18524 .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT ' 18524
ADDRESS
10303 M1I�lr BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNEn'a
NAME PLAN CHECK VALIDATION
D �. 1 �E��-�Vy/ 1�1 � 9 QTY. ELECTRIC PERMIT FEE 1
• �•/'M 'r�ONE�yoi? 1
CONTRACTOR'S
NAME 14b JOUTLETS-SWITCHES-RECEP 10.00/1.00
SJwe KATVWLaO5I1 ' uc.No. 'fVdd?sLIGHTING FIXTURES
Q 1.00 dDV
CONTRACTOR APPLIANCES /
ADDRESS 4.00
L(oZO
PHONE �b PANELS 10.00 DATE OF APPLICATION
OR PANELS PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER .
LIC.No. SIGNS TRANS. _3.00
ADDRESS ENG - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
APPLICANT a IIP EMP.METER OR POLE INS. 20.00 - _3 Q J
ADDRESS MOTORS - SEE FEE SCH.
DRESSE55
w V
s 2 SERVICE CHANGE 20.00 r
Foo LICENSED CONTRACTORS DECLARATION ` J
a i w I hereby affirm that I am licensed under provisions of Chapter 9 s] ISSUANCE DATE'
Q w (commencing with Section 7000)of Division 3 of the Busines d' BLDG. ELECT. PLG. --MECH.
F G z License Cla CoJe,' my license is in full far:'4,/L/Y9t°I � �,r ❑
o z�C License Class Lie.Number ✓
r w F Date-"
Contractor$`PV4:e-1K* GI#u Ot rjl ."10
a se i yr 1'Y �L �-r^- BUILDING PERMIT
5 m Q OWN(?R-tl UILDCR DECLARATION
d v INFORMATION
w ; vFi I hereby afRrm that I am exempt from the Contractor's License MISC.- - REFER TO ORD VALUATION $/FT.
F m O J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 ('�
Code:Anycity or county which requires a permit to construct, - ODD
Q Q Q 0O Improve,demolish,or repair any Structure,prior to Its Issuance,also ELEC.CONTR. - LIC.NO. ELEQ oO D
O, requires the applicant for such permit to file a signed statement that TOTAL a PERMIT TO
n w$ he is licensed pursuant to the provisions of the Contractor's License
.F 2 Y Law(Chapter 9(commencing with Section 7000)of Division 3 ofihe
4 o Rosiness and Professions Code)or that he isexempt therefrom and OTY. PLUMBING PERMIT FEE 1 ` l ` K�IJL •�
(c I_ the basis far the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
5y any applicant for a permit subjects the applicant too civil penalty -
ofnot mom than five hundred dollars(5500).): I ALTER-DRAIN&VENT-WATER (EA.) 5.00 . VD-
❑ 1,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
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
properly who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 So.FT.FLOGS AREA TOTAL ACREAGE
-� himself re through his own employees,provided that such improve-
mmovefo not intended oroffercoforeale.Iided that such
ebuilding GAS-EA.SYSTEM-1INC.4OUTLETS 8.00
or improvement is sold within one year of completion,the owner- GAS--EASYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or it, . BUILDING USE
prove for purpose:of sale.). RES IND CON PB Other
_ El 1.as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ 1:3 ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. ' 6,00 ASSESSORS PARCEL NO.
and Professions Code:1 h Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-.B4P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
- WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have u certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy themof(Sec.3900,Lab.C.).
Policy No. Company _
O ❑ Certified copy is hereby furnished. -
Z Z ❑ Certified copy is filed-with the city inspection division. FIRE SPRINK ENERGY T-24
O Applicant MISC.- REFER TO ORD. Y(] N❑ Y C] NE]
~ PERMIT ISSUANCE 10.00
ATW ; CF.RTIFICCOMO!NSATION INSURA CF EXEMPTION FRM l INR61-RS PLG.CONTR, LIC.NO. PLG OU FLOOD ZONE A.L.U.C.
D' O (This section need not be completed if the permit is for One TOTAL 6` O Y❑ IN Y❑ N❑
D Z hundred dollars(81001 or less)
V O 1 certify His he perlirmal of work for which this per- OTY. MECHANICAL PERMIT FEE. FEE SUMMARY
LL I- mil i ss a not emplo any n in any manner so as to
U bee to he Workers' a tion L, sof C.Iil'orni..
0. Dato Applicant BUILDING
} N NOTICE.TO AI'PLICAN'I': If, mak' 's Certificate of fix-
f.. ? nnp[iou,you should become subject to I e W kers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you mus o fliwilh comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=0C.F.M.) 4.00
- CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of(lie wnrk for which this permit is issued(Sec. MICROFILM
3097,Cie.C.), HEATING UNIT(TO 100,000 B,T.U.) 8.00
Lender's Name H EATI N G UN IT'(OV ER 100,000 B.T.U.)9.50 9 c OQ
- - - - Lender's Address ELECTRIC
1 certify that 1 have read this application and state ilwt the above VENTILATION FAN (SINGLE) 4.00
intornation is correct. 1 agree to comply with all city and county PLUMBING
1 ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
a above-mentioned properly for inspection purposes. g01 LER-COMP (Over 100,000 BTU)SEE FEE SCR. MECHANICAL
(We) a to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
C. no s t liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
run ny y accrue against said City in Consequence of the
ranting o ern MFCH.CONT. LIC.NO. MECH.-
.01 Signature of ilea t/Contractor I ., TOTAL TOTAL [ �y 6t
OFFICE COPY / F .
CITY OF CUPERTINO
INSPECTION DIVISION
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♦ POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 18524
INSPECTION DIVISION ;
JOB INSPECTION RECORD
' • . )E,E PERMIT EXPIRATION
JOB ADDRESS_I � T+ 3 ( `•LW�P im I UNIT# �- LOTW
PERMIT EXPIRES IF WORK
OWNER I' �I] bot,D CONTRACTOR rT d O�.S E9 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD I— DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. F►i'tJY
GARAGE SLABS ]
ItTOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,� 1989
UNDERGROUND /SLAB j.,U� , v7 -+{ 1 _/
PLUMBING `I. '�' 1�� i '
1d ot Q wft M,
' ELECTRICAL � IssuANce unre
MECHANICAL BLDG ELECT,I PLG. MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 8u1LOPERM]T
' INFORRMMATTIONION
'
WOOD FLOOR VALUATION S+FT.
PLUMBING '
MECHANICAL 3� U(�.D
PE hllT i0
ELECTRICAL - I
FRAMING - E�' e III
INSULATION - STORIES - TYPE c�GN5rR '
OCC GROUP RES UNITS
" PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED.
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.IT aLOOR AREA TOTAL AFRPAGE
•DIAPHRAGM THE CONSTRUCTION fAX IS PAID
BUILDING USE,
ROOF SHEATHING - - Res IND CON Pe ,onlr '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS D E INSP. F-1El 0 1
ASSESSORS PARCEL NO
ROUGH SAN.4
PLUMBING ;7oe, t/ ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.clLe No 1
ELECTRICAL - BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST' GAS I '
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y "F 'YD "�
EXTERIOR SHEAR ' ELECTRICAL'RELEASE FLOOD zorve n,L U
INTERIOR SHEAR FIRE DEPT, Y "I[:] Y ❑' "❑
• SHEETROCK GRADE ' FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS euILDiNc, .;
SCRATCH COAT ELECTRIC . PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL'BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ,
i
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICDO
e...r2r I1L „OO
I:- ONE WORKING DAY•BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
-. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX --�
PLEASE READ REVERSE SIDE BEFORE TOTAL ill
CALLING FOR FINAL INSPECTION. ,
OFFICE COPY