18582 ' APPLICANT TO FILL IN.INFORMATION WITHIN RED LINES =USE BALL POINT PEN ONLY
PERMIT NUMBER -
r BUILDING PROJECT IDENTIFICATION APPLICATION $.PERMIT
• �x' a0IL Inc � � '�
ADDR a 18 5 8 2
- 'la`s OHn DvIHL BUILDING- ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME L OTY. ELECTRIC PERMIT FEE
/{Nt '
I'IV rIfAN SMfTH PHDNE zs b O
CONTRACTOR'S I '
NAME - UTLETS-SWITCHES-RECEP 10.00/1.00 6
-- __. .�V� F10//E/N'lP/C• ' LIC. LIGHTING FIXTURES 10.00/1.00 -
coNTRAcroas 57V.17Kjis Sl Zfo APPLIANCES-RESIDENTIAL 4.00
I t4Ai 1prC ST•, PHONE,5-0. 19do IPANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO. ,
OR PANELS (OVER_200 AMP) 20.00 �D5
ENGINEER 1 A
r LIC.NO. SIGNS TRANS. 3.00 141. F7P-
" - ARCH OR END. , PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5,00 - -
t
. ZIP EMP. METER OR POLE INS. 20.00 /'-2
ADDDRESSDRESS
APPLICANT'S MOTORS SEE FEE SCH-
SERVICE CHANGE P A in o,20.00 4._ 7'Q'�/sV LLI
} Lo0 o' " LICENSED CONTRACTORS D17CLARATION /1 y
a i u I hereby affirm Ihm I am licensed under provisions of Clmpter9 - hY'r 1) tl I`CIA-I ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business anti - �• BLDG. ELECT. P,LG. 'MECH.
� Oz Professions Code,an([my license is in full force and effect. y f - ❑
z 012 - Llcunsn Class Lie Number %, E:p y, h-1-�,1L
O z I- Dme - Contractor tri l;l 0f r11!'f?rfino
H _
BUILDING PERMIT
rt ¢ ¢ OWNER-BUILDER DECLARATION - -
a a U - INFORMATION
K
g" y I hereby affirm that Lam exempt from the Contractors License MISC.- REFER TO ORD
•F, ._ o a. Law forthe followingreason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or'county which requires a Permit to construct,alter, �Z�
a, improve,demolish,orrepair any structure,prior to its issuance, Bo ELEC.CONTR. LIC.NO. ELEQ
A d0¢ req litres the applicant for such permit to file a signed statconat that TOTAL Z�o PERMIT TO
.w he is licensed pursuant to the provisions of the Contractor's License
� za Low(Chapter 9(commencing with Section 7000)of Division 3 of the12
4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢-Ho the Innis for the alleged exemplion.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant lbr a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
- of not mare than five hundred dollars(S500).):
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00
their.sole compensation,will Jo the work,and the structure is not .00C.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions- DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The,Contraclor's Licensu Low does not apply to an owner of -
proporty_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- .
ments are not intended or offered for 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 it". BUILDING USE
RES IND CON PB Other
ipr 0 fors owner ofshep INDUSTRIAL WASTE INTER. 3.0:00 ❑ ❑ ❑ ❑' ❑ •
❑' d as owner OI the properly,he exclusively contacting with
Z pro contractors to construct the Project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:The Contractor's License s th docs not apply -
to an owner rel' h projey who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 _
contracts for such projects with a conlmctoH s)licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00
- the Cn ntrnee s License Law. TRACT N0. PARCEL NO.
❑ taro exempt under Seo ,B.&P,C.for this WATER HEATER W/VENT 6.00 -
reason
Owner' - Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKER�SS' obi PENSAFION DECLARATION WATER TREATING EQUIP. 5.00
I Iwrehy of t 411nt I have a cerlif ieole of consmtt to sclhinsure,or a certificat f Workers'Compensation Imur:mcc,or a certified It ZONING - ENG.SITE NO.
copy there Sec.3800,Lab.C.l.
Policy N Company '
0 ❑ Rifted Copy is hereby furnished. FIRE SPRINK ENERGY T 24
z'Z Certifier X-ls fled with t Inspection division. -
App kart _s+�p*s �y�� MISC.- . :REFER TO ORD. Y ❑ N❑ Y.❑ N❑
L0 PERMIT ISSUANCE - 10.00
LU - CERTI FICAFEDINSWI PTION NSURAN1'WORKIik S' FLOOD ZONE A.L.U.C.
CL COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG,
CL O (This section need not he completed if the-permit is for one TOTAL Y❑ 'N❑ Y ❑ N❑
2hundred dollars IS l00)or lcsx.l ,
'U.O ' I certify that in the perfoonm¢e of the Work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
EL H mit is issued. I shall not employ any person in any manners as to -
U become subject to the Workers'Compensation Laws of CaliforRia. n
d Date Applicant ALTER OR ADD TO MECH. 5.00 -BUILDING
} to NOTICE TO APPLICANT:II',after making Ibis Cerlil kale of li x- _
? emption,you shouldOccome subject to the Workers'Compensation APPLIANCE' 5.09 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 10,000C.F.M-) 4.0
CONSTRUCTION LI:NDING AGENCY '. AIR HANDLING UNIT(OVER 10MC.F.M.) 6.0 SEISMIC FEE •46
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DU 0
the performance of the work for which this permit is issued(SeeMICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,00 B. .U:) B.
Lender's Name HEATI NG UNIT(OVER 1 OnRon.B.T:U.to :n ELECTRIC
Lender's Address - -
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n corral. 1 egret t0 comply with all city and county PLUMBING
hereby
aces and a representatives
alive lig In building construction, and BOILER•CCMII,P I3 H.P.or 100,000 B.T.U.1 6.00
hereby authorize representalliesec this city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
aliuvomentinnnl propetlyfor inspection purposes.
.(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
- r- - -- Cu tertino a tot
liabilities,judgments, costs and ex enses which PERMIT ISSUANCE 10.00 v
1 a5t/ / s p CONST.TAX
.. r
in aI vuy ucc ue a• i t City i consequence of thein• his per MECH.CONT. .,LIC.NO. MECH.0rorALTOTAL 3
ature of plicant/Coatmc or Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF,BUILDING' '
rFRM1frt NUMBER '
CITY OF CUPERTINO ,, .. 18582
INSPECTION-DIVISION"
JOB INSPECTION RECORD ".
/ T `� ! _ _ PERMIT EXPIRATION -
JOB ADDRESS O c �� ��� w�-'•� UNITE# - • _LOT it
PERMIT EXPIRES IF WORK
OWNER J- 4 CONTRACTOR �/' f—D IA,1p; '- , IS NOT STARTED WITHIN
1
INSPECTION - DATE INSPECTOR INSPECTION.RECORD 180 DAYS OFPERMIT,ISSU-•
FOUNDATION _ ANCE OR 180 DAYSFROM
ALLGRADING* -
RA" r LASTCALLED.INSPECTION.
_ � � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF r PERMIT VACIUA noN
-- PREGUNITE, - CUPERTINO STANDARDS. t�
�• GARAGE SLABS 1" - - ' 11� i ey.,.( 4 7'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED DUNS1V S a
- UNDERGROUND,/SLAB S �rt'IOJ ,1 .I 'F_,. ,`
PLUMBING yy,, 6C� �,'- •'�"•� +` ,�'�
ELECTRICAL - 3ti1R@" SELECT_ r_P7G.^ _
MECHANICAL •uwc•. ELECT - rLc. MECR
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - r BUILDING PERMIT
I t� INFORMATION
WOOD FLOOR f VALUATION- S/FT.
' PLUMBING -
MECHANICAL ,• m �t `L F : ?3rQU�O� '
_ ELECTRICAL .p vERMIr ron
FRAMING
STORIES TYPE CONSTR.
'
INSULATION '� ,
,. ' -.
OCC.GROUP .RES.UNITS
11VA'CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO:FT•;FLOOR AREA ICTAL ACREAGE
DIAPHRAGM
ROOF NOTE:NO FINAL INSP. BE MADE BEFORE
• THE CONSTRUCTION TAX IS PAID -
- - -
' ' - BUILDING USE
ROOF SHEATHING .RCs wo CON .. Re om.+
— -APPLY NO ROOFING UN IL ABOVE HAS BEEN SIGNED",:+ FINALS DATE INSP•. "' .❑ ❑ ❑'
ROUGH " �SAN.q - nssessoRs vaRCEL No.
PLUMBING - ELECT.ENERGY - -^'TRACT No. PARCEL NO,
• TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY - •', r - _
• ELECTRICAL BUILDING ENERGY ACC DATE., ACC,FILE NO.. r: -
:,. . FRAMING. ELECT,FINAL TEST
INSULATION • . PLUMBING ZONING •ENG.SITE NO,
GAS TEST -. GAS . - i
MECHANICAL " FIRE SPRINK; ENERGY T-24
COVER NO WORK UNTIUABOVE HAS BEEN SIGNED HEATING ❑. NE - ° ❑ N❑ .
EXTERIOR SHEAR ELECTRICAL RELEASE r FLOOD ZONE _ ALL.uc
INTERIOR•SHEAR FIRE DEPT. _. Y❑. No Y L�] N
.' SHEETROCK - GRADE.. . FEESUMMARY
EXTERIOR LATH BUILDING BUILDING ,VU
' .INTERIOR LATH .TEMPORARYAPPROVAL5 - -
SCRATCH COAT ELECTRIC - _ PLAN CHECK
.'�;` •, GAS •FEE
NO TAPE OR PLASTER UNTIL.ABOVE HAS BEEN SIGNED: OCCUPANCY -SEISMIC FEE
�•. 4. OCCUPANCY OF BUILDING IS NOT FERMI I I ED UNT I LBUILDING FINAL IS SIGNED By BUILDING INSPECTOR:'
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC
J ONE WORKING,DAY BEFORE REQUIRED INSPECTION.
O PLEASE GIVE JOB-ADDRESS WHEN PHONING.
Z.
PLUMBING
SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX c�
PLEASE READ REVERSE SIDE BEFORE 4 ' TOTAL 3� �t !
CALLING FOR FINAL INSPECTION. /
r. OFFICE COPY "`+