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09669 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER EDING APPLICATION & PERMIT 09669 10500 Rid eview Court ADDAEss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION "AME QTY. ELECTRIC PERMIT FEE Digital UC 5 NAME ONE oNuIACTOR's UTLETS-SWITCHES-RECEP 10.00/1.00 0. C. McDonald Cola NO 177271 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 AOOee.'s 1150 W. Santa C1araRSt. _295-2182 PANELS 10.00 DATE OF APPLICATION ARCIRlFCT San Jose PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. 5.00 PERMIT VALIDATION ADOHESS SPECIAL CIRCUIT /005 Dies TA Cni- glizd ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. -` ADORES' P.O. BOX 26560 San Jose( 95159 SERVICE CHANGE 20.00 { 0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 9/���(Y a v u I hereby aftinn dF,i I am licensed under...visions of Chapter Y ISS/u ANIC DATE aa y tconrnewhog with Section 70001 01 Division 3 oKf�theye yBusiness and BLDG. ELECT. PLG. MECH. F.m i Prufeesion.C.,kdndjl6lice..... in lull to'C1 /L/ 1. ❑ ❑ ❑ (� . o m License Class Lie m Nuber L/ 1 LACI O.C. MGDonal a¢ '¢ BUILDING PERMIT OWNER-BUILDER DECLARATION U REF ER TO ORD INFORMATION I bereby affirm that I ant exempt front the Contractors License. MISC.- VALUATION $/FT. u o a Law fur the following remun.(Sec,703 I.S.Busine.sand Prutessiune PERMIT ISSUANCE 10.00 Code:Any city w ..,try which m,rao,i,,111th to con,Tum alter, $ K ¢ O improve,denudidh,or repair any slmamre.Prior to it,issuance,ebN ELEC.CONTR. LIC.NU. ELEG. O Q N,uires the appk,unl fu,ouch permit W Il lc a a,,n,d.Ce mu,nl that TOTAL PERMIT TO Zw m" he is licensed pa uuanl..the..rrvisiun.ul the Con traawr',Li..nsc a Le.(Clminer 9(eonrw...ingwith Section 7000)ol'Division3 of the a li,ninnS and No csluna Coder or That hr i>caampl Ihercflunl and DTV. PLUMBING PERMIT FEE MECH aro the W,is lin 1h,alleged ea.'m Vtion.Any'riul,i ion of SeclioC 703 L$ STORIES TYPE CONSTR. � 3 m by any ap,f,int lire a pcnn t ubjars,tb.amdlcunl D.a civil "Rill, ALTER-DRAIN& VENT-WATER (EA.) 5.00 of nut more than Joe hurdled Until,(55001.): ❑ I,As owner of the prop""..or lily ejull o>ees with wages s BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole c........nsatimh, will Jo the work, Ind m d daw ructe ia .nut incoosd or If..d or site (Sec. 7044. Rusinca and Plol",luns DRAINS-FLOOR. ROOF,AREA,COND. 5.00 Code:The Cuntraner', Li..on>e Luw Jot,not apply m an owner of ....p.... .in.buildsur impru>..lh"'culan,I who Java such wwk FIXTURES-PER TRAP 5.00 -SO FT.FLOOR AREA TOTAL ACREAGE hinuolf or through hi,own employees,prosielrJ that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 moots are not inter ded ur offered lar sole.Ih how osor,the buildhog or Inpruveut D. is sold within ono y,it of con.plctlmh, tr 011ILI GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will love Ill,buNcn of Proving Thal he did nm buil)or inh- RES IND CON PB Omar pane for pt'p.,of side.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ O h as owner of the Property',an vWusively Contracting.ith licen>oJ emus.or, w eointruel the ,,.j,,l ISee. 7044,It......... LAWN SPRINKLERS- I INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Convnwrs License Law Joes nut apply I.ua..1111 us property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 cunt/ct,lar such Projects will a c.I nlctorw licensed,.marl to tri Contractor',License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ tum exempt under sec. .B.Sp.C.Lor thio WATER HEATER W/VENT 6.00 reason Owner Dane WATER SYSTEM 5.00 ACC.DATE ACC FILE NO. WORKERS'CONIPENSAiION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby'atfirm that I Ease a Certificate of Consent In self insure. ZONING ENG.SITE NO. or a...tificale of Work,,,Compen,Aiun Insurance,or a"Hired copy IberspS18hh .4' Firemans Fund Policy No. h U n Cutilied ugry1 he eby lumished. FIRE SPRINK ENERGY T 24 Z Z �,C°r�h�'d aop)�I �'itl�)rt(c/)'��' hn'+.1/ion .livisiun. MISC.- REFER iz O APit Y /e' � /// Y ❑ N❑ Y ❑ No y CERTIFICA'fli OP IiN1.1'ION FRONT WORKERS' PERMIT ISSUANCE 10.00 FLOOD 2oNE A.L.u.c. UJ > CUNIPENSA'1'ION INSURANCE PLG.CONTR. LIC.NO. pL 4. O (This xciion Cecil not be completed if the Tennis is lir one L ,\\ Y❑ N❑ Y❑ N❑ ::) Z hundred dollar (S100)or ln..l L) O I certify[hat in File perhurmanee us the work fur which tbi>per OTY MECHANICAL PERMIT C\>V� FEE FEE SUMMARY {- mit i,issued,I ,hall nm employ any person in any...saner w m to OW beconc subject to The Workeli Compensation Laws W California. BUILDING Dale Applicant ALTER OR ADD TO MECH. } N Sol ICE TO APPLICAN'P: II',alter making put,Cvrtil ie,I,of Fx- F ? nmption,you Should become subject Io the Workeri Cmnpensation APPLIANCE 00 PLAN CHECK provisions of (lie Labor Code, you must forthwith comply with - FEE U such TR,6,iun.no this permit shill be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.ItU CONS I'RUCL'IoN LIiNDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE I hereby astir... it.[ there is a construction lending agency lar EXHAUST HOOD (WITH DUCT) 5.00 the RFIonnanee ul'the work for which this permit is issued(See MICROFILM 3097,Civ.C.). HEATING UNIT LTO 100,000 B.T.U.) 8.00 Lcndcr'.Name HEATING UNIT(OVER 100,000B.T.U.N.50 ELECTRIC Lender's Address - I ...lfy that I have reins thio apiuicitlon and tate thw tire above VENTILATION FAN (SINGLE) 4.00 IGURI all... 1> cornu.1.gree to Comply with all city and..only BOILER-COMP13 H.P.or 100,0008.T.U.) 6.00 PLUMBING ordinances it d 'We law, relating us building mlbtrucliun, and rose- eutpoued NpeR,for ins of thio city 1.es anter upon .be BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL Q �- abuve�memiuneJ PropertY lar inspersion Pur..axa. (We) agree to save, indcmidly and keep harmless Ihe City tri MISC.- REFER TO ORD. 'y J/° Cupertino against babilitie>,judgment, Cwt and eapemn which L CONST.TAX fray in a y ay accrue x,,irnt suit City in eonw, cree of the 1 PERMIT ISSUANCE el'8-:8Q gra Ning 1 s Pernul MECH.CONT. LIC.NO. "TO M. /0 00 z S /l�yJ� P.C. McDonald 177271 TOTAL rJ TOTAL na mol'. PLl:all/Contrano Dale OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 09669 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 40 20 diL'.'Vl/fl C71 UNIT# _LOT# PERMIT EXPIRES IF WORK MWNER -/ .CONTRACTOR C, Ae ' ,) IS NOT STARTED WITHIN ON DATE INSPECTOR INSPECTION RECORD tauDAYSOFPERMITISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PERMIT VALIDATION TE UNTIL ABOVE HAS BEEN SIGNED ERGROUND /SLAB ELECTRICAL - ISSUANCE DATE BLDG. ELECT. PLG. MECH, MECHANICAL ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �, BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING -* MECHANICAL ELECTRICAL 6 PERMITTD FRAMING .� -" � SIGH TYPE CONSTR. INSULATION IJP 01'(1110 City of OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ $O.FT',FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING uSE RES IND CON PB OiA+l APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ------ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT ND. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACCTLLE Np. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY L}A MECHANICAL - Y ❑ N� Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR iFIRE DEPT. Y❑ N❑ 4 Yo NO , SHEETROCK IGRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR. TEMPORARY APPROVAS BUILDING L - FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER EDING APPLICATION & PERMIT 09669 10500 Rid eview Court ADDAEss BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION "AME QTY. ELECTRIC PERMIT FEE Digital UC 5 NAME ONE oNuIACTOR's UTLETS-SWITCHES-RECEP 10.00/1.00 0. C. McDonald Cola NO 177271 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 AOOee.'s 1150 W. Santa C1araRSt. _295-2182 PANELS 10.00 DATE OF APPLICATION ARCIRlFCT San Jose PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 ARCH,OR ENG. 5.00 PERMIT VALIDATION ADOHESS SPECIAL CIRCUIT /005 Dies TA Cni- glizd ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. -` ADORES' P.O. BOX 26560 San Jose( 95159 SERVICE CHANGE 20.00 { 0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 9/���(Y a v u I hereby aftinn dF,i I am licensed under...visions of Chapter Y ISS/u ANIC DATE aa y tconrnewhog with Section 70001 01 Division 3 oKf�theye yBusiness and BLDG. ELECT. PLG. MECH. F.m i Prufeesion.C.,kdndjl6lice..... in lull to'C1 /L/ 1. ❑ ❑ ❑ (� . o m License Class Lie m Nuber L/ 1 LACI O.C. MGDonal a¢ '¢ BUILDING PERMIT OWNER-BUILDER DECLARATION U REF ER TO ORD INFORMATION I bereby affirm that I ant exempt front the Contractors License. MISC.- VALUATION $/FT. u o a Law fur the following remun.(Sec,703 I.S.Busine.sand Prutessiune PERMIT ISSUANCE 10.00 Code:Any city w ..,try which m,rao,i,,111th to con,Tum alter, $ K ¢ O improve,denudidh,or repair any slmamre.Prior to it,issuance,ebN ELEC.CONTR. LIC.NU. ELEG. O Q N,uires the appk,unl fu,ouch permit W Il lc a a,,n,d.Ce mu,nl that TOTAL PERMIT TO Zw m" he is licensed pa uuanl..the..rrvisiun.ul the Con traawr',Li..nsc a Le.(Clminer 9(eonrw...ingwith Section 7000)ol'Division3 of the a li,ninnS and No csluna Coder or That hr i>caampl Ihercflunl and DTV. PLUMBING PERMIT FEE MECH aro the W,is lin 1h,alleged ea.'m Vtion.Any'riul,i ion of SeclioC 703 L$ STORIES TYPE CONSTR. � 3 m by any ap,f,int lire a pcnn t ubjars,tb.amdlcunl D.a civil "Rill, ALTER-DRAIN& VENT-WATER (EA.) 5.00 of nut more than Joe hurdled Until,(55001.): ❑ I,As owner of the prop""..or lily ejull o>ees with wages s BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole c........nsatimh, will Jo the work, Ind m d daw ructe ia .nut incoosd or If..d or site (Sec. 7044. Rusinca and Plol",luns DRAINS-FLOOR. ROOF,AREA,COND. 5.00 Code:The Cuntraner', Li..on>e Luw Jot,not apply m an owner of ....p.... .in.buildsur impru>..lh"'culan,I who Java such wwk FIXTURES-PER TRAP 5.00 -SO FT.FLOOR AREA TOTAL ACREAGE hinuolf or through hi,own employees,prosielrJ that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 moots are not inter ded ur offered lar sole.Ih how osor,the buildhog or Inpruveut D. is sold within ono y,it of con.plctlmh, tr 011ILI GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will love Ill,buNcn of Proving Thal he did nm buil)or inh- RES IND CON PB Omar pane for pt'p.,of side.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ O h as owner of the Property',an vWusively Contracting.ith licen>oJ emus.or, w eointruel the ,,.j,,l ISee. 7044,It......... LAWN SPRINKLERS- I INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Convnwrs License Law Joes nut apply I.ua..1111 us property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 cunt/ct,lar such Projects will a c.I nlctorw licensed,.marl to tri Contractor',License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ tum exempt under sec. .B.Sp.C.Lor thio WATER HEATER W/VENT 6.00 reason Owner Dane WATER SYSTEM 5.00 ACC.DATE ACC FILE NO. WORKERS'CONIPENSAiION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby'atfirm that I Ease a Certificate of Consent In self insure. ZONING ENG.SITE NO. or a...tificale of Work,,,Compen,Aiun Insurance,or a"Hired copy IberspS18hh .4' Firemans Fund Policy No. h U n Cutilied ugry1 he eby lumished. FIRE SPRINK ENERGY T 24 Z Z �,C°r�h�'d aop)�I �'itl�)rt(c/)'��' hn'+.1/ion .livisiun. MISC.- REFER iz O APit Y /e' � /// Y ❑ N❑ Y ❑ No y CERTIFICA'fli OP IiN1.1'ION FRONT WORKERS' PERMIT ISSUANCE 10.00 FLOOD 2oNE A.L.u.c. UJ > CUNIPENSA'1'ION INSURANCE PLG.CONTR. LIC.NO. pL 4. O (This xciion Cecil not be completed if the Tennis is lir one L ,\\ Y❑ N❑ Y❑ N❑ ::) Z hundred dollar (S100)or ln..l L) O I certify[hat in File perhurmanee us the work fur which tbi>per OTY MECHANICAL PERMIT C\>V� FEE FEE SUMMARY {- mit i,issued,I ,hall nm employ any person in any...saner w m to OW beconc subject to The Workeli Compensation Laws W California. BUILDING Dale Applicant ALTER OR ADD TO MECH. } N Sol ICE TO APPLICAN'P: II',alter making put,Cvrtil ie,I,of Fx- F ? nmption,you Should become subject Io the Workeri Cmnpensation APPLIANCE 00 PLAN CHECK provisions of (lie Labor Code, you must forthwith comply with - FEE U such TR,6,iun.no this permit shill be deemed revoked. AIR HANDLING UNIT(TO 1Op00C.F.ItU CONS I'RUCL'IoN LIiNDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE I hereby astir... it.[ there is a construction lending agency lar EXHAUST HOOD (WITH DUCT) 5.00 the RFIonnanee ul'the work for which this permit is issued(See MICROFILM 3097,Civ.C.). HEATING UNIT LTO 100,000 B.T.U.) 8.00 Lcndcr'.Name HEATING UNIT(OVER 100,000B.T.U.N.50 ELECTRIC Lender's Address - I ...lfy that I have reins thio apiuicitlon and tate thw tire above VENTILATION FAN (SINGLE) 4.00 IGURI all... 1> cornu.1.gree to Comply with all city and..only BOILER-COMP13 H.P.or 100,0008.T.U.) 6.00 PLUMBING ordinances it d 'We law, relating us building mlbtrucliun, and rose- eutpoued NpeR,for ins of thio city 1.es anter upon .be BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL Q �- abuve�memiuneJ PropertY lar inspersion Pur..axa. (We) agree to save, indcmidly and keep harmless Ihe City tri MISC.- REFER TO ORD. 'y J/° Cupertino against babilitie>,judgment, Cwt and eapemn which L CONST.TAX fray in a y ay accrue x,,irnt suit City in eonw, cree of the 1 PERMIT ISSUANCE el'8-:8Q gra Ning 1 s Pernul MECH.CONT. LIC.NO. "TO M. /0 00 z S /l�yJ� P.C. McDonald 177271 TOTAL rJ TOTAL na mol'. PLl:all/Contrano Dale OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 09669 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 40 20 diL'.'Vl/fl C71 UNIT# _LOT# PERMIT EXPIRES IF WORK MWNER -/ .CONTRACTOR C, Ae ' ,) IS NOT STARTED WITHIN ON DATE INSPECTOR INSPECTION RECORD tauDAYSOFPERMITISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PERMIT VALIDATION TE UNTIL ABOVE HAS BEEN SIGNED ERGROUND /SLAB ELECTRICAL - ISSUANCE DATE BLDG. ELECT. PLG. MECH, MECHANICAL ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �, BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION SIFT. PLUMBING -* MECHANICAL ELECTRICAL 6 PERMITTD FRAMING .� -" � SIGH TYPE CONSTR. INSULATION IJP 01'(1110 City of OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _ $O.FT',FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING uSE RES IND CON PB OiA+l APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ------ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT ND. PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACCTLLE Np. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY L}A MECHANICAL - Y ❑ N� Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR iFIRE DEPT. Y❑ N❑ 4 Yo NO , SHEETROCK IGRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR. TEMPORARY APPROVAS BUILDING L - FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY