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17693c* r Ron Powers General Contractor Lic. #401660 1093 Virginia Ave. Campbell, Ca. 95008 0 (408) 370-3141 7 JUNE 89 CITY OF CUPERTINO BLDG DEPT PERMIT # 17693 I REQUEST THAT THIS PEaJIT BECOME VOID DUE TO NONE PAYMENT FOR SERVICES RENDERED. I WILL NOT BE RESPONSIBLE FOR ANY INSPECTIONS AFTER THIS DATE. JUN 8 1989 BLDG. INSPECTION DEPARTMEA[T, CITY OF CUPERTINO O Z_z 0 0: T LU - a 0 D z 00 LL to h = Al 41 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 ?693 eoionaxGAPPLICATION AovREss \ Z, Z Z %% �., OF NIA C I OWNERS NAME1, �L C ` rel PHONE CITY. ELECTRIC PERMIT FEE, PLAN CHECK VALIDATION q^- 2 1 ffff 1 ,n`` (,� ty., �{/, 1 01L) 110 j` 1 D EOFAPPLICATION CONTRACTOR jb Vs uJ eR5 LIG No. 0 UTLETS- SWITCHES -RECEP 10.00/1.000-400-4/ LIGHTING FIXTURES 10.00/1.00 ADDRESSTORS .H 370-31111 b93 V i R 61 N IA Ave APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER LIE. NO, PANELS IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE'INS.' 20.00 ZIP µ` U V«. Jr / 1 ,I 1 ANT F ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 0 LICENSED CON'T'RACTORS DECLARATION -IA-AY2 1984 I hereby affirm that I ant licensed under p[ovisionsol' Chaplet 9 IcommcnCnt with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie. Number Date Conactor tr ISSUANCE OAT BLDG. ELECT. ❑ ❑ PLG. MECH. ❑ ❑ M.,,,,�g,, 'PY 1. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031.5, Businessund Professions Code: Any City Or county which requiresupermil to construct, alter, improve, demolish, or repair any structure, prior In its issuance, also requires the applicant for such permit to file :1 signed statement that he is licensed pursuant to the provisions of the Contractor's License BUILDING PERMIT Y' INFORMATION IMISC. - REFER TO ORD r • VALUATION 2,0 P0 S/FT. PERMIT ISSUANCE 10.00 I ELEC. CONTR. LIC. NO. ELEC. �y� TOTAL !/•' PE gq p4 M IT TQ DTV. PLUMBING PERMIT FEE Low (Chapter 9 (commencing with Suction 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and d 4l �y STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of8ection 7031.5 by any applicant for a permit subjects he applicant to a civil penalty of not more than five hundred dollars 18500).1: ALTER -DRAIN -WATER (EA.) 5.00 rOp, ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. urv1T5 DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property whit builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.6D 1111 56 FT. FLOOR AREA TOTALAGREAGE GAS -EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner builder will have the burden of proving that h e did not build or im- prove for purpose of sale.), ❑ 1, as owner of the property, am exclusively contracting with GAS - EASYSTEM -OVER 4 (EA.) 2.00 . ewLowG USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. licensed contractors to construct the projem (Sec. 7044, Business and Professions Code: rhe Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec.-, B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date 5.00 WATER SYSTEM ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00 I hereby affirm that I have a certificate of consent to self -insure, or o cerlificdte of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab.C.). Policy No.Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑ N❑ ENERGY T 24 Y E]N❑ MISC. - REFER TO ORD. CERTIFICATEOP EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 / D FLOOD ZONE A.L.U.C. PLG. CONTR, LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not he completed it the permit is for one Y ❑ N❑ Y ❑ N❑ OTY MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) 1 Certify that in the performance of the work for which this per- mit is issued, I shall no employ any person an anncr so as to bermrrµµ•-su ect Ira Workers' mensa Sri Law W'California. Date 'ANI:nt, NOT GTO APPLICANT': I(, (ter making thi Certificate of lix- emption, you should become subject to the Workers' Compensation BUILDING ALTER OR ADD TO MECH. 5.00 UD APPLIANCE 5,00 PLAN CHECK provisions of the Labor Code, you trust forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE r I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097•Civ.CJ. EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 . HEATING UNIT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC r Lender's Name Address Leader's Addss I certify that I have read this application and state that the above information is correct. I agree to comply with all city odd county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon line above-mentioned property for inspection purposes. VENTILATION FAN (SINGLE) 4.00 PLUMBING V' 0 BOILER- COMP (3 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL S" • Z MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may any way accrve/e s 'J City in Consequence of the gra n Of this' p • 't. 1/ act �,�,q -1 -8 CONST. TAX PERMIT ISSUANCE �,r2. H. ECH. CONT. LIC. N0. MECH. OTA C TOTAL `ISighatureof Applican t/ 'If tot Date APPLICANTS COPY I• 0 POST THIS CARD NEAR FRONT OF BUILD! G CITY. OF- CUPERTINO INSPECTION DIVISION hR.rw` JOB INSPECTION RECORD f.�o� ' ! `I�� e1n/ JOB ADDRESS �/'�i—C O so F1L,-r—A <J#T# OWNER �/E CONTRACTOR B1,V'.P PERM;TNUMBER 1769 �4R^�,T(EXPIRA`TIgN MyyIT/ )PIR((ES IF� R S�yV STARTT D WPfKIfl tee D YSOFPERMITISS CE OR 1e I DAYS FROM LASTCALLED INSPECTION. i SPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATIONA NOTE: ALL GRADING AND DRAINAGE SHALL BE.INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. PWD UFER - PREGUNITE PERMIT VALIDATION - ,dp '�• /t v• IoU`LL ( ISSUANCE GATT' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED `{� Z 1989 UNDERGROUND/SLAB PLUMBING ^, .�.i{ __,y,Do 1d V4 CD ELECTRICAL "' MECHANICAL - 9LOG ELECT. PLG, MECH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT INFORMATION ' WOOD FLOOR VALUATION - SIP T. PLUMBING - MECHANICAL ELECTRICAL ' PE r..+I,r�./rp 0014 FRAMING INSULATION - .. STORILS TYPE CONSTR. OCC GROUP HE$ UN i TS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE '. THE CONSTRUCTION TAX IS PAID - - "' sn. PT aooR AREA ' rarAL ACREACF DIAPHRAGM - ROOF SHEATHING Pe , 0m1- RPs IND BUILDING CON Q ` ❑ Q- (] ED APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ASSESSORS PANCEUNO PLUMBING ELECT. ENERGY'• .• TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO. ' MECHANICAL- MECH.'ENERGY ELECTRICALACC, BUILDING ENERGY DATE ACC PILE NO, FRAMING ELECT. FINAL TEST INSULATION PLUMBING . ZONING - ENG. SITE NO. GAS TEST . GAS - MECHANICAL FIRE SPFRNN "D ENERGY T.24 . N � COVER NO WORK UNTIL ABOVE HASjBEEN=SI'GNEO HEATING EXTERIOR SHEAR ELECTRICAL RELEASE ,. FLOOD ZONE r ❑. ND A u.c. v ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING—BUILDING INTERIOR LATH' . 'TEMPORARY APPROVALS SCRATCH COAT. _ ELECTRIC PLAN CHECK FEE. GAS- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -.SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC ' y, PLUMBING MECHANICAL covsT. TAX IMPORTANT.! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL Jay OFFICE COPY 1, 0 • O' Z P0 cc - LU > CL 0 =)Z UO LL U W A U NPPLICANT TO FILL IWINFORMATION WITHIN RED LINES - USE BALL POINT'PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION'Sl PERMIT• BUILDING -ELECTRICAL -PLUMBING -MECHANICAL BUILDING ADDRESS;L �/ �Z M be"NIA GIR_ OWNER'S 2.00 INDUSTRIAL WASTE INTER. . AME�( N�jGFS@@�J QTy, ELECTRIC PERMIT FEE �` IM PHONE 1.00 SEWER -SANITARY -STORM EA. 200tt/10.00 CONTRACTORS "Roh . 0 UTLETS-SWITCHES -RECEP 10.00/1.00 ,/0 BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 x WATER TREATING EQUIP. 5.00 Lcc,N401 Am LIGHTING FIXTURES 10.00/1.00 3.00 ADDRESS oR's YM 3'70.1( ADDRESS PPLIANCES- RESIDENTIAL . 4,00 ' '& IAM A NE �J7 X93 V A�4HorvE PANELS 10.00 Rcwrecr PANELS.IOVER 200 AMP) 20.00 OR O ENGINEER uc.NO. SIGNS TRANS. 3.00 ' ADDRESS ENG' SPECIAL CIRCUIT 5.00 TEMP. METER OR POLE INS. 20.00 ZIP APPucANTa MOTORS . FEE SCH. ADORE" ,PASEE - SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 onmencing with Section 7000) of Division 3 of the Businessand )fessions Code, and my license is in full force and effect. sense Class Lic. Number IS Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from Ilse Contractor's License w for the following reason. (Sec. 7031.5, Business' and Professions ode: Any city or county which requires a permit to construct alter, Prove, demolish, or repair any structure, prior to its issuance, also luires the applicant for Such permit to file a signed statement that is licensed pursuant to the provisions of the Contractor's License MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 E LEC. CONTR. LIC. NO. ELEC. TOTAL Business and Professions Code) or that he is exempt therefrom and QTY the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500) ): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for Sabi. IE however, the building or improvement is sold within one year of completion, the owner- builder wnerbuilder will have the burden of proving that he did not build or im- prove for purpose of sale.). ' ❑ 1, as owner at the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 an exempt under Sec. ,BAP.C. for this reason Owner Date WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec, 3800, Lab.C.). Policy No. Company • ❑ Certified copy is hereby furnished. C Certified copy is filed with the city inspection division. CERTIFICATE 01' EXEMPTION FROM WORKERS' COMPENSATION INSURANCE PLG.( 1 This section need not be completed if the permit is for one ndred dollars (S 100) or less.) 1 certify that in the performance of the work fur which this per- QTY t is issued, 1 shall not employ any person jp arj�manner so as to em ption, you should become subject to the Workers' Compensation provisions of the [.shot Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm thai there is a construction lending agency for the performance of the work for which this permit is issued (Sec. Lender's Name Lender's Address I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon 'the above-mentioned property for inspection purposes. (We) agree m Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may J�pB any way accru Id City in consequence of the mrRrfg oft D9IINt. PLUMBING PERMIT FEE NLTER-DRAIN & VENT -WATER (EA.) 5.00 a 00 SACK FLOW PROTECT. DEVICE 4.00 GRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES -PER TRAP � 5.UU P17 GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 INDUSTRIAL WASTE INTER. . 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200tt/10.00 WATER HEATER W/VENT 6.00 WATER SYSTEM BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 x WATER TREATING EQUIP. 5.00 PERMIT ISSUANCE - . 10.00 (z e PERMIT TO ORD. LIC. NO.I PLG. .'1 �j OD TOTAL MECHANICAL PERMIT I FEE ALTER OR ADD TO MECH. 5.00 7. U APPLIANCE 5.00 AIR HANDLING UNIT (TO 10p00C.F.IA) 4.00 AIR HANDLING UNIT(OVER 10= -. .) 6.00 EXHAUST HOOD (WITH DUCTI. 5.00 HEATING UNIT (TO 100,000 B .U. .00 HEATING UNIT (OVER 100,00 VENTILATION FAN (SINGLE 4.00 BOILER-COMP(3H.P.or100,000B.T.U.) 6.00 x BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MISC.- REFER TO ORD. PERMIT ISSUANCE - . 10.00 (z e :ONT. LIC. NO. MECH. TOTA�L ^� vrrlue Wry . IL 17693 1 121' Nb 1 u l Pr •PERMITVALID. r^2lil J. t+!jIU ❑ ❑ ❑ BUILDING PER M L(. MECH. ower ENG. SITE NO. FIRE SPRINK Y ❑ N ❑ ENERGY T.24 Y ❑ N ❑ FLOOD ZONE Y ❑ N ❑ A.L.U.C. V ❑ N ❑ FEE SUMMARY BUILDING PLAN CHECK FEE SEISMIC FEE MICROFILM ELECTRIC O b ar PLUMBING O d MECHANICAL 23'- CONST. TAX TOTAL 130-70 0 I.• w L-3 A POST THIS CARD NEAR FRONT OF BUILDING . CITY- OF' CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD rr JOB ADDRESS e��9 P .� �¢-AJ2-'5- /' "'a�UNIT# _LOT# • OWNER (f 'G+✓ CONTRACTOR {.NC a -� -L,/ T.M 1W711. FERMIT'ExPI TION PERMIT -EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS DF PERMIT ISSLI OR, 180 DAYS FROM LASTCALLED INSPECTION. ' INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATIONAWE NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIT/ OF LUPE TING STANDARDS. '- PAID UFER PREGUNITE PERMIT VALIDATION - •�"; 4-f ' ^ CE unrz GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED or I K'. A..1.11:..� a;\T-'�'j .1g8 IpV 91• UNDERGROUND /SLAB ' PLUMBING �q 2odFr'rZAri ouprti� + Y7lC � � ELECTRICALi MECHANICAL ELECT. ---- PLG. MECR.' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT ll! ''ti' IN FORMATION WOOD FLOOR VALUATION X�T�'-9' S/FT. - PLUMBING I- - - MECHANICAL ELECTRICAL _ PERMIT TO T / �UD��ICN FRAMING INSULATION STORIES, TYPECONST.R. • OCC. GROUP RES'UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE ' THE CONSTRUCTION TAX IS PAID- ' - SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM - ROOF SHEATHING 2-4— Q / 1 BUILDING USE RES IND CON.PB OR", 0 ❑ 0 Q APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED •FINALS ROUGH SAN.M A55E550RS PARCEL NO PLUMBING - ELECT. ENERGY- TUBS & SHOWER PAN -' ' jDATEINSP. PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC. FILE NO FRAMING-, ,Ct; ELECT. FINAL TEST INSULATION PLUMBING .zONwc ENC. SITE No, GAS TEST GAS FIFESPRINK ',,'ENERGY i^ A'( Y1 .1 T-24 � "� MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE FLOODZONE- v 0 NO A.L UC.. Y L NO: INTERIOR SHEAR - FIRE DEPT. SHEETROCK -\ - GRADE - FEE SUMMARY EXTERIOR LATH BUILDING - - BUILDING q�•.� as INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. 'fMICRO FI,M;-V �(;1 ". ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION. O Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE'- UE ECT(i quit " PLUMBING�? �= MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY 0¢i F00 QUU G<d 20_2 oyH� IS y M J IS a w a E: 3a. ' F W LL 0 J Q B Q O A mau X Y i 0 rtHm s 3-' 0 _z z P 0 cc: j W - aQ D z' UO LL V, 0a } N APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER , . 15711 •"' BUILmNG AOnp ESS %rte OWNER'S NAME F,I //1 9 ✓` l/ P..NE TV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION , p ' NgMBrRAcioRs < �Q ,3Fd7 /NC-l�� o. / � UTLETS -SWITCHES -RECEP i1O .00 d'00 LIGHTING FIXTURES' 10.00/1.0 - O CooAess roR's APPLIANCES' -RESIDENTIAL 4.00 PHON DATE OF APPLICATION PANELS 10.00 ARCHITECT DR / 1.. ENGINEER iciig I f„1 ✓ �O 1414 x [� rIII///�� L IYl4ECm. No 6444 `r✓ PANELS (OVER 200 AMP) 20:00 SIGNS TRANS. 3.00 PLAN CHECK FEE P.C. NO. ARCH. OR ENG. TORIES 2'0 C 2q E f( �nP 5I2 SPECIAL CIRCUIT 5.00 PERMIT VALI DATION ie /) EMP. METER OR POLE INS. 20.00 APPLICANT S -�� ADDRESS }� 2-H S, -YP /ILTQ Ci fGf Q MOTORS'' SEE FEE SCH. SERVICE CHANGE ' - 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, it y license n in full fore � v - License Class - Lic. Numht Dale!WT - Contract., DECLARONDOIIr I hereby collo that 1 so exempt from the Contractor's License Lawlor he AnyylOr following tywhn. fhee. requires PerBusmitto and Professions Code: Any coolish coumy whiny structure p riort o its issuance. also- imheapplic,.r repairanyrmittotipriortolisIatementthat requires 1he applicant for such permit 1. filo a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he isexempt therefrom and irliQlASSUANCE DATE . t ILDWITLECT. I PLG. MECH. pai-a_'l UILDING PERMIT INFORMATION s . ` MISC.- REFER TO ORD - PERMIT ISSUANCE 00.90 �' VALUATION S/FT. a89 ELEQCONTR. LIC. NO. ELED. �%(• V� TOTAL OL`� RMITO P E T {�-�,�/ E % T O / OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 1 by any applicant for a permit subjects the applicant toacivil penalty of not more than five hundred dollars (5500).): ALTER-DRAIN&VENT-WATER(EA.) 5.00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the Structure is not BACK FLOW PROTECT. DEVICE 4.00 occ. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 6-» intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- memsarenotintendorofferedforsale. If, however, the building de FIXTURES - PER TRAP 5.00 SD. FT. FLOOR AREA TOTAL ACREAGE GAS -EA. SYSTEM -I INC. 4 OUTLETS 6.00 or improvement is Sold within one year of completion. the owner- - builder will have the burden of proving that he did not build or In)-- prove for purpose of sale.). ❑ 1, as owner of the properly, am exclusively contractingwith . .. GAS EASYSTEM -OVER 4 (EA) 200 BUILDING USE RES IND CON PB Orner ❑ ❑ ❑ ❑ ❑ 'INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors) licensed pursuant to the COnlmcl.r.'s License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. O lamexemptunder Sec ,B.&P.C.lorthis WATER HEATER W/VENT 6.00 reason Owner Dere - WATER SYSTEM _ 5.00 ACC. GATE ACC. FILE N0. ' WORKERS'COMPENSATION DECLARATION WATER TREATING EOUIP. 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. ' Copy the e f S 00*C. ��.,'" Policy �b ny T ��q� - FIRESPRINK Y❑ N❑. ENERGY T 24 V ❑ N❑ ❑ Certified copy is hereby furnished / .. pplicant ❑ .Ceifjed c rtr opy,is-yyyl lh,f't A-/41i� 't MISC. - REFER TO ORD. - CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLO, eJ-p TOTAL L_ COMPENSATION INSURANCE (This Section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N❑ hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 slmll not employ any person in any manner m as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING �--�- become subject to the Workeri Compensotion Laws of Culimmia. Dale ApplicantALTER NOTICE TO APPLICANT: If, after making this Cetllfieme of Es- - OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or, this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER IOACCF.M.) 6.00 SEI SMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 )nee o! the work for which this permit is issued (Sec. 309 , C'vC MICROFILM HEATING UNIT (TO 100,000 B.T.U.)' 8.00 HEATI NO UN IT (OV ER 100,000 B.T.U.) 9.50�� ELECTRIC Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct I agree to comply with all city and county ordinances and. state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING - BOILER- COMP (3 H.P. or, 100,000 B.T.U.) 6.00 BOI LER-COMP (Over 160.000 STU) SEE FEE SCH, MECHANICAL J hereby authorize representatives of this city to enter•upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (We) agree' to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the CONST. TAX 01 PERMIT ISSUANCE MECH. CONT. LIC. NO., MECH. TOTAL U TOTAL rant f this cr i elute of pp a t/Contractor Uate OFFICE COPY I, UJI IHW yNnu.IvtAH r-HUlvI Uh bUI LUINLi GT'OF CUPE�NOY L•- INSPECTION DIVISION JOB INSPECTION,RECORD � J, ��,,tC��r�• JOB ADDRESS r�-��% S. -/i L" AN-•�-+4 Fes"'- ✓-�; UNIT _LOT# '/ / OWNER c(/ C -/y C'\/ CONTRACTOR UJI VCH�f t; ,� •y JOt.L/-r/ 571 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180DATSOFPERMIT ISSU- ANCE OR -1O DAYS FROM LAST CALL E OIYJSPECTI ON. INSPECTION DATE'INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTI 0 STANDARDS.. ' UFER PREGUNITE - PLNMIT VALIDATION ' IsiUANCE DATE G. ELECT. PLG. MEn1 0 El 0 GARAGE SLABSlb POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,L_;,,Q--_ A.VAA UQo. """"-� UNDERGROUND / SLAB PLUMBING ,2��-�j' j?aoPf�N/t� PS'N/ 0`9P,�WC-- dt /PTT' z-94 a c,O 4. ELECTRICAL M% CH AN ICAL 1,U L DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT. ATION INFORM ' WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL " ELECTRICAL " PENMII i0 FRAMING_ _ - INSULATION. STORIES TYPE comsTR DCC GROUP Nes UNITS ' PLACE NO S_UBFLOORUNT^IL^ ABOVE HAS BEEN SIGNED NOTE: NOTINAL INSE. SHALL BE MADE BEFORE CONSTRUCTION TAX-ISPAID Sll. 11 _ TUTAL ACREAGE ^ DIAPHRAGMTHE ROOF SHEATHING — — BUILDING USE HEs IND CON PH Om., ❑ 0 0 C] El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SANA ASSESSORS PARCEL NO PLUMBING i ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO . PaNceL rvo MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC.DATF ACC. FILE NO FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING Ervc. SITE NO. GAS TEST GAS FIHESPHINK Q N[� ENERGY T )i " NC] MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE ELOOO LONF r .N� AL UC. y ❑ NEI INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE^UMMARY EXTERIOR LATH BUILDING BUILDING' INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, t etggg, F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. r PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE —. ¢ 3?; MICROFI LM ' ELECTRIC PLUMBING a tT MECHANICAL' CONST. TAX IMPORTANT!,,1 I ,i; ,.�i. PLEASE READ REVERSE SIDE BEFORE t ' I . F'"I 1@' " CALLING FOR FINAL INSPECTION. TOTAL DJ APYLICAWTS POSTING COPY