14568 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• PERMIT NUMBER - ---
,s - BUILDING PROJECT IDENTI FICATIO APPLICATION & PERMIT A [[�Q
-� emcewa " $}J v Q
j ADD ESSI?- S O �, BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
xx OWNERS
NAME _ G} CITY. ELECTRIC PERMIT FEE �SGI� p
st '' PH� �� 13 - 6 (_
DONTRAcrDRsGQ •(ry1„`' CoA$7. UTLETS-SWITCHES-RECEP 10.0011.00 -
NAME
�[ LIC,NO LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
x ADDRESS PANELS 10.00 DATE OF APPLICATION -
i �/��- PHONE �'_ � PLAN CHECK FEE P.C.N0.
ARCHTECT � G,( PANELS (OVER 200 AMPI 20.00 ,
EUGINEER SIGNS TRANS. 3.00 '
LID.No. PERMIT VALIDATION
ARCH.oR ENG. SPECIALCIRCUIT 5.00
ADDRESS
ZIP MOTORS
METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS - -
SERVICE 20.00 �//Y/a 0
00 0 LICENSED CONTRACTORS DECLARATION ISSUANCE DATE
a Uz W I hereby ufERn that I am licensed under provisions of Chapter 9 ELECT. PLG.' MECH.
h a e_ (commencing with Section 7000)of Division 3 of the Business and
H o Professions Code, d y license is in full fort Ilett
2 o uu'i - License CI �__Lic.Numbet%� rC ' '�
o N r° Date Contractor - q DING PERMIT
Q y i J P
a c w ER.¢u1LDER DECLARATION REFER TO ORD INFORMATION
K H "1 hereby affirm that 1 um exempt from the Contractor's License MISC.- y ry 7.
$/FT.
W 3104 Law forthe followingreason.(Sec.7031.5',Businessand Poefessions PERMIT ISSUANCE 1@90 �d
Code:Any city or county which reyuimsaPermit loconslruct,alter. ELEC.GONrR, LIG NO. ELEC.
2 w> im rove,demolish,or repair any structure,prior to its issuance,also -
¢ R ef 0 P TOTAL !O PERMIT TO
o LL requires the applicant for such permit to file a signed statement that SG.D W�
m$ he is licensed pursuaN to the provisions of the Contractor's License
in
Law(Chapmr9(commencingwilh Secliun 7000)of Uivision3of the
ad CITY. PERMIT FEE
1 = 0 BPSineSS and ProfC5510n5 COIIQ)Or that he IS a%empt thClCfrOm aSTORIES TYPE CONSTR.
H the basis for the alleged exemption.Any violation of Section 7031.5
ii$ by any applicant forapermit subject3lhe applicvnt toacivil penalty ALTER-DRAIN VENT-WATER (EA.) 5.00
bf not more than five hundred dollars(ES007.1:
❑ •has owner of the property or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Ota GROUP RES.UNITS
their sole compensation.will do,the work,and the structure is not
ons DRAINS-FLOOR,ROOF,AREA,COND. 5.00
intended or offered for sale (Sec. 7044, ¢usiness and Professi _
(.'Odes TIIC f.'OOImCIUf S LICCnSC LllW dOeS nOl'Jpply t0 an OWIICr Of S,DD &a FT.FLOOR AREA TOTAL ACREAGE
'property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 7//
himself or through hisown employees,provided that such improve- GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
menta are not intended or offered fur sale.If,however,the building
or Improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING uSE
builder will have the burden of proving that he dill of build or im- RE IND CON PB Omer
proveTor purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ -I,as owner of the property,am exclusively contracting with PARCEL NO.
licensed contractors to construct tileS
project(Sec. 7044,Business LAWN SPRINKLER -1 INC 5 V.B. 6.00 ASSESSORS
and Professions Code:The Contractor's License Law does not apply ���
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 r&
contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
the Contractor's License Law. -
❑ I um exempt under Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason Date WATER SYSTEM 5.OD ACGDATE ACC.FILE NO.
Owner
WORKERS'COMPF,NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificateof consent he self-insure, ZONING ENG.SITE N0,
or a certificate of Workers'Compensation Insolence,or u certified
/C copy thereof(Sec.. Ce Lab.C.). � t fain
Policy ere Companyi-�"•-*'� FIRE SPANK ENERGY 24
Q ❑y Certified copy is hereby furnished.
Z 2 p Cc'ii y Is f Ith th dty inspection division. MISC.'- REFER TO OR D. .Z y N❑ v ❑ No
A plCanl
v0-i PERMIT ISSUANCE 10:80 /a- FLOOD ZONE A.L.u.c.
CC - CliR IFIC F .MI$P OM WORKERS', PLG. '1L�
LU > COMPENSATIONINSU ANC[ PLG.CONTR. LIC:NO. TOTAL r/r ' y❑ NO y N❑
CL a (This section need not be completed if the permit is for one '
: Z hundred dollars(S 100)or less.) FEE SUMMARY
U O 1 certify that in the performance of the work for which this per- CITY MECHANICAL PERMIT FEE
F mit is issued,I shall not employ any person in any manner so as to
,O W become subject to the workers'Conlpensatioa Laws of Caldomia. BUILDING '
a
Dare Applicant ALTER OR ADD TO MECH. 5.00
} N . NOTICE TO.APPLICANT: If,afro making this Cetlificala of Ex- 5.00 PLAN CHECK
Z _
F emplion,you should become subject to the Workers'Compensation APPLIANCE FEE
Provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10pWC.F.M.) 4.00
AI
L.I such provisions or this permit shall be decried revoked. _ ,a
R HANDLING UNIT(OVER t0,000GF.M.1 5.00
.00 SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby'alfirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5MICROFILM
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) ----
3097,Cie.CJ. -
Lender's Name HEATI NG U7
N IT ER 100,00.0 B.T.U.)9.50 ELECTRIC 10"
Lender's Address s -
1' VENTILATION FAN (SINGLE)
: Icertify that l have read this application and state that the above LET 4.00 PLUMBING ;O�
information is correct. 1 agree to comply with all city and county BOILER-COME(3 H.P.or 100,000 B.T.U.) '6.00 '
ordinances and stale law,qen relating to building construction. and ,
hereby authorize representatives of this Oily ID enter tion and BAILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL o1,4.7�
above-mentioned property for inspection purposes. REFER TO ORD. a�...i .I
(We) agree to save, indemnify and keep harmless the City of MISC.- CONST.TAX 1�
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 113.86 �-
ay'in any way scenic againstsaidCity in consequence of the MECH.
r of this Tell MECH.CONT. LIC.NO. TOTAL 7 TOTAL
IK
igualum of i no o a r e V T -
OFFICE COPY -
POST THIS CARD NEAR*FRONT OF BUILDING '
• 1
_ PERMIT NUMBER
CITY ,OF 'CUPERTINO 14568
INSPETTION DIVISION
.JOB INSPECTION RECORD
PERMIT EXPIRATION
'.� JOB ADDRESS ''111,12 KS'Tn n/ Ode UNIT# _LOT# '
PERMIT EXPIRES IF WORK
OWNER - (j coNTRAcroR r� '7i E .V�T 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
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - �� ('• �`,
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL IISSUANCE DATE'
-
MECHANICAL BLDG. ELECT. PLG. MECH
- .�
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $LFT:"
PLUMBING �p
-
/ '� ELECTRICAL .J PERMIT To -
�" FRAMING
.INSULATION STORIES TYPE CONSTP.
J:? N-/JTQK Sk TU OCC GROUP" RES UNITS
I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /aov„e
50 V'T"ELOOFi APFA TOTALACREAGE„
ROOF NOTE:N FINAL INSP.SHALL BE MADE BEFORE J X11
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - , RES IND CON PB 011r
•N� 'i APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ EL
ASSESSORS PARCEL NO..
�. ROUGH SAN.p
PLUMBING - ELECT.ENERGY.
TRACT NO PARCEL NO,
-� TUBS IS SHOWER PAN PLUMBING ENERGY ,
MECHANICAL - &- MECR ENERGY
ELECTRICAL .)C BUILDING ENERGY ACC onrE ACC.MILE NO
FRAMING - - - ELECT.FINAL TEST
E
_ ZONING ENG,SITE NO.INSULATION PLUMBING . '
GAS TEST GAS
FIRE SPRINK. ENERGY T 2
MECHANICAL' — ',P [:] N� » Y 0 N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE AL.U.C,
EXTERIOR SHEAR ELECTRICAL RELEASE - J" -1
INTERIOR SHEAR - FIRE DEPT. Y❑ N� <O - No.
,SHEETROCK - `3 GRADE FEE SUMMARY'-
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING 7 ",_SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY j SEISMIC FEE /(,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC J
IL ONE WORKING DAY BEFORE-REQUIRED INSPECTION.
F PLUMBING � !'�+—
o�, PLEASE GIVE�JOB ADDRESS WHEN PHONING.
Z, -
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
'
IMPORTANT! ' CONST.TAX'
'I PLEASE READ REVERSE.SIDE BEFORE
'. CALLING FOR FINAL INSPECTION. TOTAL'
OFFICE COPY.