17997 (2) rh
APPLICANT TO FILL-INV INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
g -,1 BUILDING PROJECT I DENTI FICATION - PERMIT NUMBER
AOOR�s�O�y QaQf1N t• !j] Li rIP��' UI LDING-ELECTRICAL-PLUMBING -MECHANICAL :;:. 1•.7997
BO1LmNG APPLICATION & PERMIT
DelmerS - --. f�'("/ PLAN CHECK VALIDATION
NAME TV. 'ELECTRIC PERMIT FEE
n! �y HONE yS -S`�3 ,
CONTRACTORSUTLETS-SWITCHES-RECEP, 10.00/1.00 �1 G/ 3 �' �•�.
uC.NO. Q LIGHTING FIXTURES -' 10.00/1.00
N ACT s
D EA
�u0tf> PPLIANCES-RESIDENTIAL 4.00
A
I If
HONE PANELS 10.00 DATE OF APPLICATION
A HIE AVF, L)f Tf•v0 PANELS (OVER 200 AMP) 20.00 ?LAN CHECK FEE .P.c.NO.
OW&N ER
Q[f F_- uc.Na.- '; SIGNS TRANS. 3.00
ARCH.11 ENG. - PERMIT VALIDATION -
ADDRESS
�7j N•.N�o RR'fSOn//}7/ SPECIAL CIRCUIT 5.00
J ZI EMP,METER OR POLE INS. .20.00 C/ -
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS/��
O4f. $�M CRII4 CV' tR T�Nl� SERVICE CHANGE 20.00
-00 LICENSED CON'TRACT'ORS DECLA ATION' L O .
a v 1 hereby affirm that 1 am licensed under pr.,dona Of Chapler') • 'ISSUANCE DATE''
n G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m Z Professions Codc,and my license is in full force and elI'ect. rtp
Z o y - Li cense Class -Lic.Number'
Q H w Ue�c Contractor p -
¢ Y ¢ a- OWNER-BUILDER DIiCLARATION. .VII BUILDING PERMIT
¢ w DINFORMATION
w. u y 1 hereby affirm that I ons exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT.
"FLLoa Code:Any city
regiresit Businessand Professions PERMIT ISSUANCE 10.00 ,� / a
Code:Any cityor county wh icy requirese permittoconstruct-alien ]� DDD'
esW Q 0 improve,Demolish,or repair any stnlClure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.'. 1 V /
D ¢ requires the applicant for such permit to file a signed slatenrent that TOTAL 1 - PERMITTO
he is licensed pursuant to the provisions of the Contractor's License L
Law(Chapter 9(emonencingwith Section 7000)of Division 3 of the
- a Business and Professions Code)or(hal he is exempt therefrom and DTV. .PLUMBING PERMIT FEE
¢ F Oo (he basis for the alleged exemption.Any violation of Section 7031.5 - I STORIES TYPE CONSTR.
n - by anY applicant fmupennit n,bjeds Om applicuntnwcivilpenal(Y'I '.A ER=D AIN& ENT-WATER (EA.) 5.00
of not arc than fi L hundred d ill r ($500)) 0
as own of U t p, pe Iy7ar rpy •n11 yL with ag . as q K F ROT CT.DEVICE . 4.00
tfteir sole com pensallon will do thew a (Ise nCt r n t OCCIGROUP ' RES.UNITS
intended or Offered fur -eld-I L. 7044 Bps d P y{ xr R •I - L R,R F,AREA,COND. 5,00 r
Code The Cool dors Licefl} law does o-app) ( 'a7S" ne' f - v
property who hl111d50r IIn PrQ COn,' h 'sL Chw X DR„ - eER,T AP ' S.00 SO FT FLOOR AREA OTAL ACREAGE
himself or through his own a yces,pr Iha h iui1?n p r
menu are nor intended or of ed for sale .I ev r the buildM06TEM-1 INCA OUTLETS 6.00 ,S
or improvement is sold withi L,iy mm i Qlc-uwner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 RumOw G.USE
builder will have the burden t he did not build or int- RES IND . CON PB •Other
prove forpurpose of,dii.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner.1 the property;ons exclusively Contracting with - ❑ 0 ❑ ❑
licensed contractors to eonstmel the Project(Sec.7044,Business LAWN SPRINKLERS-.1 INC 5 V.B. 6.00 ASS WRSPARCELNO.
. and Professions Code: Tic Contractor's License Low does not apply G ` Q
to an owner a0property who builds or improves thcryon,and who LAWN SPRINKLERS-OVER 5 (EA.) '1.00 �G-7_ 19_o0V
the Con
for su License Law.'
aconlmcLLx(s)lice :'d punuart to SEWER-SANITARY-STORMEA.20oft/10.00 TRACT,NO! - PARCELNO.
the Con I oat License Sec.'e.
- lime `nlpt under Sec. ,H.&P.C.for Ibis WATER HEATER W/VENT 6.00 ,
canon
owner - - 1) WATER SYSTEM 5.00
ACC.DATE *ACC.FILE No.
o RKJ oMPlilpf TION ION. WATER TREATING EQUIP. 5.00 -
I hereby at rl (hal I ...c-A I n
ivet,of cnsenl to all-inside, ZONING ENG.SITE NO.
or:rcertificato/f]GWorker,'Compensation Insumuce.'or a certified _
copy thereof(Sec.3800,Lob.C.). -
Policy No. ✓ Company
O 0 Certified copy is hereby furnished. FIRE SPRINK ENERGYT24
Z Z .❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. •
O Applicant - - r Y ❑ - A❑ Y ❑ N❑
f- y r - PERMIT ISSUANCE r2 .DY FLOOD ZONE A.L.U.C.
LU C,IiRI'I PICOF COMPENSATION INS PROM WORKIiRS'
aQ needhemor (NSURANCI! PLG.CONTR. LIC:NO. PLG. / / ❑ N❑ Y,❑ N❑
(This action need nut he com P@0.x1 if the permit is for ant• .TOTAL / ,
Z hundred dollarsO 100)or less.) . •- - '
(a O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE ,FEE SUMMARY
r 1 et employ on eraan in un manner so as to
H• mil is issued,I sl al n p Y Y 0 Y F _become subject to Ibe Workers Compensation Laws ofCalifurnia.: p0
w NG �d. Date Applicant ALTER OR ADD TO MECH. - 5.000 N0110E TO APPLICAN'1: IC alter making(his Certdiedle of liemption,you should become subject to thrWOrkers'Coulpensa(ion APPLIANCE 5.00 HECK
provisions of Ore Labor Code, you must for(hwilliamtply withsuch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C,F.M.) 4.00 `CONS1R UCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 C FEE1hereby affirm Thai there is a conslrucllon lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work-for which this permit is issued(Sec. FILM3oP7,Civ.C.L - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEAT(NG UN IT(OVER 100,000 B.T.U.)9.50 RIC
Leeder's Address -
1 certify that I have read this application and store that the above IVENTILATION FAN (SINGLE) • 4.00
information is correct. I agree to comply with all city and county . PLUMBING ' 6j 4
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 - t /
hereby authorize representatives of this city to enter upon the BOILER-COMP'(Over 100,000 BTUI SEE FEE SCH, MECHANICAL. I
ebove mentioned p p rly for p 4mn par +c -
_ -'(We) agree to cic mdemmfy and k harmless the City of MISC.-- I
r egamst I'ab'11' ' j dg nls Is d L•xprns w)nich r < r,/1 CONST.-TAX „
a m n wa ac ru amst I fA /Q PERMIT ISSUANCE IN' d • 1/'•'
s,
y y y fig' ' yin copse c e o (he s, l
•ranlin f[ L MECH,CONT. - LIC.NO. t MECH.
s TPTAL r TOTAL 6
T ♦ 7
S' m e of cant/ u r Uate � t,r�
OFFICE COPY P
POST THIS CARD NEAR FRONT OF BUILDING .
- 'rET+MIi NUMBER.
CITY OF CUPERTINO
_ -. .INSPECTION DIVISION . ' - "'' '
JQB INSPECTION�T/ION RECORD
("7-I�-+ITCH - `PEyRM . -N , RATIQ
JOB ADDRESS—1 "`�/ llL 4+__.�- L1�—
-NIT _LOT# Apr
.�• � , L
PERMIT EXPIRES IF WORK
- OWNER `� ��-\TN� CONTPA_CTOR C IS NOT STARTED WITHIN
INSPECTION .DATE INSPECTOR - INSPECTION RECORD - 180 DAYS OF PERMIT ISSU-
- ANCE-OR 186 DAYS FROM
FOUNDATION (7 'NOTE: LAST CALLED INSPECTION.
UFER - bCjQ ALL GRADING AND DRAINAGE.SHALL BEINSTALLED, '
PR EGUNITE f' TO COMPLY WITH THE APPROVE`D,PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS Mci,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' , SEP 11 9
UNDERGROUND /.SLAB 19V9.
PLUMBING - p "^ �y -1fV 1;. (Zt '• tf!.Y
ELECTRICAL : Of cumft ISSUANCE DATE
MECHANICAL - - _ - BLDG ELec T. L'c,J MECK
El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
�• INFORMATION
WOOD FLOOR
VALUAIIUN 'v . SIFT.
PLUMBING d @l7 10-31-sci, �(Vj�
MECHANICAL O—�.Q - fv (J -
• ELECTRICAL V PE11 IT'T^O/
FRAMING D-V4 �+
I comsrn
INSULATION sioRlEs ,
occGBour RES UN1TS(
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFO 3"
r, ooC�, ,ea,...,qrn L i/AaE.
DIAPHRAGM ^ THE CONSTRUCTION TAXIS PAID
BUILOINC,USE
ROOF SHEATHING ' — . 'RE. RES' IND ON
ROOF PB on66 ,
I ,
APPLY NO ROOFING UNTIL A OVE HAS BEEN SIGNED FINALS ATE INSP. Qx. ❑ ❑ ❑ ❑ASSLSSUHSPARCELNO^ - II
' - - ROUGH - SANA - ?j'%-7_. �^ (. oC
• l
PLUMBING ELECT.ENERGY j
THnCI NO. PARCEL NO
TUBS B SHOWER PAN PLUMBING ENERGY '
, MECHANICAL,. MECH.ENERGY -
ACC.DATE ACC.FILE NO.
ELECTRICAL - BUILDING ENERGY '-
FRAMING - ELECT.FINAL TEST -
I , ,ZONING ENG.SITE No.
NSULATIONPLUMBING ,
GAS TEST GAS
FIRESPHINK , ENERGY T-24 `
MECHANICAL ❑ N❑. , ❑ No,
COVER NO WORK UNTIL ABOVE HAS BEEN S D HEATING '
EXTERIOR SHEAR ELECTRICAL RELEASE FL°oD z°NB a.L.u.c.
INTERIOR SHEAR - FIRE'DEPT:- v❑ NE] v ❑ No
SHEETROCK - GRADE ' FEE SUMMARY
EXTERIOR'LATH BUILDING 7� , BUILDING INTERIOR LATH TEMPORARY APPROVALS '
SCRATCH COAT ' _ GELECTRIC PLAN CHECK
FEE .
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY ISEISMIC FEE' �• 1J 7
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL13UILDING F.INALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE'FOR INSPECTION BY PHONING 252-4505; ELECTRIC
Lu ONE'WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING /
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE — MECHANICAL,.
IMPORTANT! f covsT.rnx �
PLEASE READ REVERSE SIDE BEFOREI L
TOTAL'
CALLING,FOR FINAL INSPECTION.
OFFICE,COiY'