15699 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ON LY,
. BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
E + BUILDING APPLICATION & PERMIT q �+(I(]
-J• aoon_ess_.- �+ I
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL - 15699
9�7
S^
OwN R' J • PLAN CHECK VALIDAT N
�t
NAME OTY. ELECTRIC PERMIT FEE `'yoe �laebornlx � 'i`lb-IR( �d�� �.
CONTRACTOR - / .
CONTR OUTLETS-SWITCHES-,RECEP 10.00/1.00
5C.LJI-CI :+",✓ uc.No.3D� I� LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
Ib a6 &tVe1I,,oCreI* 1q1((P-Iqt3 PANELS 10.00 DATE OF APPLICA+ION -
ARCHITECT PANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.C.NO.
"T ENGINEE&5-__ f�_ LyS56C
�VV.J L'LL•V.J f J ,J.JaJ11c.No 1Ip SIGNS TRANS. 3.00
ARCH.OR ENG. 1, QV6(G SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDREEMP.METER OR POLE INS. •^
APPLICANTS MOTORS SEE FEE'SCH.
ADDRESS
PaS SleveriSCrK�tMd , SERVICE CHANGE 20.00 ��/1/ p(/
0 0 0 LICENSED CONTRACTORS UECLARA'f10N .J !A .
a o w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
z (commencing with •cion 7000)of Division 3 of the Business and
G,< H BLDG. ECT. PLG. MECH.
r o z L -ersslons Code, InY IlcenL,is In full for � � 0, ZL
Od
z O_� License C}hys_ Lie No b.. _ -
O z Date--1_ Comacto
Q Y E J BUILDING PERMIT
w u OWNIiIb BGILDIiR DECLA RATIO INFORMATION
w ;LL y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u O a Law for the following reason.(Sec.7031.5.Businessand Professions VALUATION $/FT.
1- -0 < PERMIT ISSUANCE
Code:Any city or county which requires a permit to construct,alter,
IS ¢ Q improve,demolish,or repair any stricture,prior to its issuance,also ELEC.CONTE. LIC.NO. ELECV. rya /�'
D ¢ requires the applicant for such permit to file a signed statement that TOTAL (
w y he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r z a Law(Chapter 9(coemoomengwilh Section 7000)of Division 3 of the
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
or H S the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR,
by any applicant for a permit objects the applicant to acivil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred d�llars(S500)J:
❑ 1,as owner of the property,or my employeeswith wages as BACK FLOW PROTECT. DEVICE 4,00
their sole compensation,will do the work,and the structure is no[ % Oct GROUP RES.UNITS
intended or offered for sale (Sec. 70449 Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does 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 TOTALACREAGE
himself or through his own employees,provided that such improve-. q
merits are not intended or offered lot sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 .2
�s or improvement is sold within one year of completion,the owner-
builder will have the burden of proving Ileal he did not build or int- IGAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - BUILDING USE
prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30,00 RES IND CON Pa Omer
❑ I,as owner of the property.am exclusively contracting with - ❑ ❑ ❑ ❑
licensed contractors to construct the limiect(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contr:ctoi s License Law does not apply
to:in owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 _O/O
contracts forsuch projects withn contractors)licensed puret umto SEWER-SANITARY-STORM EA.200ft110.00
the Contractor's License Law. TRACT N0, PARCEL NO.
❑ Iamcxemptunder Sec. ,B.&BC.forthis WATER HEATER W/VENT 6.00 ���--
reason
Owner _ Uatc• WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO,
WORK F.RS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-ins,uc,
or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO.
copy thereof(Sec.3500,Lab.C.). C�,J -
102 Policy No. ConhTroy_ J
O Cl Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z O PIKCetlifµyl_cgpy i d with the city inspection division. MISC.- REFER:TO ORD. y N v N
�i icant_IsC+-Y•7 ❑ ❑ ❑ ❑
~ �+ PERMIT ISSUANCE
cc CERTIFICATE OF EXEMPTION FROM WORKERS' '�°e0 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. _ PLG.
(rhiS secthin•feed not be coniplatcdl if the permit is for one TOTAL � '69� Y❑ N❑ Y ❑ N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY MECHANICALPERMIT FEE FEE SUMMARY
IL F mit is issued,I shall not employ any person in any manner so as to
O Wbecome subject to the Workers'Compensation Laws of California. p3J
.d Late Applicant ALTER OR ADD TO MECH. 5.00 BUILDING T
} N NOTICE TO APPLICANT: If,alter making this Cerit'icide of lis.
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most lirrthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE p•
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
the ,errornumce of the work for which this permit is issued(Sec. MICROFILM
3097,Cm.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 iL Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 `
information n correct I agree to comely with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating ID building lciyandconstruction, and
hereby enthorire representatives of ou city enter upon the BOILER-COMP 00,e00 0,000 BTU)SEE FEE SCH. MECHANICAL L) Of
above-mentioned prepresentorinsp of
i Purpose.
(We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD
upertino against liabilities,judgments, costs and expenses which, pERM1T ISSUANCE //p CONST.TAX B�
may in any way accrue against said City in consequence of the _
ntin this p rmi
-7/1MECH.CONT. LIC.NO.' MECH.
TOTAL 7U 14 TOTAL
Sig azure of p an[/Contrddor Date
OFFICE COPY
POST THIS CAR D.NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15699
INSPECTION DIVISION ` ,'^
JOB INSPECTION RECORD'
r// j
�n PEAMl7 EXPIRA\TION
JOB ADDRESS:p fQ 1 � �T�LL�'�6— 'Y=+ UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER `,r CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180,DAYS OF PERMIT ISSU
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
UFER � .� ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. 1
'PREGUNITE TO COMPLY WITH-THE APPROVED PLANS AND CITY OF reurvui vnl.mnn_
ON
CUPERTINO STANDARDS. , '
GARAGE SLABSt
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING - �'ipl� V"1 •': •}'¢
ELECTRICAL - - ISSUANCE DALE
MECHANICAL r.( q ELECT PLG. MECR. I
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Q�tY p+ CUIeflilimB W IT
FO
WOOD FLOOR
VALUATION
MECHANICAL " /Z-6 ERMIT TO
ELECTRICAL.
FRAMING
INSULATION
STORIES TYPE CONSTR,
�
,OCC GRuup DEC.UNITS
^'PL°ACE:INO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
5(1 ki FLO[1R AREA TOTAL nL1iLAGf'
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID cJ
ROOF SHEATHING \, NULDINC,USE
RES; IND CON PB o"'e,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS -DATE INSP. El 0 ❑ - 1:1 ❑
ROUGHSAN.N (.3,r/ ,Q /- nSSESSUHS PA RCE L NO.
PLUMBING - ELECT.ENERGY _
TUBS&'SHOWER PAN PLUMBING ENERGY 'I. C' _q��TRACT NO. PARCEL NO� •
MECHANICAL MECH.ENERGY
ELECTRICAL - �. BUILDING ENERGY — ACC DATE ACC FILE NO
FRAMING , _ ELECT.FINAL TEST
'INSULATION S` T' PLUMBING2ONING ENG.SITE NO.
GAS TEST - _ J'' GAS - -
FIRESPRINK ENERGY T 24
MECHANICAL — C Y Q NO Y ❑ N[D
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATIN L FLOOD NE A L.u.c
EXTERIOR SHEAR - ELECTRICAL RELEASE
INTERIOR-SHEAR FIRE DEPT. Y❑ "❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH - TEMPORARY APPROVALS BUILDING ,
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDINGFINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM -
w ARRANGE FOR INSPECTION BY PHONING '252-4505, ELECTRIC 2 _
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING SIU
O PLEASE GIVE JOB ADDRESS WHEN PHONING:
ZMECHANICAL (� 6
,. — SEE PERMIT FOR EXPIRATION DATE.—
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL t1!
CALLING FOR FINAL INSPECTION. -
OFFICE COPY