12185 (2) APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATIO PERMIT NUMBER
amLOING APPLICATION & PERMIT 1. 2185
ADDRESS .� V
BUILDING-'ELECTRICAL=PLUMBING-'MECHANICAL
OWNER'S - ` PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
rvT Tom's
NA -- OUTLETS-SWITCHES-RECEP 10.00/1.00 Q
1 �( �- LIGHTING FIXTURES 1400/1.00 I '
CONT ss as
' APPLIANCES-RESIDENTIAL 4.00
Q.` PHONE PANELS 10.00DATE OF APPLICATION
RC
CT PANELS (OVER 200 AMIN 20,00 PLAN CHECK FEE P.C.NO.
OR ENP
EN .�} �y
ICqu lr� SIGNS TRANS. - 3.00
ARCH.OR END. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
? ZIP EMP.METER OR POLE ANS. 20.00 '
APPLICANT MOTORS SEE FEE`SCH. ���pl I
ADDRESS I"U Pf' 0 3333YY/ N-
SERVICE CHANGE 20.00
- w
00 LICENSED CONTRACTORS DECLARATION 17 � 1n0�!
<u w I hereby affirm that I am licensed under provisions of Chapter 9 ' H / 136'UA CF DATE
2 (commencing with'Section 7000)of Division 3 of the Business and - BLDG, ELEC PLG. MECH-
0 2- Professions Code r �:ense is in fmfAV;:?i0.7- License ClassLic.NuI p®pp M ❑ ,.❑o m p w seisinBUILDING PERMIT
OWNER-BUILDER DE INFORMATION
0>� MISC.- REFER TO ORD
R
3 LL N ,I hereby affirm that I um exempt from the Contractor s License VALUATION $/FT.
H a- 0¢ Caw for the following reason.(Sec.7031.5,Business and Professions PERMITASSUANCE 10.00 �f
Code:Any,city or county which requires a permit to construct,alter,
¢ rt ¢ improve,demolish,or repair any structure!prior to Its issuance,also ELEC.CONTR. LIC.N0. ELEC.-
= <O O u requires the applicant for such permit to file u signed statement that TOTAL" PERMIT TO
w$ he is licensed pursuant to the provisions of the Contractor's Lirense
-At Z to Law(Chapter 9(eommencing with Section 7000)of Division 3 ofthe F/
¢ Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE Y-li
¢ H o the basis for the alleged exemption.Any.violation of Seetion7031.$ STORIES TYPE CONSTR.
n ';m by any applicant for a permit subjects the app licdm wacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than fivehundred dollars($500).1:
❑ 1,as owner of the property,or my employees with wages as ggCKF LOWPROTECT.DEVICE 4.00 OCCGROUP. RES.UNITS
(, their sole compensation,will do tire . .e work,and the structure is not t
intended or offered for sale (Sec. 7044, Business and,Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments11 are nut intended or offered for sale.If,however,the building
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will(rave the barren of proving that he did not build or Ino- - RES IND CON PB Other
prove l'or purpose of sale.). INDUSTRIAL WASTE INTER.' 30.00 ❑ El EJ •❑ F-1❑ I as owner of the property.am exclucontracting ntracting with
licensed contractors to construct tine project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
t to an owner o1'property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5'(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant Iti
the Contractor's License Law. - SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO, PARCEL NO.
❑ Imncxcmptninder Sec. B.&P.C.for this WATER HE W/VENT 6.00
reason
.. Owner /�y//y�R!�� Dam WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
��1Vx'eF LARATION WATER TREATING EQUIP. 5.00 -
I hereby afOrm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Luh.C.).
Policy No. Company •��L� '
O ❑ Certitledenr�y'y It b tun kI it - FIRE$PRINK - ENERGYTY4
Z Z ❑ Ct,UlJ�r�g Le th cit• nspectimi division. MISC.- 'REFER TO ORD.
O Applicant Y❑ N❑ V ❑ N❑
F y PERMIT ISSUANCE 0.00 FLOOD ZONE A.L.U.C.
1 CIi R'I'I FICATE P IiMI'fl0 OM WOIiKIiRS'
LU _ _ COMPI- SATION I RANCH PLC.CONTR. LIC.NO. I.G.P '
_ CL O (This section need not be completed if the permit is for one TOTAL • Y❑ N❑, Y ❑ N❑
D 2 hundred dollars(S 100)Or less.)
L) O 1 certify that in the perfoonance of the work for which this per- QTV. 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'ColllpeaEatlon Laws of Culitirnia..
0 y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
�- to - NOTICE '10 APPLICANT: If,after making this Certificate of Its.
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply.with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE ,.
` I hereby affirm that if is ' construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pertorniance of the wo which this permit is issued(Sec. - MICROFILM,
3097,Civ.C.L HEATING UNIT.(TO 100,000 B.T,U.) 8.00
Lender's Name' ��-✓� HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county�IBOILER-COMP(3 H.P.Of 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
above-mentioned properly for inspection purposes;
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino ago' st'liabilities,judgments; costs and a pense which ' ISSUANCE To-
PERMIT .00 CONST.TAX
may in y ay cc e,ag''nst aid City in cpns lu nc}�i
gra Ic MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL r
Signature of nn -an[ n t ctor . .Date -
t LI 1
OFFICE COPY
a �
POST CARD NEAR FRONT OF B,U,ILDING
PFRMIT NUMBER
r CITY- 0 GUPERTINO Q
k , 'I .INSPECTION'DIV.ISION
r� JOB INSPECTION RECORD
PERMIT,EXPIRATION
JOB ADDRESS 20195 STEVENS CREEK` BLVD.uNIT#'' 275 ' _Lor# '
x -°PERMIT EXPIRES IF WORK'''
OWNER W' D T CONTRACTOR REDWOOD CITY ELEC':' IS NOT STARTED'WITHIN
' INSPECTION DATE. INSPECTOR INSPECTION RECORD IOU DAYS of PERMIT ISSU
FOUNDATION . ,,;. . - ANCE OR 180 DAYS'FROM ,
` LASTCALLED INSPECTION.
r' LIFER , M,
PREGUNITE � - - - - PERMIT,VAUDAT1oN.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED"
a 1 i-
•' UNDERGROUND /SLAB - _ M3.J�'•� -
PLUMBINGMi I- • ,1. - ry qQF�
ELECTRICAL - , ,la f J 1 ' - ( ISSUaNCE DATE
BLDG. ELECT: PLG. NECK
MECHANICAL '
Cf Y �C B8I0
DO NOT"POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .' �. BUILDINGPERMIT
'a'. INFORMATIQ .
. .. WOOD FLOOR vnwnrlDN NOT. .
PLUMBING,'
MECHANICAL—
PERMIT ro
ELECTRICAL '
FRAMING "
PECONSTR`
INSULATION + - sroRlEs TV
--FCC-GROUP - RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• • 1 - SD FT I.1.00H AREA
ROOF TOTAL ACREAGE
"
DIAPHRAGM'
BUILDING USE
RES ' IND � CON PB OPnn,
0 El Q El
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED . "
ASSESSORS PARCEL NO.
.ROUGH
i PLUMBING
f •v.
GAS TEST - - _ •-,� TRACTNO, PARCEL NO.
vN -
MECHANICAL -
ACC;OATE, ACF FIE-NO.
ELECTRICAL -A -FINALS DATE INSP. a
' FRAMING • - SAN # t" zoNlNc ENc.SITE NO.
INSULATION - PLUMBING -
'_ a. GAS ,
FIRE SPRINKENERGY T"?A .
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '.'
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C. i
Y.❑ N❑ Y I] No.
LATH—EXTERIOR -- - FIRE DEPT. _
SHEETROCK '- GRADE: ': -FEESUMMARY
SHEAR'INTERIOR - 'q ^ BUILDING;
I'.. SHEAR EXTERIOR - , 'TEMPORARY APPROVALS .a " BUI1:DwG�I,' • . .
FIREWALLS - - ELECTRIC• PLAN CHECK ,
.FEE
GAS,
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
.. OCCUPANCY OF BUILDING IS NOT PERMITTEDUNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ,MICROFILM
"ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505,
~� ONE WORKING DAYBEFORE REQUIRED'INSPECTION
,,. `PLUMBING
z PLEASE.GIVE'JOB ADDRESS WHEMPHONING..
.� MECHANICAL
-
SEE PERMIT FOR EXPIRATION DAT IE .
CONST
'AMPORTANT!
TAX"
PLEASE READ REVERSE SIDE BEFORE, . 2 TOTAL''
.`CALLING'FOR FINAL INSPECTION.'.
OFFICECOPY_' '
r