14684 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
".BUInI NG PROJECT IDENTIFICATION - - PERMIT rvumeER
'h1.OING APPLICATION & PERMIT - 14684�O 'A
ADORE S�•)//DD ��n9' v `F
� 4p ,,,��/� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
�[ OWNER'S PLAN CHECK VALIDATION
NAME // QTY. ELECTRIC PERMIT FEE
Dr.R C . m4 PHONI:f�s -7
NAME
CONTRACTORS G�7
7R1 7 OUTLETS-SWITCHES-RECEP 10.00/1.00
N
UC.xo. LIGHTING FIXTURES 10.00/1.00 -
ADDRESSroR's —APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10.00 DATE OF APPLICATION
nnCHITECT" PANELS (OVER 200 AMP)' , , - 20,DD PLAN CHECK FEE P.G.N .
o
NGINEER
LIC.NO. ISIGNS TRANS. 3.00 '
ADDRESS eNa SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPucnrvr5 MOTORS SEE FEE SCH. _ X
ADDRESS v. -
SERVICE CHANGE 20.00
- -00 LICENSED CONTRACTORS DECLARATION e`Q JJ
a U w I hereby affirm that 1 am licensed under provisions of Chapter 9 L U ISSUANCE DATE'.
m Q y IcommeoCing:with Section 7000)of Division 3 Of the Business and BLDG. ELECT. PLG. MECH.
Hoz Professions Code,and my license is in full force and effect. •--"Ln 1 ❑ - 1:1
❑, 02 —w License Class Lia nn,wr Q
Dale Contractor
a x f _ BUILDING PERMIT
R n,0 - OWNER-BUILDER DECLARATION INFORMATION
w3 H 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
m¢ Law for the following reason,(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires r ,
Permit to construct,alter, I�0
2 to < improve,demolish,orYepair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.' OC
r O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u w m he is licensed pursuant to the provisions of the Contractor's License
"+�'
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
H z
!:-T Business and Professions Code)or that he is exempt therefrom and OTY- PLUMBING PERMIT FEE a fJ
,^,r'C 1--o the basis for the alleged exemption,Any violation of Section 7031.5 STORIES TYPE CONSTR.
a �3:$ by any applicant for a permit subjects the applicant toa6vil penalty ALTER-DRAIN -WATER IEA.) 5.00 '
of not more than five hundred dollars(5500),):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 400 OCC.GROUP RES.UNITE
their sole compensation,will do the work,and tire . .
e structure is not .
intended cur 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 builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SOL FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such Improve-
mentsare not intended oroffered for sale If,however.the building GAS-EA.SYSTEM-l1NC.40UTLETS 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 he did not build or an. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Odher
. .
❑ 1,as owner of the property,am exclusively contracting with ❑s ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .6.00 - ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License.Law docs not apply,
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for s r(
such projectwith a coniraitos)licensed pursuant to
the Contractor's License is w. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
'
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 -
reaso
Owne Date — WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
ropy thereof(Sec.3800,Lab C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is Filed with the city inspection division.
HO Applicant MISC- REFER TO ORD.
'Y❑ N❑ Y N❑
CERTIFICATE017 EXIiMP.TION l°ROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LU > ICOMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y F] N❑ Y F] N❑
0- Z( This section need not be completed if the permit is for one TOTAL
hundred dollars IS 1001 or less.)
U O 1 certify that in the performance of the work for which this per- OT,. MECHANICAL PERMIT FEE FEE SUMMARY
ly — mit is issued,I shall not employ any person in any manner so as in
_ O W become subject to the Workers'Compensation Laws of California. ��•1
y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT: If,after muking,this Certificate of Iix-
r ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK p
provisions of the Labor Code, you must forthwith comply with FEE (�J 2—
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 UNITIOVER I0,000GEM.16.00 SEISMIC FEE �•�O
I hereby affirm that there is a construction lending agency I'or 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 HEATING UNIT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC
I certify that I have read this upplicalion and state that the above VENTILATION FAN (SINGLE) 4.00
. information is.correct. 1 agree to comply with all city and county. - PLUMBING
ordinances and state laws relating to building construction,.and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000BTU)SEE FEE SCH. MECHANICAL
above.mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Misc.- REFER TO ORD. -
upertino against'liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrueagainst said City in consequence of the
ranting of this permit. MECH.CONT. LIC.NO. MECH '
o�Q� (cif �- /9-dr8 TOTAL TOTAL 33
Signature of AppThcanl/Co ru Uate
OFFICE COPY
POST THIS CARD NEAR FRONT OF BU,ILDING: .. RdIrNUMBER
CITY: OF ' CUPERTINO '
1468 Q
INSPECTION.DIVISION
. JOB INSPECTION RECORD
'.PERMIT EXPIRATION }
JOB,ADDRESS 10400 Castine Avenue UNIT.# _LOT'#
U% PERMIT EXPIRES IF WORK
• owivER DT. 'R.C. Cha Indri CONTRACTOR • IS�NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD i'aoDAYS oF.PEd'nnlTBsu
FOUNDATION - - ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER .ALL GRADING •AND DRAINAGE SHALL BE"INSTALLED
'PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY.Of PERMrt VALIDATION'
GARAGE SLABS
CUPERTINO STANDARDS. d ,
- -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB -
PLUMBING o
ELECTRICAL AR }, U ISSUANCE DATE
MECHANICAL ELECT.. .:PLG. MECR. ,
•' . - Ct�Y of�Ln� �
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y' BUILDING PT
WOOD FLOOR INFORMArbN:
PLUMBING
VALUATION $IFT"t
- - '
{
MECHANICAL -
ELECTRICAL . . ' V to CL. (O OUL w"X PERMIT To
FRAMING - _ f•; •/
STORIES -TYPE CONSTR.
;. INSULATION - £ �
b , y QLv\-LGT
oLLtN✓° - ,
C �.
CL C occ GROUP BEs.UNITS
ID4x&v,. 14tPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIG ED d a �%k C-! III
So7T-FLooF AREN ro?AL ACFEACE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
a' BUILDING USE
ROOF SHEATHING RES IND ' CON _PB 00—
APPLY
.•APPLY NO ROOFING UNTIVABOVE HAS BEEN SIGNED- FINALS DATE INSP., ❑ ❑ L 1:1
I'
-ROUGH SAN.q ASSESSORS PARCEL NO_
PLUMBING ELECT,'ENERGY
"TRACT NO. PARCELND
TUBS BSHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY' '• _ _
BUILDING ENERGY ACC DATE ACC.FILE NO.
ELECTRICAL -
FRAMING ELECT.FINAL TEST ' -
INSULATION • PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS' - :
• - 9 K
FIRE$PRINK' ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - I I] "L. ° "�
FLOOD ZONE -A.L U.C,
EXTERIOR SHEAR SE
INTERIOR SHEAR F YLN� .Y LNL,SHEETROCKFEE SUMMARY
EXTERIOR'LATH - '3 —
WTERIOR 'LATH - TEMPORARY.APPROVALS BUDDING - ; ;a:.G1 7i1�
SCRATCH COAT ELECTRIC t PLAN CHECK
GAS - • FEE "....-.�:•
I NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY -
SEISMIC'FEE "
I' 0CCUPA NCV OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE.FOR F� . INSPECTION BY PHONING 252-,4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
i . O PLEASE GIVE JOB ADDRESS WHEN'PHONING. "
z + ffHAN
' SEE PERMIT FMEXPIRATION'DATE'
IMPORTANT!PLEASE READ REVERSE'SIDE BEFORECALLING FOR FINAL INSPECTION.
OFFICE COPY