16443 4PPLICfkNT TQ FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
{iT
BU1 LDI NG PROJECT I DENTI FICATION rERmrt NUMBER
/ SO LONG APPLICATION & PERMIT
/ / �a v BUILDING - ELECTRICAL-PLUMBING-MECHANICAL -6443 -
OWNER'$ - - PLAN CHECK VALIDATION
NAME
OTY. ELECTRIC PERMIT FEE
ONE
O THACTOfl'S'
AVE UTLETS-SWITCHES-RECEP 10.00/1.00
C <P
• Q./e•�� '
LIG..ca LIGHTING FIXTURES , ' ,10.00/1.00 ,
CONTRACTORS -APPLIANCES 4.00
ADDRESS �9,,//11 //� /J //, -
j V (i`•�-A'N- 1HONE " - PANELS 10.00 DATE OF APPLICATION A '
onncnrtEc - PANELS (OVER 200 AMP) ' 20.00 PLAN CHECK FEE _P.C,NO.
ENGINEER
LIC.Ro. ISIGNS TRANS. 3.00
EOR ENG. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 � -
AvvucANrsADOBE
MOTORS SEE FEE SCH. -
a\/L"'"-'� I SERVICE CHANGE 20.00
W¢ z
Foo LICIiN51iU CONTRACTORS DECLARATION - `/��t�(,�(.(/lv�V""'-
a i W 1 hereby at firm that I am licensed under provisions of Chapter 9 t 1 ISSUANCE DATE
fcrommencin wl Iron 70001 of Division 3 f the Business
m ¢ N r, ,7�r�'/1' DG.. ELECT. PLG. MECH.
8
I F � Professions Codc � d my licenec is in full fu-✓-Z�� •I❑- (�
z o�, - Date Class Lin.Number_rJ_(_/ .,JAN 1 01989
��
O z F Dale Contractor
¢ I[ ¢ OWNER-BUILDER DECLARATION _ BUILDING PERMIT
S a T v - INFORMATION
w ; N 1 hereby offinn that I um cxcmpLfnlm the Contractor's License MISC.- Tlprpw
FLLoa Law for the following mason.(Sec.70715.Businessand Professions PERMIT ISSUANCE 10.00 ]-,Up VALUATIO U SIFT.
Code:Any city or county which requiresa perfor to construct,alter, 73/O�
¢ 4 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.GONTR. LIC.NO. ELEC. L
n wD LL requires the applicant for such perand to Ille a signed statement that TOTAL 1,J y/ PERMIT TO
he is(Chapter
Pu(commencing
the provisions of the )of Division License
Law(Chapmr9fcolnmencingwith Section 7f1001of Division3 ofthe
x ¢o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
IS F$ the basis for the alleged exemption.Any violation uf5ection 7031.5 STORIES TYPE CONSTR.
d ; by any applicant lin a cruntsuhjects lheapplicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than Five hundred dollars(5500).1:
❑ I,as owner of the property,or in,employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
v their sole compensation,will do the work.and the structure is not
intended or offered for sale (Sec. 7614, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 _
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- •1 /C±
i40 meets are nor imcnded onsffcrul far.mlc.ll.huwcvoq the building GAS-EA.SYSTEM-1 INC. OUTLETS 6.00 f/� l7 -
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA.) 200 BUILDING USE
builder will have the burden of proving that h . . .
e did not build or ism- RES IND CON PB OrNar� '
t prove for purpose of sale.l. INDUSTRIAL WASTE INTER30.00
❑ I,as owner of the property,am exclusively contra .contracting with ❑' ❑ ❑ D ❑
licensed contractors to construct the project (Sec. 7144,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO,
and Professions Codc The Contractor's License Law does not apply r
to as owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractors)licensed pursuant Io
the Contracmr's Liccnu l.uw. SEWER-SANITARY-STORM V-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
t reason
Owner Date WATER SYSTEM - 5,00
" ACC.DATE ACG FILE NO,
WORK HRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
�1 I he m1firm that I have a certificate of consent to self-insure, E O •Y� 214' ZONING ENG.SITE N0.
( or a certificate of Workers'C om�pp@@pLLLLLLq{{{{{ssssssution In or neat 'rt ifal L
'opy Nia. f(Se Cin Wb.C.� /� -
Policy No. Coutpany C,�s�4fQ/)//p '/AFp - -
I O ❑ ferulic crcbY'fun'01J -
Z Z ,ife -m a Ilea with a city.inspecl' ''inion. FIRE SPRINK EN ERGY T-Z¢
I O Applicant MISC.- REFER TO ORD. Y [:] Is - v ❑ N[3
~ PERMIT ISSUANCE 10.00
TSN C" IFICAT'F,OFEXEMP'1'ION FROM WORKERS' - rOD FLOODZONE A.L.u.C.
I LU -EL 0 'CONIPENSATION INSURANCES PLG.CONTR. LIC.NO. PLG. 1I O8 YQ' N� Y � N�
(This section need not be completed if the pcRed is for'one TOTAL `/
::) Z hundred dollars(SI00)or Isss-) -
U O 1 cenily that in the perfonnan a of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to
O W become white,to the Workers Compensation LaAs of Califomu. ^Od
Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING J(
} r6ia NOTICE TO APPLICANT: If,alter making this Certificate of fix.
F Z emption,you should become subject to the Workari Compensation APPLIANCE 5.00 PLAN CHECK
prisions of 0¢ labor Code, you must forthwith compwith ly FEE -
U
such provisions or this pennit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00
CONSTRUCI[ON LENDING AGENCY AIR HANDLING UNMOVER 1g000CEbt) 6.00 SEISMICFEE.
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) ' 5.00 -the perfarmonce of the work for which this permit is issued(Sea MICROFILM _
3097,Civ
.C.I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT 100,000 B.T.O.)9.50
Lenders Address ELECTRIC T
1 certify that I have read this applicalion and state that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct I agree to comply with all city and county - PLUMBING- _
ordinances and state laws miming to building construction, and BOILER-COMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby authorise representatives of this city to enter upon the
ahove-montioned property for inspection purfses. BOILER-COMP (Over loo, RTu15EE,FEE SCH. MECHANICAL. (D v
(We) agree to svve, indemnify and keep hannlrss ,he City of MIS Z: REFER TO ORD. a
uperti liabilities,juhgments, costs and expenses which CONST.TAX
m' any w aacme agRr City in consequence of the PERMIT ISSUANCE 10.00 0 - - 77r 3
an mg permit. ECH.CONT. LIC.NO. MECH. 4
l TOTA} / [�- TOTAL
I Si Applicant Con Tac r Wile _ 6 7�
' OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING Y� PE RnulNun+eER
CITY OF. CUPERTINO s r 16443
e INSPECTION DIVISION
JOB INSPECTION RECORD
Q _/ ,AI �, PERMIT EX�PPIRIA'TION' tt1
JOB ADDRESS � � `-' b ��� U i 11 0) f'je •UNIT# LOT# ' F" 1 `� . Kc- •i
owrvER �-o S-r $( Sc �PERMI�E XPIRES`IF WORK:.
CONTRACTOR SS Q--(SC\- .IS-'NOT STARTED WITHIN
_ INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS•OF PERMIF,ISSU
FOUNDATION _ ANCE OR 180,DAYS FROM
�� NOTE: 1 LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGESHALLBE INSTALLED -
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERAur VALIDATION-
CUPERTINO STANDARDS. .r
GARAGE SLABS , a-� ' ` + , ' f lz�- 7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED yem;e ;
UNDERGROUND /SLAB y
PLUMBING
WY Of Cupertino' �Z�
ELECTRICAL ISSUANCE UArc
T MECHANICAL �18LLDD7G. e1.Ec1. y�Pp-` \NEECCI-C
00 NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR
INFORMATION
� wnn ,nO � $IFT.
PLUMBING vn
�p P
MECHANICAL'
ELECTRICAL - �/P�E RFFu_rpr�o
FRAMING ,• - iV V~ ��'
�rORICs iVPE CONSTR.
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - "
$O Fi.FLOOR AREA iOIAL ACREAGE
ROOF ( THE CONOSTRUCTION TAX IS AIDFINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM ,'�j a .
- - ' BUILDINGUSE
' ROOF SHEATHING n I1 CON 1+Es IND CON Po wo..
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS tATINSP. ❑ 0 ❑ E ❑
ASSESSORS PARCEL NO,
ROUGH SAN.N - Z
PLUMBING +O .2 - ELECT.ENERGY -' 1 _ 3TUBS&SHOWER A — TRACT NO. . PARCEL NO
N-L 1 PLUMBING ENERGYMECHANICAL - _ MECH.ENERGY ELECTRICAL BUILDING ENERGYAcc.OnrE Acr.,F,aE NoFRAMING - 27� ELECT.FINAL TESTZONING ENOSITE NO.
INSULATION - .Ly '' - PLUMBING In kff?
GAS TEST GAS - -
' MECHANICAL FIRE SPRINn ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'Y "� ` N[:)
.
EXTERIOR SHEAR l ELL�
ECTRICARELEASE FLOOD TONE 'A.L UC. '
INTERIOR SHEAR IfU FIRE DEPT. -
YD . N . -� 7 N❑ .
SHEETROCK ..` GRADE _ FEE SUMMARY
EXTERIOR LATH BUILDING
' INTERIOR LATH - ( TEMPO RARY-APPROVALS euILDwG �0 '
SCRATCH COAT . Ci ELECTRIC PLAN CHECK "
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE' ( '
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED'BY,BUILDING INSPECTOR. MICROFILM
ELECTRIC.'
w ARRANGE' FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION'. PLUMBING
�. Oz PLEASE GIVE JOB ADDRESS WHEN PHONING..
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL '
IMPORTANT! CONST.TAX `
PLEASE READ REVERSE SIDE BEFORE- TOTAL +
CALLING FOR FINAL'INSPECTION.
OFFICE COPY