15653 ApPI,.ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•BUILDING PROJECT IDENTIFICATION 'PERMIT NUMBER +
euaolNc
APPLICATION & PERMIT
ADDR SS
{ �032s, 17-q C7-, BUILDING—ELECTRICAL—PLUMBING—MECHANICAL S''i ' 56,53
OWNER'S uw p. PLAN CHECK VALIDATION
�a [�. � P 1'G OTV, ELECTRIC PERMIT FEE
IV/O• • r E9%6�O ` =t
CONTRACTOR'$ /`•
' rvAME OUTLETS.SWITCHES-RECEP 10,00/1,00
i' LIC.No. LIGHTING FIXTURES 10.00/1.00 '
! CONTRACTOR'S
ADDRESS APPLIANCES-RESIDENTIAL 4,00
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT, PLAN CHECK FEE P.C.NO.
1
OR TT.�//�tIr1��� PANELS (OVER 200 AMP) 20.00
ENGINEERYLM1`n I I L
ALL///•. ` R• uc.rvD. SIGNS TRANS. x3.00
ARCH.OR ENG. VS'�
aoDREss C�, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
-
il`� I' ZIP49"O EMP.METER OR POLE INS. •• 20.00
ADDRESS
-- AMOTORS - SEE FEE SCH:
' `�' - � -
p SERVICE CHANGE 20.00
0
02 LICENSED CONTRACTORS DECLARATION
<u u I hereby affirm that I am licensed under provisi"nsof Chapter 9 (� ISSUANCE DATE
Z w (commencing with Section 7000)of Division 3 of the Business and
rn ¢ e. BLDG. ELECT. PLG. MECH.
H 7 i, + Professions Code,and my license is in full force and effect.z O'y C, Liccliw Class - -'Lie.Number
'O m Date Contractor
city of cnperts^.�.
¢ BUILDING PERMIT
m M a OWNP.R-BUILDER DECLARATION
a c w INFORMATION
'w g:LL in - 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
r u O j Law forlhe followingreason.(Sec.7031.9,Business and Professions PERMIT ISSUANCE' 10.00 VALUATION $/FT.
i Code:Any city or county which requimsa permit toconstrucl,alter, - ��
Q`� ¢ o improve,demolish,or repair any structure,prior to its eslmncc,also 'ELEC.CONTR. - LIC.NO. ELEG. '7
e. wO u requires the applicant for such permit to file a signed statement that TOTAL,/ #D PERMIT TO
m¢ he is licensed pursuant to the provisions of the Contractors License (K-
H Law(Chapter 9(commencing with SCcl ion 7000)of Division 3 ofthe h
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
a F $ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
By any applicant for a permit subjects the applicant to a civil penalty ALTER
of (EA.) 5.00
<f net more than five hundred dollars($500).1: - - - - -'
/t�f I,as owner of the property,or my employees with wages as
IWK sole compensation,will do the work,and the structure is riot BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
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 to an owner of - -
properlywhobuildsorimprovesthereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FL00g7Jq�I1EA TOTAL ACREAGE
ribuit lace through.hie ownemployees;provide)however,
such improve. ,1'T C�
mems are notintended wnemployeesn provided
that such
building GAS-EA.SVSTEM-11 8.00 ,' br JQ3
or improvementis sold within one year of com .pletion,the owner- GAS-EASYSTEM-OVER 4 IEA) `200 BUILDING USE
builder will have the burden of proving that he did not build or im+ . . AES IND -CON PB Omar
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE ❑
❑ I,as owner of the property,am exclusively contracting with
t--�— licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-.1 INC 5 V.B. IS= ASSESSORS PARCEL NO.
) aid Professions Code:The Contractor's License Law does riot apply -
to an owner ofproperty who builds or improves thereon.and whD UAWN'SPRINKLERS-OVER 5 (EA.) 1.00 '
con(ract,for such pro,lecte'.wilh a cmnmeloo,o licensed 1011",1111 to a X•
the Comraclor's License Caw. SEWER-SANITARY-STORM EA.•200ft/10.00 TRACT NO. - PARCEL NO.
�. ❑ Illm exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00 '
leas
con WATER SYSTEM.. 5.00 . ACC.OATE ~ACC.FILE NO.
la
WORK• S'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 L )
I hereby affirm that l have a certificate ofearisenl to self-insure, '
D,a.aerlificme of Workers'Compensation Insurance,or a certified ZONING .'ENG.SITE NO.
r co}iy lherrof)See 3800,Iab.C.).
Policy No. Company
Q I ❑ Certified copy is hereby furnished. - - - 1 FIRESPRINK ENERGY T24
Z ❑ Certified copy is filed with the city inspection division.
Of—Applicant - - MISC.- • - REFER TO ORD. Y ❑" N� ' Y Q NQ,
CC mPERMIT ISSUANCE 1 00
CERTIFICATE Oh EXEMPTION FROM W'ORKERS' A• FLOOD ZONE A.L.u.C.
-
LU fr ' COMPENSATION.INSURANCIi PLG.CONTR. LIC.N . - ren � N� —'v� N�
EL •` (This section need not be'completed if lite permit is for one TOTAL V
0 'Z hundred dollars IS 100)or less,)
I certify that in lite performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F ' mil is issued,I shall not employ any person in any manner so as to '
PWbccomo subject to the Wnrkurs Compenxulion Laws of C:difurnla. D BUILDING Lf CSG
a Date Ap1bc°m ALTER OR ADD TO MECH. 5.00
W NOTICE TO APPLICANT': If,after making this Certificate of fix-
? Fortino,you should becona subject m lite Workers'Compensation APPLIANCE 5.00 PLAN CHECK
'} provisions of the Labor Code, you must forthwith Comply with FEE
suc1,provisions or this permit shall he derated revoked AIR HANDLING UNIT(TO 10,000C,F.NL) 4.00
l CONSTRucnoN LENDING AGENCY AIR HANDLING UNIT(OVER t0,000QF.M.16.00 SEISMIC FEE ' .III
I hereby affirm.that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 -
the performance of ilia work for which this permit is issued(Sec. -- MICROFILM
3097,Civ.CJ. - HEATING UNIT(TO 100,000 B.T.U.) 6.00
LenderName
s N0 D
Lender's Address HEATING UNIT'(OV ER 100,000 B:T.U.)B.50 ELECTRIC
;I certify Ihet9 have read this applir tion and state that the above VENTILATION FAN (SINGLE) 4,00 -
• infornuV lOn i6 carred.I agree to comply wish 1111 cit)'and count Y. PLUMBING
ordinances and state laws relating t0 building Construction, and BOILER-COMM H.P.OF 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to Cuter upon the BOILER-COMP lose,100,000 BTU)SEE FEE SCH. -MECHANICAL,
above-mentioned property for inspection purposes.
:(We) agree to save, indemnify and keep harmless the City of. MISC.- . REFER TO ORD.
Curerlin0 against liabilities,judgments, costs and expenses which- PERMIT ISSUANCE 10.00 CONST.TAX �-----
ay in any way necrue against said Ciry in consequence Of the U
• �t mIL MECH.CONT. !"LIC.NO. - MECH.
!.`_ ��Z �p�# TOTAL O7 TOTAL Z6Vsy
Slgaffi6ie of A}splica / ontrador Dat 7" l
OFFICE COPY
I' -POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
,.. . CITY OF CUPERTINO . '
- _ INSPECTION DIVISION1' 653
JOB INSPECTION RECORD
2 '.p /•� —r- " - '� F PERMIT EXPIRATION
JOB ADDRESS_�.v�Ld_6 ( [ Y` I S 1 cL G� UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER J 0 CONTRACTOR, •• - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR- INSPECTION RECORD . 180 DAYS OF'PERMIT ISSU--'
FOUNDATION - ANCE OR 180'DAYS FROM-
.
NOTE: •
LIFER - � -. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION.
PR EGUNITE
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PCRMIT•VAu0ATION
•CUPERTINO STANDARDS. f_'
GARAGE SLABS • - - - - - 9 �'
POURAO CONCRETE UNTIL ABOVE HAS BEEN SIGNED c
UNDERGROUND /.,SLAB . SEP
PLUMBING . ; �, \.I,
ELECTRICAL P% - �rly '3"r�""3• . ISSUANCE DATE
. . MECHANICAL - ,. .BLOC., ELECT PLG, MECH
a M El 2
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED' BUILDING PERMIT. _
WOOD FLOOR
INFORMATION
- •YALUATION $/FT.
PLUMBING
MECHANICAL`
ELECTRICAL a .. - PERmInTo
CLtGo 1Ld {9
FRAMING _
INSULATION , -' .. sro,+lEs TYPE CONsrR.
A ..
OCC.GROUP RES UNITS
jP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOO RFA TOTAL ACREAGE,
_ ROOF, 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE �� U":
DIAPHRAGM THE CONSTRUCTION TAXIS PAID /
BUILDING USE-
ROOF-SHEATHING RES IND coN PB On .
4"_'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALSDATE INSP: 1:1 '❑" ❑ 1:10
ASSESSORS PARCEL NO
ROUGH', - SAN.N
.,. PLUMBING - ELECT'ENERGY' ',
TUBS 8SHOWER PAN PLUMBING,ENERGY TRACT NO, PARCEL NO-
F '
' MECHANICAL - - MECH.ENERGY
ACC DATE ACCFILE NO '(
ELECTRICAL- ' BUILDING ENEflGY
FRAMING ELECT,FINAL TEST
PLUMBINGZONING ENG.ENc.src E,No.
,INSULATION •,
1 GAS TEST GAS
MECHANICAL * RE SPR INK ENERGY.i 14
- _ -
COVER NOWORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ E, "❑
ELECTRICAL RELEASE ' FLooG ZONE A.L u.c.
EXTERIOR SHEAR
INTERIOR SHEAR - FIRE DEPT. " - v ❑. "❑ ..v ❑ "❑. '
SHEETROCK. GRADE I FEE SUMMARY
EXTERIOR,LATH - BUILDING'
INTERIOR LATH _ TEMPORARY•APPROVALS- - BUILDING. -
1
SCRATCH COAT ELECTRIC PLAN CHECK '
If GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANcy - SEISMIC FEE-
n• - ••• OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM -
.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC �:00
F ONE WORKING DAY BEFORE REQUIRED INSPECTION: ' PLUMBING •r
O� PLEASE GIVE JOB ADDRESS WHEN.PHONING.
— SEE PERMIT;FOR EXPIRATION DATE' MECHANICAL'
IMPORTANT!' '~ CONST.TAX ---_
1 PLEASE READ REVERSE SIDE BEFORE: b , ,
CALLING FOR FINAL INSPECTION.'
TOTAL• �. I
OF.FICE COPY '
ADDITIONAL PERMIT PER �S/ S3
aul 1tia-PRBiE b
ADORF�sg�
A"157-4t:�
( T !FEESUMMARY
.BONE o . 3
corvTRAc*ons BUILDING
tU LIC.NO. PLAN'CHECK
CONTRACTORS FEE
ADORFss
"NONE SEISMIC FEE
OTY. ELECTRIC PERMIT FEE
UTLETS-SWITCHES-RECEP ELECTRIC
LIGHTING FIXTURES
PLUMBING
APPLIANCES-RESIDENTIAL
PANELSQ MECHANICAL
SIGNS '
SIGNS TRANS. TOTAL
SPECIAL CIRCUIT
EMP.METER OR POLE INS. PERMIT VALIDATION
qn
MOTORS SEE FEE SCH. 7`16— IV
O SERVICE CHANGE
Z 2 4' K�
F- ° TOTAL
Lo ISSUANCE DATE
LU > CITY. PLUMBING PERMIT FEE 86 EILE�CT. v1.TE mete.
Z ALTER DRAIN&VENT-WATER(EA.) LP' ❑
V O BACK FLOW PROTECT.DEVICE � y
O 1U DRAINS-FLOOR,ROOF,AREA,COND. N
} m FIXTURES-PER TRAP - n
F ? GAS.EA.SYSTEM-I INC.4 OUTLETS -I� � 1990
(� GAS-EA.SYSTEM-OVER 4(EA.) tl
INDUSTRIAL WASTE INTER. P1Ry vst I4.^"_
LAWN SPR IN KLERS-1INC 6 V.B. a44ULrnAL'J'-v'
LAWN SPRINKLERS-OVER SIEA.I
SEWER-SANITARY-STORM EA.200f2/
WATER HEATER W/VENT
WATER SYSTEM
0
WATER TREATING EQUIP. -
• OTY. MECHANICAL PERMIT FEE
ALTER OR ADD TO MECH.
APPLIANCE
AIR HANDLING UNIT(TO IQOOOCF.M.)
AIR HANDLING UNIT(OVER 10,000C.F,M.)
EXHAUST HOOD IWITN DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000 B.T.U.) '
VENTILATION FAN(SINGLE)
BOILER-COMP(3 H.P.OE 100,000 B.T.U.)
BOILER-COMP IOmv 100,000 eTUI SEF.FEE SCH.
TOTAL