13637 PERMIT NUMBER
APPLICANT TO FILL IN INFOI- V ' -ION VVI-IIIIIV ICED LINES - 'USE B/\L1- POINT Ff-id ulv '
APPLICATION & PERMIT
S
BUILDING PROJECT IDENTIFICATION 13637
XBUILDING BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
AgDRE55 PLAN CHECK VALI-ATION
o3 0
wNER's ELE,CTRICPERMIT e, -�'� FEE;1
TAME
PHOry
TRA Tom S ,,.,, OUTLETS-SWITCHES-RECEP 10.00/1.00
CON
NgmE � ^ ,x` /O� 0 LIGHTING FIXTURES 10.00%1.00
CONTRACTOR'S PP LIANCES-RESIDENTIAL DATE OF APPLICATION
10,00
ADDRESS pPLAN CHECK FEE PC.NO.
PANELS 20.00
ARCHITECT PANELS (OVER 200 AMP I
3.00
SIGNS
ENGINEER SIGNS TRANS. PERMIT VALIDATION
% IIC.No. 5.00
ADDRESS ENG, a�� CYw� ,� / SPECIAL CIRCUIT 20.00
Z n , ,
_.. / �' ✓✓�T �J���` EMP.METER OR POLE INS.
MOTORS SEE FEE SCH.
gPPLICANT'S ]�0 F/� 00�7� 6/U /f/�E;� .✓ SERVICE CHANGE 20. o 6
o x i C ISSUANCE DATE
w O O - LICENSED CON'I'RACI' RS UIiCLARAI'ION BLDG. ELECT. PLG. MECH.
to u u 1 hereby affirm that I am licensed under pruvisno s of C'hapler 9
_an (commencing will,Section 7000)of.Division 3 0l the Business uno
o protestors Code and... license is m full force vl el fc`I
I- ,q z �- Lia Number_ ...I.BUILDING PERMIT ,
License Cla t
Z D'��/ tR 1. Contmdor -ff1P1:16�-� 'T R^s ORMATION;,'C' �'
o y F Id\ Date /"1 INF.
-' e COG REFER TO ORD 8/FT.
W a OWNER-BUILDER DECLARATION MISC.- VALUATION
E BEU
o a N I hereby affirm
that I am exempt from tBusinessrunJ Ir',Licenserof ssions PERMIT ISSUANCE T�Q/1
w u LLO 4 Law for the following reason.(Sec,70J L5, ` LIC.N0. ELEC. .(
r -N � CuJe:Any lily or county whid,rcyuircsapermit tuconstruct,ala'o ELEC.GONTH. TOTAL PEriMIT TO
2 w a Y improve,Demolish,or repair any srtunurc,prior to Ile iss'uanc0.
M ¢ 0 rel t-a theapph andlar such pulnit toliltasignnteto n'nllhal
u w$ he Is licensed puraaent t0 the pro Ivor&of the Contr 1 tar s License -_ PLUMBING PERMITI, ,' TYPE CONSTR.
Law(Chapler'J(comm re, with Seuimn 70001 of Uivt-im3ul the STORIES
r ? < Ousines and Prolessiu 1 Code)ar that he is exu rpt tbu Innn and • _
s o the bases 1'ur the alleged exemption.AnY violation oI Section 7031 5
Ir: r o ALTER-DRAIN&VENT-WATER (EA.) 5.00
nam by an aphcant for a P, Ht subiudsthe applicant toncivilpenally S.UNITS
ol'not more than live hundred d011xrs($500).): I BACK FLOWPROTECT.DEVICE 4.00 OC GROUP
❑ I,as owner of the properly,or my employees'with wages as
their sole- I cnsatiun,will du Ibe work,told tem structure is not ROOF,AREA,GUN D. 5.00
intended or offered for sale (Sec. 7044, Business and Profession DRAINS-FLOOR,
Cole:The Contractor's License Law does not apply tD ml owner of F IXTUR ES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
properly who builds Or improves thereon,and who docs wch work p)�`
himself or through ,is own employees,provided that Such "tile Prove-ing � , GAS-EA.SYSTEM-11 NC.40UTLET$ 6,00 �� BUILDING USE
mems me not intended or offered for safe.If,Imwever,
Hc owner- GAS-EA.SYSTEM-OVER Efl 4 IEA.) 2• RES IND CON Pe oQ
or improvement illavis sold within one Year of completion, 30.00 ❑ ❑ ❑ ❑
builder will have the burden of proving that he did not mild or int INDUSTRIAL WASTE INTER.
prove for purpose of sale.) ASSESSORS PARCEL NO.
❑ I,as owner of the property,am exclusively contract tris wish
licensed contractors to construct the project,See. dO1s Business LAWN SPRINKLER$-1 INC 5 V.B. 1 00
and professions Code:The ConlmcOH's License,,Law Ju..nandµFlo LAWN SPRINKLERS-OVER 5(EA.) 1,00
to an owner of property who builds or imp /
contracts for such projects with a contractor(&)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00 r TRACT N0. PARCELNO.
the Contractor's Liceme Law. BAPL.for It's / VSAT ER HEATER W/VENT 6.00
❑ I um exedlpt under Sec' ACC.FILE NO.
reason 5,00 ACC.DATE _
Owner Uarc / WATER SYSTEM 5.00
WORK ERS,COMPIINSATION DECLARATION WATER TREATING EQUIP. ZONING ENG.SITE NO.
I hereby affirm that I have.a certificate of consem to sell:insure,
or a certificate of Workers Compa/ t)op 1rU�anit�� IIJ .
copy thereQQ'(�Scc�.33800,Lub.C.). 6677 FIRE SPRINK ENERGY T-29
Policy N0. Compw,Y-:.YT -�- ❑ N❑
O ❑ Cer it ied copy Is hereby to d. REFER TO ORD. Y❑ N❑ Y
Z Z ❑ Ce lifp'd s f1 ed a the city inspection Aivision. MISC.- A.LU,C.
Applicant 1b�YJ�`7 �'--'----- --- PERMIT ISSUANCE FLOOD ZONE
J= CEF: ljI ICA'ITOF EXEMPTION FROM WORKERS' LIB.IS PLG. Y❑ IN Y ❑ N❑
Lu
j COMPBNSA 110N INSURANCL
PLG CO�BJD 13t TOTAL
CL 0 (This section need not be completed If the permit Is for un. FEE l .FEE SUMMARY
� z hundred dollrs(SI00)p`less) TY '`MECHANICAL PERMIT // Q
o O I certify that in the rlOnnance of Iile wrxvn n anyrmamurtSo as to I, BUILDING (O (���
if is,&sued,I shall not mnPloy any I c 5.00
LL 0 U become subject to the Workers'Compensation Laws ul Culifornu. ALTER OR ADD TO MECH. -
O ED DateApplicant 5.00 PLAN CHECK
r So NOTICE TO APPLICANT: If,afler making tlris Cert ificutc ul'fix- FEE
Z emption,you should became subject to the Workers'Conrpensatm l APPLIANCE
euoh signs olnshe this Permitde,shall n lost deemed revoked'o rl ly with AIR HANDLING UNIT ITO 10,000C.F.M.) 4.00
V AIR HANDLING UNIT(OVER 10=C.F-M.1 6.00 SEISMIC FEE ';i
CONSTRUCTION LENDING AGENCY 5.00 MICROFILM
/ EXHAUST HOOD(WITH DUCT)
I hereby affirm that there is a construction lending agency for / HEATING UNIT(TO 100,000 B.T.U.) 8.00
the performance of the work for which this pernit is issued(Sec. os`
3097,Civ.C.). HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
Lender's Name
Lender& 4.00 Address VENTILATION FAN (SINGLE) PLUMBING Q✓
I certify that I have read this application and stute that the above BOILER-COMP 13 H.P.or 100,00D B.T.U.) 6.00 QS/7
information is correct I agree t0 Comply with all city and county MECHANICAL
ordinances and stale laws relating to building construction,upon, and BOILER-COMP love,100,000 BTU)SEE FEE SCH.
hereby authorize representatives of this city to enter upon the REFER TO ORD.
^' ubove.menUoned property for inspection PurPoses,, MISC.- CONST.TAX
(We) agree to save, indemnify and keep bar 1pless the City of PERMIT ISSUANCE 10.00
Cupertino against liabilities,judgments, costs and expenses which
Indy in any WJY aCCrlre alai Sal C III COnsetlllence of tlltl LIC.NO. MECH.
p tIIIip MECH.CONT. TOTAL CltfdL TOTAL
grunting of�Appdu,'1'9-1
pit J 0
U.ue
L//3 934
SignanueCnnt actor_-' CCG'!
POST THIS CARD NEAR FRONT OF BWI,ILDING iERMIT NUMBER
� CITY OF CUPERTINO 13637
l INSPECTION DIVISION
JOB INSPECTION RECORD j
J-
PERMIT EXPIRATION
JOB ADDRESS .21030 Rainbow Drive UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER ' ErOC Sung CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD180 DAYS OF PERMIT ISSU.
FOUNDATION . - _ V, q- inc-4puYh ANCE OR 180 DAYS FROM
UFER
GC'L rfF1Ch b hoL1�e +U01- �a[CtcA LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB k' ;
PLUMBING
ELECTRICAL
• ISSUANCE DATE
MECHANICAL - BLDG. ELECT. I PLG MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDPA W BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION $/FT.
PLUMBING A ; �
MECHANICAL _ 3.? r 30 A,
ELECTRICAL PeRMIT TO
FRAMING ^-24 Cl�yot _ ..�.6,�
INSULATION STOHIES W TYPECONSTR.
i
CC.GROUP RES.UNITS
[P.LE'ACE`.NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED UAv T` r
SO,FT.FLOON AHLA TD1'AL ACREAGE
ROOF IF ep- �
DIAPHRAGM /
BUILDING USE
2 R[S INIT CON PB Oih,q
APPLY NO ROOFING UNTIL ABOVE HAS BELON SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING RoUr,,
GAS TEST
TO ACT NO, PARCEL NO.
-
MECHANICAL f-/y-
ACC.DATE ACC.FILE N0.
ELECTRICAL - FINALS DATE INSP. ,
FRAMING _ SAN *_ I
ZONING ENG.SITE NO.
INSULATION' PLUMBING
GAS
FIRE$PRINK ENERGY T 2
MECHANICAL • Y ❑ No "Y 0 N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.0 C.
LATH-INTERIOR /Z,- ELECTRICAL
LATH-EXTERIOR FIRE DEPT. Y❑ N[:] i Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR - ,� •TEMPORAR PPROVALS BUILDING •J
. FIREWALLS - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
UCCUPANCYOFBUILDINGISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BV BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,. ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY -