14408 APPLICANT TO FILL IN INFO RIVIATION VVITI-IIIV RED LINES - USE BALL POINT PEN ONLY
4UI LDING PROJECT I DENTI FICATI ON PERMIT NUMBER
TaUILDING I APPLICATION & PERMIT
ADDRESS
L BUILDING - ELECTRICAL-PLUMBING -MECHANICAL 14408
UWNCI"
PLAN CHECK VALIDATION
TV. ELECTRIC PERMIT FEE �I//�r,❑y1\
• V! PHONE
NACT
N" OR, UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
noDeR sTORs A/' PPLIANCES-RESIDENTIAL 4.00
pN�HONE p PANELS 10.00 DATE OF APPLICATION
OR RCHITLCT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,L'.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ADDRESS OftENE, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
Z11 TEMP.METER OR POLE INS. 20.00
ADDRESSTv MOTORS SEE FEE SCH. `�
SERVICE CHANGE 20.00 P{+wt `Yy"•�r-r�"1
O a z J
F O a LI('I:NSED C'(INl'12A("I'ORS DECLARATION
a Z 6 I herebyal'l inn that I sent licensed malar pruvision,,d Chapter
H Q (ecrumincing with Section 7000)of Division 3 of Ilse Busincss and 'Z nJa ISSUANCE DATE
N 2 I'nNessiuns
C. n try license is in full fume ,it a Ib-I `BLDG. ti LECT J PLG. MECH.
' 0 . - License Cluss_G- s7_Lio.Nunlber_a.y� � ",,•71 rlv Q
4�,,�r Dale_«--_sJA_(L7_Conlractar u l4
m W u OWNER-BUILDER OECLARA"PION BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
W ; e.y I hereby sell(Erin Ilial I ant uxenlpl from Ilse Contractor's License -
u O v, Law for IIfe following reason.(See.7031.5,Busincsand Professions `ALUATION $/FT.
� - Code:Any citYorcounty which requires a pennil toconstruel,aper, PERMIT ISSUANCE 10.00 Vim- S
G, ¢ improve,demolish,or repair any structure,prior to its issuance,also .ELEC.CONTR. LIC.NO. ELEC. Lam'
oO LL requires the applicant for Such Period to IIIe a signet(staicro of that TOTAL ,3�
A w y m he is licensed pursuant 14)the Provisions of the Contractors License PERMIT TO
rz > Law(Chapter 9(commencing with Section 7000)of Division 3 ul'the (�C//F �, ./ r
4 x o the basis
and professions('ode)or thin he it Cion of Section 70 and GTY. PLUMBING PERMIT FEE V g r y'�' / Ce--
L, I- o the basis for lire alleged exemption.Any violation of Section 7071.$ STORIES TYPE CONSTR.
L, ; m by any applicant fur a permit subj"ts the applicam tua civil penalty
of not more than five hundred dollars(S500),): ALTER-DRAIN& VENT-WATER (EA.) 5,00 � •V r-lL
❑ 1,as owner of the properly,or my employees will,wage's as /"V
BACK FLOW PROTECT. DEVICE 400
their sole Compensation,will do the work,and file .
structure is not OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'Iliac Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOORAREA TOTALACREAGE
Ilinoutf or Through his own employees,Provided that such inlPnna
menu are not intended ur uttered for sale,IL l,awcver,lire building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or inpth
n,iet: cut is sold within 0110 year of coinplelion, the owner GAS-EASYSTEM-OVER 4 (EA ) 2
builder will have e harden of proving that h . . .00 e did not build or i... BUILDING-GS I-E
prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner of the property,am exclu,bely co ninclinB will,
licensed Contractors to cmnilrutl life pl'nju'l(Sec. 7044,IlusincssLAWN SPRINKLERS 1 INC 5 V.B. 6.00
unit Professions Code:Tim Contractor's License Law does not apply' - ASSESSORSPARCEL NO.
In an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts lin such Projects with a conlructons)licensed Pursuant l0
the Contractor's License•law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I all exempt under Sec. ,li.hl'.C.fur this ItualmI WATER HEATER W/VENT 6.00
Owner Dal`' WATER SYSTEM 5.00
ACC.GATE ACO.FILE NO.
WORK Ii RS'COMI'IiNSATION UGCLA RA1lON WATER TREATING EOUIP, 5.00
1 hereby affirm, that I have a carliftcall,nt Commw to self-insure,
or a ccritical,of Workers'(omperoalion Iluurance,ser a ceftil'ieJ ZONING ENG.SITE NO.
im' } 491nLpaain)rC-.1),iSs
O ❑ Certified 7y/ILY1fNM� _ L- 1)
Re -
Copy is hereby I'umishcJ.
Z Z Af Certified y is file will the cily inspection division. FIRE$PRINK ENERGY T]0
CC OAPPhcanl � MISC.- REFER TO ORD. Y [] N❑ Y � N❑
CER'I'IFICA'FF 017 I:XEMITION h OM WOI(KIi RS' PERMIT ISSUANCE 10.00 /d FLOOD 2orvE A.L.u.c.
LU > CON114 NSATION INSUIIANCI. PLG.CONTR. u0.NO. _
C' fl'IRS sect ion nccJ nal be conlplClcd ill tlm Pcnnit if Or one T TALA Y N Y ry�
Z lumdied dollar,IS 100)or I,,,.)
L) g 1 cerlilY that in the purl uroance of Die work for which this per CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is iss,fed,1 Shull not enl Ploy any person in any runner Sous to
O W become subject W the Workeri Compensation Laws of California.
G. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING L) f�
} 2 NOTICE 'I'O API'L Appli. If,seller making this COrlil Ecorse or Ex
H - en,ption,you should hecome subject to the W.Rkers'CompOn,uliou APPLIANCE 5.00 PLAN CHECK
provisions of file Labor Code, Yau must forthwith consply with FEE
U such provisions or this pennil stiall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"C.F.M.) 6.00 SEISMIC FEE L '
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
IIIe Perfonnince of the work fat which Ihis pennil is issued ISec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
• I certify that 1 have read this application and stale that file above VENTILATION FAN (SINGLE) 4.00 -
information is correct.I agree to comply with all city and county - PLUMBING
ordinances and stale laws relating m holding Construction, and BOILER-COMPO H.P.or 100,000 B.T.U.) 6.00
hereby authorize rcprescntalives of this oily to enter upon the BOILER-COMP IO ver 100,000 BTUI SEE FEE SCH. �ZLC,
above-menlitned property for inspection purposes. MECHANICAL r -
(We) agree to Save, indemnify and keep baroness the City of MISC.- REFER TO ORD: /S�
upertino against liabilities,judgments, costs and expenses which it CONST.TAX
may in un,�7 I accrue uµainsl suit City in consequence of IM PERMIT ISSUANCE 10.00 Q _.
rmOing of Is Inil. . MECH.CONT. LIC.NO. MECH,
TOTAL o / / TOTAL �/� SS^
Signal re ul,\pp icon(/C'outraclor Uatc V
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION 14408
r JOB INSPECTION RECORD t
� r
PERMIT EXPIRATION
JOB ADDRESS 21700 - RAINBOW COURT UNIT it--LOT;Et
- PERMIT-EXPIRES IF WORK
OWNER DAVID .PHIPPS CONTRACToRAQUARIUS POOLS IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- -
FOUNDATION ANCE'OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED q
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS. �1
�,v
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL -es, fit ISSUANCE DATE
MECHANICAL - BLDG. FuECT Pt.(;. Mi:CCIH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION V T-,
PLUMBING � � - ^v>:
.MECHANICAL
ELECTRICAL PL.NRF TO
FRAMING
INSULATION STORIES TYPE CCASTE.
OCC GROUP RES UNITS
;PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,I T,FLOOR AREA TRIAL ACRIAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . .
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE .
ROOF SHEATHING Hes IND CON PB on..•,
' 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE INSP. 1:10 El 1:1E-
ASSESSORS PARCEL NO,
ROUGH SAN.p
PLUMBING ELECT.ENERGY
TRACT N2 PARCEL NO.
TUBS&SHOWER PAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY '
ELECTRICALBUILDING ENERGY ACC.DATE ACC.FILE NO
' FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO.
INSULATION - - PLUMBING -
GAS TEST• - GAS
- • FIRE sPRINK ENERGY74
MECHANICAL �?.C�_S-'�'- I ] T. N
"
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � �
ELaoD mNr: A.L u.c.
' EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y "❑ Y ❑ "�
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
Q"'
INTERIOR LATH, TEMPORARYAPPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
J GAS FEE
'- .NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY _ SEISMIC FEE /Sj
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
Lu
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0 PLEASES GIVE JO ADDRESS WHEN ING DAY BEFORE UPHONINGIRED PECTION. PLUMBING
g Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL + ""
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY