16843APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
OFFICE COPY
APPLICATION PERMIT
&
- I
BUILDING - ELECTRICAL-' PLUMBING - MECHANICAL
,PERMIT NUMB ER
I 168-:4`3
So .-I
WING
ADDRESS / /
MSL-L/�„�e� .W
NAME
` V "IFS PHONE
CITY. ELECTRIC PERMIT FEE
PLANCHECK bIOATION
•�///.��t��(�Jgf1�
/ a •% U - -
DATE OF APPLICATION •h
. NAMERAcroRs -
4TSr'�A2D MW6nW,.,
OUTLETS -SWITCHES -RECEP 10,00/1.00
LIGHTING FIXTURES 10.00/1.0s ao
CONTRACTORS
DDRESS 415 -
(41 LIOS' NE 941-4444
APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ORcHITEcr
ENGINEER !'
" Lie. No. -
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE .C. NO.
SIGNS TRANS. 3.00
ADDRESS ENG._
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
rrEMP. METER OR POLE INS. 20.00
zip
APPLIDDACESNr's
ADOREss '
MOTORS SEE FEE SCH.
"
SERVICE CHANGE 20.00
OU //,30100
0 0
LICENSED CONTRACTORS DECLARATION
Q
1 hereby affirm thatLI am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full fore e e t.
License ClassLic. Number
Date SaECnntm
Q SSUANCE DATE
L ECT. PLG.' MECH.
_ ❑ ❑
t
`
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law Professions
ing ounty whichequire .a permit to
Code: Any city
Code: Any city or county which requirese permit Io consuanc alter,
ImprOV¢, delllOhSh, Or repair any S1rnClar¢, p110r to its ISSUanC¢, UI50
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contrremr's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
t ILDINGPERMIT
INFORMATION
IMISC. - REFER TO ORD
PERMIT ISSUANCE A7 01W
VALUATION
O/
$/FT.
ELEC. CONTR. _LIC. NO.ELEC. / �7i
TOTAL U -{•,•�
-
QTY. PLUMBING PERMIT FEE
- PERMIT TO
TT �s ! '
4t. lam/ 7-,-- 1)
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).1:
STORIES
TYPE CONSTR.
'
ALTER -DRAIN IEA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered foi sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
ploperty who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve.
merits arc not intended or offered for sale. If, however, the building
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
SG. FT. FLOOR AREA
TOTAL ACREAGE
or improvement is Sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.): IINDUSTRIAL
131, as owner of the properly, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB Omer
❑ ❑ ❑ ❑ ❑
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS • OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
Contracts for such projects with a contractor(s) licensed pursuant to
the Conlmctor s License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec. ,BAP.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of Consent to sel4insum'
or a certificate of Workers' Compensation Insurance, or a certified
-
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, LaNCJ.
Policy No. Company
❑ Certified copy is hereby furnished.
Certified copy is s the - i s ection division.
Aplicant
„
FIRE $PRINK
v ❑ N ❑
ENERGY T.24
v ❑ NC]CERTIFICATE
MISC. - REFER TO ORD.
OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10,00
FLOOD ZONE
I A.L.U.C.
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y ❑ N❑
N
Y ❑ ❑
PLG. CONTR. LIC. NO.
TOTAL
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per-
mil is issued, 1 shall not employ any person in any manner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
7
Q /
become subject to the Workers' Compensation Laws of California.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
APPLIANCE. 5.00
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 '
CHECK'
FEE
?
&3
J
emption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (OVER 1OA00C.RM.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
',I hereby affirm that there is a construction lending agency I'or
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T,U.) 8.00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
C
I certify that I have read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. ]Agee to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER•COMP(3 H. P,Gr100,000B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives' of this city to enter upon use
above-mentioned property for inspection purposes.
to save, indemnify and keep harnsless the City of
st liabilities, judgments, costs and expenses which
",crue
ay accrue against said City in consequence of the
rmiL
-�-
MISC. - REFER TO ORD.
PERMIT ISSUANCE
CONST. TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
F
TOTAL
Ica on racier Date
OFFICE COPY
1
Location
Subject
J
File No..
Date /� Y
�7 v
Approved _
Date Inspector
e
�. POST THIS CARD NEAR FRONT OF BUILDING
J CITY OF CUPERTINO
PERMIT NUMBER
16843
INSPECTION DIVISION
JOB INSPECTION RECORD
a�M��co
b PERMIT EXPIRATION
JOB ADDRESS `'�'�� UNIT# _LOT#
•' -
PERMIT EXPIRES IF WORK
OWNER .C$ CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
w INSPECTION DATE'!;. INSPECTOR'
INSPECTI,ONIRECORD
. FOUNDATION I -
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIT' OF
UFER I
i
'vElmuT vALmnnoN.
PREGUNITE`.' •t
CUPERTINO STANDARDS.
-
.r+
ISSUANCE DATE
GARAGE SLABS.
NPOUR NO CONCRETE UNTIVABOVE HAS BEEN SIGNED
UNDERGROUND /'SLAB
PLUMBING-
ELECTRICAL-
MECHANICAL I
BLDG ELECT
ALG, MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- 1
t ,�Q
-
BUILDING PERMIT
' INFORMATION
WOOD FLOOR
VALU?TION
$/Fi.'
PLUMBING
,0,1
Q
pf
MECHANICAL
- ELECTRICAL
PERNUT rMo
,T-,U
'FRAMING
zI NSULATION
STORIES
TYPE CONSTR,
OCC. GROUP
RES UNITS
URLATCE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so IT PLoaH AREA
TOTAL Ace encE
p DIAPHRAGM'
ROOF.SHEATHING
UIL USE
RES IN CON coN Pa' omP,
IA APPLY N I ROOFING UNTIL ABOVE HAS BEEN SIGNED
FII.
FINALS DATE NSP
ROUGH
SAN.tt
ASSESSORS PAHCEL NO
PLUMBING -
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO.
PARC LNO.
•
MECHANICAL
MECH.ENERGY
ELECTRICAL:
BUILDING ENERGY
ACC DATE
ACCfILE NO
'
FRAMING -
ELECT. FINAL TEST
INSULATION -
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST
MECHANICAL
'FIRE. SPRINT(
ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOD ZONE
Y❑
ALUC.•
Y ❑ N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
4tt_,
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
'PLAN CHECK
FEE
-^•'�'
-
GAS
ANO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY'
SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING E INAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
f
µ' ONE WORKING DAY BEFORE REQUIRED; INSPECTION.
PLUMBING
�Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
.
MECHANICAL
1.
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!'
TOTAL
—�/
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
S / G
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
OFFICE COPY
APPLICATION PERMIT
&
- I
BUILDING - ELECTRICAL-' PLUMBING - MECHANICAL
,PERMIT NUMB ER
I 168-:4`3
So .-I
WING
ADDRESS / /
MSL-L/�„�e� .W
NAME
` V "IFS PHONE
CITY. ELECTRIC PERMIT FEE
PLANCHECK bIOATION
•�///.��t��(�Jgf1�
/ a •% U - -
DATE OF APPLICATION •h
. NAMERAcroRs -
4TSr'�A2D MW6nW,.,
OUTLETS -SWITCHES -RECEP 10,00/1.00
LIGHTING FIXTURES 10.00/1.0s ao
CONTRACTORS
DDRESS 415 -
(41 LIOS' NE 941-4444
APPLIANCES- RESIDENTIAL 4.00
PANELS 10.00
ORcHITEcr
ENGINEER !'
" Lie. No. -
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE .C. NO.
SIGNS TRANS. 3.00
ADDRESS ENG._
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
rrEMP. METER OR POLE INS. 20.00
zip
APPLIDDACESNr's
ADOREss '
MOTORS SEE FEE SCH.
"
SERVICE CHANGE 20.00
OU //,30100
0 0
LICENSED CONTRACTORS DECLARATION
Q
1 hereby affirm thatLI am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full fore e e t.
License ClassLic. Number
Date SaECnntm
Q SSUANCE DATE
L ECT. PLG.' MECH.
_ ❑ ❑
t
`
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law Professions
ing ounty whichequire .a permit to
Code: Any city
Code: Any city or county which requirese permit Io consuanc alter,
ImprOV¢, delllOhSh, Or repair any S1rnClar¢, p110r to its ISSUanC¢, UI50
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contrremr's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
t ILDINGPERMIT
INFORMATION
IMISC. - REFER TO ORD
PERMIT ISSUANCE A7 01W
VALUATION
O/
$/FT.
ELEC. CONTR. _LIC. NO.ELEC. / �7i
TOTAL U -{•,•�
-
QTY. PLUMBING PERMIT FEE
- PERMIT TO
TT �s ! '
4t. lam/ 7-,-- 1)
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).1:
STORIES
TYPE CONSTR.
'
ALTER -DRAIN IEA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
intended or offered foi sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
ploperty who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve.
merits arc not intended or offered for sale. If, however, the building
FIXTURES - PER TRAP 5.00
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
SG. FT. FLOOR AREA
TOTAL ACREAGE
or improvement is Sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.): IINDUSTRIAL
131, as owner of the properly, am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 IEA.) 2.00
BUILDING USE
RES IND CON PB Omer
❑ ❑ ❑ ❑ ❑
WASTE INTER. 30.00
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
LAWN SPRINKLERS • OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
Contracts for such projects with a contractor(s) licensed pursuant to
the Conlmctor s License Law.
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
❑ lam exempt under Sec. ,BAP.C. for this
reason
WATER HEATER W/VENT 6.00
Owner Date
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of Consent to sel4insum'
or a certificate of Workers' Compensation Insurance, or a certified
-
ZONING
ENG. SITE NO.
copy thereof (Sec. 3800, LaNCJ.
Policy No. Company
❑ Certified copy is hereby furnished.
Certified copy is s the - i s ection division.
Aplicant
„
FIRE $PRINK
v ❑ N ❑
ENERGY T.24
v ❑ NC]CERTIFICATE
MISC. - REFER TO ORD.
OF EXEMPTION FROM WORKERS'
PERMIT ISSUANCE 10,00
FLOOD ZONE
I A.L.U.C.
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one
Y ❑ N❑
N
Y ❑ ❑
PLG. CONTR. LIC. NO.
TOTAL
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per-
mil is issued, 1 shall not employ any person in any manner so as to
OTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
7
Q /
become subject to the Workers' Compensation Laws of California.
Date Applicant
ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
APPLIANCE. 5.00
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 '
CHECK'
FEE
?
&3
J
emption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
AIR HANDLING UNIT (OVER 1OA00C.RM.) 6.00
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
',I hereby affirm that there is a construction lending agency I'or
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM
HEATING UNIT (TO 100,000 B.T,U.) 8.00
Lender's Name
Lender's Address
HEATING UNIT (OVER 100,000 B.T.U.)9.50
ELECTRIC
C
I certify that I have read this application and state that the above
VENTILATION FAN (SINGLE) 4.00
information is correct. ]Agee to comply with all city and county
ordinances and state laws relating to building construction, and
PLUMBING
BOILER•COMP(3 H. P,Gr100,000B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives' of this city to enter upon use
above-mentioned property for inspection purposes.
to save, indemnify and keep harnsless the City of
st liabilities, judgments, costs and expenses which
",crue
ay accrue against said City in consequence of the
rmiL
-�-
MISC. - REFER TO ORD.
PERMIT ISSUANCE
CONST. TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
F
TOTAL
Ica on racier Date
OFFICE COPY
1
Location
Subject
J
File No..
Date /� Y
�7 v
Approved _
Date Inspector
e
�. POST THIS CARD NEAR FRONT OF BUILDING
J CITY OF CUPERTINO
PERMIT NUMBER
16843
INSPECTION DIVISION
JOB INSPECTION RECORD
a�M��co
b PERMIT EXPIRATION
JOB ADDRESS `'�'�� UNIT# _LOT#
•' -
PERMIT EXPIRES IF WORK
OWNER .C$ CONTRACTOR
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
w INSPECTION DATE'!;. INSPECTOR'
INSPECTI,ONIRECORD
. FOUNDATION I -
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CIT' OF
UFER I
i
'vElmuT vALmnnoN.
PREGUNITE`.' •t
CUPERTINO STANDARDS.
-
.r+
ISSUANCE DATE
GARAGE SLABS.
NPOUR NO CONCRETE UNTIVABOVE HAS BEEN SIGNED
UNDERGROUND /'SLAB
PLUMBING-
ELECTRICAL-
MECHANICAL I
BLDG ELECT
ALG, MECH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- 1
t ,�Q
-
BUILDING PERMIT
' INFORMATION
WOOD FLOOR
VALU?TION
$/Fi.'
PLUMBING
,0,1
Q
pf
MECHANICAL
- ELECTRICAL
PERNUT rMo
,T-,U
'FRAMING
zI NSULATION
STORIES
TYPE CONSTR,
OCC. GROUP
RES UNITS
URLATCE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so IT PLoaH AREA
TOTAL Ace encE
p DIAPHRAGM'
ROOF.SHEATHING
UIL USE
RES IN CON coN Pa' omP,
IA APPLY N I ROOFING UNTIL ABOVE HAS BEEN SIGNED
FII.
FINALS DATE NSP
ROUGH
SAN.tt
ASSESSORS PAHCEL NO
PLUMBING -
ELECT. ENERGY
TUBS & SHOWER PAN
PLUMBING ENERGY
TRACT NO.
PARC LNO.
•
MECHANICAL
MECH.ENERGY
ELECTRICAL:
BUILDING ENERGY
ACC DATE
ACCfILE NO
'
FRAMING -
ELECT. FINAL TEST
INSULATION -
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST
MECHANICAL
'FIRE. SPRINT(
ENERGY T2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICAL RELEASE
FLOOD ZONE
Y❑
ALUC.•
Y ❑ N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH
BUILDING
BUILDING
4tt_,
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
'PLAN CHECK
FEE
-^•'�'
-
GAS
ANO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY'
SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BUILDING E INAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
'ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
f
µ' ONE WORKING DAY BEFORE REQUIRED; INSPECTION.
PLUMBING
�Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
.
MECHANICAL
1.
— SEE PERMIT FOR EXPIRATION DATE —
CONST.TAX
IMPORTANT!'
TOTAL
—�/
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
S / G
OFFICE COPY