13349 APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•' CI-LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 13349
ADDRESS
S s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
me - PLAN CHECK VALIDATION
NAME a eente.Y-44 Ky.) a� DTV. ELECTRIC PERMIT FEE n
PHONE 24'0 ^
C Nrnacro 's UTLETS-SWITCHES-RECEP 10.00/1.00
ME f0
uc.NO. LIGHTING FIXTURES 10.00/1.00
co acroHs PPLIANCES-RESIDENTIAL 4.00 �Q �'
AO ESS
It7ttwHONE -4 ltff PANELS 10.00
DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEERC .,/_ A _
CIY/51 rEF`.+3¢ C. LIC.No. SIGNS TRANS. 3.00
ARCH.CR ENG. PERMIT VALIDATION
AOOREss r C7 Cit abet-.e SPECIAL CI RC 5.00
I C V ZIv J(J EMP.METER OR POLE INS. 20.00 .
APPLICANT
ADDRESS MOTORS SEE FEE SCH. �
f I/ ,S�i SERVICE CHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION L
is u I hereby affirm that I am licensed Linder provisions of Chapter 9 ISSUANCE DATE
n <N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
R w Z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑
Z O m - License Class Lic.Number
-
2 m r w Dale Contractor
a m f J BUILDING PERMIT
a o u U OWNER-BUILDER DECLARATION INFORMATION
X ; LL I- I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u O Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10 00 VALUATION $/FT.
w Code:Any City or county which requires permit to construct,alter, p��y OO�'
IL 5 Q O improve,demolish,or repair any structure,prior to its issaanCe,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u F he is licensed pursuant to the with provisions of the Contractor's License
> Law(Choter9(cosions Co with Section is exempt theefion oofthe
a Business and Professions Code)on that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
W 1-$ the basis for the alleged exemption.An
g p Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant Loa civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars 0500)):
❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business snit Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law floes not apply to ant owner of -
. properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided flint such improve.
ments are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
I or improvement is sold within one year of completion,the owner-
builder will have the burden ofproving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Out.,
❑ I,as owner of the property,am exclusively contracting with ❑ 0 ❑ ❑ El
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A55ESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN EA.200ft110.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Ser.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSA'fION DECLARATION WATER TREATING EQUIP, 5.00
1 hereby affirm that 1 have u certificate of consent to sell=insure,
or a certificate of Workers'Compensation Insurance,or it certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C).
Policy No. Company
0 ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with [tze city inspection division.
O Applicant MISC.- REFER TO ORD. Y 0 N� Y ❑ NE]
cc y CER'I'IFICA'1'EOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L-UC.
LLI > COMPENSATION INSURANCE, PLG.CONTR. LIC.NO. PLG.
LL 0 (This section need not be completed If the permit Is for one TOTAL - Y 0 No Y[] NQ
7) Z hundred dollars 1$IOD)or less.)
L) 0 I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. G
0. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING _/fo Sa
} W NOTICE TO APPLICANT: If,after making this Certificate of Bx-
F.. ? emption,you should become subject to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
C.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 16, 73
the performance of the work for which this permit is issued(Sec. MICROFILM
3097, . HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's
s NNaa me HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and 130ILER-COMP(3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP Over 100,000 BTU)SEE FEE SCM. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue-against said City in consequence of the PERMIT ISSUANCE 10.00
grant' f this permi MECH.CONT. LIC.N0: MECH.
TOTAL TOTAL !�Q/73
Sign of Applicant/Co r orte It 11
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO Rn,ITNDn,BER
INSPECTION DIVISION 13349
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 940 S. STELLING ROAD UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER REDEEMER LUTHERAN CUJURSCTOR COGUN INDUSTRIES,- ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT fSSU-
FOUNDATION ¢ 1��v- /30 oqh P6 - T� Od ANCE OR 180 DAYS FROM
UFER - E-S-F' *//r7- Rod x LAST CALLED INSPECTION.
2GaLr r
PREGUNITE, PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,
UNDERGROUND /SLAB n j
PLUMBING fl
l FSI
ELECTRICAL
ISSUANCE DATE
MECHANICAL �ALoc. !!ELECT. PLO. MECH.
P
OO NOT POUR FLOOR.UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VA WATION
PLUMBING � " � - $/FT.
MECHANICAL
ELECTRICAL - PERMITTO
FRAMING
' 9NSULATION - 7r0RIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT.FLOOR AREA TOTAL ACRE/GE
ROOF
S DIAPHRAGM j
BUILDING USE
RES IND CON PB 00Ie,
1 APPLY NO ROOFINIT UNTIL ABOVE HAS BEEN SIGNED [I E 11 cJ
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS.LEST - TRACTNO, , PARCEL NO,
i
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL -�' FINALS DATE INSP.
FRAMING SAN *
ZONING ENG.SITE NO.
i INSULATION - � 47j PLUMBING �.
d GAS _
�•' I MECHANICAL FIRE SPRINK ENERGY T�34
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ NEI10
"�
FLOOD ZO NE A.L.U.C.
LATH-INTERIOR � -'J..��- ELECTRICAL _� �S-
LATH-EXTERIOR FIRE DEPT. Y❑ NE] Y0 NEI
SHEETROCK GRADE .FEE SUMMARY
SHEAR INTERIOR BUILDIN -
SHEAR EXTERIOR %„-j.3 TEMPOR YAPPROVAL BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
.NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM.
I L ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
q, IZ- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB'ADDRESS WHEN PHONING.
I
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. t 1
OFFICE COPY