16593 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING NG PROJECT 1 DENTI FICATI ON 'PERMIT NUMBER
BUILDING - APPLICATION & PERMIT
AooR Ss / Hor�E s,-�-,,o p: 16 59 3
O 6��o BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
AE PLAN CHECK VALIDATION
` C�o2�S OTY. ELECTRIC PERMIT FEE
J PHONE
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
g� e S(tr�TME /U^(O. 0LIGHTING FIXTURES 10.00/1.00
CONTRACTORS _ L.� PPLIANCES-RESIDENTIAL 4.00 '
zlyy7 N7'!-. t)d S/: PHONE7�S�.3.3GiY PANELS 10.00 •'
DATE OF APPLICATION,
ARCHITECT PLAN CHECK FEE R.C.NO.
on PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENa. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION -
¢ in u 1 hereby affirm that I am licensed under provisions of Clmptcr 9
Q z w ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and
ye Professions Code,and li cote is infull force.'yry1 f c OCTLOG. ELECT. PLG. MCH.
o i E
T o License Cl z �y Lic.Number "�7� k/ 1 19880 El
W r w Datc 4 Number-
Contractor
- E
art ¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT
d o a UMISC.- p INFORMATION
X g LL m 1 hereby offinn that I am exempt from the Con tractor's License
R U 0 < Law for the following reason.(Set.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT.
Code:Any city or county which reyuiresu permit roconstrucLaher. - 10.00
QQ¢20 Improve,demolish,or repair any structure.prior to IIS Issuance,also ELEC.CONTE. LIC.NO. ELEC."
o LL requires the applicant for such permit to file a signed statement that TOTAL
n w m he is licensed 9(Copursuant to tiro provisions of the Contractor's License PER'M 17 TO
H z a
Law(Chapter and,9(Commencing Codewith Section is exempt
the of o of the (l/•l //7777111
q o Business and Professionsxempt or that he is enempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r m the basis for the alleged axemplion.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
d3 � by any applican t for a permit subfects the applicant to a civil penalty ALTER-DRAIN (EA.15.00
of not more than five hundred dollars(5500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00
their sole compensation,will do the work,and the structure is not . 000.GROUP RES.UNITS
-intendedor offered ]or sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 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
himself or through his own employees,provided c
ovided Umt such hprove-
SO.FT.FLOOR AREA TOTAL ACREAGE
mentsare not intended oroffered to,sale.If,however,the building GAS-EA.SYSTEM-11NC.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 im- BUILDING USE
prove for purpose ofsale.). RES IND CON PB Other
- RL,">z. ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 El F-1 ❑
P _s a, licenuit common. to construct the project(See 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
r +' El 1:3
and Professions Code:The Contractor's License Law docs not apply
ti to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
'fy contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
_ O I am exempt under Sec. ,B.&P.C.tor this 6.00
reason WATER HEATER W/VENT
Owner Date WATER SYSTEM 5.00
ACG DATE ACC.FILE NO.
WORKERS'COMPENSA'rION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby:dorm that I have a certificate of Commnt to self-insure.
or a Certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.l.�T�%�COs�/'
fS
Policy No. Company
O ❑ Cen icd copy is hereby lurnishod.
z 2 Cerlifi d ropy fled with the city inspection division. FIRE SPRINK ENERGY T-24
O Aricantpl� MISC.- REFER TO ORD. Y ❑ N❑ Y CD N[J
fY ti CERT'IFICATIi OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FL000 ZONE A.1-1
u.c.
LLI > COMPENSATION INSURANCE: PLG.CONTE. LIC.NO. PLG.
(L o (This section need not be completed if the permit is for one TOTAL Y❑ N Y 0 No
Z hundmA Aollurs fSl00)nr lCssJ
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued, I shall not employ any person in any manner so as to
0U become subject to the Workers'Compensation Laws of California. -
y NOT Applicant ALTER OR ADD TO MECH. 5.00 �'•� BUILDING
} w NOTICE 'f0 APPLICANT: If,alto making this Certificate of fix- -
F 2 emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such ansi,ions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC•F.M.1 `4.00
CONSTRUCTION LI7NDING AGENCY AIR HANDLING UNIT(OVER 10000.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5MU
00 6.S d
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). G UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Addos.v NGUNIT(OVERIOQOOOB.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the aboveLATION FAN (SINGLE) 4.00s'�
Information is correct.I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and -COMP(3 H.P.or 100,000 B.T.U.) 6.00hereby autlloriic representatives of this city to enter upon theabove-mentioned property for inspection purposes. -COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL(We) agree to save, indemnify and keep harmless the City'of - REFER TO ORD.upel]ino against liahilitics,judgments, costs and expenses whichCONST.TAX
may in any way�acctr�ue against said City in consequence of the ISSUANCE 10.00 2-U'Uranting o�is pct it LIC.NO. MEETAH.8 •• 7 �D TOTAL
Signalurtrol App1¢ant/Contractor Date <
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF• CUPERTINO "' 16593
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS �V `� �-'ll IA.IL�s� UNIT.# '_LOT#
F� ERMIT EXPIRES IF WORK
OWNER vV S� —e CONTRACTOR .� 5-or IS STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: - ANCE OR 180 DAYS FROM
UFER ALL'GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND.CITY OF PERMIT VALIDATION
GUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BL❑DG. ELECT PL❑c. .NI
00 NOT POUR"FLOOR UNTIL ABGVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
MECHANICAL
ELECTRICALd� j PERnuT To
FRAMING - PFFD I t_Q�
INSULATION OUT 11988 STORIES TYPE CONSTR,
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED City Of Cupertino.
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.PT aooR AREA TOTAL AOREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
.; f ROOF SHEATHING sulLDIrvc-USE
HES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ 1:1 E) ❑ ❑
ROUGH nSSESSORS PARCEL NO
SAN.k
PLUMBING - ELECT.ENERGY
TUBSB'SHOWERPAN PLUMBING ENERGY - TRACT No PARCEL No
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY Acc.DATE ncc.FILE No
FRAMING ELECT.FINAL TEST
INSULATION, PLUMBING zoNlNc . ENC.sIrE No.
GAS TEST GAS
MECHANICAL FIRESPHINK ENERGY T.74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ 'Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE 0.L.UC.
INTERIOR SHEAR - FIRE DEPT. ' r ❑ No
SHEETROCK - GRADE '
EXTERIOR LATHBUILDING FEE SUMMARY
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC i 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
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I� ONE WORKING DAY BEFORE REQUIRED.INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL '
IMPORTANT!- CONST:rax'
PLEASE READ REVERSE SIDE BEFORE �7
'CALLING FOR FINAL INSPECTION. TOTAL 7Jv
OFFICE COPY