07455 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
u BU DING PROJECT I DENTI FICATI ON - PERMIT NUMBER
iZat- NGAPPLICATION & PERMIT 1' 7455
ADDRESS J,i
• _ _�,��3 g2 (VQp ilii A BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNEH'SnOni PLAN CHECK VALIDATION
NAME K r'QT YcSN EILR /)'IR2T11.1 OTY. ELECTRIC PERMIT FEE
t 2 PHONE
AMECONTRACTORS ( OUTLETS-SWITCHES-RECEP 10.00/1.00 �. 30
1 /`
N ' J 4
. .w ILl,L Y3M F�� LIGHTING FIXTURES' '.10.00/1.00 7•S-0 LIC.NO.
-- r - CONTRACTOR'S APPLIANCES--RESIDENTIAL 4.00
ADDRESS
• PHONE I PANELS - 110.00 1• DATE OF APPLICATION
OR ITT n�YL /x PANELS(OVER 200 AMP) . 20.00 . PLAN CHECK FEE P.C.NO.
ENGINEER
- uc.no. SIGNS TRANS. •� j'•. 3.00 '
ARCH.OH ENG. S'NfV L}IIVTQ/U/O PERMIT VALIDATION
ADDRESSy-;S S, /9 SPECIAL CIRCUIT {•_ °-5.00 .
LO zip'71IDz EMP.METER OR POLE INS. .'20.00Z_�--�-�
A
Daa essTS/d3$2 02R'IJCi67 AU6N LLE" MOTORS . SEE FEE SCH: -
CuPB12T1.UO 1 CA q er U( SERVICE CHANGE { , 20.00 (• CLI
o o LICENSED CONTRACTORS DECLARATION J UL
¢ u U 1 hereby affirm that I run licensed under provisions of Chapter 9 �b : ISSUANCE GATE
wan (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT.' PLG... MECH.
r m z Professions Code,and my license is in full force and effect. n r r, 1) P :0001 .
z o m- License Class Lie Number
Q w Date - Contractor ' '
< x nnnorF' BUILDING PERMIT
¢ ¢ w
OWNER-BUILDER DECLARATION _ _ ..
Ow.A MISC.- REFER TO ORD INFORMATION
w ; LL H 1 hereby affirm that I am exempt from the Contractor's License
a o a Law for the following reason.(See 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 ( ,vt VALUATION . S/FT.
H - Code:Any city orc'ounty whichrequiresapennit tocrmstrucl,tiller,
¢ K G 2O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. , ELE
T C. ��O
¢ requires file applicant for such permit m file a signed statement that ( . TOTAL .30 PERMIT TO
wm" he is licensed pursuant to the provisions of the Contractor's License
r z r Law(Chapter 9(conmtencing with Section 7000)of Division 3 of t he AI'O 1 D
a Business and Profusions Code)or Nrof he is exempt therefrom and QTY. PLUMBING PERMIT FEE /1 V
¢ m the basis for the alleged exemption.Any viulalion of Section 7031.5 ' I STORIES-. TYPE CONSTR.
La byany applicant for a permit subjects tile applicant loacivil penalty ALTER-DRAIN -WATER IEA.) 5.00 ,Q('
of n9Ymom than five hundred dollars(S5001.):
)K ,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE '4.00
their wile compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
_ intended or offend for sale (Sec. 7044, Business and Professinns DRAINS-FLOOR,ROOF,AREA,COND. 'S.00
Code:The Contractor's License Law does not apply to an owner of '
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 1 5.00 . -QO SO.FT.FLOOR EA TOTAL ACREAGE
himselfor through his own employees,provided that such improve-
meatsarenotinlendedorofferedforsale.If.however,the building ' GAS-EA.SYSTEM-.I INC.4QUTLETS 6.00 I(�.3'L
-� or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or ins- GAS-EA.SYSTEM-OVER 4 (EA.). 2.00 - BUILDING USE
RES IND CON PB
prove h 'Other
'oir purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑
❑ 1,uswner of lire property,sin exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INCI5 V.B. 6.00 ASSESSORS PARCEL NO.
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'.OVER 5 MA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Conimcmr's License Law.' - SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
❑ la...exempt order Sec. .B.&P.C.1'or this WATER HEATER W/VENTi 6.00,Lo p
reason
T to .ff.8q WATER SYSTEM 5.00 Q qca.DnrE ACC.FILE No.
. WORKI:RS'COMPI:NSATION DECLA RA"FICK WATER TR EATING ED
UIPI - 5.00
I hereby affirm that I have a cerlificu¢•of400senl to WltI insure. I
or a certificate of Worker,'Compensation Insurance,or a certified 1 t ZONIrvG ENG.SITE NO.
copy thereof(Sec.3800,Ul,.CJ. {
Policy Nn. Company
O ❑ Certified copy is hereby furniwhed. FIRE SPRINK ENERGY T.24
Z 2 ❑ Certified copy is filed with the city inspection division. '
O Applicant MISC.- REFER TO ORD. Y ❑ N❑ ' Y❑ N❑
CC T CERTIF-ICA'I'F.OF 1:XEMPTION PROM WORKERS' ' PERMIT ISSUANCE 10.00 Z.CO FLOOD ZONE A.L.U.C.
Lu > COAIPENSA'1'ION INSURANCE PLG.CONTR. LIC.NO. I PLG. /�s
d U (This section need rut be completed if the pennil is for one TOTAL'3 9 4b v❑ N❑ Y❑ N❑
Z hundred dollars IS 100)or lcgx.)
r U O 1 certify that in the perfornsance it tile work for which lhiv per- QTY. MECHANICAL'PERMIT FEE FEE SUMMARY
U F mil is issued,I shall not employ ang'perwn in any manner so as to
U become subject Compensation to file Workers'Com ensation Laws of California.
n Dale / - APPlicam ALTER OR ADD TO MECH. 5.00 `�. AD BUILDING
} to NO11C17 'f0 APPLICANT': IL after making this Certificate of Ex-
F. Z engslion,you should become subject to file Workers'Compes:dion APPLIANCE { - 5.00 PLAN CHECK
provisions of the.Labor Coda you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. i AIR HANDLING UNIT(TO 10=r-F.M.) 4.00
CONSTRUCTION LENDING AG17NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 7.64P
• 1 hereby,affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this pennil is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 .00
- Lender's Nome -
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC .30
`-' -
1 certify that I have read This application and state that the above VENTILATION FAN (SINGLE) 4.00 - v n_
information n correct, I agree to comply with all city and county PLUMBING 3 O •QV
ordinances and state lows relating to comply
with constract inn'L,nd nd county BOILER=COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby aulhorire representatives of this city to enter upon the' 7 BOILER-COMP (Over 100,000'BTUI SEE FEE SCH. MECHANICAL �� 0�
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC:- REFER TO ORD.
. - Cupertino against liabilities,judgments, cost, and expenses which CONST.TAX
may iii any way accrue against said City in conseiluence of the PERMIT ISSUANCE 10.00 A,049
molingo tthis permit. ' p' MECH.CONT. LIC.NO. MECH.,
TOTAL. 'TOTAL 7f 7,_-V
' Sign arc of Applicant/Contractor Dn[c 1
OFFICE COPY
t POST THIS CARD NEAR FRONT OF BUILDING =
PERMIT NUMBER
CiTY .OF CUPERTINO c 17455
INSPECTIONDIVISION
JOB INSPECTION RECORD
" PERMIT EXPIRATION
r }
JOB ADDRESS - (U3�Z. 0���\G.o . -VC UNIT# µ _LOT#
•`t--` I 'PERMIT EXPIRES
IF WORK- '
owrveN JcL fir!om L1/t CONTRACTOR �_ �f �• IS' NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECT10N RECORD. ••180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYSFROM
FOUNDATION Z_ NOTE:'
LASTCALLED INSPEC710N.
. UFER•�� _ - � ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT VALIDATION
CUPERTINO STANDARDS.
• GARAGE SLABS Z PMID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �� /
FOu N•D tom'+o tiS F��
UNDERGROUND /SLAB . �,�,�
s Y1'10 u. STde. J
PLUMBING G �S IL�NS �_rS_CfO�eLL l !{ 41' It. tilC !'
ELECTRICAL ' ElF.R.b°R�ISa�' ISSUArvcE uATE `✓�''�
MECHANICAL
ELECT,� PLG.. MECH.
DO NOT POUR.FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDING PERMIT
INFORMATION
.°WOOD FLOOR;
- VALUATION SIFT."
PLUMBING - •"
. MECHANICAL
PERMIT TO
-__•- - ' .ELECTRICAL - - A
... FRAMING •. Del � /CS KOL�
INSULATION - stoR,Es Tvve Nsn Ar
_ I ,. `• . , ; , y ALL.GROUP , FEES UNITTb"E,ti,
V CPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ' -
$O,4 T,FLOOQZ I EA TOTAL ACREAGE
- ROOF ,NOTE:NO FINAL INSP.SHALL BE MADE BEFORE- f frnJ ,
DIAPHRAGM 'r • THE CONSTRUCTION TAX IS PAID
_ �E,, BUILDING USE
ROOF SHEATHING - 1 I . RES IND CON PB . Om.•.
" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ . ,E] ❑ ' ❑
ASSESSORS PARCEL NO .
ROUGH . SAN.#
PLUMBING I - ELECT.ENERGY - `
TUBS&SHOWER PAN - PLUMBING ENERGY . TRACT NO. PARCEL NO.
MECHANICAL '+ - MECH.ENERGY
` - ELECTRICAL' ACC.DATE AcG FILE NC.
_ BUILDING ENERGY .
• FRAMING ELECT.FINAL TEST,' ' zorvlNc ENO.SITE No.
INSULATION -,. PLUMBING !
GAS TEST _ GAS :. J
FIHESPRINK ENERGY TQd
MECHANICAL' v ❑ INNO
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
E FL000zoryA,L.uc,
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR; FIRE DEPT. i _ v❑ N❑ v ❑ IN
SHEETROCK - GRADE FEE SUMMARY
• EXTERIOR LATH - BUILDING E. ' BUILDING
' INTERIOR LATH - TEMPORARY'APPROVALS G - ���!•-�
SCRATCH COAT ELECTRIC - PLAN CHECK
... _. - GAS
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
ARRANGE FOR INSPECTION BY PHONING 252-4505,1 ELECTRIC'
F ~i ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING p'G
0� PLEASE'.GIVE JOB ADDRESS WHEN PHONING.
.z MECHANICAL
1 ' . i •d,0�.
- SEE.PERMIT FOR, EXPIRATION DATE - '•
. IMPORTANT! CONST.TAX - �� • .
P•L.EASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. -, TOTAL ' Zr36
OFFICE COPY;
• f. •I