8442 Arr LlUAIN I I U I-ILL 11\1 I lulu Vill I hIN IiEO LINES - USE BALL POINT PEN ONLY
�. BUILDING PROJECT IDENTIFICATION RMIT NUMBER
pyE lNG APPLICATION & PERMIT (j��
r A�Ogsss •.• _✓ U
K� 'ah"no ak4 UILDING-ELECTRIGHL`.'='PLUM6ING-MECHANICAL
NANEH S /1 �i
NAME `//�i� /.l
fir,l`c 1/ ��OsN j c�yC-'7CI OTS:• ELECTRIC PERMIT _ `:FEEi^ PLAN CHECK vquonnoN
G YP /ISc�c' 1e I i0 } n
coNTgncrogs OUTLETS-SWITCHES-RECEP 1000/100 l' \
NAME
CONTRACTORS LIC,No. LIGHTING FIXTURES 10.00/1.00
ADDRE 'OOgsss PPLIANCES-RESIDENTIAL 4.00
ARCHITECT
PHONE PANELS 10.00 DATE OF APPLI CATION
N
OF PANELS (OVER 200 AMP) 20.00 PLACHECK FEE P.C.N0.
ENGINEER
AELIC.No. SIGNS TRANS. 3.00
NG.
ADDRESS GRE55 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS rs MOTORS /LP
AOOHEss SEE FEE SCR.
Z
SERVICE CHANGE 20.00
D o (� (/
F o a LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00 J
a i n1 hereby affirm that 1 -111 licensed under provisions of Chapter9
(co
w ¢ w mmencing with Section 7000)of Division 3.f the Business and ISSUANCE DATE
H a Professions Code,-nd my license is in full toren and cIf,,,, VLDG. I ELECT. 1 PLG. MECH.
O 0=C License Closs Lic.Number
A h_ Dale COnlraclor ❑ ❑
¢ E J
E e, w 4 OWNER-BUILDER DECLARATION } BUILDING PERMIT ,;,,,
W 3 LL m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD yt•>'?''IN FORMATION
F LL o¢ Law for Lila following reusvn.(Sec.7031.5,Businessand I'rol'essions PERMIT ISSUANCE VALUATION $/FT.
E a COJe:AnY city or cuunlywhichrequiresa permilloconelruc,,all,, 10.00 � O�M
Q Q ¢ IlnplOVe,dL'1110I6I1,Ur repair ally structure,prior IO its 11 L...i",also 15 LEC.CONTR. LIC.NO. ELEC. d V v
O¢ reyuims the applicant(W such pernlil to file a signed xlalcmmlt Ilia, TOTAL
n w m" he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
La l( omm �c...g with Section 7000LIf Division Sul the
y i 1.
o Business and I r 1 'sl l l'Code)Or,h-(box exempt iho,o rom and OTY. PLUMBING PERMIT ;FEEy`,
¢ r o (he basis for tile alleged exunpllml Any violation ul Seella17U31.$ STORIES
( R. puwlry ALTER-DRAIN&VENT-WATER (E TYPE CONSTR.
o- 3 °I by any applicant for a pernnl subiects thea llicant loo Civil
of not more than five hundred tlollor SSOOIJ: EA.) 5.00
❑ Las owner in the p ill dote my unployees wish wages us
their sole compenxmion,will do the work,and the structure is not BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
intended or offered for Sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Conlmctor's License Law does not apply l0 an..no,of
properly who builds Or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00
himself or through his own employees,provided that such improve. 50.FT.FLOOR AREA TOTAL ACREAGE
ments are not intended or offered for sale.Il',however,the buildillg GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
Or Improvement is sold within one year of completion, the owner-
builder will have the hurden of proving Ilia,he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.), 2.00 BUILDING OSE
P(uY'to,
,as. artoftho.J. - INDUSTRIAL WAS TE INTER. 30.00 s IND CON PS Olhe!
XI d-s owner of,he properly,am exclusively, 7044.8 with ❑ ❑ ❑ ❑
licensed contractors to le Contra the project(Sec. 7044,Business LAWN SPRINKLERS•1 INC 5 V.B. 6.00
and Professions Code:The C'ontractor's License Law docs not apply ASSESSORS PARCEL NO,
to an owner of property who builds or improves foreon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 r
contracts for such 1`1010cts With a contractors)licoawd pursuant 10
(he Contractor's License Law. SEWER•SANITARY-STORMEA.200tt/10.00 TRACT rvo. PARCEL NO.
❑ 1 am ex• ylt under c. B.&P.C.for this
reason_ ELj( -' WATER HEATER W/VENT 6.00
Owner Dale/ _ . WATER SYSTEM
5'00 ACC.DATE ACC.FILE N0.
ORKEftS'COA1PIiNSA'fION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby uffurn Drat I have a Cerlific-le ufcOmenl m self-insure,
or a cerdri'aa of Workeri Compensation Insurance,Or a certified ZONING
c-PY Werelll ISO.3800,Lab.C.). ENG.SITE NO.
Policy No.___Cnntpwly
O ❑ Ceriited copy is hereby furnlshed.
Z 2 ❑ Certified copy is tiled will, the city inspection division. FIRESPRINK ENERGY T 24
� O Applicant MISC.- REFER TO ORD.
W Y� N� Y � NEI
OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
W > COMPENSATION INSURANCE FLOOD ZONE A.L.U.C.
CL O PLG.CONTE. LIC.NO. PLG.
This section need not be completed if the per nlil is for one TOTAL Y N�
C::) ZO hundred unred dollars($100)or IessJ Y ryo
1 certify that In the performance of the work for which(his per. °"
LL F- ImI Is issued,1 shall not cul to an OTY. , MECHANICAL PERMIT ;y' FEE P sF ea rd-FEE�$UMMARY t t*G^t;Y'
U tiny YPcrson in any manner so osm ..
become subject to the Workeri Conlpeosation Laws ul'Calil'omia.
ED DOLL ICANI-rel . 5.00 BUILDING 31 3-0
} OL NOTICE TO APPLICANT: Ifil,alter making This Certicatn of Ex-
ALTER OR ADD TO MECH
)- 2 em Ptian,you should become subject to the Workeri Compensation APPLIANCE
Provisions of the Labor Code, you most forthwith comply with 5.00 PLAN CHECK
U such provisionsor this Penni(shull Decorated revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10W0O6M.) 6.00 SEISMIC FEE
1 hereby affirm Ihut (here is- construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
tile (a
e perrmance OI'the work for which this permit is issued(Sec. MICROFILM
Lender's Name
Lender's Address HEATING NIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that have read this application and state that the above VENTILATION FAN (SINGLE) 4,00
information n correct. I agree to comply with all city old county PLUMBING
oNinances and n-le laws rel-ting m building Construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city ,o enter upon the
-bove-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to mve, indemnify and keep hurtles, the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs and expenses which
granting Of this pemliL
tea in any way accrue aRalllsl Said Clly in Coil equeuce Of[Ile PERMIT ISSUANCE 10.00 CONST.TAX
MECH,CCNT. LIC.NO. MECH,
Sil18 YP� TOTAL 'TOTAL .3�
Si twe ol'APPlicarn/C'ontruulor dale r
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
✓l' PERMIT NUMBER
r CITY OF CUPERTINO
INSPECTION DIVISION 44
JOB INSPECTION RECORD
PERMIT EXPIRATION '
JOB ADDRESS A16 E O ?rB"'hVidow G7. 'UNIT# LOT#
" - .F PERMIT EXPIRES IF WORK-
OWNER V4-.; �U/yC CONTRACTOR - ISNOT STARTED WITHIN
- INSPECTION DATE' INSPECTOR- I INSP CTION RECORD 180DAYS OFPERMIT ISSU-
FOUNDATION 91113 4 _ . ANCE OR 180 DAYS FROM
d-
LIFERo LAST CALL ED I NSPECTION.
• � �.
PREGUNITE
.` PERMIT VACIDnnoN
J
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . ,
UNDERGROUND /SL`AB " *�
PLUMBING I t./
ELECTRICAL' - - ' Is uANCE TIEMECHANICAL I:' - - BLDG. E ECT PLG. MECH.' !
❑ El , ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED V BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION $IFT_
'
MECHANICAL- - `A1
ELECTRICAL PERMIT TO
FRAMING
INSULATION s Es EcomsrR.
` OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF ' SO,FT.FLOOR AREA E.TOTAL ACRE AGE
K
GM - - - - - -
BUILDING USE
RES IND- CON PB OIM1pr
rNO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑' ' ❑ ❑ '
ASSESSO'ou EL NO.
- ROUGH, ,
G'
. O , TRACT NO. PARCEL NO..
ICAL ..
ELECTRICAL FINALS , DATE INSP. ACC.DATE Acc.FILE NO,
FRAMING 3 SAN # -
INSULATION -- PLUMBING zowmc ENc.SITE No. '
_ GAS ' - . .
MEDHANICQL^ FIRE SPRINK, ENERGY LIG
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED 1HEATING - •" - Y ❑ ♦N❑ Y ❑ N❑
. .
' LATH—INTERIOR - - ELECTRICAL -
-FLOOD ZONE A.LU.0
LATH—EXTERIOR FIRE DEPT. `"❑ N0. Y ❑ N❑
SHEETROCK .. GRADE F.EESUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR 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 NOTPERMITTED UNTIL BUILDING.FINAL ISSIGNED BY BUILDING INSPECTOR. ,MICROFILM
ARRANGE FOR INSPECTION BY PH=INSPECTII
ELECTRIC
0� ONE WORKING DAY BEFORE REQUPLUMBING.
Z PLEASE GIVE JOB ADDRESS WHEN SEE PERMIT FOR EXPIRATMEcryANICA� '
IMPORTANT! CONST.TAX,
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL,INSPECTION.
• OFFICE COPY .. " .