15529 APPLICANT T0--FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER. •.
no eE"sR' ' � APPLICATION & PERMIT 29
P/WGJ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL . 5 aJ
OWNER'S
NAM PLAN CHECK VALIDATI
\/ '1II DTV. ELECTRIC PERMIT FEE - /Q(, p
F TPHONE I / 70
CONT'HAIC 's�y� UTLETS-SWITCHES-.RECEP 10.00/1.00 ,
V NM 60N7T-- Llc.No. Q LIGHTING FIXTURES 10.00/1.00'
CONTR
ACTOR S Jf1{�/ ��{p���'/r PPLIANCES-RESIDENTIAL - 4.00
?j "V � • FRONE t✓/- PANELS 10.00 DATE OF APPLICATION
PLAN CHECK FEE RC.N0.
/yePANELS (OVER 200 AMP) `20.00
/ha Lie.NOalf SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
- aD ss `/ 11 SPECIAL CIRCUIT 5.00
(9(� ^ -B EMP.METER OR POLE INS." 20.00
aPPucarvr's MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
IS
o LICENSED CONTRACTORS DECLARATION v0
a o w I hereby affirm that I an licensed under provisions of Chapter 9 ISSUANCE GATE
(commencing with Section 7000)of Division 3 of the Business and -
wi Professions Code,and my license is in full for d c. •B�L,O.G�e CT. PLG. MECH.
z O,_A- License Cl ss Lia Number f�l7MK- 11
S,w IS at Date -ConvanorAC
< Y s U I �J�R pN QQ BUILDING PERMIT
¢ ¢ w WNIi R-BUILDfiR DIiCLAR ON
x w y` horohy afl'ims that 1 am exmnpl from the Contractor's License MISC.- REFER TO ORD INFORMATION
"' LL O a Law for ale following reason.(Sec.7031.5,Businessund Professions 10.00 VALUATION $/FT.
r - . PERMIT ISSUANCE �/DOQ
Code:Any city or county which structure,
a tune permit to construct,,also
IS
¢ a o improve,demolish,nr repair any stnmture,prior to its issuance,also ELEC.DONTR. LIC.NO. ELEC.
n 'a G u requires the applicant for such permit to file a signed Statement that TOTAL PERMIT TQ�'a
w m he is licensed pursuant to the provisions of the Contractor's License
iii Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe Lsp�
z p Business and Professions Code)or that he isexemPt therefrom and
IS H o the basis for the allege)exemption.Any violation of Section 7031.5 QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR.
'dim by any applicant for a permit subjects the applicant lou civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not mare than five hundred dollars fS500).)
❑ I,as owner of the property or my employees with wages as BACK F LOW PROTECT. DEVICE 4.0 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:'file Contmalor's License Law docs not apply to an owner of
Property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems arc not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.40UTLETS 6.00 -
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the harden of proving that he did not build or an. BUILDING USE
-� prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ I,as owner at tile property,len exclusively contracting with
licensed contractors In construct Ihu project(Sec. 7044,Business - LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
11
and Professions Code:The Contractor's License Low docs notapply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projects with a contractotfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
Ilia Contractor's License Law. TRACT NO. PARCEL NO.
•❑ I:ogexempl under Sec. ,134P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'I ION DECLARA'I'[ON WATER TREATING EQUIP:. 5.00
I hereby affirm that I have a certificate of consent to self-insure, C9; 'afY
or a Curti I ica to of Wo rkeri Com ts.(am IF lalmacy,prv-Cerrirird '1 1 ZONING ENG.SITE NO.
copy Thereof(Sea 3800,Lab.C:;,
Poliev qo. Compani `;" �
O ❑ Certified co Y ereh r11511Cd. �( FIRE SPRINK ENERGY T-24
Z Z y� Cee." d c by n fit d Ih the city i spection division. ❑ ❑ ❑ ❑
µ-o- A�licantY`t`' ��._�� MISC.- REFER TO ORD. v N v N
W CERTI ATE OF EX EMPI'ION FROM WORKERS' PERMIT ISSUANCE10.00 FLOOD ZONE A.L.U.C.
W,� COMI'IiNSATION INSURANCEPLG.DDNTR. LIC.NO. zlpLG.,.,
11 I'1'hi, section need not be completed if the pannit Is for one TOTAL Y N� V N�
Z) Z hundred dollars(S 100)or Tess.)
�U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,1 shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
i Dam Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOl ICI7 TO APPLICANT': If,after nmlim,this Certificate of fix
F ? emption,you should become subject to ale Workara Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed'revoked. AIR HANDLING UNIT(TO 10/100C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE t,1/j�/ �
I hereby affirm that there is a construction Irinding agoncy for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
• l certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree Rt comply with all city and county PLUMBING
ordinances and slate laws relating to building construcflon, and BOILER-COMP(3H.P.ur100,000B.T.U.) 6.00
hereby authorize representatives of this city to•emer upon the
above mentioned property for inspection purposes, BOILER-COMP IDVBr 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Save, indemnify and keep harmless.the City of MISC.- REFER TO ORD.
upertin Inst liabilities,judgments, costs unA expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ay ' any -rue against said City in c nsaqu nee of the
r' sting oft Is r I MECH.CONT, LIC.NO. MECH.
Sol./ TOTAL TOTAL
Si re of Ap nt/Contractor Dmc /; J / ,-1•`--
OFFICE.COPV
POST THIS CARD NEAR FRONT OF BUILDING T'FT+MIT NUMBER
CITY OF CUPERTINO 15529
' INSPECTION DIVISION
JOB INSPECTION RECORD
N• PERMIT EXPIRATION
JOB ADDRESS ZOi'jo -�—VLEIAZ UNIT# _LOT#
I PERMIT EXPIRES IF WORK
OWNER (%,f},� coNTRActoR 7 IS NOT STARTED WITHIN
I •"+t:c""'r+b` fNSP..E_C-.ID ;Fi-W*Y0ATEYv 'INSPECTOR,t;`h�-ok SP, CT ON; COfibz:,+J,t ' x'Fe 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PUOUT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS -
" tlUq;NU Ctl T i N i ANIIVE? AS}, E. _:. 0 _ I17-� -T gd r CSL -
UNDERGROUND /SLAB Cact%itrA -1-covA "
PLUMBING ��E/• J'{��71/�1 -
ELECTRICAL �'Q 6'4 tel. ISSUANCE DATE
MECHANICAL /-,L,� EDO ELECT PLG. MecR
.;DO NOT POUR,F,f OtlRI NTIL"ASOVE. AS,BE SIGNEbi CV „I,Ef*'f'+llN dbMA RWll1S?4I
WOOD FLOOR VALUATION slv r. IW
PLUMBING ,
MECHANICAL
ELECTRICAL ...yyam�-_ PEHnIn
FRAMING A
STORIES TYPE CONSTR
INSULATION
GHUUP RES UNITS
;PLACE± bESUB ..L tlR': TIL'ABtlVE= ASIBEE IONEOE
6(1,IT.11 OUR ARIA TOTAL 4CNF'.l(;E
ROOF NO E: O FINA INSP.SHALL BE MADE ORE
DIAPHRAGM TH NST TION TAX IS PAID
i- RUIIUING USE
ROOF SHEATHING HFS INu Cory Pe Ow..
EAPPLY,!NO:
POST TLHIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
PERMIT NUMBER
INSPECTION DIVISION 15529
JOB INSPECTION RECORD `
JJ _/
JOBADDRESS_I()J/ 990 ,J(�.,� /�h� G� PERMIT EXPIRATION
UNIT# _LOT#
OWNER PERMIT EXPIRES IF WORK
CONTRACTOR ' �— IJS—T IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD: 180 DAYS OF PERMIT ISSU
FOUNDATION
LIFER NOTE: ANCE OR 180 DAYS FROM
ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIt VA117110-
GARAGE SLABS CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (;)-I ��� � Cfl l
PLUMBING
UNDERGROUND /SLAB cav\- 1VA Co VA
— !
ELECTRICALISSU
C2ne(�aK
MECHANICAL FLEE CE DATE
OG LECt. PLG. MEOI.
El El , El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Q BUILDING PERMIT.
WOOD FLOOR Of "INFORMA IdN;;,'.;,-s
PLUMBING VALUATION g/FT
MECHANICAL
ELECTRICAL
FRAMING
PERMII
N7Ce/ode ya��
INSULATION
STORIES TYPE CONSTH.
OCC.GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF
NOy�E:NO FINAL INSP.SHALL BE MADE BEFORE sa Fr.rLNNR AREA rorAl.ncnenr.E
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING
BUILDING USE
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED • I,+,. 4y. RES INu CON PN DII,.
ROUGH FINALSh''lk,y ,;r g"tDATE r INSP.,,: ❑ ❑ ❑ ❑
PLUMBING
SAN.N' A& SORs PARCELNO
TUBS 8 SHOWER PAN ELECT.ENERGY
PLUMBING ENERGY TRACI NO. PARCELNO
MECHANICAL
ELECTRICAL MECH.ENERGY
1.t/ - BUILDING ENERGY ACC.DATE ACC.PILE NO.
FRAMING �� C!C 6•.2 ^
INSULATION ELECT,FINAL TEST
PLUMBING zowNc ENc.SITE No.
GAS TEST
GAS
MECHANICAL EIRE SPRINK ENERGY T.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N0 Y ❑ .[j
EXTERIOR SHEAR ELECTRICAL RELEASE FLOND ZONE A.L.U.CINTERIOR .
SHEETHEAR
ROCKFIRE DEPT. Y❑ N❑ Y ❑ ❑
N
GRADE
EXTERIOR LATH .
BUILDING .'. .`FEE SUMMARY
1
.INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC
PLAN CHECK
GAS FEE
TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDI NG ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR MICROf�.�lV Ofl
MICROFILLMM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
` • o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL %C,s
OFFICE COPY
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