECT•(DENT(FICA710N
-
APPLICATION & PERMIT
BUILDING. -ELECTRICAL— PLUMBING — MECHANICAL
.PERMIT NUMBER y
1 C /� Q .
' I J `t u
ADDRESS'
0 rf) � w� ,.A
OWNER'S
NAME h
'Rv �a1�,� P.ONE4d6-496:
-
QTY. ' ELECTRIC PERMIT - FEE
.. .
PLAN CHECK VALIDATION
' .
^
DATE OF APPLICATIONS
CONTRA OV - • -
NAME II// .r •
t5 VE R1q CCkr .uc. rvo. YJ 2/•
OUTLETS:-,SWITCHES-RECEP_10.00/1.00'
`LIGHTING FIXTURES 10.0011.00
CONTRACTOR'S - .
ADOREss / Ip �"
PHONE
.PHONE `p ��
APPLIANCES ".4.00 -
PANEL$ '10.00 _
ARCHITECT
OR
ENGINEER
LIC. NO. "•
'PANELS (OVER 200 AMP)' 20,00
PLAN CHECK FEE "'P.C. NO.
-
SIGNS TRANS.' 3.00-
ADDREss ENC.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS.- 20.00.
' t zIP ..
'
AOORFss -F
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE - 20.00
' -
LICENSED CONTRACTORS DECLARAT ION
- I hetehy affirm That I a,, licensed under provisions of Clwptcr 9
(commencing with Section 7000) of Division 3 Of the Business and
Professions Code, a d my license is in full force and creed.
License'Class Lic. Number/o 2/ lyra
Date J4 gib/ _. Contractor' - -
ISSUANCE DATE
E
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BLDG. ELECT. PLG. MECH.
❑ ❑ ❑
.. -.
-• ; SE', �p
i -
OWNER -BUILDER -R DECLARATION ',
I hereby of"firm that 1 }un exenhpt from the Contmcmr's' fire vse
Law for the following reason. (Sec. 7031.5, Businessand Professions
Code: improve, Bern y Or coon pair Say req... ut prior tots nslnhet, alter;
any r itt ori e a sig o its issuance, also,
or for such
equirife applicant
requires the applicant 1"Or surer permit lu file a signed statement Lthaticense
he is licensed pursuant to the provisions of the Contractor'.,ivisium 1-irense
Law(Clha,,it 9(aommencln.wi th Section 70001of DIllumm3ol' the
c�
- -
BUILDING PERMIT '
INFORMATION -
L MISC. —. „p ., REFER TO.ORD
_
PERMIT ISSUANCE 10.0 -
- VALUATION
$/FT.
ELEC: CONTR. LIC. NO.
" I
p
ELEC. ` QI
TOTAL �l 1
PERMIT TO
•/���LL/S
_
.PLUMBING
Business Codc) or that he is pt and+
QTY,. - PERMIT • FEE
]or he dle,cd cation....
the basis for tate alleged exemption. Any violation tt oaclion eralty'
by any applicant for apenre dollars the appliwmtoacivil penalty'
of not more than five hundred (55001.1: �
STORIES
,TYPE CONSTR.
ALTER -DRAIN 5.00 "
❑ I, as owner of the property, or not employees with wages as
their sole compensation, will do the work, and the structure is not'
- BACKFLOW PROTECT. DEVICE "4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sea 7044, Business and Professions
Code: The Contractor's License Law does ..[*apply man owner of
_
FIXTURES -PER TRAP'*, 5.00
GAS - EA. SYSTEM - I INC. OUTLETS 6.00
property Who build, or improve, tlhereOq and who tIOM such work
himself or•through bis own employees, provided that such improve-
mems are not intended or,)ffc,cd for sale. If, however, the building
SQ FT. FLOOR AREA
,
TOTALACREAGE
or improvement is sold within one y,m.ot complatirn, thu owner-
builder will have life burden of proving that he did not build or int-
prove 1, as ownerose ofsale.). r, - �
❑ L as owner of the property, am excursively contracting with
GAS: EA. SYSTEM - OVER 4 (EA.) .' ; 2.00
-
- BUILDING U6E
'RES IND CON PB Other
❑ ❑ ❑ ❑ O ❑
INDUSTRIAL WASTE INTER. 30.00 `
tire prijensf Sec. 7044, Business
licensed c, ni.n, lod to The
and Professions Code: The Co ou ldsr s License Law dons non apply
to an owner of property waw builds or improves thereon. and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00.
ASSESSORS PARCEL NO.
•
LAWN'SPRINKLERS - OVER 5'(EA.) 1.00
contracts for such prujec(s with a contractuns) licensed pursuant to.
the CO ntractor's License Law: _TRACT
SEWER -SANITARY -STORM EA. 200ft/10.00
NO.
� PARCEL NO.
❑ I:un exempt under Sec. ,E.&PC. for this
WATER HEATER W/VENT'
reason
,6.00
Owner Date'
ry
WORKERS'COMPENSA'I' ION DECLARAI-ION
WATER SYSTEM 5.00
Ace. DATE
'
ACC. FILE No.
'
WATER•TREATING EQUIP. 5.00
" I hereby affirm (hut 1 have U corlificale of etmsanl to set Ginsuro.
or a certificate of Workers' Compensation Insurance, or a cerlificd
ZONING
ENG. SITE NO.
copy thereof fSec. 3800, Lab.C.).
policy No. Company
❑'.Certified copy is hereby furnished.
❑ Certified copy is filed with ilhelcity inspcclion division.
Applicant
'-
FIRE SPRINK
Y.❑ ', No
'ENERGY T-24
v ❑ N❑
MISC. - REFER TO ORD.
•: CIiRTI PICATLi OP EAEION ION PROM WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L. U.C.
` COMPIiNSAT10 N' INSURANCIi
(This section need not be complete) if the permit is•lix one
PLG. CONTR. LIC. NO.
TLG OTAL
v ❑ N ❑
N
Y ❑ ❑
h undred dollars f$ 100) itlessJ h
-
'•al certify that in the performance of the work for which this per-
mit is issued, 1 shall not employ any person in any ..harm,, so as to
QTY.. MECHANICAL`PERMIT FEE '.
-FEE SUMMARY
BUILDING
•hecom subject the Workers' mppnmtiyn Laws of Cal'fojnia.
[)are 23_ �Appl'n°nt�.�.x '- � - -'
NOTICE TO APPLICAN'1: If, after making Ihis,Curtificate' of Ex.
_
ALTER OR ADD TO MECH. " '5.00 -
APPLIANCE 5.00
PLAN CHECK
emption, you Should become subject to the Workers' Compensation
. provisions of the Labor Code,�you.must forthwith comply with
such provisions or this pennit'shall be deemed revaktd.
FEE
-
AIR HANDLING UNITITO 10=C-F.M.).'4.00
AIR HANDLING UNITIOVER 10=C.F.MX6.00,
SEISMIC FEE
rn
JV
�CO NSTRUCf1ON LL!NOING AGENCY,."
1 herchy Afire'for, there is a construction lending, agency for
EXHAUST HOOD (WITH DUCT). �' 5.00 ;'
•-
the performance of the work for which this permit is issunl (See;
MICROFILM
HEATING UNIT (TO 100,000 B:T.U.) 8.00
N. me
Lender's Name
HEATING UNIT (OVER 100,000 B.T.U.)B.50
ELECTRIC
'
Lenders •
VENTILATION FAN (SINGLE) 4.00
-
I certify that l haveread Misapplication and state that theabuve
I intonnotion'Is correct. I agree to comply with all city and county
ordinances and'smte laws relating to, building construction, and
PLUMBING
BOILER- COMP (3 H.P. Or 100,000. B.T.U.) 6.00
BOILER -COMP IOver, 100000 BTU) SEE' FEE SCH:
MECHANICAL
hereby uUlh.ri,e representatives Of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to a,,, indemnily and keep harmless the City of
MISC.- - .REFER TO ORD'.
Cupertino against liabilities, judgnte..ts,rcosts and expenses which
may in any way, accrue against Said City in consequence of the
r ting of this per it. -
PERMIT ISSUANCE `10.00
CONST. TAX
MECH. CONT.. •LIC. NO.
I
MECH.
TOTAL
+,
TOTAL
Signature o f Applicant/Contractor Date .
OFFICE COPY
/-,A
POST. THIS,CARD NEAR FRONT OF. BUILDING'
'
'
'.•
'CITY,
- PERMIT NUMBER'
0F: CUPERTINO
`.15648
INSPECTION' DIVISION
JOB INSPECTION RECORD +• ,
JOB ADDRESS ("LyoUA
-'
PERMIT EXPIRATION
,a2 UNIT#+, _LOT#r -
kEx
. pERM1T EXPIRES 'IF WORK•
-
. OWNERAQ CONTRACTOR U(J L �•
IS. NOT STARTED WITHIN
1813 DAYS OF PERMIT'ISSLI
,."ANCE OR 180 DAYS, FROM
' LASTCALLED INSPECTION.
-
INSPE TION DATE ' INSP CTOR
- INSPECTION RECORD -'
FOUNDATION p {' -
NOTE: `? ..
'�"
ALL GRADING AND DRAINAGE. SHALL BE' INSTALLED
TO�COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
•, :LIFER �+• .
PREGUNITE
PEHNIT VALIDATION- .
•.
Iss �nNCE DATE
GARAGE SLABS -'' .. .r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND:/SLAB---
PLUMBING
+
ELECTRICAL, -
.MECHANICAL
r - -
SLUG. ELI:CT:
.PLG. . MECH..
El
*
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
A1Q
BUILDING PERMIT
INFORMATION
.' . WOOD FLOOR'
PLUMBING �, � - � .r
VALUATION
SIFT:
MECHANICAL -
P
n
ELECTRICAL >%
A
M `
J' PERMIT TO
I7WE&-L'Cd'
FRAMING
.
_ 0�•C1�Y'
' INSULATION .: - - -
sTolaes•
uvvE CONSTR,:'
•
,
OCC GROUP
RES UNITS
PLACE NOSUBFLOOR•UNTIL ABOVE HAS BEEN SIGNED
ROOF ..
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THECONSTRUCTION TAX IS PAID
• .. - -
.so ICPLOOR AREA
TOTALACIIEAGE
'
DIAPHRAGM
ROOF SHEATHING -
eUILDING USE -
'HHS IND C'ON -PHI 0,1— '
O ❑ 0 -0 El
APPLY NO'ROOFING'UNTI0ABOVE HAS'BEEN SIGNED
FINALS l-.,' 'DATEr^ °'INSP*
ROUGH
SAN.N'
ASSESSORS PARCEL NO.
"
PLUMBING + ,< C ...r)
ELECT.'ENERGY-
TUBS.BSHOWER PAN _'
,�
- -
PLUMBING ENERGY
r TRACT NO.
'
PARCEL NO,,
MECHANICAL.
MECH..ENERGY
ELECTRICAL
BUILDING ENERGY � -
ACCzu ATF
'ACC. I'TH NO
FRAMING
ELECT, FINAL TEST - -
` INSULATION -
PLUMBING
TONING
ENG, SITE NO..
GAS TEST -
GAS
'•. i••••= -
MECHANICAL
FIRE SYRINK
° � - NE
ENETIGY'T24,
.0 'NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ,
HEATING -
EXTERIOR,SHEAR -
ELECTRICAL RELEASE
FLOOD ZONE
❑ 'NO
A.LUC.
,L N❑
INTERIOR SHEAR '
FIRE DEPT.' -
SHEETROCK'
GRADE -
FEESUMMARY
EXTERIOR LATH
BUILDING,,. - _
.
BUILDING
s�
INTERIOR LATH
-
TEMPORARY APPROVALS
SCRATCH COAT.
ELECTRIC .
PLAN CHECK
FEE.
.j
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY - -
SEISMIC:FEE,,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
ARRANGE'FOR INSPECTION BY PHONING 252'-4505,
ELECTRIC ,
H� ONE'WORKING DAY BEFORE REQUIRED INSPECTION.'
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
PLUMBING,—
'
— SEE PERMIT FOR EXPIRATION�'DATE — _
MECHANICAL
CONST. TAX
IMPORTANT!
t+
��fl
PLEASE READ'REVERSE SIDE BEFORE
• CALLING FOR FINAL INSPECTION.. -
TOTAL
. ?�.F
OFFICE COPY
Ada,