18712 APPLICANT TO FILL IN INFORMATION WITHIN RED.LINES=W USE BA.LL',POINT PEN ONLY,
ILDING PROJECT IDENTIFICATION
ADG - APPLICATIN & PERMIT "' - . ' KP:ERMITNUMBER
ADDRESS
BUILDING ELECTRICAL-
0.S CQROL 87 G
1.
n , OwrvERS�-`£Q RM. UQ nQ+ - - k ` PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT it FEE
"B
7jjlnclf/ 7'7 ESL•. PNE YYG=96�'
CONTRACTOR'S
NAME .. pQ,CLSr'J'L?1C�.. LITLETS-SWITCHES-RECEP 10.00/1.001. ;u0
E' IQ, n� sv£ ! LIGHTING FIXTURES 10.0000
LIC.ND.ya y7 ey .
CONTRACTORS.y/,�2 2-p5-t4a aa_ qqO'v`�- APPLIANCES-RESIDENTIAL}, ' . •4.00'.•ADDRE ' '
SQ�z. . /o S E CCG PHONE�76_� 7� PANELS 10.00 DATE OF APPLICATION. CrI
ARsa,y - - PLAN CHECK FEE - 'PC,NO.
OR PANELS (OVER 200 AMP) > 20.00 _
ENGINEER - - -
LIC,NO, SIGNS TRANS.' " `3.00
ARCH.OR ENC..' - - b P ER MIT VALIDATION
ADDRESS' - - SPECIAL'CIRCUIT . 5.00 ..
zie EMP.-METER ORPOCE INS ;$'2000
APPLICANTS
ADDRESS • MOTORS SEE FEE SCH. 1.
' - SERVICE CHANGE' 2000 - �I yt�kU LL;
o o LICENSED CONTRACTORS DECLARATION
< I'hereb affirm[hal I am licensed under provisions of Chapter 9
Y' p P • ' •ISSUANCE DATE
(commencing with Section 7000)of Division 3 oC[he Business end - _ BLDGELECT. PLG. MECH.
�,z
Professions
Code,snd'my license Is In full to yynd ef�Cgg�cft
0 i m o License Class - 1 Lio Number Nd 77 Bpi - ❑
ad Date - Contractor '�! +'
2'y 6i of Cu.Fertino,' .
'st A, w¢, ° OWNER BUILDER DECLARATION, P I 1 - BUILDING PERMIT-
" MISC.- - REFER TO ORD INFORMATION _
x ;°' r I hereby affirm that I am exempt from the Contractors License _
.F moy VALUATION $/FT.
J Law for the following reason'($ec 7031.5,Business Professions PERMIT ISSUANCE' .. 10.00 2„Q�f".
�,IS e 'r+ Code.Any city or county which requires a permit to construct,alter,. �/ / Q
p improve,demolish;or repair any structure,prior to its issuance,also ELEC.DONTR. 41C.NO. n`ED
`/ V b- (•D _ ``
I.,
w m LL requires the applicant for such.petmit to file a signed statement that +' TOTAL ^ll
D PERMIT TO• - _
he is licensed pursuant to the provisions of the Contractor's License
'i Law(Chapter 9(cc nimencing withSection 7000)of Division 3 oft ° -
t a t Business and Professions Code)or that he is exempt therefrom and Y.
PLUMBING PERMIT -' FEE" I �A 2'
W 1_$ the basis for the alleged exemption.Any violation Of Section 7031.5 'T STORIES TYPE CONSTR.' -
by any applicant for a permit subjects the applicant to a civil penalty - ALTER-DRAIN&VENT-WATER (EA.) 5.00
Got
of t more than five hundred dollars($500).): '' . '
O 1,as owner of the properly,or my employees-with'wages as BACK FLOW PROTECT. DEVICE '4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not - - " '
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,'AREA,COND. 5.00 a,f)
Code:The Contractor's License Law does not apply to an owner of - 'I .
property who builds or improves thereon,and who docs such work FIXTURES=PER TRAP .5,00 �e(1 SO.FT:FLOOR AREA •TOTALACREAGE
himself or through his own employees,provided that such improve-
. menu are not intended"or offered for sale.If,however,the building GAS-EA.SYSTEM-1,1 NC.4 OUTLETS. 6.00 " t` ."p ••or improvemeN'is sold within one year of completion,the owner- - ING.
-
.GAS-EASYSTEM OVER 4 IEA' I' 2.00 -BUILDUS builder will have the burden oC proving that he did not build or im- t RES IND L INNCON E 1 , Omar
prove dor purpose of sale.). INDUSTRIAL WASTE INTER.. .30:00 '"
❑ I,as owner of the property,am exclusively,contracting with - ❑. p❑ j El❑_
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply - r
to an owner of property who builds or improves thereon:and who LAWN SPRINKLERS-OVER 5'IEA.) '1.00 ,
contracts for such projects will,a eman ctor(O licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00 - - P `
the Contractor's.License Law. TRACLNO. - 'PARCEL NO.
'❑ lam exempt under Sec. - ,B.&P.C.I'otlhls
reason WATER HEATER W/VENT"- 6:00 S -
Owner Datel WATER SYSTEM 5.00
ACL.DATE ACC.FILE NO.
i WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP 5.00 1 t`
I hereby affirm that I have a certificate of consent to self-insure,
or,a certificate olIWOrkers'Compensation Insurance,or a certified - - ZONING , 'ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). 57,4 2.-r-g�0 rt p - F
Policy No.-Company-yCeo��1,m�pany _ I -
Q P cc,
opy74-here furnished. - - FIRE SPRINK ' ENERGY TY4
Ce I I Ith the city Inspection division.
I;•, O : Applicant MISC.- - .REFER TO ORD. - `♦♦ Y ❑r N❑ .y v.❑, -•NEL
rn PERMIT ISSUANCE 10.00 ,t,.Up , ,FLOOD ZONE "'A A.L.U.C.
_
CC - C IF 'XEMPTION FROM WORKERS'
W OMPENSATION INSURANCE f+ PLG.CONTR. LIC.NO. PLG:
CL 0 (This section need not be completed:if,the,permit Is for one I TOTAL ��.0�' Y❑ N❑ Y❑ -N❑
hundred dollars($100)or less.)
U O 1 certify that in,the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE 'FEE SUMMARY.
W I- mit is issued,I shall not employ any person in any,manner so as to
Wbecome subject to the Workers'Compensaliom Laws of California: '
GO Date ' Applicant ALTER OR ADD TO MECH. 5.00 BUILDING / I 0
} to NOTICE TO APPLICANT: If,alter makinglliis Certificate of
Ex-emption,you should became subject to the Workers'Compensation APPLIANCE - - 5.00 PLAN CHECK �+,Q
provisions of the Labor Code, you must forthwith comply with FEE a [•�D
•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 10=C.F.M.) 6.00 SEISMIC FEE 6.3�
I hereby affirm that there is a 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 Name
Lender's Address H EATI NG UN IT IOV ER 100,000 B.T.U:)9.50 'ELECTRIC •�, � , '•
' I certify that I have read this application and state that the above VENTILATION FAN (SINGLE)
information Is correct. I agree to comply with all city and county PLUMBING IO B d
ordinances and state laws relating to building construction, and BOILER-COMM H.P.or 100,000 B.T.U.) ,6.00 -
hereby authorize representatives of this city.to enter upon the '
! above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.,. MECHANICAL,
•^ (We) agree to save, indemnify and keep harmless the City of MISC.'- - REFER TO ORD
uja rtino against liabilities,judgments Costs and expenses which - CONST TAX
may in ny way accrue against said City in-consequence'of the PERMIT ISSUANCE v. 1000 I. ..,
rantin f this ermit MECH.CONT. LIC NO. MECH
✓'D Q�9 TOTAL TOTAL
�? S3
ontractor, hAte - „
OFF,ICEtOPY ,
POST THIS CARD NEAR FRONT OF BUILDING PERN,ITNUMBCR
0. CITY OF CUPERTINO,
-I 1 z1
�. NSPECTION DIVISION 18? �
JOB INSPECTION RECORD y
PERMIT EXPIRATION },
JOB ADDRESS-�1 0 �� ��_ ee 1" UNIT# _LOT# PERMIT EXPIRES IF WORK
J
OWNER ' CONTRACTOR 43 - IS NOT STARTED WITHIN
ON EC
INSPECTIO ATE INSPECTOR INSPECTIORD 180 DAYS OF PERMIT ISSU
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION:
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
-CUPERTINO STANDARDS. Yra
GARAGE SLABS ;
- ��® 1 ! �.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB " . OCT 10 1989 ;f vli .i:14 L` 1 •
PLUMBING
ELECTRICAL - It(Of'CDpBrhOIssunrvcE DATE
MECHANICAL - - BLDG ELECT, PLG. MECH,
t t ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION S/FT,
� - - L
.MECHANICAL I� ,' � !/
ELECTRICAL - PERNUT ro 11
FRAMING - - Vt
INSULATION - STOWES -TYPE CONST
- OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
50,FT FLOOR AREP
' ROOF - - - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE TOTAL ACREAGE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
�•' - ROOF SHEATHINGR'E IND CON
USE
Pe' ,oil,,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El ❑'
ROUGH SAN.H- ASSESSOes PARCEL NO.
PLUMBING AW ELECT.ENERGY
. TRACT NO, PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL ;. MECH..ENERGY
I` ELECTRICAL BUILDING ENERGY ACC,DATE ACC.FILE No.
' FRAMING — ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION � PLUMBING
GAS TEST _ GAS
• MECHANICAL - FIRE SPRINK ENERGY T%24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING.: Y "❑ ` ❑ . NtV
.
EXTERIOR SHEAR ELECTRICAL RELEASE - •FLOOD'ZONE. AL.U,C.
INTERIOR SHEAR' FIRE DEPT, Y E] 'N.❑ ° ❑'' No
SHEETROCK GRADE r FEE SUMMARY
EXTERIOR LATH BUILDING. -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE .1 I
.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE '
OCCUPANCY OF BUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNEDBY BUILDING INSPECTOR. ���C
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE GIVE'JOB ADDRESS WHEN PHONING. PLUMBING
V Z - SEE PERMIT FOR EXPIRATION DATE- MECHANICAL '
' IMPORTANT! ' " • CONST;TAX
PLEASE READ REVERSE SIDE BEFOREDA 4r
TOTAL
CALLING'FOR FINALN.
INSPECTI '
O
OFFICE COPY