17043 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
4- ' ';1UI LD1 NG PROJECT IDENTIFICATION
PERMIT NUMBER
BUILDING APPLICATION & PERMIT x11
A ,
u D MI(2visTALOT 2 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL i� 17043
OWNER'S PLAN CHECK VALIDATION
"A1ME/� 1{'11 �s// ryry �J� /� CITY. ELECTRIC PERMIT FEE J
ACTORS l '• SISY PXONELSS ZL D 1-1
�pCL 1
CONTRACTOR'S J
JN E u /' SOZgSS UTLETS-SWITCHES-RECEP 10.00/1.00 7S7 3
ame-$ H. `JIS4 LIC.RO. LIGHTING FIXTURES 10.00/1.00
C,ONTRACTOR'5
ADDRESS A,1�! n/� �J� (] APPLIANCES RESIDENTIAL 4.00 AdcK (Q/�9
Qb�Q GNA MV(�PHONE255-Glp-7D PANELS 1D.00 DATE OF APPLICATIOIJ�F/a Ci
ARCXITECT ^n / ^ PLAN CHECK FEE P.C.NO.
OR rIC�W�' ��IWV PANELS (OVER 200 AMP) 20.00
ENGINEE
LIC.NO. SIGNS TRANS. 3.00
ARCH.omE G. PERMIT VALIDATION
ADOREsss I�l.T3E2,T0 WA,I C�^/s�A SPECIAL CIRCUIT 5.00
G fJ(f� EMP.METER OR POLE INS. 20.00 / r I.
ADDRESS rs MOTORS SEE FEE SCH. C//��-- �\��I/
ADDRESS (�e
- A �+ SERVICE CHANGE 20.00 I/�
�oo LICIINSEUCONTRACTORSDL'CLARATION �. ��A✓UGI
Q U U I hereby aftano Him 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
e, W (commencing with Section 7000)of Division 3 or tire Business and �J(�
a u 4y- BLDG. ELECT. PLG. MECH.
H 0 i Professions Code mlmy license is in full 1' LsIIy1 •f tc , v
z 0"ul- LiCBrr C`as}_m� Lic.Nu t LLG,���yL1�H{{�.��y�,/� �fly71�
o y r Date S1sL ConlraC r T"
¢ w OWNBR-IS UILUIiR D. RATION City vuMw1BW BUILDING PERMIT
MISC,- REFER TO ORD INFORMATION
F
;a- N I hereby affirm that 1 am exempt from the Contractor's License VALUATI47 ON S/FT.
F10 J I.S.for lire following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 D
,A- Code:Any city or county which requires a permil to consirmet,alter, ilyllylll
ac ra a 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIG NO. ELEC. V�^e�
0 LL requires the applicant fnr such permit l0 file a signcA stulemenf thin TOTAL 3 ERMIT TO
N u w he is licensed pursuant to the provisions ol'the Contractor's License F
Hii Law(Chapter 9(Cocrmencingwith Section 7000).f Division3ol'the
4 4 o Business and Professions Code)or that he ieexempt therefrom and QTY. PLUMBING PERMIT FEE
W H lire basis for the ulleged exemption.Any violation Of Section 7031.5 STORIES TYPE CONSTR.
n by any ore applicant for a subjects S500The licam loacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars([try employees):
❑ Las owner at the property,or my.andtwith wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP RES.ONITS
(heir sole compensation,will Jo the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:The Contractor's License Law does not apply to an owner of
property who builds Or improves Ihercon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR A EA T TALA REAGE
,® bimsell re of rote his own employees,provided that such improve- [
or improvement
sold or within
ronefor
year le.
If,mpletinl the
GAS-EA.SVSTEM-11NC.40UTLETS 6.00 3147
or improvement is held within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 l
builder will have the burden of proving that he did not buil)or im- BUILDING USE
prove for purpose of sale.). . INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB other
.131,as owner of the properly,am exclusively contracting with 0 ❑ ❑ D ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Piofessions Code:The Contractor's License Law does not apply J
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 zl= _
conlruels for such projects with a contractor(s)licensed pursuant In SEWER-SANITARY-STORM EA.200tt/10.00 JJ
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for Ibis 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 thal l have a cerlificurc of ennsect to sell-insure, •f ZONING - ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy otercof(Sec.3800,Lub.C1Fr4auD r -
Policy No. Cma,any
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z Certified 'opY is fit d wish �m city inspection division.
p A plica. •�+ fL-ar -� MISC.- REFER TO ORD. v N� v 0 N�
CCN CI FICA1'EOh IiXF:h11'I'ION PROAf WORKERS' PERMIT ISSUANCE 10.00 ,Z70 FLOOD ZONE A.L.U.C.
W > COMPENSA'I']ON INSURANCE PLG.CONTR. LIC.No. PLG. p v N V
C O (This section teed nal he completed if the permit Is for ono TOTAL L N
:) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I strait not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a
Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 'u
} to NOTICE TO APPLICANT, If,after making this Certificate of rix.
H ? umption,you should be co.le subject to tiro Wnrker%Conqunsption APPLIANCE 5.00 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 10OW C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE I
I hereby affirm that there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of tire work for which this permit is issued(See. MICROFILM
3097,CR.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 a 93
Lender's Address ELECTRIC
I ready' is I have read this to comply
and stun that dIo Bunte VENTILATION FAN (SINGLE) 4,00
information n correct I agree to comply wish ell city and county PLUMBING 3
hereby
n Station state taws relating to building construction, and BOILER•COMP(3 H.P.of 100,0006.T.U.) 6.00
hereby aulhorirc representatives for ins inspection
this city es enter upon the BOI LER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL 3
ahove.mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. J
-- Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 �,U(I CONST.TAX D z�L
may in any way accrue against said C'Ay in consequence of the
r of this permit MEC;.CONT. LIC.NO. MECH.
OTAL qTOTAL 1$720'
>itHmr.of Applicant/Contractor Dae IL
OFFICE COPY
POST THIS CARD NEAR FRONT OF B
PERMIT NUMBER .
CITY OF CUPERTINO
INSPECTION DIVISEL2
dio 1.70 3
JOB INSPECTION RE :3
/ � �; .PERIy11,T1
K
,EXP IRATION;,
�W JOBADORESS_L. &VTI _ l,l, —UNIT# LOT#k
PERMIT EXPIRES If�WfJR
OWNER J ,S S CONTRACTOR -1 P� r('.S(.[ JIS1NOT S�TART�ED WI/JTiHINo
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITfISSU'
FOUNDATION
NOTE: ANC. OR 180 DAYS FROM
-
LIFER � 'ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNITE TO COMPLY WITH THE'APPROVEDr PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS CUPER71N0 STANDARDS. PAID n®
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ rAa / �'�
UNDERGROUND /SLAB JUN 2 81999 �ry
PLUMBING �/u1���yy.��{{//11.����jj�� �. �17�/v x.`!
ELECTRICAL Wy.1R VY�1GN" ISSUANCE DATE
MECHANICAL �I BLDG ELECT I PLD. MECH
4
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED f, BUILDING PERMIT
WOOD FLOOR INFORMATION .
PLUMBINGWATION Q sIFT.
MECHANICAL
ELECTRICAL �PP7ER�M,IIT TT
FRAMING - • " Vj' ��� �. �� �J�Wr EI
INSULATION _ �� STORIES TYPE CONSTR
y -ry .1 �y JCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 7 � -
$p 1'L I'I.ORH AREA �1'9`LAC E.AGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -; y Il yI�
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -% �� f
HUILDINU USE
ROOF SHEATHING Res IND CON PB Dm,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ O O I]
ASSESSORS PARCEL NO
ROUGH SARK
PLUMBING 2 ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC PILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG SfTE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRESPRINK ENERGY L]0
MECHANICAL Y ❑ N0 Y [] No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE AL.UCv Q N� 10
NI]
INTERIOR SHEAR' FIRE DEPT.
SHEETROCK IGRADE FEE SUMMARY
EXTERIOR LATH k rL, BUILDING
INTERIOR LATH Z TEMPORARY APPROVALS' BUILDING
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, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I `.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
It IMPORTANT! coNsr. TAX zf 172
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY