14584 (2) APPLICANT TO,FILL IN INFORMATION WITHIN RED LINES -.USE BALLPOINT PEN ONLY
BU LDI NG PROJECT 1 DENTIFICATI ON ' ;,.PERMIT NUMBER
' APPLICATION•&,.PERMIT An BUILDING-EECTRICAL-PLUMBINGMECHANICAL 1458 n VQ4} 4
O NEWS
- �If 1 PLAN CHECK VALIDATION
N
\. AME - �j'jj -t OTY. ELECTRIC PERMIT FEE
.1 CO TRACTOR'S PHONE ZIZ fOQ yrLO -
NAME �,y OUTLETS-SWITCHES•a RECEP, . 10.00/1.00 ' AR
„(/y� ua ND. Z LIGHTING FIXTURES '10,00/1.00 r v'
.ONTn AC R'S• r '
ADDRESS APPLIANCES 4.00 -
M (D PHONE �� 1 PANELS ' 10.0.0 DATE OF APPLICATION•{' ^
ARCHITECTPLAN CHECK FEE P.C.yNO.
'•
OR � '�', PANELS (OVER 200'AMP)�• - �20.00. •' v..
ENGINEER' ° +
LIC.NO, SIGNSTRANS. '3.00
AARCH.OR DDRESS ENG: _ ., SPECIAL CIRCUIT 5.00 PERMIT VPCIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDRESS rs - MOTORS -SEE FEE SCH. A'ry `^"- + r
Is-
aooR Ess i�' -
SERVICE CHANGE ' .2000, _ .IKJ
O o O LICENSED CON'T'RACTORS DECLARATION. _ A -i 1�1 f�'
at u v I hereby affirm that I on licensed under provisions of Chapter 9 `2 �I SSCUANCE DATE r
ran 0,monomicing with S edam 70000 of Di ision 3 of the Business suit
_ BLDG: ELECT. L PLG. u MECH
r o z Irl a ns Code,y�my Ilecnsc Is in f II In 1 IeI
Z o Liu Ile V U NI tl a Ln .. rtin p -
o N.= Dale G ss� j Comm lor. l Z7 ,
; BUILDING PERMIT
¢ ¢ ¢ - OWNER-BUILDER DECLARATION " '
o a" MISC.- ' REFER TOO RD INFORMATION
wg H I hereby affirm that 1 am exempt from the Contractor's License - VALUATION.<
LLo ¢ Law lot the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 r' $/FT.
Code,Any cityor'counly which repilresapertnitto Cnnstruct,ulter, -
¢ ¢ a O improve,demolish,or repair any llmorn,prlorto its issuance,also ELEC.CONTE. +•LIC.N0. -, O
ELEC.
-,O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
n E, m - he Js licensed pursuant to the provisions of the Contractor's License Q
F Z i
Law(Chapter 9(winmencing with Section 7000)of Division 3 ofthe
•4 i o Business and Professions Code)or that he is exempt therefrom anA CITY. PLUMBING PERMIT FEE
Qt the[he basis far the alleged exemption.Any violation ofSection 703 L5 ,r. - STORIES TYPE CONSTR. '
u ; _ by any applicant to,a permit subjects llie applicant to civil penalty '
IN not more than ALTER-DRAIN (EA.) 5,00
five hundred ddLR,(S500)J: -
- ❑ I,as owner o['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.GHOUP_ RES.UNITS-
intended or offered'for sale'(Sec. 7044;Business unA Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Low does not apply to an owner of - "
popeity whobuilds or improves thereon,and who docs such work FIXTURES-,PER TRAP 5.00 SO.FT FLOOR AREA TOTAL ACREAGE
hi iself or through[,is own employees,poovided ihdl:uch'intprove-
areatsamnot intended oNoffered for sale.if,ho evi(tire building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is...If.ithin one year of completion,the owner GAS-EA.'SYSTEM.OVER 4 (EA.) 2.00
builder will have tire burden of proving that he did not build or im- BUILDING USE
prove for purpose of sole J. INDUSTRIAL WASTE INTER. 30.00 RES IND: .CON PB _ Omer
❑ Las owner'of the properi Y.am cxdusively contiading with ED.,
Q.' .� El 0
I licensed contractors to construct the.project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ' ASSESSORS PARCEL NO.
and Professions Code;The Contractor's License Law does not apply -
to ani.owner of-property who builds or improves thereon.and who ,_ LAWNiSPRINKLERS-OVER 5 (EA.) 1.00
contracts Gusuch projectswith a eontraeloins)licensed pursuant to _ SEWER-SANITAR V-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 NO.
WORKS RS'COMPI'NSA990N DI:CI.ARATIONA''T.` WATER TREATING EQUIP. 5.00 ' '
I herebyaffirm that I have a ocnificate of consent to self-insure
or ircenificate of Workers'Compensation Insurance,or a certified ZONING ` ENG.SITE NO.
+ .. copy thereof(Sec.3800o,00, �pL pump
amu p�
Policy Company F/F/ �'E//`r/,/
❑ moriiedc pY ulpbyf 51 ` A FIRESPRINK- ENERGYT24
Z Z` Crt fe y s I��"I 1 ieclion.division. .. -
/ J " MISC. 'REFER TO ORD.
~ rn - PERMIT ISSUANCE , •10.00
' .�� CE;J FICA'pS OI'.EXEM EXEMPTION I'ROh1 WORKCRS'. FLOOD ZONE A.L.U.C:, `
LU �•• COIVPENSATION INSURANCE - PLG.CONTR. - LIC.NO. PLG.
EL 0 - (This section need not be Completed if.tile pemtil is forgone TOTAL Y:[]. -NEI ` YO_ N_
D Z hundr d dollers'(S 1000 ,IcsIJ -
U O ;. I emily that in the jmrforma I'•of the work For which this per. CITY :`MECHANICAL PERMIT' FEE .. FEE SUMMARY
LL F nils s bleed;•I shall not employ any person in'any manner so as to ,
U bee m vblect to the Worker' Comp C, tion Laws of California.
O w DatL AP hcant BUILDING a
0. p ALTER OR ADD TO MECH.. - 5.00 O s
_ - } 0 NOTICE TO APPLICANT: If,after making H C tific t .mLE.. - -
F- Z comonle,YOU should become Subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code you most fo ihw'th CrouPlY with - FEE ' a
V such pn'vio.os or this permit shall be deumedrevoked AIR HANDLING UNIT(TO 10SWC.F.M.) 4.00
-
.CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 6.00 SEISMIC FEE
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,Civ.C.). - .. HEATING UNIT(TO 100,000 B.T.U,)" 8.00 -
Leer's Name HEATING UNIT(OV ERx100,000 B.T.U.)9.50
Lenm der's Address ELECTRIC.,,
I certify that,I have rad thisapplication and state 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 budding construction, and BOILER-COMP(3H.P.or 100,0008.T.U.1 6.00
• �' - hereby,authorize representatives of this City to enter upon the _ BOILER-COMP (Over l00p00 BTUI SEE FEE SCH. 'MECHANICAL -
mioned property for inspection put Uses. -
.Ove) ngeeto'save'indemnify and keep hartnluss'IIic City-of " MISC.- - REFER TO ORD. < -
Cupertino a most liabilities,jud6munh, costs and expenses which - - CONST.TAX e - ,�
may In an way accrue 1gyRed said City in consequence of the PERMIT ISSUANCE 10.00
m III i M1. \ MECH.CONT - LIC.NOr MECH. - -
Ie, TOTAL TOTAL '
., Sign' are o f A,pIrcmaUC.ntCmt., Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
1 ++. PERMITNUMBER
-IT OF 'CUPERTINO :
�: ;. 14584
INSPECTION-DIVISION -
JOB INSPECTION RECORD "
` gT PERMIT EXPIRATION
,201.9,5 STEVENS CREEKLVD ZZBO#'
` JOB'ADDR E55 .UNIT# LOT#f .,1 .. PERMIT EXPIRES'I F IN
OWNER QUIDMUNC CONTRACTOR -HUETTIG','SCH'ROMM' IS NOT STARTED WITHIN'
INSPECTION DATE- INSPECTOR INSPECTION RECORD':,;' � 180DAYSOFPERMITISSU-
FOUNDATION " 1 y, .ANCE OR 180 DAYS FROM
' .NOTE: LAST CALLED INSPECTION.:',
• UFER ALL GRADING,AND DRAINAGE-SHALL BE INSTALLED'
PREGUNITE TO COMPLY WITH THE.APPROVED PLANS'AND CITY OF •" . PLHMEI VALIDATION
CUPERTINO STANDARDS p� P
GARAGE SLABS ,G' - v ',ia - < +.- �, •Y rr
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED P �
UNDERGROUND /SLAB ,
_, •> PLUMBING
i
ELECTRICAL .. '!t 1' Is ANCE'DATE ,°`*•:
MECHANICAL - - - .T ,. - DI PLc.. . MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS.BEEN SIGNED ' " BUILDING PERMIT
WOOD FLOOR ,. INFORMATION
PLUMBING1 1, ,re }' vnwnrlON SIFT.
_ MECHANICAL ` t'-"5•�yr
0. - YER M1IIT Tp
1 ELECTRICAL'
FRAMING, _ .. - G1, �..%r-1 ti..
INSULATION .' .. STORIES TYPE CONSTR.
LA
_ -
•, - .•.
OCC GH(tUP- ..HES.UNITS Ij
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF . - NOTE NO FINAL INSP,SHALL BE MADE BEFORE m FT,FLOOR AREA TOTAL [REALE
.'' DIAPHRAGM• THE CONSTRUCTION-TAXIS PAID
.BUILDING USE
ROOF SHEATHING - ti ` ' Hes' . IND - CON PB Ulm•,
ElEl
APPLYNO'.ROOFING UNTIL ABOVE HAS BEEN SIGNED .FINALS ' ' ,•--'DATE .",. INSP. - � I
_ nS51 SSORS PARCEL NO
n•
ROUGH. : r SANA
PLUMBING ELECT.ENERGY f- '
TRACL'NO,. PARCELNO.
TUBS&SHOWER.PA PLUMBING ENERGY
" MECHANICAL MECH.ENERGY `� - '
ACC.DATE ACC FILE NO,
ELECTRICAL' BUILDING ENERGY . °•i'�s , 'r = -'
FRAMING .1 - ELECT:
'FINAL TEST
ZONING LNG.SITE,NO,.
INSU LATION,", _ p- PLUMBING. '
°. GAS TEST GAS
FIRE SPRINK ENERGY L}9
MECHANICAL ". -
• - COVER NO WORK UNTIL ABOVE HAS'BEEN SIGNED _'HEATING'. - Y �'. N E. ° 0, •N�
i
•FLOOD 20NE A. 0 C.
' EXTERIOR SHEAR � ELECTRICAL RELEASE .• '- ' L� '
INTERIOR SHEAR.' FIRE DEPT,' Z'L '.�, ,Y ❑ "❑ ' ❑ N❑:
SHEETROCK. Y GRADE ;t FEE SUMMARY -
EXTERIOR 'LATH BUILDING
.INTERIOR'. LATH' - - - TEMPORA RY APPROVAL BUILDING y �„
SCRATCH COAT - ELECTRIC 1 PLAN CHECK'
GAS F - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuP,ANcv. _ - sE1sMIC F,EE,• 4 ICy"•'
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFIIM�
ARRANGE FOR INSPECTION:BY P,.HONINGf252-4505 ELECTRIC' '.
Iw— ONE WORKING,DAY=BEFORE REQUIRED,INSPECTION PLUMBING
z�. PLEASE GIVE JOB ADDRESS WHEN PHONING
�• ti - MECHANICAL••.
- SEE..PERMIT FOR EXPI'RATION''DATE` , ''
IMPORTANTI CONST.TAX
-.L'PLEASE.READ REVERSE.SIDE BEFORE' ° TOTAL'. f
CALLING.FOR FINAL"INSPECTION: ' ` ' I 1
WFICE'COPY