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1722141) 0'¢ i W 02 aww •~i. Q J� zoi�S Lc M E J X ; ww0a wy ¢ ¢ a 0 u a K w�t Hz zio W 3 O Z2 I..• OC N> LU _ as D Z UO LL Oa � z A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY. 'BUFLDI NG PROJECT IDENTIFICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 17 2 21. BUILDINGAPPLICATION AODgSs� 30 �L Q C`! OW'NER'S "AME ��/ `/• may/ 1� • I klXS� 1Z CW..NE7�P QTY. ELECTRIC PERMIT FEE '- PLAN_ CHECK VALIDATION ,'1{Elj{, YY 89.'D 189. GREG PAib _ GATE OF APPLICATION CONTRACTOR'S NAMB~44 SC-�3 L. Not ,3 UTLETS- SWITCHES -RECEP ,00/1.00. a,„ LIGHTING FIXTURES 0.00/1.00 'XCa nooness rolls �w 1jAPPLIANCES <oJ �T�x� i�i'3..E 5% y nHONE © • RESIDENTIAL 4,00 PANELS 10.00 ARCHITECT on _ ENG EER 14� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. , - SIGNS TRANS. 3.00 A cH. OR ENG. ADDREss .iTA IIP - - SPECIAL' CIRCUIT 5.00q PERMIT VALIDATION h TEMP. METER OR POLE INS. 20.00 ADDRESSNT's - ADDRESS `fA)✓j� - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Cod •, yiW license is in fill[ fu i I fe License Class Lic. Number Date Contractor ISSUANCE DATE BLDG. ELECT. PLG. MECH, T BUILDING PERMIT INFORMATION : /'V%� OWNER -BUIL ER DIiCLAR /6pOG� I hereby affirm that I am exempt from the Contractor' License Lew far the following reason. (Sec. 7031.5, Business and Professions Code Any city or county which requires a perm 11 to construct,alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9( commencing with Section 7000) of Division 3 of the Business and Professions Code) or that be is exempt therefrom and IMISC. - REFER TO ORD PERMIT ISSUANCE 10.00 I b t VALUATION I 0M- - SIFT. - ELEC. CONTR. LIC. NO. ELEC.,3% Q ,W�x TOTAL 3 U LW PERMIT TO P,� 11' I QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 703 L$ STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant Lou civil penalty of not more than five hundred dollars ($500).1: - - - ALTERDRAIN&VENT-WATER IEA.) 5.00 ' ❑ I, 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, GOND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of pproperty who builds or improves thereon, and who does such work meats are of rote his own employees, provided that such improve- If, howeveq (lie FIXTURES -PER TRAP 5.00 so. Fr. FLooR REA /.. lL TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6,00 irr� orim improvement within year the o nc" or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or iIn- 'prove for purpose of sale.). ,❑ L.as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1,00 licensed contractors 10 construct the project (Sea, 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 ASSESSORS PARCEL NO. contracts for such projects with a contractorts) licensed pursuant to the Contractor's License Law. SEWER -SAN V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-, RAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM _ - 5.00 ACC. DATE ACC, FILE NO. WATER TREATING TVL 5,00 . WORK E:RS'COMPENSATION DECLARATION - I hereby affirm that 1 have x certificate of consent m self -insure, or a certificate of Workers' Compensation ormance,•or a certified co IT ereof(Sec. 3B Lab.C.LJ-K Pjb OSeYPany-�x LY_-sL��' �❑ edified copy is larch) furnished. Certifie c is filed wi t c ci 'nspec 'a div"on. Applicant ZONING ENG. SITE NO. FIRE SPRINK V ❑ N❑ ENERGY T-24 V ❑ N❑ MISC.- - REFER TO ORD. CERTD4CAT li OF EXEMPTION FROM WORKERS' �•�x PERMIT. ISSUANCE 10.00 a.(,! FLOOD ZONE A.L.U.C. COhIPENSATION INSURANC17 (Phis section need not be completed if the permit is for One Y ❑ N❑ Y ❑ N❑ PLG. CONTR. LIC. NO. PLG. TOTAL IW��•'p��5 hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any mannerso as to OTV. MECHANICAL PERMIT FEE FEE SUMMARY - BUILDING Is� becomesubjecttotheWorkers'Compensation Laws of California.co Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Hx- OR ADD TO MECH.. 5.00 APPLIANCE5.00 �' AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject in 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 10= C. F.M.) 6.00 SEISMIC FEE 2S�J CONSTROCI[ON LENDING AGENCY 1 hereby affirm that there is a construction fending agency for the performance of the wZfor which (his permit is issued (Sec. 3097, Civ.C.). /l/� EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM �• HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name (aL Candor's Address✓�/ `( HEATING UNIT (OVER 100,000 B.T.U.) 9.50 IJt! ELECTRIC Q 3V I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. [.agree to.comply withall city and county $rdinances and slate laws retiring to building construction, -and hereby actio riz property folinsp of this hereby authorize representatives of this city it)es enter upon the purposes. PLUMBING BOILER -COW I3 H.P. Of 100,0008.T.U.I 6.00 - BOILER -COMP (Ovar 100,000 BTU) SEE FEE SCH. MECHANICAL I . MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of upertino against liabilities, judgments, costs and expenses whichCONST. ay in any way accrue against said City in consequence of the TAX PERMIT ISSUANCE 10.00 �06 anting of this permit. MECH. CONT. LIC. NO. MECH. TOTAL 1 Q hlt� TOTAL 9ignalure of Applicant/Contractor Date OFFICE COPY I POST THIS CARD NEAR FRONT OF, BUILDING �t CITY ,OF-CUPERTINO PERMIT NUMBER +�' 1722ii DIVISION, INSPECTION JOB INSPECTION RECORD rti j4;NI ��RMIT • E%P1 R'ATION I K.$QA Us_7. _UNIT# _ JOS ADDRESS LOT# ' [ PERMIT EXPIRES IF WORK OWNER Wll/„/FiY�� CONTRACTORyO.(. 1\F��' �C�yg -DATE IS NOT STARTED WITHIN IUUUAYsoFPERMITISSU. ANCE OR 180 DAYS FROM LAST CALLED INSPECTION.' INSPECTION INSPECTOR INSPECTION RECORD - FOUNDATION • - NOTE: . . ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINOSTANDARDS. LIFER G�l / O - PREGUNITE� - PERMIT VALIDAALION GARAGE SLABS ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING'. ' ELECTRICAL- �� MECHANICAL BL� ELLC PLG, MF.CHF DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR VALUATION SIFT. II. PLUMBING MECHANICAL ELECTRICAL - PERMIT TO `I x� •. i �1� FRAMING ,INSULATION STORIES ECONSTR. I IP,LQGE OCC GROUP RCS UNITS NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -! - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID . so. Fr PLooR REa .ri.� I TOTAL ACREAGE + I ,DIAPHRAGM BUILDING USE 'ROOF SHEATHING m„, CON PB oFLI ❑ ❑ ❑ %fPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ASSESSORS PAHCEL NO. PLUMBING ELECT. ENERGY TUBS SSHOWER PAN PLUMBING ENERGY TRACT NO.. PARCEL NO MECHANICAL MECH.ENERGY ' LECTRICALBUILDING ENERGY ACC DATE ACC. FILF: No FRAMING ELECT. FINAL TEST A in.+ INSULATION -' - PLUMBING ZONING ENG. SITE NO. GAS TEST g-6.-19 GAS FIRESP PINK ENERGY.T 24 MECHANICAL Y ❑ i E] Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR•SHEAR ELECTRICAL RELEASE i ELooD ZONE Y❑ N❑ AL. u.c.". V❑ N❑ INTERIOR SHEAR - FIRE DEPT. SHEETROCK GRADE FEESUMMARY EXTERIOR LATH IBUILDING -BUILDING, -Ills oQ ' ,INTERIOR LATH - TEMPORARY APPROVALSV SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS 'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -ILia5 OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECT OR. MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC 4D, w_- , ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o. PLEASE GIVE JOB ADDRESSMEN PHONING. MECHANICAL; - SEE PERMIT FOR EXPIRATION DATE - CONST. TAX IMPORTANT!:. PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINALANSPECTION. i�f : .� OFFICE'COPY 41) 0'¢ i W 02 aww •~i. Q J� zoi�S Lc M E J X ; ww0a wy ¢ ¢ a 0 u a K w�t Hz zio W 3 O Z2 I..• OC N> LU _ as D Z UO LL Oa � z A APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY. 'BUFLDI NG PROJECT IDENTIFICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 17 2 21. BUILDINGAPPLICATION AODgSs� 30 �L Q C`! OW'NER'S "AME ��/ `/• may/ 1� • I klXS� 1Z CW..NE7�P QTY. ELECTRIC PERMIT FEE '- PLAN_ CHECK VALIDATION ,'1{Elj{, YY 89.'D 189. GREG PAib _ GATE OF APPLICATION CONTRACTOR'S NAMB~44 SC-�3 L. Not ,3 UTLETS- SWITCHES -RECEP ,00/1.00. a,„ LIGHTING FIXTURES 0.00/1.00 'XCa nooness rolls �w 1jAPPLIANCES <oJ �T�x� i�i'3..E 5% y nHONE © • RESIDENTIAL 4,00 PANELS 10.00 ARCHITECT on _ ENG EER 14� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. , - SIGNS TRANS. 3.00 A cH. OR ENG. ADDREss .iTA IIP - - SPECIAL' CIRCUIT 5.00q PERMIT VALIDATION h TEMP. METER OR POLE INS. 20.00 ADDRESSNT's - ADDRESS `fA)✓j� - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Cod •, yiW license is in fill[ fu i I fe License Class Lic. Number Date Contractor ISSUANCE DATE BLDG. ELECT. PLG. MECH, T BUILDING PERMIT INFORMATION : /'V%� OWNER -BUIL ER DIiCLAR /6pOG� I hereby affirm that I am exempt from the Contractor' License Lew far the following reason. (Sec. 7031.5, Business and Professions Code Any city or county which requires a perm 11 to construct,alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9( commencing with Section 7000) of Division 3 of the Business and Professions Code) or that be is exempt therefrom and IMISC. - REFER TO ORD PERMIT ISSUANCE 10.00 I b t VALUATION I 0M- - SIFT. - ELEC. CONTR. LIC. NO. ELEC.,3% Q ,W�x TOTAL 3 U LW PERMIT TO P,� 11' I QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of Section 703 L$ STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant Lou civil penalty of not more than five hundred dollars ($500).1: - - - ALTERDRAIN&VENT-WATER IEA.) 5.00 ' ❑ I, 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, GOND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of pproperty who builds or improves thereon, and who does such work meats are of rote his own employees, provided that such improve- If, howeveq (lie FIXTURES -PER TRAP 5.00 so. Fr. FLooR REA /.. lL TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6,00 irr� orim improvement within year the o nc" or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or iIn- 'prove for purpose of sale.). ,❑ L.as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -I INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1,00 licensed contractors 10 construct the project (Sea, 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 ASSESSORS PARCEL NO. contracts for such projects with a contractorts) licensed pursuant to the Contractor's License Law. SEWER -SAN V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-, RAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM _ - 5.00 ACC. DATE ACC, FILE NO. WATER TREATING TVL 5,00 . WORK E:RS'COMPENSATION DECLARATION - I hereby affirm that 1 have x certificate of consent m self -insure, or a certificate of Workers' Compensation ormance,•or a certified co IT ereof(Sec. 3B Lab.C.LJ-K Pjb OSeYPany-�x LY_-sL��' �❑ edified copy is larch) furnished. Certifie c is filed wi t c ci 'nspec 'a div"on. Applicant ZONING ENG. SITE NO. FIRE SPRINK V ❑ N❑ ENERGY T-24 V ❑ N❑ MISC.- - REFER TO ORD. CERTD4CAT li OF EXEMPTION FROM WORKERS' �•�x PERMIT. ISSUANCE 10.00 a.(,! FLOOD ZONE A.L.U.C. COhIPENSATION INSURANC17 (Phis section need not be completed if the permit is for One Y ❑ N❑ Y ❑ N❑ PLG. CONTR. LIC. NO. PLG. TOTAL IW��•'p��5 hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any mannerso as to OTV. MECHANICAL PERMIT FEE FEE SUMMARY - BUILDING Is� becomesubjecttotheWorkers'Compensation Laws of California.co Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Hx- OR ADD TO MECH.. 5.00 APPLIANCE5.00 �' AIR HANDLING UNIT ITO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject in 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 10= C. F.M.) 6.00 SEISMIC FEE 2S�J CONSTROCI[ON LENDING AGENCY 1 hereby affirm that there is a construction fending agency for the performance of the wZfor which (his permit is issued (Sec. 3097, Civ.C.). /l/� EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM �• HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name (aL Candor's Address✓�/ `( HEATING UNIT (OVER 100,000 B.T.U.) 9.50 IJt! ELECTRIC Q 3V I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. [.agree to.comply withall city and county $rdinances and slate laws retiring to building construction, -and hereby actio riz property folinsp of this hereby authorize representatives of this city it)es enter upon the purposes. PLUMBING BOILER -COW I3 H.P. Of 100,0008.T.U.I 6.00 - BOILER -COMP (Ovar 100,000 BTU) SEE FEE SCH. MECHANICAL I . MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of upertino against liabilities, judgments, costs and expenses whichCONST. ay in any way accrue against said City in consequence of the TAX PERMIT ISSUANCE 10.00 �06 anting of this permit. MECH. CONT. LIC. NO. MECH. TOTAL 1 Q hlt� TOTAL 9ignalure of Applicant/Contractor Date OFFICE COPY I POST THIS CARD NEAR FRONT OF, BUILDING �t CITY ,OF-CUPERTINO PERMIT NUMBER +�' 1722ii DIVISION, INSPECTION JOB INSPECTION RECORD rti j4;NI ��RMIT • E%P1 R'ATION I K.$QA Us_7. _UNIT# _ JOS ADDRESS LOT# ' [ PERMIT EXPIRES IF WORK OWNER Wll/„/FiY�� CONTRACTORyO.(. 1\F��' �C�yg -DATE IS NOT STARTED WITHIN IUUUAYsoFPERMITISSU. ANCE OR 180 DAYS FROM LAST CALLED INSPECTION.' INSPECTION INSPECTOR INSPECTION RECORD - FOUNDATION • - NOTE: . . ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINOSTANDARDS. LIFER G�l / O - PREGUNITE� - PERMIT VALIDAALION GARAGE SLABS ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING'. ' ELECTRICAL- �� MECHANICAL BL� ELLC PLG, MF.CHF DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR VALUATION SIFT. II. PLUMBING MECHANICAL ELECTRICAL - PERMIT TO `I x� •. i �1� FRAMING ,INSULATION STORIES ECONSTR. I IP,LQGE OCC GROUP RCS UNITS NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -! - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID . so. Fr PLooR REa .ri.� I TOTAL ACREAGE + I ,DIAPHRAGM BUILDING USE 'ROOF SHEATHING m„, CON PB oFLI ❑ ❑ ❑ %fPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ASSESSORS PAHCEL NO. PLUMBING ELECT. ENERGY TUBS SSHOWER PAN PLUMBING ENERGY TRACT NO.. PARCEL NO MECHANICAL MECH.ENERGY ' LECTRICALBUILDING ENERGY ACC DATE ACC. FILF: No FRAMING ELECT. FINAL TEST A in.+ INSULATION -' - PLUMBING ZONING ENG. SITE NO. GAS TEST g-6.-19 GAS FIRESP PINK ENERGY.T 24 MECHANICAL Y ❑ i E] Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR•SHEAR ELECTRICAL RELEASE i ELooD ZONE Y❑ N❑ AL. u.c.". V❑ N❑ INTERIOR SHEAR - FIRE DEPT. SHEETROCK GRADE FEESUMMARY EXTERIOR LATH IBUILDING -BUILDING, -Ills oQ ' ,INTERIOR LATH - TEMPORARY APPROVALSV SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS 'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -ILia5 OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECT OR. MICROFILM . ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC 4D, w_- , ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o. PLEASE GIVE JOB ADDRESSMEN PHONING. MECHANICAL; - SEE PERMIT FOR EXPIRATION DATE - CONST. TAX IMPORTANT!:. PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINALANSPECTION. i�f : .� OFFICE'COPY