14583 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NO PROJECT I DENTI FICATION PERMIT NUMBER
BD4mmc APPLICATION & PERMIT 14583
. ADD Ess
�I`( BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
owry EH' - PLAN CHECK VALIDATION
' I(E 'Ifj� 'l-"� l�a'C�H��� CITY. ELECTRIC PERMIT FEE
I Cru . �I Harv, �w'ZIz� /Y3 %rjy�
I NAMpnacTURs OUTLETS-SWITCHES-RECEP 10.00/1,00
ie TT
`�• o. � �U LIGHTING FIXTURES 10.00/1.00
r.OrvTRac 0 i APPLIANCES 4.00
Aof]HEss 11 �q/o n
dC' ��noNc 3L-L' L PANELS 10.00 DATE OF APPLICATION
ORRCnrtEE,fST, PANELS IOV ER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
E m EI/�I-' hjTi uc mo. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
APPLICANT
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00IZ�. F-
y tIl
' w00 LICENSIiU CONI RAC'I'ORS❑EC1.AR,\'HON
a u v 1 herebyal lirin Ihal l ant Iiconxd under foramens of Ch'vlrler 1 ---- ISSUANCE DATE
z w (Contra mein•with Sectio,70001 yl'Division i Little Basin...unit
In a a N /\IEpG Lrr. ntl'L❑G. MECH.
w" I'rolessiuns Cute m li:cns,i, n lull lilr'esDJ�ll[e 10 IILJYJI,V lI1L JI
0 i F 0' Licenu rf Ly Lie.Numbe� '�'`i [.
Dale ��/--' fLJ Contrera, L4. {y
< r s l+I?6,(�h '1� BUILDING PERMIT
¢ Ica OWNER-BUILDER DECLARATION
s o a U INFORMATION
w ; w w I hereby affirm that I am escmpt front the Camra,ur's License MISC.- REFER TO ORD
VALUATION $/FT.
Fw Ua Law far the following reason.(See 7031.5,Busin.•.uund Podcssion' PERMIT ISSUANCE 10.00 _
Lode:Any e'll)'Or cmmly which ,T uirn a pcnnil to,onsl mel.alw, L^/
rt R a O improve,demolish,nl,epuir any slrmlure,Prior Io w
its ixunc,calso ELEC.CONTR. LIC.NO. ELEC, Iso (_(J
0 u rcyuins the applicant far such permit to IIIc a signed d.wamnl Ihut TOTAL PERMIT TO
n W m lie is licensed Pursuant to the prosisiuns of the Contractor's License
Law(Chapter 9(wmnencinNx'ith Section 7000WfDivision 3 nl the
i c Business and Professions Code)of that he is exemia Iherctium and DTV. PLUMBING PERMIT FEE 144T. I
X r the basis for lh,alleged exeuop[ion.Any vjul,lion of Saelion 7031.5 STORIES TYPE CONSTR.
i3m by any aPpli,ant to,a Perrin11olects the apflicani III o civil Penally ALTER-DRAIN -WATER (EA.) 5.00
of not more tiwn Ike hundred dollms($500f))
❑ 1,as uwner of the Properly,or my anpluyns with wages as BACK FLOW PROTECT:DEVICE 4.00 5CC.OROUP RES.UNITS
their sale compensation,will Ju the woA,and the araCtllre is not
intended or olferN for sale (Sec. 7044, Bmincss unit Pruksions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:Thr C.rHad lur's License Law does net apply loan owns of
properly who builds or impmses thereon,and who does suclh work FIXTURES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE
lin s'If of Ibmugh his own cmplu1'ccs,pnwided Ihul such inpmavc.
menu are nal intended or uttered lar sale if however,the building GAS-EA.SYSTEM-11 PIC.4 OUTLETS 6.00
or i,if prov.mcar a old is Illin one year of comPlctiun, till awn n GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
build,,will hove the burden of pnrvin,[hal he did ,at build IIIiso,. BUILDING USE
HES IND CON PB Oman
trove fur purpose of ealc.l. INDUSTRIAL WASTE INTER. 30.00
❑ L as owner of the pmtruct ant exclusivelyISe contracting with ❑ ❑ ❑ ❑ ❑
and Pro contractors to he
ton Pl I...I (See. does, Business LAWN SPRINKLERS- I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and 1'howner of Cud property The Conbuilds
uas o License Law dues no[apply.
Ioan trowner ofprojewho bui Maar intleroves fithenar,endwho LAWN SPRINKLERS-OVER 5 (EA.) 1.00
lie C.a air',Lceneeu wall acunvoaurlsl licensed punuallt to SEWER-SANITARY-STORM EA.200ft/10.00
the Conimc[ur's License Law. TRACT N0. PARCEL N0.
(Ca5U11
❑ I our eae.PI under Sec. ,B.&P.C'.fin,On, WATER HEATER W/VENT 6.00
Owner Dwc WATER SYSTEM 5,00
ACC.OATE ACG FILE N0.
WORK ERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby ullinn trot I have a cernhede of consent to sell-insure, ZONING ENG.SITE N0.
or a eenn
i0ta of Workeri Cmnpe'nsutiun Insurance,or'a cvnil'icJ
copy IhereiSl 0 ee, 1900,L'i,C.L/•
Policy No. Qmgsany_F�IZI-IL�L ✓�`'1-�
O r Certified Coh a er yfl l''hc 00 FIRE SPRINK ENERGY T 24
eflifieJ d I�y I��q Iii division.
zp�. A eat- _-ZVS.�i' i IV�.fW_F '/ MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CC W . FICA 11;01'EXEMI'I'ION PROM WORK Ii RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTH. [JC.NO. PLG.
Z (This wonon need out be co a,l,ed it III, pm nit is fur one TOTAL Y❑ N❑ Y ❑ N❑
hundred della,,IS 100)or less.l
U O 1 certify[hal in the perfunnance of the work for which cols per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U out is issued.I shall not eahploy'any person in'.sty manner sin as to
hewn,subject m the Woken'Conhrymsatian Laws of California.
d Date Alspuean[ BUILDING /)(�,
} to NOTICE '1'O AI'PLICAN'1': Il,aHcr nuking this Certlli,m,of la ALTER OR ADD TO MECH. 5.00 LUJ
2 emptiun,you should hecunm,.beam to the W'urkLF,Canhpcnsa[iall APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must Holovilh cuntply wish FEE
U such provisions o,This permit shall be de,med resrk,d. AIR HANDLING UNIT(TO 10OCCC.F.M) 4.00
CONST NUC'f[ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ,3 ;
I hereby affirm Ihut there is It construction lending agency for EXHAUST HOOD )WITH DUCT) 5.00
the perl.nnance of the work lar which fills permit is 'issued(Seo. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender i Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this applicutan I'd'late that file above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree In comply with all city and county agQILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
erdinunc
es nd state lows relating to building cons[luafion, and
hereby authurim roperty I.,inve,spection
of this city rh enter ufmh the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL �\
obrebyove ia[Ianed property for intfemur pis ity ts.
IWO •mc In savr, indcmoil'y and keels harmless IhC ('hy nl MISC.- REFER TO ORD. �
try III a Its[ liabilities,j st id . lysin mW ec."n, which PERMIT ISSUANCE 10.00 CONST.TAX
Inay in try' C rue tet id ('i[y in cuns,quonm ul the
•ranting all 1 lhl MICH.CONT. LIC.NO. MLCH.
1� •��1,'fu•1�� 2 Z.���; TOTAL TOW
'i� uturc ul'Apphe fCud'a'k, Date
OFFICE COPY
ANT TO-FI'LL IN INFORMATION WITHIN RED LINES'- USE'BALL'POINT PEN ONLY
I LDI N PROJECT I ID FICA a .PERMIT NUMBER,,
NG � .-" . APPLICATION;& PERMIT. "�
ESB . ,.._ v - 1.4 583
• C�� BUILDING-ELECTRICAL-PL`UMBING-MECHANICAL
PLAN CHECK VALIDATION
OTV. ELECTRIC PERMIT FEE
I _
GNE ZZ'ZIZ
NAmEoACToa's UTLETS,-SWITCHES-RECER 10.001100,
LIGHTING FIXTURES 10.00/1.00
CONTRAS OR'S
ADDRESS
' l PPLIANCES-RESIDEiNTIAL 4.00 - a
PANELS 10.00 'DATE OF APPLICATION
. " ORCHITe T ,r- - - • PANELS (OVER 200 AMPI'" '20.00 - PLAN CHECK FEE P.C.No.-•
OR .
E GI ,
LIC.rio. - SIGNS TRANS. 3.00
ARCH.OR ENG. - - PERMIT VALIDATION
ADDRESS - SPECIAL CIRCUIT - 5.00
- ZIP EMP.METER ORIPOLE INS. 20,00 -
APPUCANrs ; 1 ?MOTORS SEE FEE SCH.
+ SERVICE CHANGE 2000 - f1 p.. QQ.S(IrrI'
0 o LICENSED CONTRACTORS DECLARATION - AR 4-
".0�. -1 hereby affirm that I am Itrense l under provisions of Chapter 9 - ISSUANCE,ATE '
H (re,nm slog til S 1 ,,."{000) s DIVISIOII 3 n the Busanes and-, Clion�LG•� MECH.
°i Prolcssums Cod my license is In full fores�d.�f�c. s�
0 0 w w License CJusc Lie Nr ub 'tI
H Dam Y Contmcmr
BUILDING PERMIT
¢ a a OWNER-O'UILDEiR9)C:CLARATION -
_ 0 a o, - INFORMATION
E
C u H 1 hereby affinn'Ihut I um encmpt from the Contractor's License MISC.- REFER TO;ORD _
u D.J Law for lire following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE -• 10.00 VALUATION Dl$/FT.
r - ' Code:Any city or countywhieh requires a permit to constructalter, rte ^
Q ¢ Q 2 - improve,demolish;or repair any structure,prior to its issuance,also ELEC.DDNTR, LIC.NO. ELEC.
- 0 ac requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO^
a w m he is licensed pursuant to the provisions of the Contractors License _
Law(Chapter 9(commencing with Sect ion 7000)of Division 3 of the E. -�• A^
a Business and Professions'Code).or that he is exmnpt Ihercl'mm and QTY. , PLUMBING PERMIT FEE II - - "'1'I
the bms'is forthe alleged exemption.Any violation ofSeclion 7031.5 }' STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA15.00
` of not more than five hundred dollars(5500).): . -
0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do tire work,and the structure is not DCF GROUP. RES.UNITS
intended or offered.for sale(Svc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ; _
Code:'fire Contractor'.s License Law does not apply In an owner of
propCrly who builds or improves Iltereon,and who floes such work FIXTURES-PER TRAP_ 5.00 60.FT.PLOOR AREA TOTAL ACREAGE
himself or Through his own employee,,provided that such improve
meats are not intended or offered for sale.if,however,tlm building GAS-EA.SYSTEM-11 NC.4 OUTLETS6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.1 2,00
builder will have the burden of proving that he did not build or im- BUILDING USE
HES IND CON PB Omer
prove for purpose if sthe p INDUSTRIAL WASTE INTER. 30.00
❑ d as owner.,,the property,ant projec fSe .onset ingwith �. SE SP Q ED
liceitaco contractors to construct tire pricense La. 7044,Business 1 LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:'fhe homraclor s License Law docs not apply
to tr owner of property who builds tr improves Ihcrcun,and who LAWN SPRINKLERS-OVER 5 IEA.1 1.00 '
r - con tmcis for st¢h projectswithith a emiractor(sl licenxd pursuam to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No.
❑ I am exempt under Sec ,B.&P.C.for this - WATER HEATER W/VENT 6.00
reason'
Owner 1. Date - WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
hereby affirm that 1 have a certilicale of consent Gt sal Ginsure.
or o certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
y . copy If- o c 3800,Lab.C.l -
loh .Nn Company
Cerlafred C I: r yl .. L - FIRE SPRINK ENERGY T-24
� // ertifie division.
z Qx. AI O rant MISC.- REFER TO ORD. v N❑ 'v ❑. , No
'x~ rn " PERMIT ISSUANCE - 10.00 '
( IFICA'PEPE EXEMPT ION FROM WORKERS' FLOOD ZONE A.L.U.C.
W > ' COM PIiNSAT10N INSl1RANCli PLG.CONTE. LIC.NO. PLG.. '" • '
�'Zi ,,iris sealed need not be c.Dlp)cted.if lire liennil is for.one _ - TOTAL V�' -Nn Y,[D IN
Hundred dollars(SI00)orlcss.)
U O" 1 certify that in the performance'of the work for which this ice- DTV. MECHANICAL PERMIT FEE FEE'SUMMARY
Ly F mit is issued,I Shall not employ any person in any manner so as In
U become subject to the Workers;Cmnpensation Laws of California.
0'w'' Latc At licum • _ - - BUILDING pp
a I p ALTER OR ADD TO MECH. 5.00 ZU3 '
NO'[ICE.f0-APPLICAN'P: If,melee making this Cerlll'icalc,f lex- e _
Z emplion,you Should become subject lo flue Workers'Cbntpensallon APPLIANCE 5.00 PLAN CHECK' '-
provisi,)ns .1'the Labor Code, You must forthwith comply with FEE '- '
U • such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UN5.
IT(OVER 10=C.RM.) 6.00 .SEISMIC FEE 60I hereby.affirm,that there is a construction lendingagency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this pemit is issued(Sec. MICROFILM
C
3097,Civ .f - rHEATING UNIT(TO 100,000B.T.U.) 8.00 -
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address 'ELECTRIC -
I car'
ify that I haveread this.ppliYon and state that Ote above VENTILATION FAN (SINGLE) 4.00 -
tnf r ration is i iD erI agree t omply with all city and county PLUMBING-
ordinances and slat laws relatutt, I, building a struchim, and BOILER-COMPI3 H.P.or 100,000E,T.U.1' 6.00
h authorize representatives rl This city to •star upon Thu
by
above-mentioned properly for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. . MECHANICAL
(We tee to Save, indemnify and keep_harniless the City of MISC.- REFER TO ORD. -
Cupertino a ainst liabilities,judgments, costs cad expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any w ecr m ' Inst vad City in crotuequence of the
r- ", ranwing (t e if l , MECH.CONT. - 'LIC.N0. ' MECH.
IV/1NMIrAf .�•4a� TOTAL '' TOTAL
UD /1QQII__
I ,lure o'Applican Contractor Date 2Q W
OFFICE COPY,
1'.
POST'THIS' CARD NEAR FRONT OF BUILDING
P.RMIT NUMBER" !
' G.ITY OF CUPERTINO 14583
INSPECTION'DIVISION, ,
JOBINSPECTION RECORD
+ , - ST. # 1-eRERMIT,EXPIRATION =
�aedD'oRE`ss 20195 -STEVENS CREEK"BLVa'.UNIT# '200 -1oT#
_ •PERMIT EXPIRES IF WORK
OWNER'• FIDELITY •TITLE - WDT CONTRACTOR 'Huet IS-NOT STARTED,WITHIN .
INSPECTION" - DATE INSPECTOR INSPECTION RECORD -' �18o 13AYS'bF_PERMIT ISSU-
,FOUNDATION,. .� •±. ••;, .. - A.— OR'I8 D`AYS�FROM
.., - •. ..
'NOTE: .' LAST CALLEDINSPECTION.,,
UFER - • - ALL GRADING AND DRAINAGElSHALL BE INSTALLED':
PR EGUNIT,E., - CUPERTINO STANDARDS.TO COMPLY WITH THE APPROVEDTLANS'AND
VCIT Y OF S ?I:Rnu rvn Don nom
_ -
IGARAGE SLABS, -
! POUR NO CONCRETE UNTIL ABOVE'HAS BEEN SIGNED .. • 1�'�1D F'I" ,'-' '
UNDERGROUND*/SLAB "g6hgt'
PLUMBING I•; •' - - - ' - R ,Y fir IJO�f:
ELECTRICAL . - - ISSUANCE DATE '
MECHANICAL -- •y(I + Pic MECO
00 NOTPOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _+ BUILDING PERMIT
rvry
WOOD FLOOR INFORMATION -
(PLUMBING" ' _ ^' VALUATION
MECHANICAL �"�
ELECTRICAL PERMIT TO
FRAMING':
INSULATION'' Yiunles rvPE CONsrR.,
occ GROUP: �. RES.UNITS:
_ - 1, ' .'i. .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.; ` 11 sl Fr.aooR RE rorAL ACREAct
ROOF. . i "
DIAPHRAGM
THE CONSTRUCTION TAXIS PAID
• .."I tiro ._ _ '
ROOF SHEATHING - w". _ RES •:1NO (.(INc USE a
APPLY NO-ROOF,NGUNTIL'ABOVEMAS'BEEN SIG NE0 ' FINALS • ' DATE 1 INSP., ❑! '❑ ❑ ❑ ❑
. ASSESSORS PAHCEL NO:
ROUGH- SAN,p
I PLUMBING _ - ELECT:ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY .ad •
i MECHANICCAL, ��' MECH.ENERGY -
I , '+, ACC.DAT E: ACC.FILE NO,
ELECTRICAL
d - 'BUILDING ENERGY -�/
,FRAMING -y ELECT.FINAL TEST
ZONING ENG,SITE NO.
'INSULATION - PLUMBING
1
GAS TEST ' ' ' _ GAS
MECHANICAL ` .)�•� FIRE sPRw K' ENERGY T2
-COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING- . 00 NE N❑, ` ❑ "�
` '�?'
7000OU/OA L,u.0
EXTERIOR SHEAR' ELECTRICAL RELEASE
INTERIOR SHEAR'., -- FIRE DEPT, +
p2fY ❑ •„NE ❑ NO
• SHEETROCK y-5' '. . GRADE' ' FEE SUMMARY
EXTERIOR LATHBUILDING .Z
INTERIOR LATH .•. TEMPORARY APPR VALS BUILDING
I - SCRATCH COAT _ <:F ' '. - ELECTRIC:
i
•PLAN CHECK
- -;? GAS
NO TAPE OR,PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. .SEISMIC FEE- ' �• ! l�
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR; •MICROFILM '
l' :ARRANGE FOR dNSPECT,ION.BY,PH6NING 252-4505 eLEcrRIc
( LU ., 'k yr, I, , _ _
p� ,•. ; ONE'WORKING DAY'BE'FORE REQUIRED INSPECTION w PLUMBING
Z_ PLEASE-GIVE JOB ADDRESS,WHEN PHONING
1 = SEE PERMIT FOR EXPIRATION DATE —`. { MECHANICAL
4IMP09TANT, CONST.TAX
f
° PLEASE READ REVERSE SIDE BEFORE r
CALLING FOR'FINAL.INSPECTION:^a'
( _ I e OFFICE COPY..'ll