154974
r
,.,_APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY -
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
UILDING— ELECTRICAL— PLUMBING — MECHANICAL
PERMIT NUMBER
. 1 [ j� �7
.1''1'
eBUILDINGI
ADDRESS
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-
NAME
'Nam^E TT '•x PC6 A
W vl/1v • l \V ONE
OTY. ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
DATE OF APPLICATION! "
NAreERACToas
LIC. NO.
ADDRESS TORS
• PHONE t
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00'
APPLIANCES -RESIDENTIAL 4.00
PANELS.10.00
ogcHITECT -'
ENGINEER
LIC. NO.
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH a°ss ENG.
ZIP
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
•�-� .�f
`LNq ✓./,'fr-VI/}'
ISSUANCE GATE
BLDG. ELECT. PLG. MECH.
TEMP. METER OR POLE INS. 20.00
APPLICANT'S ^
ADDRESS -//
MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am'lice mcd under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect.
License Class Lie. Number.
Date Contractor
,
'
t from the ION
OWNER -BUILDER that I am exempt
I hereby affirm ehat'I am exempt from the Contractor's License
Law forthe following reason.(Sec. 7031.5, Businessand Professions
Code', Any city or county which requiresPermit tO cons nc alter,
improve, demolish, in repair any structure, prior to itsissuaua issuance, also
requires the applicant for such ronnit ns oiler signed statement that
he is licensed pursuant to the provisions oltire700 Contractor's License
Law (Chapter ndPrcicomm, C ng ode)with Section is exempt thereto andtlic
Business and Professions Coder or that he Is exempt ecrd'n70 and
the basis for the alleged exemption. Any violation of Section malty
for five permit subjects (500).he licanttoacivol penalty
by any more
of not more wenn Cove lie prop rty, o (my em):
❑ I, as owner at the will d property, or my employees with wages as
inter sole compensation, will (S the work, and the structure is not
intended or offered For sale (Sea 7044, notBusinesspply to Professions
of
Code: The whobuild or License Low dour not apply m an owner of
Work
himslf property Who buildsorrwne employees, thereon, providwho does such improve.
himself re through his own employees, provided were such improve
forsale,if, howeveq tire the o nee-
or uts improvemenotnt is sold it within one year ofcompletionhedi, the owner -
or improvement have
is sold burden
builder will have [ho burden ofproving that he did not the
or im-
prove of sole.).
C) 1, 1, asas owner of the property, am exclusively contracting with
licensed contractors dto construct the project (Sec. 7044, does not apply
and Professions property Contractor's o License s th docs not apply to an owner of h projects
who builds or improves thereon. P, ami who
tiro contracts for such projects with a contrador(s) licensed pursuant to
the Co rs License Law.
I mexe pt under Sec. ,B.&P.0 f renis
reas< �J
BUILDING PERMIT
INFORMATION
MISC. — REFER TO ORD
PERMIT ISSUANCE10.00
VALUATION
"
ELEC. CONTR. LIC. NO.
ELEC.
TOTAL
PERM
�$��'
QTY. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
ALTER -DRAIN -WATER IEA.)5.00
BACK FLOW PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
'
DRAINS -FLOOR, ROOF, AREA, COND. 5.00
FIXTURES - PER TRAP 5.00
GAS-EA.SVSTEM-I1NC.40UTLETS 6.00 ..�'—
SQ FT, FLOOR AREA
TOTALACREAGE
GAS - EA. SYSTEM -OVER 4 (EA.) 2.00
BUILDING USE
RES IND CON PB Other
� .E] 0 0 ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS -1 INC5V.B. 6.00
ASSESSORS PARCEL NO.
'
LAWN SPRINKLERS -OVER 5 (EA.) 11100
SEWER -SANITARY -STORM EA, 200fC[10.00
TRACT No.
PARCEL No.
'
WATER HEATER W/VENT 6.00
Own' Datc O
WORK F-RS'COMPFNSATION DECLARATION
I hereby affirm Ilial I love a certificate of e...ent t0 self-houre,
or a certificate of Workers' Compensation Insurance, ora certified
copy thereof'(Sce. 3800, Lab.C.). - -
Policy No. Company
WATER SYSTEM )ss. 5.00
ACG DATE
ACC. FILE NO.
WATER TREATING EQUIP. 15:00 _ ° •
w
ZONING
ENG. SITE NO,
•-
MISC.- - REFER TO ORD.
11 Certified copy is hereby furnished
copy is Bled. with the city inspection division.
Applicant' -
Applicant
FIRE SPRINK
YE] N�
ENERGY T-24
Y❑ N[]
CER' 1'I FICA' 117 OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section peed not be completed If the permit, is for one
hundred dollars ($100) or less.)
I certify that on the performance of the work for which this per.
mit is issued, I shall not mnploy any person in any manner SO TIS to
become subject to the Workers' Compensation Laws of California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become suhject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
to performance of the work for which [his permit is issued (Sec.
3097, Civ.C.).
PERMIT ISSUANCE 10.00 /V —
FLOOD ZONE
Y N
A.L.U.C.
'
Y-[3 N O
PLG. CONTR. LIC. NO.
,PLG. ''11 (fTJ
TOTAL 0?d _
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
'
ALTER OR ADD TO MECH. 500
.
APPLIANCE 5.00
PLAN -CHECK
FEE
AIR HANDLING UNIT (TO 10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.FM.) 6.00
SEISMIC FEE
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's AddressELECTRIC
I certify that I have read this application and store that [Ie above
information ccs n correct I agree to comply with all city and county
ordinances and stale laws atives to building construction, and
hereby authorize representatives this cozy to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
upertino against liabilities, judgments, costs and expenses which'
ay in any way accrue agoaJl.� said City in m. •quence of the
r' g his peel
pg
HEATING UNIT (OVER 100,000 B.T.U.) 9.50
VENTILATION FAN (SINGLE) 4.00
BOILER-COMP(3 H.P. Or 100,000 B.T.U.) 6.00
PLUMBING
BOILER -COMP lose, 100,000 BTU) SEE FEE SCH.
MECHANICAL
MISC. - - REFER TO ORD.
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL
Signature of A pplican a/Contractor ate
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY 'OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
_
JOB'ADDR ESS .-20401. Stevens Creek Blvd. UNIT# -LOT#
' -
OWNER WDV Properties CONTRACTOR -
.PERMIT NUMBER -
15497
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT ;STARTED WITHIN
-
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSP ECTION.
INSPECTION DATE INSPECTOR
INSPECTION RECORD
' FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
TO COMPLY WITH THE APPROVED PLANS AND CIN OF
CUPERTINO STANDARDS.
UFER -
PREGUNITE -
PERMIT VALIDATION
i
'
-/,Ir,f
ISSUANCE DATE
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED^
.UNDERGROUND/SLAB
PLUMBING'
ELECTRICAL . -
MECHANICAL
BLDG,
ELECT I
PLG. MF,CH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
_
'BUILDING PERMIT
INFORMATION
WOOD FLOOR
'VALUATION
$IFT.
PLUMBING �
-
MECHANICAL
ELECTRICAL
-
- PERMIT rO
FRAMING
INSULATION
STORIES
TYPE CONSTR.
�POACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- -
OCC.GRODP
RES UNITS
'
1 � ROOF-
NOTE:. NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
$O FT FLILII All
TOTAI. ICIILAGI
-
'
DIAPHRAGM
ROOF SHEATHING
'BUILDING USE
RES IND CON PB 00 -
❑ ❑ ❑ CLD
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS DATE INSP.
ROUGH •
sAN.a
NOPARCEL NO.
PLUMBING -
ELECT. ENERGY
TUBS &SHOWER PAN -
PLUMBING ENERGY
TRACT • NO.
PARCEL NO
MECHANICAL -
MECH.ENERGY
ELECTRICAL � - -
BUILDING ENERGY
ACCDATE
.
.
ACCFILE NO
FRAMING -
ELECT: FINAL TEST '
INSULATION ^
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST .�
GAS
%
MECHANICAL
FIRE SPRINK
Y ❑ N❑
ENERGY T 2
Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR -
ELECTRICAL RELEASE "
FLOOD ZONE
Y❑ N❑
A,L UC
Y'L -N❑
INTERIOR. SHEAR -
FIRE DEPT.
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING -
BUILDING
INTERIOR CA7H-
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC I
PLAN CHECK
FEE
•
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY VSEISMIC
FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL,BUILDING FINAL ISSIG NED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLEASE GIVE JOB ADDRESS WHEN PHONING.
z
— SEE PERMIT FOR EXPIRATION DATE —
MICROFILM
ELECTRIC '
PLUMBING
MECHANICAL
coNsr. rax
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING`FOR FINAL INSPECTION:
TOTAL
OFFICE COPY