16475 APPLICAINJ-1 TG FILL IN INFORIVIA-1 ION WITHIN RED LINES - USE GALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
JDILDING E- ELECTRICAL.-
TION & PERMIT 164 75
Aonncss
-�'a CAL-PLUMBING-MECHANICAL
NAME PLAN CHECK VALIDATION
RIC PERMIT .FEECONDigCiDH'S
rvAME HES-RECEP 10.00/1.ODLIC.No. ZRES 10.00/1.00 O
CO NiHACTOn's
ADDRESS PPLIANCES-RESIDENTIAL 4.00
ST-l.'L'C'!(( C2K PHONE rRj3 PANELS 10.00 ...
AHCRI CT DATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE
ENGINEER
RLIC NO. SIGNS TRANS. 3.00
AENL.
ADDRESS
SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS r$ SEE FEE SCH. ��
ADDRESS /''� / MOTORS ,/\-��`�,�6 p Nu
;ur L-+eK �(✓�( r-e '«fie SERVICE CHANGE 20.00 �y LC-^'"'
D02 //
se O o ,LICIiN51(U C'ON'1'li4("1'0125 I1CC1.Alt A'IJUN L.
G u W 1 hereby alfinn that I unl keened aside, oovoiu,,.d Chapnr 9
N Q (eonnneocin6 will'Section 7000)of Uiviaiun 3 of the Bu,nusa and ISSUANCE DATE
r N i 1'ro1'essiom Cod L,and my license is in lull liens it ul LH 11, BLDG. ELECT. PLG. MECH.
' Oso -_ License Clam Lic.Number_
o G IJmc_ 91
¢ ¢wOWNER-BUILDER DECLARATION V BUILDING 0ERMIT
La
w ; L y 1 hereby affirm Ilial I am exallIn from the Collraclor'a Lic,nx• MISC.- REFER TO ORD FORMATION
FLLo4 LJwlorlhel'ollowislre. 1.11.(Set.7031.5,B Hsinessand Professions PERMIT ISSUANCE-
E m�so ) TION S/FT.
Cade:AnY city ur county which requRLsa Felon to Lushes,alley, o-��ppq
¢ < g0 improve,demolish,or Rdrd...y Structure,pilot to its issuance,u]W ELEC.CONTE. LIC.NO. ELEC. \\T�
0¢ requires the applicunl ler HnLls Penoil to file a signed alalcnmN UIUI TOTAL -
u m Ile is licensed.....roan.In the pnrvisions of tls,Can lnl:lon'a License �' dd / PERMIT TO _
Law(Chupter 9(cmnmeneing with SCLliuD 7000),4 Dwiduniollhr FE�+\] i6L vC IL�T � C�
g x o Ilusiness and P olbsaims Cud,)or thin he is exnnPl R@a'lUnis and OTY. PLUMBING PERMIT �pj U r
¢ r m Il',iasis for tlm:dlegcJ exclll Ption.Any violJl Tun ol'Semiun 7031.5
SWEDES TY/ /�-
6 i Ily Jlly aPPlll'JIII fir J our I sub1ee la III,a p 1,I II'all 11.a,I ell Penall
��n t mon Chau live hundred dollars($500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
�6 I,as uwnur of the properly,or Ry cmplayees wish wages as BACK FLOW PROTECT. DEVICE 4.00
their sole Lompensxlian,will Jo the wofk,and the slfuct Pe is To OCC.GROUP RES.UNITS
Hr
tended or offered for Pale(Sec. 7044, ((.sines, art l'ml'essio"a DRAINS-FLOOR,ROOF,AREA,COND, 5.00
Code:The Cmdtuclor's License Law does not apply Io an owner of
PUPefly wbo builds or ins Proves thereon,and who docs such work FIXTURES-PER TRAP 5.00
• hlnlaell or through his own employees.Provided Del such ins Pruve. O 50.FT.FLOOR AREA TOTAL ACREAGE
menu are not intended sir'itlorcJ fat sale If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or ingxovensenl is sold within one year of completion,die owns,,
WELL,will huvc the burden of proving But he dist nod build or illy GAS-Eq, SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove 11,as owner
of sulc.l' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB om.r
❑ d as owner of Il',proper.( all,exclusively contracting wills � ❑ ❑ ❑ ❑
IicenreJ conuaaors In construct the project ISec. 7044, liusin,a' LAWN SPRINKLERS.
1 INC 5 V.B. 6.00
and Professions Code:The Contractors License Law dues cul apply ASSESSORS PARCEL NO.
to an owner of prapeHy who builds or improves Ihereou,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts I'or such projects with a cuntucloda)licensed Pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200it/10.00 TRACT NO. PARCEL NO.
❑ I um ex,nlpt under Sec. ,Il.dl'.C.Ibr Dnia
reason WATER HEATER W/VENT 6.00
Owner �u it C [)at, _ -. WATER SYSTEM 5.00
YYN,"�Ct' ACC.DATE ACC FILE N0
W' .
ORRIiRS'COAIPISNSATION I". RAI )N WATER TREATING EQUIP, 5.00
I hereby Jllinn that I huvc a Lerli(icate ul consent In aclGinsu«•,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE N0.
copy thereat(Sec.3800,Iah.C.).
Policy No. company
0 ❑ CeRilied copy is hereby funiist,,d
z Z 0 Certified mPy is tiled will' 'lie city Gn plltuur division, FIRE SPRINK
ENERGY T'24
FO Applicant MISC.- REFER TO ORD �
Cr - Ch R1'1171CATI:01'I:XI'MPlD. Y� Nv0 N4
Lu
FROM WORKERS' PERMIT ISSUANCE r;gD
Lu J COMPENSATION INSURANCE PLG.CONIH. FLOOD ZONE A.L.U.C.
d D LIC.NO. PLG.
Z hate dolserlars Susedlop cul be conpsleleJ it the ..count is I'ur rule TOTAL Y� NEI Y C3 N❑
U O hundmJ dollars 151001 ar less.)
LL 0 mil i HEY "Eats is III''Ldu¢III IWalme'it D"work I'ur which this per OTY. MECHANICAL PERMIT FEE
I Y any .0,11.11 In any oulnncr so as Ia FEE SUMMARY
0 w become subject to the Workers'C'unlpensaliou Laws of C'ulilorniu.
C. Ilan ICAN 1:nt ALTER OR ADD TO MECH. BUILDING
} C. DNOIate : TO AI'I'IJ pplil IL ul'LLv making Ibis Cecil Teem of nix 5.00
en.Prior,You slmuld become subject to Ilse Workera'Comp,ns:Iiun APPLIANCE5.00 PLAN CHECK 7C
pre Wamns Of tire Labor Cod,, you Insist hrtOLwilh cumply with
U such pravisions or this penuk shall be decm.8'I,vuked. AIR HANDLING UNIT(TO 10=11F.M.) 4.00 FEE
CONS'fRur-PION LIiNUINC AGEAIR HANDLING UNIT 10moc.RM.) 6.00 SEISMIC FEE t
I hereby uIli rnl the there is a Lonstruclian lending..'Lucy Iia EXHAUST HOOD (WITH DUCT) 5.00
lite offun lance u1 the work Ibr which this permit is issued(Sec.
3097,CN.C.). HEATING UNIT( MICROFILM
TO 100,000 B.T.U.) 8.00
Lennes's Nome
Lender's Address HEATINGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC
'• mI certify Run l huvc read this alPlicmioo and stmt:that the above VENTILATION FAN (SINGLE) .df00 -1
in. eld on is correct. I agree to comply will,all Lily and county
ordinances and stare laws reaming to building construction, and BOILER-COMPI3H.P.Or100,000B.T.U.) 6.00 PLUMBING
her,by Julhuriee rc re,oDaliv. o1 this Lily to ,er upon tire
V
above-mentioned propery lot inspection pugwses. BOILER-COMP IOvor 100.000 BTU)SEE FEE SCH. MECHANICAL /
e) agree to save, in
Cupetlilm against denmil'Y amt keep harmless tile Y e Cil of MISC.-
REFER TO ORD.
liabililics,juJgmenu, esu and expenses which
,nay in any way Jecole :Igninsl laid City Its consequence of IIIe PERMIT ISSUANCE T 0 CONST.TAX
grunting of Ibis •nail. /f MECH.CONT. LIC.NO, MECH.
I '- /• ? ('-RPYSmY� %/i
TOTAL / TOTAL ff G'S
"ignalur,ul IThcunl/C mlraLlut Uw, �� �;
OFFICE COPY ��
POST THIS CARD NEAR FRONT OF BUILDING 11I WII NIINiM 11
CITY OF CUPERTINO 16475
INSPECTION DIVISION
JOB INSPECTION RECORD
1 PERMIT EXPIRATION
,/ 1 �p
JOB ADUR ESS 65VY��V_i�.j k'9N 1T J< _LOT V PERMIT EXPIRES IF WORK
CONIIIACTOn IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UPFR ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH I'HE APPROVED PLANS AND CITY OF: "1111.111 IA ITA I II.N
_ CUPI'.RHNO STANDARDS.
GAHAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDO� -{!- i S
UNDERGROUND /SLAB
PLUMBING
ELECI'RICAI- ISIII IAN(I uA II
MECHANICAI. nuu, Il1.1, 1 r1 r, wCI,
l
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ WOOD FLOOR INFORMATION
AN v A1.IIA 11nN sll-r
PLUMBING
MECHANICAL
ELECTRICAL rl unlit IU.
cl zLl ``
FRAMING 7
INSULATION nHu„ `� ypls�l
II:1: , 11111.I• 1114 IINNllti
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
sit• ,nl,w nurflOOF. NOPE:NO FINAL INSP.SHALL BE MADE BEFORE II A uHAI AcnIAl.1
[DIAPHRAGM THE CONSTRUCTION TAX IS PAID
❑uIL1IING usl
ROOF SHEATHING 111, IN ulN IN;
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L 17 L L L
A,1);j S1.1111 'AM I I N,1 -
ROUGH SAN.# . ---
PLUMBING ELECT.ENERGY
IHN;I Nu 1'1111CI I.Nq
TUBS R SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC IlAll ACI: I DLI.N11
FRAMING ELECT.FINAL TEST
INSULATION JIININI; I'Nr SI II NO
. PLUMBING /:1, ;y'-,
GASTEST GAS
MECHANICAL
[III SI'IIINA I NI H61 l ]4
n L
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N
IIIIIIn.IINI AI IDC
EXTERIOR SHEAR ELECTRICAL RELEASE i
INFERIOR SHEAR FIRE DEPT. -._ `tlL , L "L
SI'IEETR ICK GRADE
��'- FEE SUMMARY
EXTERIOR LAIR BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCHA'I CII COAL JELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SFISMIC FEE J Z'
OCCUPANCY OF:BIJI LDING IS NOT PEHMITT EU UNTIL BUILDING FINAI-IS SIGNED BY BUI LDING INSPECTOR. MICHOFILM
U-1 ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, l � _
. F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. �.
— SEE PERMIT FOR-EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY