8908 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
' BUILDING PROJECT IDENTIFICATION • PERMITNUMBER
'sU,LO, APPLICATION & PERMIT O
ADDRESS
2Q L45 �, �.11LDING-ELECTRICAL-PLUMBING-MECHANICAL
4- OWNER'S
NAM11E PLAN CHECK VALIDATION
. _1�V -rye ELECTRIC PERMIT FEE
L,Yv I!/ PRONE
CONTRACTORS
UTLETS-SWITCHES-RECEP 10.00/1.00
L,C.NO. L4 LIGHTING FIXTURES 10.00/1.00
C,ONTRACTORs pp LIANCES-RESIDENTIAL 4.00
ORESs
-�. O Iil� PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
E R 657 I,j'-1f C;
7 uc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. .(�y^f PERMIT VALIDATION
ADDRESS qq n tf/y / //-Li al SPECIAL CIRCUIT 5.00
nv EMP.METER OR POLE INS. 20.00
APPLICANT LL���,>� .n MOTORS SEE FEE SCH.
ACT II K-f/
SERVICE CHANGE 20.00 (7
w O o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00 p1D f��'f��
< i 1 hereby affirm that I am licensed under provisions of Chapter 9 SSUA CE DATE
¢ n (commencing with Section 7000)of Division 3 of the Business and BL CECT. PLG, MECH.
H m Professions Code,and my license is in full force a d effect. ❑ ❑
Z o w - License Class Lic.Number I�sl lSS
ZH w ,areAr&L � - Contracmr
It x I� Q DING PERMIT
K 0 w OWNER-BUILDER DECLARATION INFORMATION
K
;LL h I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
a. Law forthe followingreason.(Sec.7031.5.Business and Professions VALUATION $/FT.
H - < PERMIT ISSUANCE 10.00
0� Code:Any city orcounty which requires a permit mcnnstruct,alley, Q /(�
¢ ¢ ¢O improve,demolish,of repair any structure,prior to Its Issuance,also ELEC.CONTE. LIC.NO. ELEC. / J
LL requires the applicant for Such permit to file a Signed statement that TOTAL PEEM T TO
A w mhe is licensed pursuant to the provisions of the Contractor's License ��(
Fzi
POST THIS CARD NEAR FRONT OF BUILDING
- PFRMIT NUMBER
CITY OF CUPERTINO �
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION .
JOB ADDRESS UNI _L T# '
- - PERMIT EXPIRES IF WORK " '
OWNER CONTRACTOR .IS NOT STARTED WITHIN
INSFOCTION DATE INSPECTOR I /IN_S?t_CTION FrECORID .180 DAYS OF PERMIT'ISSU-
'FOUNDATION - r)--a lrov" 3' &IO:O4-G-tis( LFII. A 180 DAYS
FROM +
LIFER {civ-� 15 'b' •I•I0.`4SO yOJ. 4 (/
N.
PREGUNITE ( .s' G � -f JT PERMIT VALIDATION
V._
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
•UNDERGROUND /SLAB
PLUMBING S /�--pZ'G -7-:y, G•1 ,`,' j
ELECTRICALS-a-=�- ISSUANCE DATE
MECHANICAL _ G'el fp. JpL,� n ELBCT:^ PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING. - VALUATION SIPyT�.,
MECHANICAL '-
ELECTRICAL - PER
FRAMING'
INSULATION D Iss ., yPE DNS
OC O RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FLFLOORAREA TOTAL ACREAGE
DIAPHRAGM'
T BUILDING USE
.. , RESIND C N PB CON
.,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ El ❑ ❑
ROUGH "ASSESSORS RCELND.
'.
PLUMBING - -
• GAS TEST
TRACT NO, PARCEL NO.
MECHANICAL
ELECTRICAL FINALS DATE INSP. ACC.OATE ACC.FILE NO,
-
_ FRAMING SAN #
ZONING 'ENG.SITE NO.
INSULATION PLUMBING
GAS
MECHANICAL •FIRE SPRINK ENERGY T44
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - 'v ❑ N❑ I Y ❑ N❑
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. Y❑ '1N❑ Y ❑ No
SHEETROCK - GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING. .. :
SHEAR EXTERIOR - " . TEMPORARY APPROVALS BUILDING +
FIREWALLS ELECTRIC - PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BV BUIL DING INSPECTOR.
MICROFILM• _
ARRANGE FOR INSPECTION =252-4505,, ELECTRIC-F- ONE WORKING DAY BEFORE ON. PLUMBING
PLEASE GIVE JOB ADDRESS WSEE PERMIT FOR EXMECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
AFFICE COPY