12963 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.. -iBGILD1NG PROJECT IDENTI FICATION PERMIT NUMBER
..IL 1'.0 7120 #5 w-�- g K, 2Lr APPLICATION & PERMIT
ADDRESS - 12963
GIlFRT7 O BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
rypME TAP-G E'T �j"(Oly glair QTY ELECTRIC PERMIT FEE
S7 vocA-kCA y1Y
i
Nass croR's UTLETS-SWITCHES-RECEP 10.00/1.00
�- NAME - 1L 1 L�16rI GO.
-//y111-/`T',-1 1-c.No. LIGHTING FIXTURES 70.00/1.00 �
f,ONTHACTOggS -
ADDRESS L�}D -I>•1 L420A_r AaV� APPLIANCES-RESIDENTIAL 4.00
E A P{TdlrEPANELS 10.00 DATE OF APPLICATION
ORRCHITECT I IIr t IAAA 4 &c- 4 r*5G t-IATr PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER '"4"ICT 111-4
1-c.NG.6:3"10 4- SIGNS TRANS. 3.00
ADDRESS ENGwe 1-141 i�'� 5LJITE � SPECIALCIRCUIT 5,00 W PERMIT VALIDATION
NaY OZ
4 .S `. 1454-1 nP�� EMP.METER OR POLE INS. 20.00
ADDRESNT's I I IoM (/E{ RS, ����fHT MOTORS SEE FEE SCH. ,,,1 �a v(
1TrG-TIG L G• - Q(W SERVICE CHANGE 20.00 V
SU1 .. ff,I
w
09 LICENSED CONTRACTORS DECLARATION Cl VuQ( ����7
¢ v I hereby affirm that I am licensed under provisions of Chapter 9 SSUAN CE DAZE
nw (commencing with action 7000)of Division 3 of the Business and
¢ q
H w 2 Professions Code, my license is in full fPLG. MECH.
or c t% BLDG.- ELECT,El El El CI ss Con trNumber
O � License H C Date -� Conaztor
a x fa
OWNER-BUILDER DECLARATION BUILDING PERMIT
¢
Lr s va INFORMATION
w3 u-r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
LL o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
� - Cade:Any city or county which requires a permit to construct,alter, AS? o-o---r�
X. s-¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
wO a. , requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
$m he is licensed pursuant to the provisions of the Contractor's License
FZ > Law(Chapler9(commencing with Section 7000)of Division 3 ofthe /N7�•k/OR /��Q�
4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ . 0 the basis for the alleged exemption.Any violation of Section703L5 STORIES TYPE CONSTR.
nby any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 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. 5.00
Code:The Contractor's License Law does not apply to air owner of
properly who hour,or int proves thereon,and who Aocs such work FIXTURES,PER TRAP 5.00 SO,FT,FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
�� mesme not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-1 6.00
ni
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
O I,as owner of the property,am exclusively contracting with ❑ ❑ 0 0 ❑
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 an owner o1property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I um exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.PILE NO.
WORKERS'COMPENSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-ins m
or a certificate of Workers'Com pe at(o Ineur nc r• r ietl ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab C.
/- Policy No. Conipany �
O ❑ Carifi Copy is hereby cost d. FIRE SPRINK ENERGY T 24
z�- ,❑ Cetlif copy is Ie h he cit in motion divis nn. -
y MISC.- REFER TO ORD.
Q Applicant _ Y N❑ Y � No
~ va PERMIT ISSUANCE 10.00
fY - CER 'IC b ;R FLOOD ZONE A.L.U.C.
LU 1 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be Completed if the Permit is for one TOTAL Y N� Y [] NC]
Z) Z hundred dollars(S 100)or less.)
U O I certify that in the performance of the work for which this per- QTY. .MECHANICAL PERMIT FEE FEE SUMMARY
U_ H mit is issued.I shall not employ any person in nny Inanner so us to
O Wbecome subject to the Workers'Compensation Laws of California. bo 00
MECH
OU Date Applicant BUILDING 08
},Do NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO . 5.00
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE i7 SD
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lire performance of the work for which this permit is issued(See. - MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG U N IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
infonouth n is correct.1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, unit BOILER-COfVP(3H.P.Or100,000B.T.U.) 6.00
hereby authorise representatives ec this city to enter upon the BOILER-COMP IOvar 100,000 BTU)SEE FEE SCH. MECHANICAL
hereby
autioncd property forimsp ofth i purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities ju ments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may i any way aceru said C'y in conseque, a of e
gr i of this p i t MECH.CONT. LIC.NO. MECH.
TOTAL JV
TOTAL Op.�,Tl
.11=11050f Z
- a
OFFICE COPY
i.
POST THIS CARD NEAR FRONT OF BUILDING"" i'• a.
"PFRMIT NUMBER
CITY OF CUPERTINO
3 .
. 1296 z
DI ,
INSPECTIONV'ISION
JOB INSPECTION:RECORDB,_,,� ;'d,•, ,•., , �i`
' 20745 STEVENS CREEK `"'' r .PIER 11 EX;IRAT.ION`
JOB ADDRESS UNIT# LOT#
PERMIT EXPIRES IFj WOIPI,
OWNER TARGET STORES ' corvrRncroR CONLON CONSTRUC Is NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION r/ Lr7 a /1"7 Q 7a/ - �'o r�.�/ ANCE OR 180 DAYS FROM
O / LASTCALLED INSPECTION.
. `LIFER L ' r} — �/� •�� A r{A T r
�/ 4RAW?Z&AfQ/ b SW
PREGUNITE N PERMIT VALIDATION"
'rBAk PA '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7 D� �gRTi4L QyGftltAA
UNDERGROUND /SLAB ��'/.760, oe" `
PLUMBING (/&lr-Rtrr om M ?
A -/1)- F7 Vb /i✓ -f OkeV—P- '1' //�/G�'IA
ELECTRICAL 1?A/w/A<e Stcvye OJj1/LLCtl sunrvcE DATE
MECHANICAL S�A 4i- BLD ELECT. vLc. MECR.
O 2
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED -I D-W i r tic �r p BUILDING PERMIT
WOOD FLOOR bc-[unW-AMV9 P-WL 4-M*Z%A O?t INFORMATION
PLUMBING
�. VALUATION
�tI-fit ~-1•�t{. GI..�
MECHANICAL
ELECTRICAL - -1}- °O -/Z�( . 123 PERMIT TO
FRAMING /2y - /2S- 134 - 139-/y/ � tv�1� JI CPO
INSULATION u�- y B wy q, //G RIES TYPO corvsrR.
TC e✓ 5 7 PbwY,4 , ecT-j~ s..4 041e
,WIMra•,iIU�7d pvuT DDD.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' a/SL/C t7'960A
• ROOF ��� -rN�� 7f s', Q('r SO FL FLOORAREA TOTALACR6AGE
DIAPHRAGM /,�1NNN OC
^/ BUILDING USE
RES IND CON PB GO—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED KOC ❑ ❑ ❑ ❑ ❑
ROUGH �7-Y CeE Q�w11 b� ASSESSORS PARCEL NO.
PLUMBING c5-d( r�Frv`u
GAS TEST 6_-� Y"•�j" `t/45,01jM Jyxe4or iFFMr TRACT NO PARCEL NO.
MECHANICAL - J tT wesrwnu , SN-4eg 13.49AAP4
ELECTRICAL - °m Acc. TE ACC.FILE NO.
FINALS DATE INSP.
FRAMING SAN #
ZONING ENO.SITE NO.
INSULATION PLUMBING tl7
GAS vjp_p7
MECHANICAL -
FIRESPRINK ENERGY T 74
'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No Y ❑ N❑
FLOOD ZONE A.L.U.c
LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR ,9-y FIRE DEPT. Y❑ N❑ Y ❑ No
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR - BUILDING , -
SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING / U'
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
• Z� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTALS
CALLING FOR FINAL INSPECTION.
OFFICE COPY
Grp
9-112
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