C 8143eiv oivrwniviF i 1srIV VV I In I IV nCIJ LI IN CO - UbC t$ALL I`UIAI I 1-1=1\1 UNLY
BUILDING PROJECT I DENTI FICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
PERNUTNUMBIER
8143
IU"
WILDING
ADDRESS
26 �36)
......
NAME
E
QTY. �EICTRICIPEPMIT,',�'..�;l', FEE i
PLAN CHECK VALIDATION
DATE OF APPLICATION
C 00NTRACTOR S
k1amf
T+
JAr-AllSh,elleii! Vbe-lil L 'c%--
OUTLETS -SWITCHES - RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S_
1�1 Ile' 11-A '111 P110NF IL X'
RESIDENTIAL 4.00
�_APPLIANCES.
PANELS 10.00
ARCHITECT
OR
-NEE �7,,5
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ADDRRCH.ESSR OENG.
it
A737 J4 1, e V -C 3;,(JJSe el- nP f6/n-
SPECIALCIRCUIT 5.00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 20.00
APPLICANTS
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
TEMP. POLE 30.00
I hereby affirm that I mo licensed under t,.v ....... a of Chaplet 9
(,climmencub, with Section 7000) of Division 3 of the Business and
Professions nC it ,it try license is in full
L!cumseC;So Lie. N.inI!,1,'❑
1175 111SUANCE DATE
4.. ELE PLO. MECH.
wan I .1_0
Date C.,,Iru,t. es-o9iie, Ikk:tE-
zw
OWNER -BUILDER DECLAR T
misc. - REFER TO ORD
MISC.
I hereby auto. thal I .. L.umlo from the CcannIul.,', Licurst,
Law for lite following R,as.r. (see 7031.5, business and Professions
Code:structurep
-It INFORMATIONI?;'?4�:i'
IYPWALUDISVILAI 'I- $/FT.
3,CV, 600.
PERMIT ISSUANCE 10.00
CONTH. LIC. NO.
improve. dconslish, or repair any structure, prior to its issuance, also
requires the applicant lor such permit to file a signed statement that
tic is licensed pursuant to the provisions of the Coninuctom 's License
PER TO
La. (Cha pne, 9 (commencing with Section 7000ocrDimim. 3 1 tire
Business and Profe,ska,r Code) or that lie is exempt thene(Tont and
tile basis for tire alleged c,,cmploal. Any violation ofSe,than 7031.5
by any applicant for a peorril subjects the applicant to a civil penalty
of not more than I ive hundred dollars ( S500).)-
DTV.'.:. PLUMBING PERMIT.
STORIES
TkPE CONSTIT
ALTER -DRAIN & VENT -WATER (EA.) 5.00
0 1, as Owner of the property, or my employees with wages as
their Sale compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES, UNITS -
DRAINS -FLOOR, ROOF, AR EA, COND. 5.00
intended or offered for othe (Sec. 7044. Business and Professions
Code: The Contractor's License Law does riot apply to in owner or
FIXTURES - PER TRAP 5.00
GAS -EA. SYSTEM - I I NC. 4 OUTLETS 6.00
property win builds or improves thereof, and who does such work
hinDell or through his own employees, provided that such improve-
mers are not intended or offered for sale. If, however, the building
$0, FT, FLOOR AREA
TOTAL ACREAGE
unprovement is sold within Our, year of completion, the own"-
under will have tile burden of proving that lie did not build or ill-
Coin,
GAS - EASYSTEM -OVER 4 (EA
. .) 2.00
-_
BUILDING USE
for purpose .1 Sale.),
. 0 1, as owner of [lie property, all; exclusively contracting with
RES IND 0 IT Othin,
❑El
INDUSTRIAL WASTE INTER. 30.00
licensed contractors to construct the project (See. 7044, Business
.oil Professions Code: The Contractor's License Law does 'let apply
to an owner of property who builds or improves thetcon, and who
LAWN SPRINKLERS - 1 INC 5 V.S. 6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSIESSUIP Pri NO,
contracts for such projects with a continuous) licensed PUrSLJaul 10
[tic Contractor's License La..
0 1 am exempt under Sue. , BAP.C. for this
lu.�rn
SEWER -SAN ITARY-STORM EA. 200tt/1 0.00
TRACT NO,
PARCEL NO.
WATER HEATERW/VEPT 6.00
Ow= Dalc
WATER SYSTEM 5.00
ACC.DATE
ACC. FILE NO,
WORKERS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate Df Consent to sell -imam,
ZONING
END, SITE NO,
or a cut t �A, r R.R." Insurance ., a .,titwd
Po tosYNb. Comny,
• cernried copy is hereby furnished.
• Cut 111c, th tic it
y fit inspection di"i'an
A tipfic I� py
i�,
FIRESPAINK
Y E] N[]
ENERGY T-24
Y C] NC]
misc. - REFER TO ORD.
III FICATE 01
OF EXEMPTJON 17RONI WORKERS'
COMPENSATION INSURANCE
(This sectuan need not be computed it life permit is for one
PERMIT ISSUANCE 10.00
FLOOD ZONE
❑❑Y
A.L.U.C.
E] NE)
PLG. CONTR, LIC. NO.
PLG,
I TOTAL
hundred dollars (S]OO) mrIco.)
I certify that in the performance of if,, work for which "'is per'
mil is issued. I shall not employ any person in any manner so as to
become subject to the Workers'Compunsalion Laws of California.
`I
TY. MECHANICAL PERMIT FE E
.FEE SUMMARY;:
08 ADD TO MECH. 5.00
DateApplicant
NOTICEFTOAPPLICANT� If, site, making this Certificate of Lt,_ALTER
BUILDING
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
PLAN CHECK
FEE
emption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be duetted revoked,
AIR HANDLING UNIT(OVER 10=11F.M.) 6.00
SEISMIC FEE
CONSTRUCTION LANDING AGENCY
I hereby affin,that the,, is . ccalo,nenco, lending agency to,
the pedo, ... an" of the work for which this permit is issued (See
3097, Civ.C.).
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address
HEATING UN IT (OVER 100,000 B.T.U.) 9.50
ELECTRIC
I certify that I have read this application and slate 11,11 tits
Icounty
VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all ch, and
clime ces and star. laws relating to building if'
lin,se.t.tiles of this city RLR"�
hereby inulbortac � unic ).D; 11i"
above-mantioned property for inspection purposes.
PLUMBING
lBOILER,7(3,HP.OrlOO,0008.T.U.I 6.00
80 LE COMP Over IOO,OG0 BTU) SEE FEE SCH.
MECHANICAL
(We) agree to save, indemnify and keep harmless the city of
Cupertino against liabilities, j.dgm .... s, Costs and expenxs which
may in any wayd C -
. Lou is S.o City In c ...... pa"", of tire
Wait .6.1 this union.
L4 �AI CA?,_5
misc. REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
I
TOTAL.
noutme .1 Ap,helar/Cononaeloo I Vale I
OFFICE COPY
I
OFFICE COPY
O
t ' YUJI I NIJ L:Ah LJ NtAh t-hUIN
S P;i�,l
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION
^^ �j J
B ADDRESS C-561S+Te S+Te rIS ( kB`
OWNER 1 CONTRACTOR
I Uh bUI LUI IN
RECORD
`
CiUNIT# LOT#
r"M, NUMBER
Cp�,�
U 1 '.
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU,
CE OR 180 DAYS FROM
STCA LLED INSPECTION.
' INS CTI ON • DATE INSPECTOR
INSPECTION RECORD
FOUNDATION
- �p / �
�'� ,QiW f�N
LIFER
PREGUNITE
— —
3-vTP��
VADATION
PERMIT LI
ISSu AN OArE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
y�4-r>-
ELECTRICAL
MECHANICAL
•/•�-4-fir �,� ....
LU
L
PL M C
. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
_
Bw DIERMIT
INFORMATION ,
WOOD FLOOR_
IALUATION SIFT.
PLUMBING
MECHANICAL
ELECTRICAL
MIT
FRAMING
INSULATION
STORIES
TYPECONS'
OCC.GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
SO,FTFLOOR Al1EA
i0i/L ACREAGE
DIAPHRAGM
BUILDING USE
RES IND CON PB Ulnen
❑ El❑,� ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST
TRACT N0.
PARCEL NO.
MECHANICAL
ELECTRICAL
FINALS DATE INSP.
ACC. GATE
ACC. FILE NO.
FRAMING ..,v�.r, -�, (;
SAN u
INSULATION
PLUMBING
ZONING
ENG. SITE NO.
GAS
FIRE SPRINK
v ❑ N❑
ENERGY T Y<
v ❑ N❑
MECHANICAL S^
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
FLOOD ZONE
Y ❑ No
A.L.0C.
,
Y ❑ N[]SHEETROCK
LATH-INTERIOR
ELECTRICAL i2S J
LATH-EXTERIOR
FIRE DEPT.,7J,' t
GRADE
FEE SUMMARY
SHEAR INTERIOR
BUILDING .S% i-
BUILDING
SHEAR EXTERIOR
TEMPORARY APPROVALS V'
FIREWALLS
ELECTRIC
PLAN CHECK
FEE
GAS
SEISMIC FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANTI'
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
OFFICE COPY
O