15169 'APPLICANT TO,FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY ;
1'UU I L DING PROJECT IDENTI FICATION ` 1 'PERMIT NUMBER '
all;LDING ' . APPLICATION&'PERMIT
.V�'ti �(�
'�j. rIDORE55 - J I
OS�3 . JJ W� - e✓,p_. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL . 51J
OWNER'S -
VALIOATION
rvnA^IIG I_. �j'/�/� ?,-s TV. ELECTRIC PERMIT FEE PLAN CHECKair
I„ -PHONE J�v `7
CONTRACTOR 5 - 0
NAME' �- UTLETST SWITCHES-RECEP 18.90/1.00 ((II
. . _ 'gin: e- �l-lir- arc:No. p �I��� LIGHTING FIXTURES 1Bc00'11.00 -.
CONTRACTORSPPLIANCES RESIDENTIAL - !4[-
_ o//pPR ss SSX. Z
A - ,
/�z_ A tip- ;PHONE' • �p)> .�PANELS y '' 10.00 DATE OF APPLICATION.T'
ARCHITECT e - - - - PLAN CHECK FEE P.C.NO.
OR- Q�-y PANELS (OVER 200'AMP) .20.00
EN- GINEER
4• /�/LL uc.No.' Q SIGNS TRANS. 3.00
ARCH.OR ENG. .• ,n 1 pERMIT.VALIOATION�
ADDRESS ,l q SPECIAL CIRCUIT 5.00 '-'
EMP.METER OR POLE INS. 20.00 y
A -. - Z MOTORS SEE FEE SCH.
ADDRESS ooREss _
So(/� Kw- - S •S- 937.1 SERVICE CHANGE 20.00 �/31 /
woo " LICENSED CON'FRACI'ORS DECLARATION - (/
< I hereby affum that I am IiccOwd under provisions of Chapter'( ISSUANCE DATE
Z,w (commencing with Section 7000)of Division 3 of the Business and< w - BLDG. ELECT.. PLG.]. MECH.
r o z To Cod A my license is in full force a fepg!-9// -
i H - License Class Con Number L -
G m�� UmeS"f Cnntmc[or
w ¢ .` ` OWNI:R-BUII.DI:R DECLARA'T'ION 11LDING PERMIT
w ;LL r •1 hereby affirm dial I am exempt treat the Contractmr,,License
MISC.= REFER TO ORD "NFORMATION
LLOa Law for The hollowing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT.
r - Code:Any city or county which requires a permit to construct,alter, � n�_ _
a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. - LIC.NO. ELEC. �� (�'�-'Q
'
O ¢ requires the applicanl for such perin it to file a signed'Statement that '' TOTAL
o. s, m" he is licensed pursuant to the provisions of the Contractor's License ,,,EEf PERMIT TO
m
F z <
Law(Chapter 9(comcncingwlth Section 7000)of Division 3of(hc - [ µ�•/'/ 7/ 61%1
z O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE - 11
the basis for the allegcJ exemption.Any violation of$ection 703L5 STORIES TYPE CONSTR.
a'; by any opplicunl for a panni(suhjects the applicant toucivil penalty -� "
Of not more than five hundred dollrrs15500).1: ALTER-DRAIN&VENT-WATER (EA.) -
' ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
- their sole compensation,will do the work,and the structure is not
r intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:-The Contractor's License Law does not apply loon owner of
property who builds or improves thereon•and who docs such work `; FIXTURES-PER TRAP . 5.00 Sa FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
ments a re not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or,Improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or air. . - RES IND CON PB Omarprove-for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ '❑
licensed contractors to construct lire project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The'Contramar's License Law does not apply -
to an owner ol`properly who builds or improves thereon,and who - LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts lorsuch projectswith a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law: TRACT NO. PARCEL NO.
❑ l am exempt under Sec. ,B.&P.C.for this
Person WATER HEATER W/VENT' - 6.00
Owner Dee WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Iasumne ,or u eertifieJ
co /Q�ol'fSec.3800,I:ab.C.), r
1•0l eT'✓n CnmponY.p7�1asG1�N - Ua
Q Cerlilied copYi hereby rnished. ^ _ FIRE SPRINK ENERGY T 2
Z Z ❑ Certified cap w,i}�n 1pe� Iuy irepection division.
P: p Applicantlfe�-- MISC.- e REFER TO ORD..D. Y ❑ �N❑ ❑ ❑v � N
cc: L5 CER'IIFICATI>OI'F.XIiMPI'IONI:ROMWORKERS' PERMIT ISSUANCE 1.9:86 , FLOOD ZONE A.L.LI.C.
W > - COINPENSWION INSURANCE PLG.CONTR. LIC.NO. PLC.
�
Z (This section rued not be completed it the permit is for one _ TOTAL �p Y❑ N❑ Y ❑ .. N❑
hundred dollars IS 100)oP less.)
U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t- mit is issued„I shall not employ any person in any manner so as to
Q w become subject to the Workers'Compensation Laws of California.
Date ApplicantEK- f BUILDING
} N NOTICE: 'r0 APPLICANT: If,after making this Certificate of ALTER OR ADD TO MECH. Ji.00 -
♦- ? CMdb n,you should become subject to the Workers'Cornpcnsution _ APPLIANCE,, 5.00 PLAN CHECK
provisions of the Labor Code, you must lorthwith comply with FEE
U such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONS'[RUCr10N LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC,FEE 3 a�
I hereby affirm that there is r construction lending,cre,for EXHAUST HOOD(WITH DUCT)•. 5.00
the performance of the work for which this permit is issued Sec: MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U'.) 8.00
' Lender's Name
Lender,AddressHEATING UNIT(OVER 100,000 B.T.U.)9.50 ' ELECTRIC
` ' "
1.certify(hut 1 have read this applicationW state that urn above VENTILATION FAN (SINGLE) 4.00
ordinances and state laws relating t0 building construction, and a 6
information is correct. I agree to comply Willi all city and county PLUMBING
BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby rnflune a representatives ins of this city s. enter upon the •BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby multo ize property for inspection purposes.
- (We) agree to save, indemnify and keep harmless the City of MISC:- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE gg.gp CONST.TAX
49'ray
in any ay accrue against said City in consequence of thss �anting of MECH,CONT. LIC.NO. TMECH
OTAL y'
°2�� TOTAL
lgnatefyof Applicant/Contractor _ Date
OFFICE COPY TI
r POST THIS CARD NEAR FRONT-OF BUILDING
- ,� • - PERMIT NUMB ER
CITY OF CUPERTINO
INSPECTION DIVISION, - 15169
I :JOB INSPECTIQN,RECOND .s 7
4 c PERMIT EXPIR�A �ON
• JOB ADDRESS >10553' ,JOhn WayUNIT# r - _SLOT.# •�'.( j ,
- - PERMIT EXPIRES IF WORK
OWNER Mike Gaf f ev CONTRACTOR. IS NOT STARTED WITHIN.
INSPECTION DATE INSPECTOR -INSPECTION RECORD 180'DAYS OF.PERMIT MSU-:1E
FOUNDATION - - - ANCE OR.180 DAYS:FROM
NOTE: - - LASTCALLEDINSPECTION.-!
r. UFER _ - ALL GRADING�AND DRAINAGE SHALL-BE INSTALLED .
�.;, 'TO COMPLY WITH THE APPROVED,PLANS AND CITY OF PERMITvnLmnnUN -.
'PR EGUN ITE CUPERTINO STANDARDS. - .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN S Dov✓ -( . .v-etvIEo ve - - • w
` UNDERGROUND /SLAB ' ' - AlUMBING �1� - VI t �' f X4`71
ELECTRICAL . '•{, - - ISSUANCE DATE °
MECHANICAL t 1 - , BLuc[ ELEcr PLC: . .�MeyH,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING _ , .
MECHANICAL. e Qj1�Y-,A1
ELECTRICAL- ,PERNIIT Tow
FRAMING
' STOHII{S - IYPE CONSTH.
INSULATIONcj
OCG GROUP RES UNITS
NPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF NOTE:NO FINAL INSP.-SHALL BE MADE BEFORE so.FT.aooR AREA rorAL ACRI ACE.,
DIAPHRAGM r - THE CONSTRUCTION TAX IS PAID•
a. BUILDING USE
ROOF SHEATHING RES IND - CON PB Ude.,
APPLY NO ROOFING,UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP. CD 0 0 E]' ❑
ROUGH - "SAN.p T - - nssessoas PAHceL NG,
PLUMBING`. Y•.ff ELECT.ENERGY
.
TUBS&SHOWER PA TRACT NOPARCEL
- � PLUMBING.ENERGY T , . NO ,17-
MECHANICAL , poO_ MECH.ENERGY -
ELECTRICAL �•d BUILDING ENERGY - L\ - Acc DATE Acc P1LC No.
FRAMING_� ,fsy. ELECT.FINAL TEST
INSULATION PLUMBING zGNINc ENG SITE No.
IF \.
GAS TEST ` GAS
. '.. - MECHANICAL "+i. rl.. EIRE SPHwK. - eNERerT-za
COVER NO WORK UNTIL ABOVE HAS BEEN SIG ED HEATING %\ "v ❑ "❑ Y 0 "�:
' FLOOD ZONE. A U.G
EXTERIOR SHEAR ELECTRICAL RELEASE r\. ,
.. INTERIOR,SHEAR - FIRE DEPT.`.- _ 'Y'El "❑ Y ❑ "Of
SHEETROCK - GRADE - FEE SUMMARY
EXTERIOR ,LATH - BUILDING
. INTERIOR LATH - TEMPORARY APPROV LS .•BUILDING %,C/�'y"� '
SCRATCH COAT - ELECTRIC '• - PLAN CHECK ,
GAS .FEE'.
NO TAPE OR PLASTER UNTIL A80VE HAS BEEN SIGNED VUUUPANCY. SEISMIC-FEE ' „
OCCUPANCY OF BUILDING IS NOT P ER MITT EDUNTILBUILDI NG FINA LIS SIGNED BY BUILDING INSPECTOR. .MICROFILM
ARRANGEFOR INSPECTION BY PHONING 252-4505, ELECTRIC 1.
o , ONEVVORKLNGDAY:BEFORE'REQUIRED'INSPECTION PLUMBING �G
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL - }
IMPORTANT! CONST:-TAX
PLEASE READ REVERSES IDE.EIEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY