18733 APPLICANT TO FILL IN IN FORMATION WITHIN RED ILINES .- USE BALL POINT PEN ONLY -'
AUI LDI NG PROJECT I DENTI FICATI ON - - r PERMIT NUMBER
BUILDING 'APPLICATION & PERMIT.
ADDRESS 87U
33
iA,7z L/yvi-( E p ✓1= BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 1
OWNER'S
PLAN CHECK VALIDATION
NAME�/f r ^ p OTY. ELECTRIC PERMIT FEE '
/B / PHONE 71'rS
CONTRACTORS
NaM�7 - UTLETS-SWITCHES-RECEP 10.00/1.00
LQC$ LION . Yes' LIGHTING FIXTURES 10.00/1.00
CONTRAADDRESS PPLIANCES-RESIDENTIAL ' ' 4.00 .
�V M�rh;v PHONE /�/��n�i PANELS 10,00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
oRi -'�'�//�A ( ///JF- PANELS (OVER 200 AMP) - 20.00
ENGINEER
LIC.NO. SIGNS TRANS, - 3.00 "
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00 - - ^
APPLICANT'S
ZIP TEMP.METER OR POLE INS. 20.00
- \r
'
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 :
Foo LICENSED CONTRACTORS DECLARATION - ,
a u u I hereby affirm (hit( 1 am licensed under provisions of Chapter 9 IO ISSUANCE DATE
yw (emarmuedn with Section 7000)of Division 3 of the Business and
¢ A S , - -BLDG. ELECT. PLG. "1,,MECH.
H w Z Professions Crnle,'md n license is in full foo nd f - ,MECr'I
o i m o Liccnsc Class /S_.—I-ic.Number— (T ., El
m r w Du[c_�O ru 2 Contractor_ 1J ��8� ❑_ ❑
:,a.q f �. - - BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION -
o d U INFORMATION
E:
; LL h I hereby affirm that I anI exempt from the Cnnimctor's License MISC.— rjj ER TO ORD
Hap J Law for the followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE - 10.00 VALUATION $/FT.
Ew> f Code:Any city orcoun(y which o"airess permit to construct,alter, -
¢ ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. -LIC.NO. ELEC. /�
p u requires the applicant for such permit ID line a aigneJ statement that TOTALPE `T TO.
La '
a m hers licensed pursuant(O the provisions of the Conlrlclor's License 111
i
Law(Chapter 9(commencing with Sect ion 7000)of Division 3 ofthe
io Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
¢ I- m (he basis for the alleged exemption.Any violation of-Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects theapplicaut ton civil penalty ,ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(55000.):
0 ,1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 . OCC•GROUP RES.UNITS
their side compensation,will do the work;and the structure is not
intended or offered I'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 docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himself though his own employees.Provided that such improve.
meats are
no(intended or offend for sa1C.If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 IEA.) 2.00
builder will have the burden of proving that h - . -
e did not build or im- BUILDING USE
Prove for purpose of sale.). RES . ]NO .CON Pa Otber
- ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 0 0 ❑ ❑
licensed contractors to construct the project(Sec.•7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6,00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law dues not apply
to an owner of property who builds or improves thereon:and who LAWN SPRINKLERS-OVER 5(EA.) .1.00
contracts for such projects with a connmctons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ Ion excnhptunde,See.—,BAP.C.for this WATER HEATER W/VENT • 6.00 - t -
reusnn ,. I
Owner _ D:ne - WATER SYSTEM 5.00 Ace.oarE ACC.FILE No,
WORKI:RS'COMPFNSA,rION DECLARATION WATER TREATING EQUIP. '5:00 °
. . •
.1 hereby aITinn that I Imve a cvalificme of emsen(to se l&imulc, hZONING
or a"atifiake 0f Workers'Compensation Insurance,or a certilied - ENG.SITE NO,
copy Iheraof(See.3800,Lab.C.). -
Policy No. Company - v
O ❑ Certified copy is hereby furnished RE SPRINK ENERGYTY4
Z Z ❑ Certified copy is fled with'tire city inspection division. MISC.- -' REFER TO ORD.
- O Applicant y ❑ N❑ Y ❑' N❑
~ rn PERMIT ISSUANCE _ 10.001,
� — Clik'1'I PICCONI E BA flON ION PROh1 WORKERS' Fi00D2oNE A:L.U.C.
W �_ COMI'IiNSA'I'ION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL O (This section need nor be compleled if the pennon is for one TOTAL Y❑. N❑ Y ❑ N❑
D Z hundred dollars IS 100)nr less.) - -
U O I certify that in the performance of the work for which this per' CITY MECHANICAL PERMIT FEE FEE SUMMARY
W U mit is issued,I sfj�ait of employ a Person Ina manner 1
0 as to.
heroine hjcnl,io tire Workers'A,p&rhCalifornia.
U a Dale 7 JCA iTa I . BUILDING
} h NOTICE TO APPLICANT: If.stmt making this Certificate of Iix" ALTER OR ADD TO MECH. . 5.00 1 ,
Z_ emption,you should heroine subject to tire W'nrkers:CompeaSmimr APPLIANCE 5.00 PLAN CHECK .
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRU(tON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT), 5.00
the performance of(he work for which this pe nn it is issued(Sec -MICROFILM _
3097,Civ.C.). III HEATING UNIT(TO 100,000 B.T.U.)
Lenders Name
Lender's AddressHEATI NGUNITIOVER100,000B.T.U.)9.50 ELECTRIC ^
l f certify that l have read this application and state that the above V ENT:LATION AN (SINGLE) f 4.00
ordinancesn is correct. I agree to comply with all city and county BOILER COMP I3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances amd slate laws twisting t0 is bidding construction,pon and
hereby authorize •preset natives of this city m enter upon tire
bove-mentinncd operly(0r inspection purposes. yeBOILER-COMP to.,100,000 BTU)SEE FEE SCH. MECHANICAL
a
(We) agree ( ave,.indennll'y and keepnss the City of MISC.- - REFER TQ-ORD. - '
-^—CupeI xga Iiabllitica,'judgmcnis, evil' nnmrmpenseS which. - PERMIT ISSUANCE CONST.TAX T�
n6 in I y uy sc
In
rim n hid City n quince of the
g is perm' MECH.CONT. LIC.NO, MECH. •'
i� ro,Ta, -TOTAL Z
hgn re u pelican actor Uate
OFFICE COPY
POST THIS CARD NEAR,FRONT.OF BUILDING
' V PERMIT NYMBER
CITY sOFTCUPERTINO IOI
GOT 0 .1999 .18733
' JOB INSPECTION RECORD• Pity, of CUFert!RD
• ' ' PERMIT EXPIRATION
JOB.ADDRESS 'ZZ3Cd •�TjL'�'I� AueUNIT#t LOT#
i r• - _/.L �' PERMIT EXPIRES IF WORK
` •OWNER - CONTRACTOR • 6(s \-V o--; C Q� IS NOT STARTEDWITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION ' NOTE: LASTCALLED INSPECTION.
UFER - " ' 'ALI,'GRADING AND DRAINAGE SHALL BE INSTALLED `
PR EGUNITE
TOCOMPLYWITH.THE APPROVED'PLANS AND CITY OF PEHnnt v on noN x l."
CUPERTINO STANDARDS.
. . GARAGE SLABS - - - - J m • �' (tl��'�NJa,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /''� 1
"'•' UNDERGROUND /SLAB
PLUMBING•" - (O oi-] �.tcy
s
• ' ELECTRICAL - ISSUANCE DATE
R
MECHANICAL - - E] ELECT. PLa, ,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
INFORMATION
WOOD FLOOR . - VALUATION $JFT.
PLUMBING ' h
MECHANICAL
- ELECTRICAL
..
J LA -1
FRAMING - G�1/Y
- siDRus TYPE CONSTR.
INSULATION*
R
' - - OCC.GROUP RES,UNITS
?PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
F .. $O EL,'LOOP AREA TOTAL ACRCAGE
' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE-'
DIAPHRAGM �: THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ' ' REs IND LUN PE oma,
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.. ❑ -11 ❑ ❑ ❑
'-� ROUGH' ' SAN.# ASSESSORS PARCEL NO
v
PLUMBING ELECT.ENERGY. TRACT No. PARCEL NO
TUBS&SHOWER PAN- , ; PLUMBING ENERGY.' -
MECHANICAL MECH.ENERGY
ACC.DATE. ACC.PILE No
ELECTRICAL BUILDING ENERGY
FRAMING ELECT,FINAL TEST
- ZONING' ENG.SITE NO.
• INSULA71 N - PLUMBING -
GAS TEST
- - GAS ,
MECHANICAL Ewe sPrarvN ENERGY T.Zu
{
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED H1'
G "❑ "❑ ° ❑ "❑ '
EXTERIOR SHEAR
�, ELECTRICAL RELEASE Fc000 zorvc
INTERIORSHEAR FIRE DEPT: - '`"❑ "❑ ° ❑ "❑
SHEETROCK' GRADE� � - FEE SUMMr4RV
EXTERIOR-CATH BUILDING -
I NTE R I OR, LATH
TEMPORARY APPROVALS BUILDING
.. SCRATCH COAT ELECTRIC - PLAN CHECK
• GAS - ,FEE ..ter..
NO TAPE OR PLASTER UNTIL ABOVE.HAS BEEN SIGNED OCCUPANCY T - SEISMIC FEE ' '
OCCUPANCY OF,BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM '
.��
'. ARRANGE FOR INSPECTION BY,PHONING 252-4505, ELECTRIC
ONE`WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN.PHONING
.e* Z
— SEE PERMIT FOR EXPIRATION DATE = MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ-REVERSE SIDE BEFORE ' �.
CALLING FOR'FINAL INSPECTION. ' TOTAL Z ry
OFFICE COPY