17428 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION .PERMITNUMBER
EDILDING = APPLICATION & PERMIT f 17428.
ADORESS 1 011"'e
ff 11
Zoe 3 ES-I-dQ4JS Cr�eK 61- BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME /�/s OTY. ELECTRIC PERMIT FEE
QIP L0 vHONE '
CONTRACTOR S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.0
/
/� �.( ( LIC.No, (JrZ('1 S 7 LIGHTING FIXTURES 10.00/1.0
JOSROaSScT,�.DRs
ADDS E . /
APPLIANCES-RESIDENTIAL 4.00
B/
PANELS 10.00DATE OF APPLICATION
ARCHITECT PLANCHECK FEE P.CNO.
OR PANELS (OVER 200 AMP) 20.00 -
ENGINEER TO A LIC,NO. SIGNS TRANS. 3.00
✓ ARCH.OR ENG. (. PERMIT VALIDATION
AODRESS 3941 CgyJGtOo SPECIAL CIRCUIT 5.00
/O O S SIP w/ M/ IS/- 4 //�
nP EMP.METER OR POLE INS. 20.00
ASMOTORS SEE FEE SCH.
ADDRESS
_
31-10S. '4 I H AS SERVICE CHANGE 20.00 IIZ I�c�
O o - LICE
NSFD CONTRACTORS DECLARATION
a u I hereby affirm chat I am licensed under provisions o'Chapter 9 ISSUANCE DATE '
I't (commencing with Section 7000)of Division 3 of the Business and
a H J BLDG. E ECT. PLG. MECH,
r y z Professions Cods,and my license is in full farce and effect ❑ - ❑ ❑
z O w- License Class Lic.Number./.S-Z./7 JUN 1 3 1989
g w r w Date=is��4-Contractor
BUILDING PERMIT
¢ ¢
OWNER-BUILDER DECLARATION
¢ ° a" MISC.- _ D INFORMATION
X S ¢r 1 hereby at l'inn thin I am exempt front the Contractor's License
¢Oj Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE _ ToTa
VALUATION $/FT.
L- - Code:Any cilyorcounty which requires a permit to cons)rucq utter,
re ¢¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. �i�. r10
CLL requires the applicant for such permit to fil...igned statement that / e I /s2.�7 S TOTAL✓ Q( PERMIT TO
e w m he is licensed pursmot to the provisions of the Contractor's License r
Hzi
Law(Chapter 9(commencingwlth Suction 7000)of Division 3 ofthe 1-
z o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE t 1
¢F pm the basis for[lie alleges,exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.UNITS
their sole compensation,will do the work,and the structure is not
-' intended or offered for sale (Sec. 7044, Business and ProfessionsDflAIN S-FLOOR,ROOF,AR EA,CON D. 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 FIXTLLF:cS-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such inrhmve,
meats are not intended or offered for sale,If,vi ed thathowever,the building GAS-EA.SYSTEM•1 INCA OUTLETS 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 im- BUILDING ING USE
RES IND Jr PB Other
prove for purpose of sale.). INDUSTRIALWASTE INTER. ' 30.00
❑ d as owner of the properly,am rmccliv Se 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 Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts forsueh projects with acontractons)licensed portant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT - 6.00
reason
Owner - Date WATER SYSTEM 5.00
ACC.GATE ACC,FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a cerllficIDe of consent to sL•If.in..im, ZONING ENG.SITE N0.
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.C.).
Policy No. Company Cl LT➢ _ 00
0 ❑ Cerriied copy is hereby lurniahed' FIRE SPRINK ENERGY T 24
Z 2 IIIL Cett'he s IF ed O tt ciry mzpe t Division. MISC.- REFER TO ORD.
O Applicant- -_. Y❑ N❑ Y❑ IN
~ �+ PERMIT ISSUANCE _ 10.00
- '.CF.RTI FICA11:OP F.XIiMP"PION FROM WORK ERS' FLOOD ZONE A.L.U.C.
LL - COMPENSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL 0 (This section need not he completed if the permit Is for one TOTAL Y❑ N❑ Y EDN❑
hundred dollars(S 100)or less.)
0 O 1 certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any munncr so as to
O W become subject to the Workers'Compensation Laws of California.
a Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex
F' Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the [..hot Code, you must forthwith comply with FEE
V such provisions or this permit situp be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work of which this profit is issued(Sec. -MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that I have read thisapplication and stat,tem the above VENTILATION FAN (SINGLE) 4.00
ordinances n estate[. 1 agree to comply with all my and county PLUMBING
ordinances and state laws relining m building construction, and BOILER-CUM P(3 H.P.Dr 1001000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. gOILER-COMP (OVB(100,000 8TU15EE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC. REFER TO ORD.
.. IC.Pc,lino against liabilities,judgm,rOs, costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
•ran'n ,Ilei clout MECH.CONT. LIC.NO., MECH.
_ TOTAL TOTAL r^3 •�
13fgnaqVApplicant/Contactor Datc fv
OFFICE COPY
POST THIS'CARD NEAR FRONT OF,BUILDING
' - PERMIT NUMBER
CITY. OF CUPERTINO 17428
INSPECTION DIVISION
-� JOB INSPECTION RECORD
2CO&3 c y rn„C TLQ( - PERMIT EXPIRATION
JOB ADDRESS/ ['��/`J •31 �-I� 4K-� UNI 42-2.0 LOT# ,q PERMIT EXPIRES IF WORK
owrvER A I2 coNTRAc*oR, (� -V'IG',r IS NOT STARTED WITHIN
INSPEC I DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATIONNOTE: E ONCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
.PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND.CITY OF I't:RMIT VALIDATION -
CUPERTINOSTANDARDS. �
GARAGE SLABS "vaI ,�
POUR.NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB , �Ir �Cin
PLUMBING - Iu 1,0'1
' ELECTRICAL - PAID -
ISSUANCE UAIE
MECHANICAL - 'B TG_' ELECT PLG. MEER,
Jl.lill 1, (I 19&A I ❑ ❑ E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BLJILDING PERMIT
-01gu
WOOD FLOOR mtf0 INFORMATION
PLUMBING VAUUATION $/FT.
MECHANICAL
ELECTRICAL PERMIT TO
FRAMINGca AII,rn1
dNSULATION STORIL ` TYPECONSTT,
OCC GROUP RES,UNITS.
t PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
„ SO,ET [LOOR PRGA TOTAL ACREAGE
_ -1 ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE- '
DIAPHRAGM- THE CONSTRUCTION TAX IS PAID
BUILOING USE
� ROOF SHEATHING � las **IND PB
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE . INSP. � o C �
.ASSEBSO 5 AHCEL NO
' ROUGH' SAN.a ,
PLUMBING ELECT.ENERGY
,TACT NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY '
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACG FILE NO
FRAMING ELECT..FINAL TEST
INSULATION
ZONING ENG.SITE NO.
,. PLUMBING
GAS TEST GAS
MECHANICAL EIRE SPRINK EN E RGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NF] ° ❑ NEI
.
EXTERIOR SHEAR ELECTRICAL RELEASE cLODU ZONE A.L.UC.
INTERIOR SHEAR FIRE DEPT. Y ❑ .-[]1 Y ❑ NO
SHEETROCK - GRADE FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY-APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS .. FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY i I SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. 1M ICROFILM
ARRANGE FOR INSPECTION BY.PHONING 252-4505, ELECTRIC 3
V_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. - PLUMBING
PLEASE GIVE JOBIADDRESS WHEN PHONING.
z = SEE PERMIT FOR EXPIRATION DATE - ' MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY