15489 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
+ - BUILDING PROJECTADENTIFICATION - . PERMITNUMBER
aDI OINq APPLICATION & PERMIT t-'
ADDRESS
R/y�
�•� S_ S^ _ 2j'6/LJ/2_ LDING-ELECTRICAL-PLUMBING-MECHANICAL /6 '15 489
OWRER's -- + PLAN CHECK VALIDATION
> r�/'qL�
QTY. ELECTRIC.PERMIT FEE -1
11 V /L- f PHONE` `
I � CONTRACTOR'S
NAME( UTLETS-SWITCHES-=RECEP 10,00/1.00
_ �.JND11-ng C/E- S� 2�dcuo. �/S7 7 LIGHTING FIXTURES 10.00/1.00 '-
roNTRAc7oRs _ APPLIANCES-RESIDENTIAL 4.00
/� 6 I'74'2ct PHONE 3 PANELS 10.00 + DATE OF APPLICATION '
ARCHITECT + - PLAN CHECK FEE P.C.NO.,.
- - OR - PANELS (OVER 200 AMP) 20.00
ENGINEER'
' LIC.No. - SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
EMP. METER OR POLE INS. 20.00
APPLICANT'S
MOTORS SEE FEE SCH. .)
'✓
ADDDRESSDRESS
SERVICE CHANGE - 20.00 /- •-
0 0 o LICENSED D CONTRACTORS DECLARATION j /�� 'f .
a U I hereby affirm that I am licensed under Provisions of Chopter 9 - Ibb ANCE DATE _
N a -N (commencing with Section 7000)of Division 3 of the Business and SLOG. ELECT]! PLG. MECH.
r N z Professions Cn -and any license is in full for p rl effe,a_-
o'y wW License Class Lie.Number 57 7 f T _ .� a I,
DateCnntmclor_ u'1,16
Q yf J �' '� -y/jt.
w a OWNER-BUILDER DECLARATION / BUILDING PERMIT
i °a " MISC.- - REFER TO.ORD, '" - INFORMATION
C ; n'N hereby infirm that I am exempt from the Contractor's License J
p1u ° ¢'- Law forlhe followingreason.(Scc.7031.5,Bushlcssand Professions VALUATION $)FT.
L - J g PERMIT ISSUANCE - '' 10.00
Code:Any.cityor County which requires a permit to construct,alter,
qq11 - q.
Q a
improve,demolish,or repair any structure,prior o its issuance,also ELEC.CONTR. LIC.NO. ELEG�al" i}I Ut1"'•'
u iL m LL requires the applicontTor such permit to filed signed statement that TOTAL
w he is licensed pursuant to the provisions of the Contractors License PERMIT TO
Law(Cllapter'J(commencingwilh Srclion 7000)nf Division3ofthc s// ��,('��
io Business and PR:fessions Code)or that he is exempt therefrom Ed QTY. PLUMBING PERMIT FEE 1 /��.' `• o
or E_ the basis]or the alleged exemption.Anyviolotion of Section 7031.5 - -
n by any applicant for u permit subjects the applicant too civil penalty - d STORIES', TYPE CONSTRY
ofact more than five hundred dullars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 -
•,❑"I,as owner of theproperty, t
e my,and t employees rust re is not
- BACK FLOW PROTECT. DEVICE . 4,00 OCC.GROUP RES.UNITS
'
their sole compensation,will.do the work,and the structure is mol
intended or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
code:;'rhe Contractor's License Law does not apply to;m owner of
propetty who builds or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
�. himself re through his own employees,provided that such improve;
or
merits improvnot ement
is sold oroffered
on year
o l completion,
(he the o urr- GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of Cliehdid cot the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00
builder will have the ale.). rot proving the he did not build or inry BUILDING USE
pave for as owner Of sale.). RES IND CON PB Other'
❑ ed as owner the property,um exclusively. 7044,contracting s INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ .❑ ❑ ❑
licotised contrumors m construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V:8. - 6:00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to as ownerof property who builds nr in,proves Ihemon.and who LAWN'SPRINKLERS-,OVER 5(EA.) i, 1.00
contracts for such projects with a contmetmos)licensed pursuant Iii SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License law. TRACT NO. PARCEL NO.
❑ 1 an,exempt under Sec. B.&P.C.to this WATER HEATER W/VENT 6.00
reason
Owner ��yy ' Lane WATER SYSTEM - `5.00 „' ACC.DATE ACC.FILE NO.
�O//W'ORK.RIC MPENSA'1'IONDlILA RATION WATER TREATING EQUIP. .5.00
1 hereby affirm that I hove n cerltficate W consent to set(-insure, -
r a,certificate.of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,1 b.C.). 77�77 ..`},
I'oycyy�yIee Company-CIO-L �•t "
Q �C,Rlfied copy is hereby furnished. - FIRE SPRINK ENERGY L94
Z Z '" ❑ Ccrtifle y is d ill 11 � y inspection'divisiod. -
O Applicant MISC.- ', REFER TO ORD. y ❑ N❑ v ❑ N❑
H rn - PERMIT ISSUANCE ,, 10.00 ,
UJ - CLR'1'I PIC COM OPG •MOTION RAN WORKIiRS' FLOOD ZONE A.L.UA.
W COh1PISNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. '
C' O (This seclion''nced-nol be completed if the.permit is lir one. TOTAL V❑ - NE] V ❑ N❑
LD Z hundred dollars IS 100)or less.) - - _ -
) O',. 1 certify (lint in the performance of the work for which this per- QTY. MECHANICAL PERMIT •F.EE - FEE SUMMARY
mil is issued,I sha11 not employ any person in any manner so as 1n ,
_ w become subject to the Workers'Compensation Laws of California. v
Date Applicant ' BUILDING 3�J
} N NOTICE TO APPLICANT: If,after making this Cenificme of Ex- ALTER OR ADD TO MECH. 5.00
- Z caption,you should hearme subject to IIIc Workers:Compensation APPLIANCE :- 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE vy
U: such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=11F.M.) 4.00
c• - CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT OVER 10=C.P.M.) 6.00 SEISMIC FEE
I
H. I Golebyaffirm that illere is a construction lending agency for EXHAUST HOOD (WITH DUCT)_ 5.00
the performance o1'the work'for which this permit is issued(Sec. MICROFILM -'
3077,Civ.C.). HEATING'UNIT1TO100,000B.T.U.) 8.00 '
Lende'r's Nude _ HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify,that l have read Illi,s applicatiod and stale that the above VENTILATION FAN (SINGLE)' - .4100
informationaesn correct. I agree o comply with all City and county - PLUMBING
and sate lows relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B:T.U.) 8,00
hereby authorize representatives of"Ibis city to enter upon the BOILER-COMP love,100000 BTU)SEE FEE SCH. MECHANICAL '
above-mentioned property for representatives
inspectionon'th purposes.
.'(We) agree to save; indemnity mW keep harmless the City-of MISC.- '' - ,REFER TO ORD. ,
-- .-Cupertino against liabilities,judgments, costs OW expenses which CONST.TAX
may in any way accrue against said it nn - $$UAN CE 10.00
o
'anti/ f th permit. MECH,CONT. LIC.NO. , -\ MECH._ TOTAL
�/ TOTAL 3 �(F�
Signature Of.4 JAierntico • Uate
OFFICE COPY .
POST THIS CARD NEAR FRONT OF BUILDING
' - PERMIT NUMBER' - I
CITY -OF, CUPERTINO 15489 .
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT,EXPI RATION
a JOB ADDRESS 21552: Regnart 'Road UNlrtk - _Lor#
' PERMIT EXPIRES IF WORK '
OWNER „I).(]_1[I GeeCONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION'RECORD - 1BODAYS OFMERMITISSU-''
FOUNDATION - ANCE OR 180•DAYS FROM
NOTE: 1 LASTCALL'ED INSPECTION. '
UFER - , 'ALL GRADING AND DRAINAGE SHALL BE'1NSTALLED
PREGUNITE • _ TO COMPLY WITH THE APPROVED PLANS AND CITY,OF +PERMIf VAIIOAnuN ,
CUPERTINO STANDARDS; +
.. .1. 'GARAGE SLABS - !r -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
- ` UNDERGROUND /-SLAB
PLUMBING.
ELECTRICAL'
ISSUANCE DATE
.i MECHANICAL ,Bun; ELer.;., PLC. MECH.
• 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - 'L r •,•;••- BUILDING PERMIT
WOOD FLOOR - - y�'� Oh rU!;, INFORMATION
PLUMBING VALUA110N S/FT.
•,.
MECHANICAL - :w, :7
ELECTRICAL, `. relvMn rO
FRAMING
INSULATION - - STORIES TYPE CONST R.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .,, '
ROOFS"
vT_r I.pOF AREA, rolAL ACRLAGF
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
p BUILDING USE
ROOF SHEATHING _
RES. IND CON Pe Go. ,
APPLY NO ROOFING'UNTIL ABOVE HAS'BEEN SIGNED FINALS'` DATE . "INSP. - E ❑ E ❑ ° ID
ASSESSORSPARCEL NO.
ROUGH' " SAN:a
PLUMBING ELECT,.ENERGY
IHACINO. PARCEL NO,
TUBS 8 SHOWER PAN - PLUMBING ENERGY '
' MECHANICAL : MECH:.ENERGY-
ELECTRICALACC,DATE ACC.FILE NO,
BUILDING ENERGY ,
FRAMING ELECT.FINAL TEST '
INSULATION , . PLUMBING , c .ZONING ENGa SITE NO.
GAS TEST, GAS -
Y'I
MECHANICAL FIRE.SPRINK' ,. ENERGY F24
' +• `
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING , ` ❑ N❑ -° ❑ ',_No
FLOOD ZONE A,LU,C`
EXTERIOR SHEAR ELECTRICACRELEASE
INTERIOR SHEAR FIRE DEPT. v❑• ,N❑ ,`" L NO
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH " BUILDING —
INTERIOR LATH - - TEMPORARY APPROVALS 'BUILDING, •
SCRATCH COAT ELECTRIC` :PLAN CHECK '.
r: " .. GAS - • FEE l
/ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ;; 13
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
n
..ARRANGE FOR INSPECTION BY PHONING 252-4505, . " ` r ELECTRIC
OUJ� ONE'WORKING DAY-BEFORE 'REQUIRED INSPECTION,
PLUMBING
z
- PLEASE GIVE;JOB'ADDRESS WHEN PHONING'.. -
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
- S . CONST.TAX
I ,IMPORTANTI'
PLEASE.READ REVERSE SIDE BEFORE
` CAILING'FOR FINAL INSPECTION. TOTAL
OFFICE COPY..:. :
a-= I