16924 'APPLICANT TO FILL IN-INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY
„ BUILDING PROJECT I DENTI FICATION - - - .PERMIT NUMBER .
BUILDING APPLICATION & PERMIT - 69,24
Poo ss 0 - o a7 2
�-� ;-
BUILDING
-ELECTRICAL-PLUMBING-MECHANICAL ,
OWNERS 9e4 `• - ., - PLAN CHECK VALIDATION '
l �A U N _1 DTV. -'ELECTRIC PERMIT - " ' FEE
Z -:I
a PHONE ♦;J�"j�Jy�
CONTRACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
•ft 14rJ 6C.NO. 4S"2-Y10' LIGHTING FIXTURES 10.00/1.00 Z8 l 3
ADNTRacraR's - PPLIANCES-RESIDENTIAL' "'4.00
-I'L4 �>-•..MV Lf'r 'HONDER Es. E ya1 ' PANELS -10.00
DATE OF APPLICATION
ARCRITECT PLAN CHECK FEE P.C.NO. "y
OR - PANELS (OVER 200 AMPI 20.00
ENGINEER _
LIC NO. SIGNS TRANS. - 3.00
ARCH OR ENG. ` PERMIT ALIDATION
ADDRESS A r. SPECIAL CIRCUIT 5.00
ZIP, EMP..METER OR POLE INS. r 20.00
' ADDRESS • MOTORS r ' - .SEE FEE SCH.
ADDRESS _
SERVICE'CHANGE "11 . • 20.00
Dai
:Foo - LICIiNSFU CONTRACTORS DECLARATION PAIDi
rt u Lo I hereby of limn that I am licensed under provisions of Chapter 9 ISSUANCE DATE' �•
H ou
a a (commencing with Section 7000)of Division 3 of the Business anti - BLDG. ELECT. PLG' MECH.
H D z.. I To fes.Ck Cod .yu�1 I ppl�yy JJy'1-nLi Is m lull torr a feet I 1. �
i o Lens-CInA_4 4_3_L Lm Number , }
o z H 0' 1)a1 �$-Contraclor.�c
a M f�' � BUILDING PERMIT•.
Ix ¢.w,� ,• owwsR-BUJLUPR DEanaAnoN INFORMATION
x _-A y,•. I hereby affirm that I a.exempt from the Contractor's License MISC.- - R TO ORD
w VALUATION $/FT.
rwoJ Law for reason.(Sec.703 L5,Business Prtmfessions PERMIT ISSUANCE - 10.00 1 .�; D� ,
Code:Anyc'lyo county whichregmI saPcmnitt construct,site,, - lL- Q
�'¢¢ nm�rove de ED SII or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. %LEC. S
w O¢ req es the applicant for such P rmil.to'file a signed statement Chat TOTAL �•(1� _
w m°' he s hcmr%ect I urn ant to lire provis ons of the Contractor's License _ - PERMIT TO ,
- r i Law(Chapter 9(commencing with Section 7000)of Division To]file �" �- VA
r w• i o Business and Irot sons Code)u ❑ t heise c t 11 ofrm and OTV. PLUMBING PERMIT FEE V
m ¢ F the basis for the alleged exemption.Any violation of Section 7031.5 ' . STORIES TYPE CONSTR.
d ; by any aolelflofloo five hundred
dollars tire applicant(011 civil penalty ALTER-DRAIN -WATER (EA.) 5.00 .
of not ,as ..Tie five hundred Property,
s[my em)', ,
heir Las..net in the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS -
• (heir sole compmmsation,will do[he work,and Dire svualure is not
intended Or offered,for sale (Sec. 7044, Busioess and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code: Tire Contractor's License Law m t DD' ow er if - -
a re Ano apply ss n i
primperty who builds'ur improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
t .cuts Arc-Dot intended or offered for sale:if,'however,the building GAS-EA.SYSTEM-11NG40UTLETS 8.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
bmilder will have the burden of proving that he did not build or ire- BUILDING USE
prove for Purpose of sale.). RES IND CON pi. Onlo;
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER.' 30'.00
❑ ❑ ❑ ❑ ❑ .,
licensed'contradors to construct the Project(Sec.7044•Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
' to Professions Core:grope The Color octor's License Law does net apply -to contracts
owner of Properly who builds tr improves rased IN,and who LAWN SPRINKLERS:OVER 5 (EA.) 1.00
tare Co is co,'S License L with o contractor(s)licensed pummIl Do SEWER-SANITARY-STORM EA.200ft/10.00
: theI [.am exempt
License Law. TRACT NO. PARCEL NO.
- O I am exempt under Sec. 8.5.PC.to;,this WATER HEATER W/VENT 6,00
reason
Owner': Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO,
WORK I-RS'COMPFNSA TION DPCI.ARA'IION ` WATER TREATING EQUIP. 5.00
-, I hereby affirm but I have a certificate of consent to s'el&insure.
or a certificate of Workers'CompensationInsurance,or a certified - ZONING ENG:SITE NO.'
copythen,�f�(Sy•e.,3R00.Lab.C.1�. '� FVN�
Policy Nn E�I+gsi;o Company �7-T-9T � -
0• .❑. Certified cop)'is hereby furnished. - - �' FIRE SPRINK ENERGY T-24
Z Z IR_,Ccrtifi' opy isi filed ill he inspection division.
O Appli'mr,__.x - MISC.- REFER TO ORD. ,Y ❑ N❑ v ❑ INEJ
CC rn ,PERMIT ISSUANCE 10.00
LU CIiRTIRCAT1i IFNi ION INSUROh1WORKIiRti' FLOOD ZONE A.LU.C.
LU >, COMI'IiNSAI'ION INSURANCE PLG.cONTR. ' LIC.NO. +,PLG, "
a -CL 0, ('fhls"section Deco,not be completed iftie permit is for Lee - TOTAL - Y❑ N❑ Y ❑ IN
qZ hundred dollars(S 100)or less.) -
CJ O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY.
..'-LL H mit is issued.4 shall not employ any person in any manner so as fo
0U.) been Time subject to the Workers'Compensal ion Laws'n(Califomiu.
Co. Date "Applicant BUILDING �' y
w NOTICH.TO'APPUCAN'1': If after making this Certificate of Fs-
ALTER OR'ADD TO MECH. 5.00 6 J r V O.
F ? ' en.ption,you should become subject to the Workers Compensation APPLIANCE. 5.00 PLAWCHECK
provisions of the labor Code, you must forthwith comply with - ' '
C„) Sn¢h provisions or this permit shall he deemed revoked: AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE -
CONSTRUCHONLENDINGAGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE . S,Q
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT)' 5.00 -
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - _ -
Lendcr'sNa.e' HEATING UNIT(OVERIDO,000B'.T.U.)9.50 ' G
Lender's Address ' .ELECTRIC r P
I'cerlify that l have read this application and state that Ole ahove VENTILATION FAN (SINGLE) 4.00 "
information is corm'or 1 agree to comply with all city and county PLUMBING'
r ordinances and state laws relating to building construction, and LER-COMPI3H.P.OT100,000B.T.U.) 6.00 -
hereby,authorire representatives of this city to enter upon the BOBOIILER-COMP IOver 100,000 BTU)SEE FEE SCM. MECHANICAL.
abuse-mentioned Property for inspection purposes.
U
to save, indemnify and keep harmless the City of MISC.; 1 REFER TO ORD.' ,
st liabilities,judgments, costs and expenses which PERMIT ISSUANCE' 10.00 CONST.TAX
yaccrue.agat 'said.City in consequence of the P rat. MECH.CONT. LIC.NO. MECH. -TQTAL �150
i TOTAL x,pli an 'onto or Uate• -
OFFICE COPY.4,
. ,
POST THIS CARD NEAR FRONT OF BUILDING
PCHMIi NUMIIEp
CITY OF CUPERTINO 16924
INSPECTION DIVISION
JOB INSPECTION RECORD
p l/` PERMIT EXPIRATION
JOB ADDRESS lqq ��1 �LI7 �e��JNIT# _LOT# ISI I s I
1 E n 1 PERMIT EXPIRES IF WORN
GINNER I --�- �r! V\ (,� CONTRACTOR IS NOT STARTED WITHIP
INSPECTION DATE I INSPECTOR >INSPECTION RECORD a 180 DAYS OF PERMIT ISSU
FOUNDATION ,-'�-$ ANCE OR 180 DAYS FRON
I NOTE: LAST CALLED INSPECTION
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PI W 'IDN
FLIDA uN
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL RLDC. ELECT. PLG. Mea
❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDFUILDING PERMIT
WOOD FLOOR ��.C221988 INFORMATION
PLUMBING „ J:
VALUATION T.
sTF
MECHANICAL City of Cupertino 3
TER." TO
ELECTRICAL
FRAMING
INSULATION
STORIES TYPECONSTH
,
Occ.GROUP NE S.UNITS
PLACE NO SUBFLOOn UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SIT FT.FL00I4 AIIEA TOTAL ACREAC.
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDINGCON ROOF SHEATHING
NES INTI CON PO IIPu
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED " FINALS.: ^:;;; -s'^DATE < . INSP. ❑ ❑ ❑
ASSESSOHSPAHCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
THALI NO. PARCEL NO,
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC,DATE ACC.PILE NO.
FRAMING ELECT.FINAL TEST
ZONING
PLUMBING ENG,SITE NO
GAS TEST GAS
MECHANICAL FIRE SPRINK ENERGY T 7
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "❑ ❑ "!
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONe ALUC.
INTERIOR SHEAR FIRE DEPT. Y❑ "Ej Y ❑ N[
S14EETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDINGl �/ -S
INTERIOR LATH TEMPORARY APPROVALS BUILDING r'
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I ISEISMIC FEE :!
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC K .
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL l
CALLING FOR FINAL INSPECTION.
OFFICE COPY
r ,
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER'
CITY 0 •CUPERTINO ' . - 16924
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
" q �0 � pc (/1�
.. JOB ADDR ESS , Sic t
` t
I� .__LV `-'rem NIT# _LO7#
��.1 I - - ,PERMIT-EXPIRES)F WORK-I
OWNER - ,I ��I ,V ;CONTRACTOR '�� ISNOT>STA RTED WITHIN '
' INSPECTION 'DATE INSPECTOR INSPECTION RECORD .180 DAYSOF PERMIT ISSU-,;
FOUNDATION , NOTE: - +: ANCE OR 180 DAYS FROM''
� 'S 4 LASTCALLEDINSPECTION:?
., UFER - ALL GRADING AND DRAINAGE SHALL°BE�INSTALLED'
TO COMPLY WITH THE APPROVED,PLANS-AND CITY OF .-,-Ptr Nor, LINA r.ION
CUPERTINO STAN
- PR EGUNITE DARDS.
GARAGE'SLABS,: - - `"c-•--. �,-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB' .
_ PLUMBING a .,. .. ,. .. r !r ..
ELECTRICAL' - .ISSUANCE DATE +
MECHANICAL ° �' - +�' - BLDG ELECT 1, PLG. M1IECH.
❑ ` El
DO NOT.POUR'FLOOR UNTIL ABOVEHAS BEEN SIGNED ''LLC q C)io PU1LDING PERMIT
WOOD FLOOR.
` INFORMATION
PLUMBING , - - _ i VALUATION f,q SIFT,.,
< `
-:City of Cupeftilio
MECHANICAL,
x
ELECTRICAL - 'E""I'T "
' FRAMING - • x. -
SIOHIES:-,• TYPF CONSTR.
INSULATION ,.
OCC'GROUP RES UNITS
` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50.FT FLOOR AREA TOTAL ACREAGE
ROOF,. - NOTE:NO FINAL INSP.SHALL"BE'MADEBEFORE
�'• : DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
+ BUILDING USE
ROOF SHEATHING - - HES. IND CON PB Om",
APPLY NOiROOFING UNTIL,ABOVE,HAS,:BEEN SIGNED_- ..•;,FINALS' .„ ",.DATE-' ..- INSP. E - 0 ❑ - Q -El
_ ROUGH SAN.#, nssEssoHs vAHCEL No,
.PLUMBING.,;-' 41 ' ELECT.ENERGY '
^
TUBS BSHOWER PAN '' � „PLUMBING ENERGY � - TRACT NU. PARCELING, '
MECHANICAL, MECH.ENERGY - "}
ELECTRICAL BUILDING ENERGY -: Acct VArz: Acc.FILE ND.
FRAMING' ELECT:FINAL TEST - -
ZONING ENG,SITE NO.
INSULATION' PLUMBING s
GAS TEST, , ,' GAS
MECHANICAL , - FIRE.SPRINK'; ENERGY Y.]C
COVERAO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y <]
^ FLOOuzUNE A',L,U,C.
EXTERIOR SHEAR - ELECTRICAL RELEASE
.
INTERIOR SHEAR , FIRE.DEPT: No,
• SHEETROCK.- GRADE '" - FEE SUMMARY
EXTERIOR LATH - BUILDING J` �/ • BUILDING '( '.P�
INTERIORLATH TEMPO RARY'APPROVALS- +�
SCRATCH COATELECTRIC PLAN CHECK ,
- GAS - .- FEE _ •
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY. . SEISMIC FEE
+ OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING"FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM' µ
i
ARRANGE FOR.INSPECTION BY PHONING 252=4505, ELECTRIC f't
~� ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING '
o PLEASE GIVE JOB'ADDRESS,WHEN PHONING
MECHANICAL
I .
-SEE PERMIT,FOR-EXPIRATION'DATE,'-- 'i-
- CONST.TAX
IMPORTANT!*
s PLEASE'READREVERSE'SIDE'BEFORE TOTAL ,
CALLING FOR FINAL INSPECTION:'.
OFFICE COPY d
I' .