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18512 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING L APPLICATION & PERMIT Y. 185.12 ADDREs,�© b70M(7 �\7 S `rC- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL „ OWNERS PLAN CHECK VALIDATION NAME �a°1Az r_ TY. ELECTRIC PERMIT FEE vlreST\6L I e ° }js PHONE I^; CONTRACTORS NAME C-36 Z"z56 OUTLETS-SWITCHES-RECEP 10.0011.00 WEST VA-ll�" RW LIC.NO. LIGHTING FIXTURES 10.00/1.00 ADORE/SS CONTRACTORS 'j 7�yf �/L1/. APPLIANCES-RESIDENTIAL 4.00 ZOO y� V.C, PHONE J/ -;NYYo PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 NGINEER uc.NO. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5,90 PERMIT VALIDATION ZIP EMP. METER OR POLE INS. 20.00 AooAess Ts MOTORS - SEE FEE SCH. O L4 " / SERVICE CHANGE 20.00 l]¢ z F O o LICENSED CONTRACTORS DECLARATION F E, 1 hereby affirm that I am licensed under provisions of Chapter9 2 i ISSUANCE DATE N a m (commencing with Section 70001 of Division 3 of the Business and t� DG. ELECT. PLC. MECH. H o z Professions Code�.,,,III�nJJJ{,,,BBm�IIy license is in full forcLyq�y cy/ 0 ❑ ❑ y,,. ❑ z o H - License Class D� Lit.Number `'L .J_f•1_ yl 9 -_ Dater l)1 F .4''_COnt JetOr Q Y F J Q w a OWNCR-BUILDER DECLARATION BUILDING PERMIT A O '" MISC.- REFER TO ORD INFORMATION w 3 LL I hereby affirm that 1 and exempt from the Contractor's License o_ Law Law for the following reason.(Sec.7031.5,Business Pr ofess;ons VALUATION $/FT. - ., PERMIT ISSUANCE 10.00 Code:Any city m county which requires a permit to construct,alter, In ¢ ¢ 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. A. uc u requires the applicant for such permit to file a signed statement that TOTAL w m he is licensed pursuant to the provisions of the Contractor's License yyy��I PERMIT TO FZQLaw(Chapter 9(commencing with Section 7000)ofDivision 3 of the y V , ,^ s i o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE / P[ H m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TV E CONSTR. a3 _ by any applicant for apcnnucivil ;l subjects tile applicant a 1,c rally ALTER-DRAIN -WATER IEA.15.00 of not more than five hundred dollars($500).): ' ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole conhpensution,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or off'emd En sale(See. 7044, Business and I'mfcssions DRAINS.FLOOR,ROOF,AREA,COND. 5.00 OL9 Code: The Contractors License UW does not apply to un owner of property who builds or improves tenon,and who does such work FIXTURES-PER TRAP 5p.00 O-4So.FT.FLOOR AREA TOTAL ACREAGE himself re Through his own mmpluyecs.provided that such improve- ct mens are meatot is sold or within year of c,however,the if, building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00 E 7-p J dr der will is sold within ono your of I,,If,] Tree,the owner- `;O / builder will hove the Horden of nrvin`tlmt he diA not build O,it.- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 f P 6 BUILDING USE _. prove for owner of sale property, INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer - _ ❑ L os owner of the ostructhe exclusively Se c 7044,tins with ❑ ❑ ❑ ❑ ❑ licensed colons od to Th e the prijen(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractl)r s License Law docs bol apply to an owner of property will)builds m improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects wilt a contranotA)licensed purstant to the Contract.,',License Law. EWER-SANITARY-STORM EA.200it/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sea ,B.&P.C.lite this Z reasonWATER HEATER W/VENT 6.00 , U n Owm,r Dat, WATER SYSTEM 5.00 6• (9/J WORK 1SRs'coNrliNsnHON nGcl.n RATION WATER TREATING EQUIP. 5.00 ACC.DATE ACC.FILE NO. I hereby infirm that I have a certificate ofconsent to self-insure, or a certificate of Worker[Compensation Insurance,or a certified ZONING ENG SITE NO. copy thereoflSec.3800,Iab.C.). Policy No. Company 0 ❑/C"I fl it pY u hereby furnished. FIRE SPRINK ENERGY T ZO Z Z 8 Celt ificd yy{1yy� is fg1.ty yah the city inspection division. Applicant_k!L+ L�l�W� MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N� HON 1 ' •PERMIT ISSUANCE LU - CIi RTIFICATISPE I A M N INS FROM WORKERS' 10.00 .Z. V FLOOD ZONE A.L.U.C. CL CO\IPIiNSAI'ION INSURANCE PLG.CONTE. LIC.NO. PLG L 0 (Phis section need not he completed if the permit is for one TOTAL Y 0 N� Y ry� Z hundred dollars IS 1000,less.) U O 1 certify(hat in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to O w become subject to the Workers'CompernationLaws(if California. CL Date-Applicant - ALTER OR ADD TO MECH. 's BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- a 5.00 (_ Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 309,7Lender's Name,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify [flat I have read this application and state'thm the above VENTILATION FAN (SINGLE) 4.00 1 information is correct. I agree to comply with all city and county PLUMBING v ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ;z,Q17 hereby unhorire representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU) FEE BCH. vY�� i ahovomentioned property for inspection purposes MECHANICAL (We) agree to save, indemnify and keep hemdess the City of MISC.- _ - REFER TO ORD. _ - Upertino against liabilities,judgments, cos is and expedscs which CONST.TAX Try t an�tlo, nst said City in consequence of the PERMIT ISSUANCE 10.00 ra�ti �/ Q MECH.CONT. LIG NO. MECH. --�� �� !R "-°-'A-�- TOTAL TOTAL �z pQ Sig atureWit Date OFFICE COPY POSTTHISCARD NEAR FRONTOF BUILDING PERMIT NUMBER ' CITY OF CUPERTINO INSPECTION DIVISION 18512 JOB INSPECTION RECORD \A;T7 G PERMIT EXPIRATION JOB ADDRESS UNIT#I _LOT# PERMIT EXPIRES IF WORK owrvER W Q lL- �u�p16TRACTOR �� V IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION ECOR 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE.INSTALLED LASTCALLED INSPECTION. PREGUN ITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAr.IDAnoN CUPERTINO STANDARDS. GARAGE SLABS FWD !- �,� r ��' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED e� / UNDERGROUND /SLAB. 1w9 PLUMBING } ELECTRICAL motcup1m /j ISSUANCE DALE MECHANICAL + LUG ELECT I PEG I NIECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED epl Vh&:-Tep OUT eg7- poyr _ BUILDING PERMIT WOOD FLOOR ' Q_ ! _ INFORMATION PLUMBING - _ VALUATION SIFT, MECHANICAL ELECTRICAL PERMIT To FRAMING INSULATION 'roRIES r ECONSTH, OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -t ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.rr aool+a+eA .LoiAE AcusAce v DIAPHRAGM THE CONSTRUCTION TAX IS PAID f ROOF SHEATHING ES TNT)) EO -USE HCOONN PB Orinv - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. EL ❑ ❑ ❑ ❑ ROUGH nssessoas PARCEE No. SAN.p PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ---AGO DATE Acc.FILE No. FRAMING ELECT.FINAL TEST INSULATION PLUMBING It IZONING ENG.SITE NO. GAS TEST - GAS MECHANICAL E INu ENERGY T-2aCOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N❑ Y ❑ " N❑EXTERIOR'SHEAR ELECTRICAL RELEASE 1 INTERIOR SHEARFIRE DEPT.SHEN❑ ❑ N❑ EXTERIOR L GRADE FEESUMMARY EXTERIOR LATH BUILDING 'INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC 1 PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION.BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING >" z0 PLEASE GIVE JOB ADDRESS.WHEN PHONING. I — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL 1�,2,dTJ OFFICE COPY I I POST THIS CARD NEAR FRONT OF BUILDING I'l ll�tlt N111.f 1if 11 CITY OF CUPERTINO 1851 INSPECTION DIVISION — • JOB INSPECTION RE0 ..-��1V \A� PERMIT EXPIRATION JIM ADDRESS �.U §7ty 1/7�...�,,(•i O.1-�_LTe_I N UNIT4- - -LO 7T PERMIT EXPIRES IF WORK INSPECTION d I� DA� INSPECTOR ALN INSPECTIO E OR IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. I [HINDA IION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. ill"rR ALI. GRADING AND DRAINAGE SHALL BE INSTALLED -----'—- 10 COMPLY WITH THE APPROVED PLANS AND CITY OF VI IINIII VAI,I IIA I UIN CUPERTINO STANDARDS. �p I:Alln,l�l ':I AItS _ ___ _ •Ti-WAJ' - ." i POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED' --�' ----" ------'--- -- UNDERGROUND /SLAB 1989_ �..v.{ ii li Gill of CU c�sunmu un rE MECIIAMCAL ` q(ua [Ltrl vu; nn c„ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CE ' _ BUILDING PERMIT _ WOOD FLOOR `-\ `\`\ INFORMATION I'LOMISINU -- - VALOAnON SIE T. MECHANICAL F1 EC IMCAL PI11 111 TO r nMIN(i V IN SETL_AT I DN """Its r VE CONSTII —_— —_---- UCC 151111,11 TIES UNITS PLACE NO_S_UBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOT E:NO FINAL INSP.SHALL BE MADE BEFORE 1 T Atli A u A ACIA,I DIAPHRAGM THE CONSTRUCTION TAX IS PAID RI I%I 11:til IINIl.111NG UM AIRING n15 IND [:UN ro Uw.. APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. ❑ O ❑ ❑ ❑ ASS[SSIIIIS 1'AIICf 1.111 rLurmllN(; ELECT.ENERGY I I IR•:^..•;DI)Vq 11 PAN _ PLUMBING ENERGY I IIAI I NO TWICE III raer:iinnlir:nL MECH. ENERGY r:Lfr,IRICAI_ _ BUILDING ENERGY AC(: Dnrt nCC FILF NO FRAMING ELECT,FINAL TEST INSU LA IION PLUMBING TUNING EN(; Sit[ NO GAS IC$1 ___-_---_ _ GAS i _ _ MECHANICAL F"It st'IIIN,< ENERGY t 2e COVER_N_O WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ NEI ` [:] N❑ Ty,IERIOR SHEAR _—_ ELECTRICAL RELEASE IEO011IONE ALUC. IfJ'IERIOR SHEAR FIRE DEPT. / "❑ No 1 ❑ No SIII:F TRUCK ----- GRADE FEE SUMMARY E Y. IEHIUR LAlll BUILDINGE - rnlOn LATH TEMPORARY APP VALS BUILDING I(,II COAT ELECTRIC PLAN CHECK _ _ GAS FEE NO TAPE OR PLASTER_UNTIL ABOVF. HAS BEEN SIGNED occ UPANCV SEISMIC FEE OCCOVANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505,ONE WORKING DAY BEFORE REQUIRED INSPECTION. 4PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE —IMPORTANT!PLEASE READ REVERSE SIDE BEFORE i CALLING FOR FINAL INSPECTION. APPLICANTS POSTING COPY