8841 APPLICAN I IU I-ILL IIV INN-UHIVIA I IUIN VVI INIIN HtU LIIVtS — USt BALL PUIN 11'tIV UIVLY
BUILDING PROJECT IDENTI FU "TION PERMIT NUMBER
I-/ nooaws •�' l APPLICATION & F MIT
1, v21&oo Ro?,)6odL) QR. �Lll x��jgJ BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 8841
OWNEH'S _ ' PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT `FEE "
Z-rlJ, .LNL. PHONE 779' 7j,_0 �flU
CONTRACTORS /�
NAME .15 — 3�'=��- %�• OUTLETS-SWITCHES-RECEP 10.00/1.00
CZ¢�G nAJq —N'T0 //J tl Llc.No. LIGHTING FIXTURES 10,00/1.00 2/
CONTRACTOR'S
nom+Ess ✓✓ VV // Mvvy/rny oj7 APPLIANCES-RESIDENTIAL 4.00 6 0
� J ..�
.0. (50KU/(J kY/l PHONE 7% PANELS 10.00 DATE OF APPLICATION
ORPCHITECT 7 PANELS (OVER 200 AMP) 20.00 (J �- PLAN CHECK FEE P.C.NO.
ENGINEER
LIC,No. SIGNS TRANS. 3.00 -
ADORESs Erva. SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ZIP / EMP. METER OR POLE INS. .00 PAID
APPLICANT'S
MOTORSS ESCH �AOoee _/(/✓�� � �,,`J
SERVICE CHANGE j o ��; /'wN Ili"
<r IS .z o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,0 L 110 IJSUXNLE vSfEO�'
u 1 hereby affirm that I and licensed under provisions ofChapter 9 LI eI-tino
Nay (commencing with Section 7000)of Division 3 of the Business and "(A BLDG. ELECT. PLG. MECH.
H w- Professions Code,allot my Ilcenxe is in full force d effect.
toy- License Class_ Uc,Nwnber_'C-E��n,. _
P y H Ua[e - — Cmvractor.p_�21-_(3L•rt;i
q
a m E E"TilkH'sixSlS BUILDING PERMIT
as w a OWNER-BUILDER DECLARATION ZK:
o s " INFORMATION. .
w ;e-H I hereby affirm that I ant exexempt train the Contractor's License MISC.— REFER TO ORD
LL O v, Law for the fallowing reason.(Sec.703 L5,tlminess and Pr0leevions VALUATION $/FT.
F — PERMIT ISSUANCE 10.00
Cade',Any city or county which requires a permit to construct,sBeq
IS u, Q 0 Improve,demolish,or repair any sl rust a re,pnor 10 it,issuance,also ELEC.CONTR. LIC.NO. ELEC.
2 requires the applicant for such permit to file a signed stWement that TOTAL �O Q PERMIT TO
a w he is licensed pursuant to the provisionsof the Contractor's License theSi.v III=
Hzi BusinmLaw and Professions
ode) r Section 7000)ofttherefion o and
S 4 o Business and Profusions Code)all that h.is exempt therefrom and GTY- PLUMBING PERMIT FEE G
or r m the basis for the alleged extlnpl on.Any via Wtiml ill Section 7031.$ - STORIES TYPE CONSTR.
e. byanyapplicunl forupernlit subjcth th,applicant wacivil pcualty
of 1101 morn tALTER-DRAIN&VENT-WATER (EA.) 5.00
han Ilve hundred dollars 155001.1:
❑ I,as owner of the propery,or my employees with wages as BACK FLOW PROTECT.DEV ICE 4.00
their sole compensation,will do the work,and lire structure is Hill OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, lluxE1Csx and PROICsslans DRAINS-FLOOR, ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner.I'
properly who builds ar improves thenen,and who docs such work 7, FIXTURES-PER TRAP 5-007,S—�• so.FT.FLOOR AREA TOTALACREAGE
himself or through his own cmployces,provided that such improv
Rents are not intended or olterud for sale.it,howevice the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
I iniprovetrient is sold within one year of completion,the awl
builder will have the burden oroving that he did not bf proving or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose at sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omer
❑ 1,as owner of the property, ,it ekclusivcly aonra,ling with
licensed canlout-rs H, construct ale project(Sec 7044,It...inn's LAWN SPRINKLERS- 1 INC 5 V.S. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of prapert, wlw builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 3( 6
ec Rlmets For such prof with a contraciarvi licensed pursuant m I
the Contractor's Lsnsc Law. / SEW ER-SAN TAR V-STO RM EA.200ft/10.00 0 " TRACT NO. PARCEL NO.
❑ lam exempt under
mason WATER HEATER W/VENT 6.00 CC
Owner Date J /90
7 WATER SYSTEM ; ACC.DATE ACC.FILE NO.
WORKF RS'COMPENSA I ION DECLARATION WATER TREATING EQUIP. 191.017
I hereby affirm that 1 have a cert it icate at consent to mch.luslu,,
or a certificate of N'orkm Compensation Insurance,or a certilled 1 f''` ZONING ENG.SITE NO.
coco py the�reof'IpS,c�.3800,Lab.Cx�11,, y
N.t.-a._yE,..ula�J'mponY lLG T-(:-� C¢Y6'fsa_t_
O ❑ Ccrifiad C ii perch taint sl . FIRE SPRINK ENERGY T-24
Z ❑ Certilird ;npie IIIc.) with tire city ell y{raelwn Jiv'xi n.
P — Applicant -iLes-, I---)t �r .4. MISC.- REFE YE] NEl YC] N�
CC W CC RTO'ICATE OP F'Xe MPTiON FROM WORKERS' PERMIT ISSUANCE 10.00 ![�� FLOOD ZONE A.L.U.C.
CL COMPENSATION INSURANCE: PLG.CONI'R. LIC.NO.
CL O (This se,Iran need Hill be completed it IIIc permit l I'or one TOTAL l Y EJ N❑ Y C] N
Z juridical dollars(S100)nrlcs.J
U O 1 certify dent in the pc,Irr nonce of the work for which thix per DTV. MECHANICAL PERMIT' FEE FEE SUMMARY,
LL U mit is issued.I shall not employ any person In any mammy so as to _
0 tobecome subject to lire Workeri Cotnpemat ion Laws of Calilurn iv.
Ia. Oil` Appl"ant ALTER OR ADD TO MECH. 5.00 BUILDING O 40
} rn NOTICE TO APPLICAN f' 11,alter nlaking thrs C,rIi Ii,,t•of Lx. Q
I— 2 cmlptioll,You should b,,I) c sud,,l a,the Work,n'Cm l,nsatiam APPLIANCE 5.00 PLAN CHECK
provisions of dw Labor Cud,, you must forthwith :amply with U FEE such provisions or this pennit shall be decmcd mvakeJ. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER1 .) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
Ill, pe,po nine, of the work nor which this penult is issued(Scc. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 10
Lender',Nwne
Lender's Address 7 HEATING UNIT(OVER 1 6,000B.T.U.) •5(J ELECTRIC
I cenily that I have read this application and state that the above VENTILATION FAN ISIN ) U5
inlorinalmo is correct. I agree to comply with all city and County PLUMBING ll�
did inanus and swn laws rclaUng w building construction, and BOILER-COMP(3 H.P.or 10 OB.T.U.) 6.00
\ hereby authorier representatives al this city to enter upon lir, BOILER-COMP (Over 100,000 RTUI SEE FEE SCH. O
abovnmca,lo,or Property for e, .1 Inspection pugs, to I MECHANICAL
(We) agree to save, ind,RHa ny and keep Ilanulcss the City of MISC.- REFER TO ORD.
CuperUmo ag,au, IiajJitics,jud"ll"n" cosh and ax pcnses which CONST.TAX '1
may`i r.any w accrue against said City in consequence of aIle PERMIT ISSUANCE 10.00 0•� .'l
Fra I gof thi emit.
MECH.CONT. LIC.NO. MECH.
i•namtta rA ,h,arl ConRl¢mr / r
'GL .0/rcC'
Rinaldo, pl __'�tY�
TOTAL TOTAL
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
COY OF CUPERTINO
PERMIT NUMBER
INSPECTION DIVISION • us fir.
JOB INSPECTION RECORD
1 I / ~.•PERMIT EXPIRATION
JOB ADDRESS �I 106D 9� {ADW ✓I UNIT#' - LOT
- J _ ,/ PERMIT EXPIRES'IF WORK
OWNER' CONTRACTOR V �r IS NOT STARTED WITHIN
INSPECTION DATE INSP CTOR 'INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
K6 ANCE OR 180 DAYS FROM
FOUNDATION
UFER LASTCALLED INSPECTION.
Z
PREGUNITE
PERMIT VALIDATION
� � •-
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL' ISSUANCE DATE
MECHANICAL BLOG. ELECT. PLG. MECH.
w w "X�j . N
00 NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOO - T INFORMATION
PLUMBING tp _ - VALUATION SIFT.
'MECHANICAL d•S 1 ',
ELECTRICAL EHMITTO
FRAMING _ e - `••SIJ �•'
INSULATION -1 J STORIES "'TYPE CONSTR.
- OCC.GROUP- .RES.UNITS
,P,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF . SO.FT.FLOOR AREA TOTAL PCHEAGE
DIAPHRAGMBU1 V -
OO/, /l�.A�G�I 'L- y-p� RES IND ILDCON USECON0,1u
---- -"-APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ' ' 0 0 ❑ ❑ 0
ROUGH
A SSESSORS PARLE L NO.
,
PLUMBING L 1
TRACT NU
GAS TEST . PARCEL NO,
MECHANICAL- - 115
ACC.GATE ACC.FILE NO.
ELECTRICAL - _� FINALS DATE INSP.
FRAMING �bnSAN n 163 -Iff _
INSULATION �y PLUMBING - zoNlNc ENG.SITE No.
Id C S GAS
FIRE SPRINK ENERGY T,24
MECHANICAL Y N[] v N�
COVER NO WORK UNTIL ABOVE HAS BEEN SI D HEATING 6�0
.
• LATH-INTERIOR . -1`�'8 ELECTRICAL FLOOD ZONE AL.U.C.
LATH-EXTERIOR 1 h FIRE DEPT. Y ❑ N 'v 0 ru❑
SHEETROCK GRADE FEE SUMMARY ,
SHEAR INTERIOR - !'� BUILDING -j..
SHEAR EXTERIOR �j TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK '
` GAS - . FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BU ILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ;
o� ONE WORKING`DAY BEFORE.REQUIRED INSPECTION. . PLUMB
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
-- IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
' OFFICE COPY • \