5725 f _ I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL,POINT PEN ONLY
(JJ CAG PR6JECT I DENTI FICATION PERMIT NUMBER
pll;p„C55 upertino 3 y , en er enant APPLICATION �� ��
20300 Stevens Creek B1gd. BUILDING -.ELECTRICAL-PLUMBING-MECHANICAL 03-T1377
NAME RS '' S k tm.i Y PLAN CHECK VALIDATION
OTV "{ " 'AECTRIC PERMIT'q " z FEEfi'
Cupertino .CRity Cgggter Assoc . .
CONTRACTORS
NAME UTLETS-SWITCHES,RECEP 5.00/1.00
NOME
ORVIN ENGINEERING L.C,NO, 150751 LIGHTING FIXTURES 5.00/1.00
AGONTNTRAC RAGaDR's relROn s APPLIANCES-RESIDENTIAL 4.00
A
077 PeStana P1. �/651-177 PANELS 5.00
DATE OF APPLICATION
ARCHITECT - - SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ON _
ENGINEER
uc,NO SIGNS TRANS. 3.00
ARCH,OR ENG. - - PERMIT VALIDATION
AD.HESS SPECIALCIRCUIT 5.00 ,
ZIP _ rFEMP.METER OR POLE INS. 15.00 n
APPLICANTS MOTORS SEE FEE,SCH. J
ADDRESS
SERVICE CHANGE 10.00
ad00 LICENSED CONTRACTORS DECLARATION O
a U- I hereM1y affn,that I it,licensed under provisions Of Cbapter9 ISSUANCE DATE
vHi z 11 (commencing with Section 7000)of Division 3 of the Business and
a v, ELECT. PLG. MECH.
r N z Professions Code Any license is in full for' a f•c El ❑
z O y - License,Cl�ss l,�e rob
D Z H w Date it a n (`AtOI to
a r f d r U111�
¢ ¢ a
OWNER-BUILDER DECLARATION - BNG PERMIT`,If�.�FA-�
O
X 3 u m 1 hereby ullirm that I am exempt from ,he Contractor's License MISC.- REFER TO ORD - ORMATION
r u_ D a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 6.00 ,ALU{ATION $/FT.
- � Code:Any city on'uunty whichrequiresa permit,.construct,alter, of�yper�t4�� o0
¢ ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC. LL s e A �(/
DLL �elIVACS t11C apphCant f for SUCH permit 10 f1IC a SlgnCd$I01em'nl that TOTAL PERMIT TO 0iD
n w m he is licensed pursuant to the provisions of the Contractor's License ✓L,.,G""�'�/!r,
F z a Law(Chapter 9(commencing with Section 7000)of Division 3 of the a1 ° z o S
i D Business and Professions Code)or that he is exempt therefrom and OTY. w PLUMBING PERMIT " u FEE;ar '\ x"N
¢ ,-$ the hasis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollar,($500).):
❑ 1,as Owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 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,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an Owner of
properly who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.60 SG.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are nutintended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
or iprovement is sold .00 within one year of completion,the.woe,- GAS-EA.SYSTEM-OVER 4 IEA.) 1BUILDING USE
boderwill have the burden of proving that he did not build or im- RES $NO CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20,00 F-1 ❑ El ❑
CI 1,as Owner of the property,an,exclusively'..tmcting with
licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
,o an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lilrsuch projects with a eonnaetons)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL No. -
❑ I and exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC,FILE NO.
WORK F,RS'COMPENSA1]ON DECLARATION WATER TREATING EQUIP. 4.00
1 hereby nlfum Ihnt 1 have o ceHil'icato of c.nscut,o self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Copy lhc'C'({(� di C.],_1-1VT
Policy bo 1 -Midi -
0 ❑ Certiliedcopy is hereby furnished.
Z Z X)X%rrifc DI i he ..�r�s1yF�pn division FIRE SPR INK ENERGY TQ4
O Applicant--It�"TN " iV alt lV ttS., pff, I MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
c rA CERTIFICA'I'I:01'FXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.LOC.
LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
1 O I Ih ' c[i.a need no, be wmPlc,ed if the permit is for one TOTAL Y❑ N Y❑ N❑
Z) Z hundred dollars($100)or lcssJ
L) O 1 certify,hal in rhe performance of the work for which Ibis per - j. h a' F A `yT S""FEEYSUMMA Rg, "
O%, MECHANICAL PERMIT'- F;EE=
LL H and Is issued,I shall not employ any person in any manner so as to - °�') x -
O W hecnme subject to the Workers'Com,cm.Roa Laws of California.
M Dale Applicant ALTER OR ADD TO MECH. 4.00 BUILDING 128 . 50
>_
28 . 50} W NOTICE '1'0 APPLICANT: If,after making this Certificate of Ex-
H Z emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you mus, forthwith comply with FEE 83 . 53
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10AOOC.F.M.) 3.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWC.EM.) 5.00 SEISMIC FEE 1 . 26.
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance cif the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's NameBan AID£LlGe-N_'Jr'$r$.A HEATING UNIT(OVER 100,0006.T.U.)7.50
Loader's Address t-t-an-Ave T$-H-10 ELECTRIC
1 certify that 1 have read Misapplication and state that the above VENTILATION FAN ISINGLE) 3.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state law eI t to building construction, and BOILER-COIV I3 H.P.Or 100,000 B.T.U.) 4.00
lrerchy mdh.rlee m emalivee of I ' to enter upon the BOILER-COMP(Over,00,000 BTU)SEE FEE SCM. MECHANICAL
shove-mentis ed p erty for lnspeclI I r ores.
(We) rec to ave, indemnify a e harmless the City of MISC.- REFER TO ORD.
Cup no against bilines,judgme Is Is and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
ay
way acc against t consequence of the
'Faa
rant f i cnnit. MECH.CONT. LIC.NO. MECH. y ,
1/15/8 TOTALT,OTAL!. 213 . 29
re i tl tract° Ma{3''3F e r -
OFFICE COPY �•
` CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PERMITNcO. �jo3oo ,ADDRESSUWNhK
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
FiI7'nL—
rlcal
Power Pole
Mica TTrir IM
emp as ec u ir3.n
molar Walis
Fire Sprinkler GeilinR
1 ixtures int/Fxt
motors
Misc. Ground�g
Temp Power
Other
FINAL INSPECTIONS DATE INSP, Not rove
Gas
Electric
Fl—umbing PLUMBING DATE INSP.
Mcnanical
� o ar Backflow
troo Underground
Planningbradinja f
Partial
ou
ire t. Roughomp ete
ea t ept. Solar Vjuh
Building Water " ns ation
utney
o 'Main
Gas _
Other
BUILDING DATE INSP. Not rove
Pad Certification
Foundation ELECTRICAL DATE INSP.
re- unite
nlab-Nimbrane Underfloor S.M.
Bond ewn Ducts & insulation
Underfloor i ers ire avers
oortee -_ Fin' aace
ie owns urease ct o0
iaPhrams _ e our Shaft
e� lsmec rac�n ansate Drain
WTls-Pane s ui ent An or_age
rame Flues 4 L=b. Air
a ter
-rirewall Int/Ext. f.o'�5jro�--
other --y
Net Approved