15717 or
APPLICANT TO FILL' IN INFORMATION WITHIN.RED LINES.='USE,BALL POINT PEN.ONLY
.� BU I LDING PROJECT-I DENTI FICATION - PERMITNUMBER '
�I/� °e"s¢¢° 1^ "[ . -APPLICATION & PERMIT 15717
- 2 ,IWf G� . Rd - BUILDING - ELECTRICAL-PLUMBING=MECHANICAL
�+ NWNERS �s7� I -
PLAN CHECK VALIDATION
`IY r _6wO-Z IZ -_ DTV. ELECTRIC PERMIT FEE '
rfCC a PHONE
CONTRACTOR'S - - -
NAM, OUTLETS-SWITCHES-RECEP 10.00/1.00 I
_ LIC.No. LIGHTING FIXTURES 10.00/1:00 '
' -- - CONTRACTORS- • ' - 'APPLIANCES'-RESIDENTIAL ': 14:00
• ADDRESS ,
PRONE , PANELS 110.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO. "
OR _ PANELS (OVER 200 AMP) 20.00 ,
ENGINEER '
ue.No. - SIGNS TRANS. '3.00 -
ADDRESS ENG. - - SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. r, 20.00 - -
ADDRESSrs - MOTORS-,, - SEE FEE SCH.
00 •I:ICENSLU CONT« e -
- : SERVICE CHANGE 20.00
RAGI ORS DECLARATION
Ai w 1 hereby affirm that I am licensed under Provisions of C1,41c,9 ' ISSUANCE DATE
w C y t (commencing with Section 7000)DGDiviwn 3 of the Business and �. y •+ BLDG,. ELECT. PLG. - MECH.
F 0 z Ifol'essions Code,and my license is in full force and effect' ❑ ❑ ❑
z 0 w License Class I Ie Number
o m � Date Cry lo" ,e
< m 5 4 !: O - BUILDING PERMIT
¢ aw1ta , ' OWNER-1{UILDIRUI CIARA710N % INFORMATION
w ; u r I lathy allirm that I mri exeml l from the Conl ractor's Llcense MISC - REFER TO ORD
u O¢. Law lot the following reason.(Sec 7031 5,Bustin mond Professions - VALUATION SIFT.
- PERMIT ISSUANCE 40.00
Cotte:Any city or county which requires o Permit to construct,alleq -
¢ te ¢ 0 improve,demolish,or repair any'structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
- 0 M requires:the applicant for such permit to file a signed statement that TOTAL,
n w m" he is licensed pursuunt,to the provisions of the Contract.,',,Llcense ` T PERMIT T�O/J7�,
H a Law(Cliopler9(commencing with Sechlon7000)of Division Sof the - - !N/fix �.Jk'./"J O(��
3 1 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING'PERMIT FE
r m the basis for the alleged exemption.Any viilalion of Section 7031.5
n5o2 by'any applicant lox a permit subjects t he applicant In a civil pent l ty n STORIES TYPE CONSTR.
ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(55001.):
❑ I,as owner cf the m
property,or y employees with wages ns BACK FLOW PROTECT. DEVICE - 4:00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not -
-'- intended or offered for sale Sec. 7044, Business nand Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00 .
Coda:The Contractor's License Law duns al apply to m,owner.I'-
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP ' '5.00 so.FT.FLOOR AREA TOTAL ACREAGE
himself m outthroughto his own employees,provided that such improve.
me ulsuovnicut i s old ,,thelld within
year
ll',miletion the budding ' GAS-EA.SVSTEM-11NC;'40UTLETS 6.00
or lder will have
sold within one year of completion;the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or inti- BUILDING USE ,
prove for purpose of sale,). INDUSTRIALWASTE'INTER'. 30.00 RES IND CON PB Omer
30.00 1,as owner of the property.am exclusively comractor,will ❑ ❑ ❑ ❑ ❑, i,
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 gSSESSORS PARCEL NO. -
I and l'mfessiens Code:The Coil ector'x License Law rice,not apply -
toanowner.of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5IEA.) 1'.00
contracts for such projects with it contraclorfsl licensed pursuant to SEWER-SANITAR V-STORM EA:200ft/10.00
the Contractor's License Law.. TRACT NO. PARCEL NO..-.
❑ Iarney�ayrpl un •r Scc. �B.&P.C.�for this WATER HEATER W/VENT 6.00
reason, �,1�,
Owner r✓ V n/.n / Late7 �I ,.
-o-�sJ- v�-,/-cv- WATER SYSTEM ': 5.00 ACC.DATE ACC.FILE NO,
WORK Ii RS'COM PENSATION DECLARATION WATER TREATING EQUIP, ' 5.00 '
I hereby affirm that I have t certificate of conscol to sell'-imure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof fSec.3800,'LaLC.l. - -
Policy No. Company
Q ❑ Certified copy is hereby furnished, FIRESPRINK ENERGY T-24
.Z'Z ❑ Cerified copy i, fled with Ilse city in,pection division. _-
O Applicant '^p MISC.- REFER TO ORD. y [:] N❑ v ❑ N❑' .,
N CIiR'I]FICA IF.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.-
.LU 5 1 COIJPHNSA'1'ION INSURANCE PLG.CONTR. LIC.NO. PLG.
D' O (This Section need not be completed if the permit i% for one - TOTAL Y❑ N❑ Y ❑', N❑
Z hundred dollars IS 100)or less.)
U O ' 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE - FEE SUMMARY
LL-p- mit Is issued,I shall not employ any person in any manner se as to
U W become subject to the Workers'Compensation Laws of Culi1'ornia. r - -
0. Date Applicant BUILDING
} to NOTICE '1'O AI'I'LICANT: IL:titer looking Ibis Cor il'ic:uc.of liw ALTER OR ADD TO MECH. 5.00 s
emphion,you should become subject In the Workers'Compensation APPLIANCE 5.00 PLAN CHECK '
provisions of the Labor Code,.you,must forthwith comply with FEE
U such provisions or this permit sla l be deemed revoked, AIR HANDLING UNIT(TO 10)000 C.F.M.) 4.00 '
` CONSTRUCf1ON•LENDING AGENCY AIR HANDLING UNIT(OVER IO,000C.RM.) 6.00 - SEISMIC FEE ITO'
I hereby affirm that'there h0ti con,trucliun lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MItCR0 ILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
_'- Lender's Ami " HEATI NG UN IT 100,000 B.T.U.)9.50
Lender's Addrness ELECTRIC _
Icerlil'y that l lEve read this application and state that the above VENTILATION FAN (SINGLE) 4.00 -
information iscorrect,I agree to comply with all city and county BOILER-COMP(3 H.P.Dr 100;000 B.T.U.) 6.00 PLUMBING
�k ordinances and slate laws relating to building-construction, and
hbove-mentllorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEE 6CN. MECHANICAL
above-memioned properly for inspection purposes.
(We) agree Ito save, indemnify and keep limmless'.,the City of MISC.- REFER TO ORD:
Cupertino against-liabilities;judgments, costs and expenses which PERMIT ISSUANCE - 10.00 - CONST.TAX'
may
i�"2Taiost sad City in conwquen of therantiMECH.CONT LIC.N0. MECH. +
TOTAL 'ISign, amt/Cool r I? _ TOTAL
OFFICE COPY
POST THIS CARD NEAR FRONT OF.BUICDING'
' - - PERMIT NUMBER
CITY .OF CUPERTINO. 15717
'INSP,ECTION DIVISION
JOB-INSPECTION RECORD J.
- - PERMIT EXPIRATION
-1 c�� s .. •
'GS . ,
/ � n
JOB,ADDR ESSP - � ' UNIT# _.LOT# •, '
;' + ' •, .- PERMIT.EXPIRES IP WORK?
owrveR" %,�.�;.. LuO�,(JZ CONTRACTOR ISNOT STARTED WITHIN;
.INSPECTION .DATEINSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU-
FOUNDATION ' '
ANCE OR'180 DAYS'FROM
• �.. - NOTE. '+ LASTCALLED INSPECTION. ,
UFER - r]• -ALL-GRADING,AND DRAINAGE SHALL. BE INSTALLED
'P.REGUNITE•'! TO COMPLY WITH THE APPROVED'PLANS AND CITY OF PERMIT VAI.111Ar1DN
CUPERTINO STANDARDS:., ,
GARAGE SLABS '
POUR NO CONCRETE UNTIL ABOVE HAS,BEEN SIGNED S 'p�,���. Ij:N'� ;' �PfN-
UNDERGROUND /'SLAB'' U'vsSYRI RS `LiF+' tr , rui
PLUMBING'. -
- ELECTRICAL it _ � ISSunNCE UA TFy`
MECHANICHL 'BLnc.., ELF'CT .. PLG' MCC..
S a1Pzlt�A �� Q ❑. ❑ ay
-
.. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED VS+�-i,R.� '�estepr�i'� - - . BUILDING PERMIT
- �. INFORMATION
WOOD•FLOOR O7: Tc.. \ ,'1l=BY `4
PLUMBING - -� r• p® UATION ',S/FT.
_ MECHANICAL .' s n �� 7•�� .Fi LL.:;,
ELECTRICAL _ J' PERnur To
FRAMING ' 1!� � ' �/V/C2 �Q UdE ,
.INSULATION STORIIis TYPECONSTR. ,
OCC-GROUP HIS.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
S[].FT FLOOR AEEA `OTAL ACREAGE' .
ROOF" NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
- "
ROOF'SHEATHING BUILDING USE
, �,! •�" � .' � ' rms IND FON PB am.
—"' "APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED'- :'FINALS' " `-DATE -INSP. ❑ '❑ ❑ ❑ ❑
ASSCSSORS PARCEL NO.
ROUGH SAN.a
PLUMBING.. . (0 lkX5.07 ELECT.ENERGY '
+ TRACT NO:. ,' PARCEL NO
TUBS 8 SHOWER PAN .PLUMBING ENERGY - -
MECHANICAL MECH.ENERGY,; .
ACC DATE. •ACC.PILENO. v
ELECTRICAL` , : - - BUILDING ENERGY,-
FRAMING'— ELECT.FINAL TEST '
INSULATION - - .• PLUMBING _ Zo"'"c ENG.SITE NO. .:
GAS TEST - - - _ '• GAS
' MECHANICAL, . ' • FIRE SPRINK, ENERGY T}C
1 :V ❑ N ,❑ V El :N❑�
COVER NO WORK UNTIL ABOVE HAS BEEN.SIGNED . HEATING
4 —t" PLOODLUNE A,L.D.C.
EXTERIOR SHEAR ELECTRICAL RELEASE _ -1
INTERIOR SHEAR FIRE DEPT: y, v❑ N❑ v ❑ N❑'
..., ,.:
SHEETROCK : - _ •- GRADE " �-- FEE SUMMARY {
EXTERIOR LH " BUILDING
ATBUILDING' (f),,,
INTERIOR'.LATH• 30- ,:, d_j� ,TEMPORARY APPROVALS ,
SCRATCH COAT - ' - - ' ' ELECTRIC PLAN•CHECK
GAS FEE
NO TAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANCY,. - f,^ SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM. .
ARRA'NGE,FOR INSPECTION BY PHONING 2524505 eLecTRic
HONE WORKING.DAY BEFORE 'REOUIRED INSPECTION PLUMawc
O� .• PLEASE,GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT'FOR EXPIRATION DATE' MEc ANicnL' '
IMPORTANT! CONST.TAX'*
PLEASE READ REVERSE SIDE BEFORE i .TOTAL
CALLING FOR FINAL•INSPECTION.
OFFICE COPY