16844 'APPLICArJY TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION PERMIT NUMBER
BwLDiNG APPLICATION & PERMIT
16844 Z/66Q � BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
Owrveu's -_
NAML PLAN CHECK VALIDATION
UaQE - OTY. ELECTRIC PERMIT FEE
PHONE
ONTflACTOR'S �� I �� „
rvamE OUTLETS-SWITCHES-RECEP 10.00/1.00 x-J,lfl
WJ�
'S
IC.ND. tgjgE� LIGHTING FIXTURES 10.00/1.00
ADDRRACTONooflsss APPLIANCES-RESIDENTIAL 4.00
tJE - /W &C PHONE - PANELS 10.00
ARmuTECT GATE OF APPLICATION
OR
ENGINEER PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
uc.
Af1CH.OR ENL. NO, SIGNS TRANS. 3.00
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00 ZI•a S��j 8
APPLICANT'S
ADDRESS MOTORS SEE FEE SCH.
Dai z� 60 I SERVICE CHANGE 20.00
Foo LICENSE[)CON'I'kACfORS Il E('LA kA"fION
a i w I hereby aftinn m
Thal I n licensed under provision,ofChapter 1)
yaw Harou na•ncmg wilh Senioo 7000)el Uivixion 3 of(lie Ilminna and ISSUANCE GATE
r w z Rul'a»iuoa Code,. id my license is in lull fury,: (' ' BLDG ELECT. PLG. MECH.
z o y Lic n,' I/4'a�q_-Lic Nordic
n� ❑ ❑ ❑
m r w I1alc.Zf Conlmnur
¢w a OWNER-BUILDER DEC.AR CiN `
'A o a " BUILDING PERMIT
w 3 H I hereby a1Nnn that I am exnmp our [he Comnet.r i License MISC.- 1}n 0U(7H' TO ORD INFORMATION
r LL o j Law for the following Hasan.(Sec.7031.5,lumines,and Professions PERMIT ISSUANCE VALUATION E/FT.
Code:Any city or,-only which myuins a pennil[.ain>nrucl,alter, 10.00
R rt ¢ improve,demolish,or repair any rHL,ImL,prior ler its issuance,esu ELEC.CONTIL LIC NO.
oLL 1 Le uppcanl fur such pennil m Idle a signed slxlcnlcul all.[ W,A w -. ,the lim lie is licensed pursuant ler the provisions of the Cmitraelm's License TOTAL
ri > Law(ClmPter 9(cmnmcncing will,Seclion 70001 if Division 3 of thPERMIT TOe /�--
i TD Business and Pfufes,luila Code)or that he is Lxenpr Dmrcfr.mi and OTY. PLUMBING PERMIT FEE
a i-m Die basis for the alleged eirerqui , Any d.hlimr of Section 7031.5
i ;m by any uPplieant 1'-r a permit subjects the applicant to a civil peiully STORIES TYPE CONSTR.
-foul more than fivelmnd,,d dullars(S500L): ALTER-DRAIN&VENT-WATER (EA-) 5.00
O I,as owner"1'Ill,properly,or my employees with wages as
their sole compensation,will do the work,anBACK FLOW PROTECT. DEVICE
d the structure is nal 4,00 OCC.GROUP RES.UNITS
intended or offered for saw'(Sec. 1044,'Business and Professions � DRAINS-FLOOR,ROOF,AREA,COND, 5.00
Code:*File Contract.,',License Law dues nut apply ler an owner of
. properly who build,or improves thereon,and who docs such work FIXTURES-PER TRAP
n
himself or through his owemployees,provided Ihul such Inipr-vv- 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
mems are net intended or offered for sale.It,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
Or Ruproveutent is,old within ane your u1c-liydegiun.tireuwner-
builder will have the bnnlell of proving Ihal he did nor IniilJ err ins- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove lur 1-as- tier.1"1"). INDUSTRIAL WASTE INTER. 30.00 RES❑ I❑ ❑N ❑ D❑,
O I,as owner of the proPetlY.am Lxchaively contracting with
licenced contmclors to corotruc, the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00
and Professions Code:The Contracloi s License Law don nil apply ASSESSORS PARCEL NO.
to an"wrier of property wino builds or improve,thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
Continent 10,such projcLis with a COmlaCloAlo licensede,there pun..dRi In
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00
❑ I mn exerqu under Sec. ,0.&PC ' TRACT NO.
PARCEL NO.
reason WATER HEATERW/VENT 6.00
Owner Dale
WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that I have a Cetlilieme of consent t.xl4 insure,
or a eeridiente of Workers'crimpen,xtion Insurance,on u certil sed ZONING -TING SITE N0.
copy Herco'IS c. 00
Policy No.,l y _-
❑ Cerl d y 1 hereby furnished.
Z Z ❑ Cerlif yy- :ed ill tire Li msp•clion division. FIRE SPRINK ENERGY T2
0 Applican[ -A
448 MISC.- REFER TO ORD. YE] N� Y [] NR
� - CV IFICATE OIe EXEMPTION I'R MWORKIIRS' PERMIT ISSUANCE 10.00
LU D COMPENSATION INSURANCE PLG.CONIIL FLOOD ZONE A.L.U.C.
CL 0 LIC.NO, PLG
Z (This seulion need not he Lompleteel if the pe rt.it i, for ane TOTAL Y N� Y IV[]0 hundred dollars($1001 or less)
SL 1- mit is issllad1iat in I Shalllnol`.m moance of the work For wJo,mune Dlis per- OTY. MECHANICAL PERMIT FEE
"HOLY any p satin in any manner vs as t. FEE SUMMARY
O w become suhjed ler nine Workers Compensation Laws of l'alifomiu.
NOT Applicant
0 00 BUILDING r7 p
} NOT 1'O APPLICANT: IL all,, ,Taking mit Certificate of Ex- ALTER OR ADD TO M5.
ECH. k
I" Z cin Pliin.You the L become e. you to Ise Workers'Comedy wion APPLIANCE
pruvi,i"ns of dile Labor Cudu, you must forthwith comply wink 5.00 PLAN CHECK
U such provisions or this permit shall be devined revoked AIR HANDLING UNIT(TO 10M)CFAQ 4.00 FEE
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEISMIC FEE S
I hereby affirm Ihat there is a cumnmetioo lending agency for EXHAUST HOOD( r
rh ... rse
e Jim nuof the wink for which [Ilia pennil U is,su'd(SecWITH DUCT) 5.00
.
3097,CifN.RHEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
L
Lender i N:I.0
Lenders Address HEATINGUNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
. Icerhly that Have ueadlhisapplication and stale thad ltualh.ve VENTILATION FAN (SINGLE) 4.00
mlormution is correct. 1 agree 10 comply with all city and county
Ordinances and state lows relaling to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
hereby aulh"rixc represemulives of this Lily to enter upon the
above-mamiuned property for inspection purposes. 801 LER-COMP (Oval 100,000 BTU)SEE FEE SET. MECHANICAL
(We) agree ler save, imdenusily and keep harmless.the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and enpcntes which
muy in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
���gr�ngrunI I this permit. ythis pernril. y
i MECH.CONT. LIC.NO. MECN.
TOTAL TOTAL
Sign' •rc of APPIi_can[/C'onlmcl-r 61.00
OFFICE COPY �J
°i POST THIS CARD NEAR FRONT OF BUILDING
Pf.EMIT NUMBER
' _ 'IA CITY I OF 'CUPERTINO 16844
— INSPECTION DIVISION
. �� JOB INSPECTION RECORD
1
///{�f P-ERMIT E)PIRATION
'JOB ADDRESS_rnr (eco ' `a / r' �UNIT# _LOT# pERMIT:EXPIRES IF WORK
b '
OWNER . Q� Q 'VIA a A
CONTRACTOR (,O NOT STARTED WITHIN '
INSPECTION DATE INSPECTOR INSPECTION RECORD - 180DAYS OFPERMIT iSSU-
FOUNDATION 'ANCE OR 180 DAYS FROM
NOTE: LASTCALLEDINSPECTION. I
UFER _ - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION; p
CUPERTINO STANDARDS.
GARAGE SLABS "'" I '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB-
PLUMBING
NDERGROUND /SLAB PLUMBING
ELECTRICAL ISSUANCE!UATE
MECHANICAL 77-Q-67 ELECT PLG. MLLH.:
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �Q�^- _ BUILDING PERMIT
WOOD FLOOR - '"'d' INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL 1988 �r'/ � E
l PERMIT TO
ELECTRICAL ItyCUp /
Of - q• r .d
FRAMING - 0�100 / 1 t�I ��,s.
INSULATION STORIES~ TYPE CONSTR. eI
OCC.GROUP RES UNITS
^`- GP.LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT FLOOR AREA TOTAL ACREAGE .
ROOF NOTE:NO FINAL'INSP.SHALL BE MADE BEFORE
DIA
rPHRAGM - - THE CONSTRUCTION TAX IS PAID
n
auaOlNr,USE
ROOF SHEATHING _ RFs IND WN PBI On ,
P_ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. '❑ ❑ El F-11ID
ASSESSORS PARCEL NO
ROUGH SAN.#
- PLUMBING - ELECT.ENERGY
.
TUBS BSHOWER PAN � � � PLUMBING ENERGY � THACT NOPAHCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY - ACC,DATE ACC.FILE NO.
FRAMING ELECT,FINAL TEST
ZONING ENG,SITE NO.
. INSULATION PLUMBING
GAS TEST GAS
MECHANICAL FIRE SHRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ OF] CD "❑
' EXTERIOR SHEAR ELECTRICAL RELEASEFI.00DLONE ALUC.f
INTERIOR SHEAR FIRE DEPT. -
❑ NEI ` Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING . - -� -
INTERIOR-LATH TEMPORARY APPROVAL .BUILDING
SCRATCH COAT _ ELECTRIC _ PLAN CHECK
GAS -FEE' '
NO TAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE , 1
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED B Y BUILDING INSPECTOR. MICROFILM
o ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F�' ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING
o. PLEASE GIVE JOB ADDRESS WHEN PHONING.
.z — SEE PERMIT FOR EXPIRATION DATE MECHANICAL
4MPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY