11556 (2) APPLICANT TO.F.ILL IRMAI;�HIN RED LINES - USE BALL POINT PEN ONLY
_BU I LD ING PROJECT I DENTIF I CATION . PERMIT,NUMBER
BUILDING LAPPLICATION & PERMIT•' A ^ r ^
r ADDRESS - - I I "� b
• BUILDING - ELECTRICA -PLUMBING.-
2n1% STEVENS ('REEK #200
OWNER'SI PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORSOUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
H L D LIC.No: 317S60 LIGHTING FIXTURES - 10.00/1.00
CONTRACTORS SANTA CLARA PPLIANCES-RESIDENTIAL 4.00
ADDRESS
1 AL'DO' AVE PHONE - PANELS 10.06 DATE OF APPLICATION
ARCHITECT PANELS IDV ER ZOO AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
• ENGINEER '
uc.No. SIGNS TRANS. - 3.00 "
ARCH.OR ENG. - , SP EGIAL CIRCUIT, 5,60 PERMIT VALIDATION
ADDRESS .r '
- ZIP TEMP.METER OR POLE INS., 20.00
APPLICANTS MOTORS I SEE FEE SCH. PAICo VIA t,
AD1 E/ LDO-AVENUE, SANTA CLARA, CA SERVICE CHANGE 20.00 l•
w o o .qn
I{LICENSED CONTRACTORS DECLARATION I M Ir1�U
a �u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
yz e, (commencing with Section 7000)of Division 3 of the Business and
H w i Professions C t (Mg�try, rise is in fulbfogrpL''�1rrtt�)��yy��H�fgqL I P!11 I i{•j� P�; MECH.
Z o m - Lico ise s LLV-Lic.Numberll/_OUIJ a `1L�11"' "•IL"II
O H w Date _Cmurrcte,
BUILDING PERMIT,
¢ w¢ OWNER-BUILDER DECLARATION } INFORMATION
o A o -
a, LL N I hereby affirm that I am exempt from the Contractor's MISC. REFER TO ORD
r's License VALUATION $/FT.
FLLO¢ Law forthe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE ,10.00
E � Code:Anycity orcounty which requires a permit to construct,alter,
' ELEC.CONTR. 'LIC.N0.
Ix re ¢ O improve,demolish,or repair any structure,prior.to its issuance,also ELEC.
-O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n w$ t he is licensed PURLS In the provisions of the Contractor's License- I .
H Z i Law(Chapter9(commencing with Section 7000)Of Division 3 o�theM"`-�H '
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT
the basis for the alleged exemption.Any violation of Section 7FEE
03
¢ =$ 1.5 STORIES„ TYPE CONSTR.
d � by any applicant for a permit subjects theapplicant to a civil penalty gLTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(8500))'.
❑,I,as owner of the property,or myemployeeswith wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not - ,
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforSale.If,however,the building GAS-EA.SV$TEM-11NC.40UTLETS 6.00
or improvement is sold within one year.of completion, the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving that h . . ,
e did not build or im- RES IND ' CON PB Orae.
t provcforpurp.w.fs.Ir.L' , INDUSTRIAL WASTE INTER. 30.00 1:1 E:1 CO � �.
❑ I,as owner of the property,'am exclusively contracting'with
licensed conturetors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:l'he Contractor's License Law does riot apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA) 1.00
contracts forsuch projects with a contracions)licensed pursuant to - SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B. .P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. ,5.00 '
.• I hareby affirm that 1 have a certificate of consent to self-insure, " ZONING ENG.SITE NO.
or a certificate}o�f Workers'Compe nation Insurance,or a certil red
PD°cY No.},fj_LI]'-)Ol,,.rY.).PAC-.-COMP-r
O ] Cerl1(�2J' pY 1ST ereby furnished. I FIRE SPRINK ENERGY T 24
Z Z )(I Certified ropy is.fled with the-city inspection division. -
O Applicant - - MISC.- REFER TO ORD. ffFLOOD
N 0 Y C] NE]
PERMIT ISSUANCE 10,00
- CERTI FICA'TIS OF fi%EMPTION FROM WORKERS' zoNE A.LU.C.
LU ` COMPENSATION INSURANCE PLG.CONTR. LIC. PLc.No, c.
CL 0 (This section need riot be completed if the permit is for one _ TOTAL N❑ Y❑ N❑
Z t hundred dollars IS 100)or Iese,) - -
'U O .1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
In is issued,1 shall nor untploy any person in any manner so as to,
0 U become subject to the Workers'Compensation Laws of California.
0 w Date Applicant - Tn BUILDING -
u - - ALTER OR ADD TO MECH. 5.00
} to
NOTICE TO APPLICANT: If,after making this Certificate of 1. -
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
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)X0C,F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEET '
I hereby affirm Wait 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name - HEATI NG UNIT(OVERA 00,000 B.T.U.)8.50
Lender's Address ELECTRIC,
I certify that I bace, ead this application aml state that the above VENTILATION FAN (SINGLE). 4.00
information is correct. I agree to comply with all city and county BOILER H.P:Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and ��.
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL I
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of - MISC.- ' REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONSTTAX
Cray in any way accrue against said City in consequence of the. PERMIT ISSUANCE 10.00 . _
granting of this permit > MECH.CONT. s L��qp MECH. .
TOTAL TOTAL
Signature ofApplieanl/CnntraCDr 44Dale, THERMAL.DESIGN SYSTEMS 15.00 �L✓
OFFICE COPY
POSTTHIS`CARD NEAR,FRONT.OF BUILDING
PFRMIT NUM9E�i -
, r ir, E : .CITY• OF. CUPERTINO 1.1556
"I.NSPECTION DIVISION
JOB INSPECTION RECORD
•; ,� r I T " PERMIT EXPIRATION"
JOB�ADDR ESS '= 20.195 ,STEVENS CREEK` .'BLVD':UNIT't#"- 200' ' _LOT#k
PERMIT EXPIRES IF WORK
OWNER W b T. GoNTPIACTod ' THERMAL- DESIGN ' SYSTEM IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD. _ 180-DAYSOF'PERMITISSU- --
a , .ANCE OR 180 DAYS'FROM ' '
FOUNDATION ' : . . : ." • .. .. - '
.. - UFER I ' to
^y-ILASTCALLED.INSPECT,ION; , "
PREGUNITE T':
"VALlON.,,POUR NO CONCRETEUNTIL ABOVEMAS BEEN SIGNED tr,hUNDERGROUND /SLAB.PLUMBINGELECTRICAL - 1 , MEER:
MECHANICAL k
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - _ , . BUILDING PERMIT
J. - INFORMATION'
WOOD FLOOR - - ,vALunnoN- s/ET.
PLUMBING,
MECHANICAL'
PERMIT TD
ELECTRICAL'• ' �•(,
_ FRAMING \'
- - sTor+Ies TYPE coNSTR
-INSULATION .
h
„ " ."OCG GROUP- '_RES.UNITS
_ PLACE NO SUM OOR UNTIL ABOVE HAS BEEN.SIGNED '
ISO.FLFLOOR AREA ,.TOTAL ACREAGE
ROOF
..® DIAPHRAGM r p. 'r - • ,
❑UILOING USE.,
b 'HES IND . CON PB OIM1ei
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El: 'o ❑' O ❑
ASSESSORSPARCELNO.
ROUGH
PLUMBING .•.. s ,
n•y
• �' GAS TEST U a 1 TRACT NO. 1. EA'RcEL NOI-
MECHANICAL.- -
'ACG DATE "ACC FILE NO
ELECTRICAL - FINALS DATE INSP.
FRAMING '^r' .;1M SAN #' zowNc ENG.SITE No. -
'INSULATION c ,; PLUMBING •T:•
GAS, `
_ MECHANICAL FIRESPRINK ENERGY T 29 .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING y� ''N,� I] NO
' LATH—INTERIOR - ELECTRICAL .. FLOOD ZONE A;L.u.c..
. V[j) N� V NF
LATH—EXTERIOR FIRE DEPT. .;
SHEETROCK a - GRADE - FEE SUMMARY
SHEAR INTERIOR - BUILDING, _d : BUILDING
SHEAR EXTERIOR ',' TEMPORARY APPROVALS" ,
FIREWALLS - ELECTRIC PLAN CHECK
• - GAS FEE
NO TAPE OR PLASTER UNTIL:ABOVE HAS BEEN SIGNED OCCUPANCYw SEISMIC FEE
1; OCCUPANCY OF BUILDING IS NOTPERMITTED UNTI L BUILDING FINALIS SIGNED BY BUILDING INSPECTOR. 'MICROFILM
r
'ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC .
® o' ONE WORKING,DAY BEFORE REQUIRED INSPECTIONPLUMewG
PLEASE GIVE-JOB`':ADD.RESS WHEN'PHONING
Z i MECHANICAL'
— SEE PERMIT FOR,EXPIRATION DATE.
- r . CONST.TAX
n ..:IMPORTANT!
PLEASE'READ REVERSE SIDE BEFORE TOTAL,
CALLINGFOR FINAL INSPECTION. ILt
OFFICE COPY