11200 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
^ BUILDING PROJECT ID NTI FICATION PERMIT NUMBER
nUILDIN �U7fS P1/P S ret APPLICATION & PERMIT 11200
CUESS e-V-4/NO epi' BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER' i/�Rn PLAN CHECK VALIDATION
NAME /P'�" EJ/__J y� QTY. ELECTRIC PERMIT FEE
CGemco SO �+ PHONE.?S3 (JV
croRs
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME //�� ,�
QO e0kos It 1411 ue,No. LIGHTING FIXTURES 10.00/1.00
ADs PPLIANCES-RESIDENTIAL 4.00
ADDRESS � SOX' 1q10 /
,5144
1./ `p/s PHONE 8 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCHOR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ESS
Zlv EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH. n
Z. SERVICE CHANGE 20.00 �W
Woo LICENSED CONTRACII ORS DECLARATION ��
<D w 1 hereby affirm that I am licensed undet provisions or Chapter 9 IS DATE
(commencing with Section 7000)of Division 3 of the Business and p
G, is H 41B JELPCT.a PLG. MECH.
H w z Professions Code,and my license is In Cull force, (tett. ❑ ❑ ❑ ❑
Z, o - License C Lic.Number / .
9 z m o Date Conlracmr
r w r
w a OWNER-BUILDER DECLARATION L PERMIT
MISC. REFER TO ORD ' INFORMATION
X 3 n m I hereby affirm that I am exempt from the Contractor s License VALUATION $/FT.
In Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 q
Code:Any city or county which requiresit permit to construct,alter, oCQ -0
rta,s-40 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /
Chu requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License /.j2'T Re/y V/�L
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
- a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
w r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
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 an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 s0,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsamnotintendedoroheredforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2,00
builder will have the burden of proving that he did not build or int BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 • RES IND CDN PB One,
[1I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
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 Cuntrumor's License Law does not apply
to an owner of property who builds or improves thereon,mW who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,B.&P.C.tar this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.OATE ALC.FILE NO.
WORKERS'COMPENSATION UECLARA'rION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate ofconwnl to self-insure,
or a certificate of Workers'Compensation Insurance,or a cyrtificd ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.0 I /`-
Policy Nn. Company-�j,Qe/2!?6_-J S FUW d
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z_ Z ❑ Certified o y is Ile ith the city pection division. MISC.- REFER TO ORD.
Q Applicant _ V❑ N❑ V ❑ No
CC PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
LU J C6 IFICCOTH MPE EXEMPTION INS FROMW'ORKfiRS'
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
1 O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N
Z) Z hundred dollars($100)or lLSS.)
U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Worker$Compensation Laws of California.
UJ y Uate Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} M NOTICE TO APPLICAN'C If,after making this Certificate of Ex-
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=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOOF.M.) 6.00 SEISMIC FEE /
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name H EATING UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
'\ I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state'laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (over 100,000 BTU)SEE FEE SCH. MECHANICAL
t above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
grantin of this permit. MECH.CONT.. LIC.NO. MECH.
/ F
re, TOTAL /`f'/9°
CI Si lure o'Applican)(Contractor Udc
OFFICE COPY
POST THIS CARD NEAR FRONT OF.BUILID ING
R1TNDMRER
CITY OF CUPERTINO 1
INSPECTION DIVISION • 1 200
JOB INSPECTION RECORD
�
(� PERMIT EXPIRATION
JOB ADDRESS a07�1 s Cr
S4-eV&nS v, 66k, UNIT# LOT#
.ER 6/1 n /J _ PERMIT EXPIRES IF WORK
CV✓ICD ee;o (Y QI�matCONTRACTOR (1..®n -l-ne. IS NOT STARTED WITHIN
INSPECTION DATE I INSECTOR qhSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER
_ - - PERMIT VALIDATION
PREGUNITE . '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _
UNDERGROUND /SLAB ~
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG, ELECT. PLG. MECH.
D El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION e
WOOD FLOOR VALUATION
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL r/,q •t •"' ='.,rt-�-•
_ FRAMING ' - t
' sroRles rvPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
1 1
�E NO SUBFLOOR UNTIL
ABOVE HAS BEEN SIGNED 60 FT.FL00RAREA TOTALACREAGE
DIAPHRAGM
BUILDING USE
. RES IND CON PB Other
""APPLIY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑
• -ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST -
.. MECHANICAL
ACC,DATE AC::F ILENC.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN *
ZONING ENG SITE NO.
INSULATION PLUMBING ' -
GAS
FIRE SPRINK ENERGY T 2
MECHANICAL v ❑ N[:] v ❑ NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C.
LATH-INTERIOR. ELECTRICAL v� NC] v � N❑
LATH—EXTERIOR FIRE DEPT,
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING,
- FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM -
T '
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST:TAX /
PLEASE READ REVERSE SIDE BEFORE TOTAL y; r
CALLING FOR FINAL INSPECTION.
OFFICECOPY /'-
' 44'
� v
jo
1
i 1
41
Cita of Cuperti"o
10300 Torre Avenue P.O.Box 580
Cupertino,California 95014 _ Cupertino,California 95015
Telephone:14 081 252-4505
DEPARTMENT OF PLAN NI NG AND DEVELOPMENT
October 3, 1984
Mr. Scott lletz
William Glass & Associates
22245 Main Street, Suite 100
Hayward, CA 94541
Re: Extension of Building Permi 11 5329
Dear Mr. Hetz:
It is agreeable to extend your permit 115329 for an additional 1.80 days.
However, there are two things I would like to brim to your attention. Any
changes to the approved plans and specifications shall be submitted to this
t department for review and should be submitted early so as not to hold up the
job. Secondly, there are several. conditions that will have to be addressed
before any final. approvals and occupancy can be granted to this permit. I
have taken this opportunity to enclose a copy of the above conditions for
your information.
If you have any questions, please feel free to call me at the above
phone number, ext. 231,
Very truly ;ours,
CITY OF CUPERTINO
v'
Jim West
Senior Building Inspector
JW/es