18382 APPLICANT TO'FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
(e i BU!,I:DING PROJECT IDENTIFICATION - PERMIT NUMBER
'9Ln.m"c y Z�Z, APPLICATION &'PERMITI.J ADDRESS ^
-- ZI2 C - L.. OLVD BUILDING—ELECTRICAL—PLUMBING —MECHANICAL -
NAMEWS R'PLY 9�g. - ; PLANCHECKVALIDATION
NAME F r J OTY. ELECTRIC PERMIT j FEE-
.
coP on 3sa-asci
,PHONE
CONTRACTOR'5 P 1.��10�( OUTLETS-SWITCHES-RECEP . 10.00/1.00
r� NAME ,
' uc.Nod LIGHTING FIXTURES 10.00/1.00
CONTRACTOR •" - PPLIANCES-RESIDENTIAL 4.00
ADDRESS' .. V� yy
PHONE PANELS 10.00 01)rTe SF�n Icnro
ARCHITECT PANELS- PANELS (OVER 200 AMP1 20.00 - PLAN CHECK FEE P.C.No.
ENGINEER $ ^,f.'t -
'ANUy�� CRAy �I uc.No. - 'SIGNS TRANS. ' 3.00ARCH.OR
ADDRESS END SPECIALCIRCUIT 5,00 ' PERMIT VALIDATION
W 64IC 9#L& AL" EMP.'METER OR POLE INS. 20.00
APPLICANT'S r Ts ! < " . - r MOTORS SEE FEE SCH.
LS3io .•orlaF'Rd r4je 104A t7n749 SERVICE CHANGE_ 20.00
wsoo LICENSED CONI RACPORS DECLARATION Mon
G U U 1 hereby affirm Ilial I am licensed under pmvisimis Of Chapter 9 ISSUANCE DATE. '
H< m (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H m z Professions Castle,and my'licen se is in full force and effect " - JR ❑ •❑ .. ❑
Z o H - License Class - Lie.Number - _
o m' r Date 'Cnnvacfor a
'
a sa E J 'r BUILDING PERMIT
¢'¢w a OWNER-BUILDER DECLARATION -
.w o LL y I hereby affirm that I am exempt from the Contractor's License MISC.— REFER70 ORD INFORMATION
u 0¢. Law for the following reason.(Sec. Professions VALUATION 8/FT.
J .'+ PERMIT ISSUANCE 10.00 oL���
'gym Code:Any city or county which retniresa permitmconsimet,alter, (J(/ -
ELEC.CONTR..3 LIC.NO.
¢ s ¢0 improve,demolish or r pair any sf ru titre I riortfo its issuance,also ELEC
n
¢ req Wres the applicant for such permit to file a signed Statement that TOTAL PER TO -
whe is licensed pursuant t the provismm OI the Ce ntrlclor's License _ - _ ,
H z t'
Law(Chapter 9(commencing with Section 70001of Utvtston3ofthe - +^' � t7�
Business and Professions Code)nr that he iS exempt therefrom and OTY. PLUMBING PERMIT FEE ��,IIISSS
¢ m. the basis for the alleged cxvnplioh.Any violation of Section 7031.5 STORIES. TYPE CONSTR.
a 3 _ by tiny applicant for a Permitsubjects the applicant to it civil penalty
of pot tlpam five hundred dollar,(S500).): ALTER-DRAIN'&VENT-WATER (EA.) 5.00
as owner of the property,or my employees with wages as BACK FLOW PROTECT,DEVICE 4.00 DCC.GROUP , RES.UNITS
their sole compensation,will do the work,and the structure is not
intended Or offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5,00
Code::Phe Contractor's License Law does not applyto an owner(i1
property who'b tilds or improve'Cher on and who does such work FIXTURES-PER TRAP 5.00 so.Fr.FLOOR AREA TOTAL ACREAGE
himself or through his Own vol ye ';provided that such improve.
( mots are not intended orofferd for sale lghowever.the building GAS-,EA.SYSTEM-l1NC.4OUTLETS 1300 ' ,
r Intprovetnent is soldwithin one year of completion,the owner GAS EASYSTEM-OVER 4,(EA.) 2.00
( builder will have the burden of proving that he did not build or inn- - . BUILDING USE
prove for purpose ofsile). INDUSTRIAL WASTE INTER: `30.00 RES IND , CON PB Omer
❑ 1,as owner,of the properly,at,, sclusivclY contracting with - --
licensed contractors to.construct the project(Sec. 7044,Business LAWN SPRINKLERS
and Professions Code:'I'he Contrm1 INC1NG 5
a
or's License Law does not apply - - 'V.B.: 6.00 ASSESSORS PARCEL NO._ a
to an Owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) -1.00 ^
contracts for such projects with a-contractous)licensed pursuant to gEWER-SANITAR V-STORM EA.200ft/10.00
Bre Co36IRKERS'COMITRATION
rs License Law. TRACT NO. PARCEL NO.
❑- x no ,B&p.Cdor 11m, WATER HEATER W/VENT. "6,00 '1 '
renum
Owner WATER SYSTEM .5.00 -
ACC.DATE ACO.FILE NO. ,
OECLARATION WATER TREATING,EQUIPv_' ,, .A 5.00 ,
hercby.nffirm that I have a certificate of em sent to self-insure,
Or a certificate of Workers'Compensation Insurance,or it certified 'ZONING 'ENG.SITE NO. s
copy there.f(Sce.3800,Lab.C.). -
Policy No Cr npre try
O ❑ Certified copy isficireby furnished. FIRESPRINK ENERGYT-24
Z Z ❑ Certified copy is fled-vvith ire city, ml •elwn division. MISC. REFER TO ORD
Applicant • .Y N Y Q NE
~ �+ PERMIT ISSUANCE,.' 10.00
LU CFRTIFICATI:OF EXEMPTION FROM WORKERS' FLOOD ZONE A.Cu.C.
W w -COMPF-NSATION INSURANCE PLG.CONTR- - LIC.NO. PLG.
rZ O (This Section need not be completed if the permit is for One TOTAL I `YE] ' NO ,Y O N❑
Z hundred dollars IS 100)or less.) - - - - _
U O I certify that in the pertirrmunce of the work for which this per- DTV. MECHAN - P FEE SUMMARY
W I- mit is issued,I slwll not employ any person in any manner so as to ICAL PERMIT - FEE'
O W become suhject to lire Workers'Compensation Laws Of California. - l
Q. Dane Applicant ALTER OR ADD TO MECH. 5.00 -BUILDING
} to NOTICE '10 APPLICANT': If,after nil aking this Certificate of Fx-
F.? emption,you should become subject to the Workers'Compensation _ APPLIANCE .5.00 PLAN_CHECK'_ -
,wisions of the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked: AIR HANDLING UNIT(TO 10=CF.M.) 4.00 '
CONSTRUCY16N LENDING AGENCY ` AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 17S
I hereby ubfmm that them,is a construction lending ugcney far 'EXHAUST HOOD(WITH DUCT) -.5.00
the performance of the work for which this permit is issued(Sec. MICROFILM' ' ';•��
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name`
Lender.,Address' HEATING UNIT(OVER 100,000 B.T.U:)9.50 � ''ELECTRIC
I.certify,that I have read this application and state that tire above VENTILATION FAN (SINGLE)
d
morn o is e r e t, I agree to omply with all try and county -
ordinances and tate laws relating to building construction, BOILER-COMP(3 H.P.Or 100,000 BT:U.)"600 PLUMBING
and _ '
hereby aumorit I r mntati sol On' city ti enterer u,Pon
al ovc nentional property fonnspe tion purposes the BOILER-COMP (Over im000 BTU)SEE FEE'SCH MECHANICAL .
-
:(Wa) agree to save, Indemnify and kccp,`harimless the City o1', MISC. y,REFER TO ORD.
-
Cupertino a against liabilities,judgments,City
in con ekpences which PER ISSUANCE _ 10.00 'CONST.TAX
may in any way accrueagainstsaid Cily in wnscquenee of,fhc -
rantagofthispermit t MECH.CONT."- LIO-NO. y . MECH. - ,
TOTAL
j ,• TOTAL, S 5� ,,�
.. alure of Appllc nil/C rat Date '
+ • sass
OFFICE COPY
POST THIS CARD NEAR.FRONT.OF'BUILDING , PERMIT NUMBER
. CITY OF -CUPERTINO 18382
INSPECTION DIVISION ;
-JOB INSPECTION RECORD
II� ., L {� (�•j �' -f � J"� 'PERMIT EXPIRATION
JO
.+ B ADDRESS•'1ll Zp'. _I–'e_1e��cY=1-1—'>51-I�`F1N1T#- _LOT# 1"pRhjIT EZPIRES IF WORK
owNERCe SO,C ' coNTRACTOR ! IS;NOT .STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 1§0IDAYS'OF'FERMITISSU-
FOUNDATION .ANCE OR 180 DAYS FROM
_ -NOTE: LASTCALLEDINSPECTION.
UFER , ALL GRADING AND DRAINAGE SHALL�BE INSTALLED
' PR EGUNITE,,•. TO COMPLY WITH THE APPROVED PLANS AND CITY OF , . PERMIT VALIDATION
CUPERTINO STANDARDS:
GARAGE SLABS 11�/ri➢Y �, ,�'t'
POUR NO.CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'
-' - PLUMBING- { ,' �.p� -
ELECTRICAL IA1Y d CupWria. ISSUANCE uarE
MECHANICAL - BLDG. .ELECT I PLG. MEC..-,
'00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 170-6 BUILDING PERMIT
INFORMATION
WOOD FLOOR amu. - HK VALUATION STF T.
PLUMBING .. o. a
MECHANICAL
PERMI TO
ELECTRICAL; `
\• FRAMING-
'INSULATION: / sroRlee� Tva^c®N .
' . - -
OCC.GHOUP -RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOOR ARE A TOTAL ACREAGE
- ROOF - - NOTE:NO FINAL INSP.SHALL-BE MADE BEFORE ,m
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF.SHEATHING,. .. f .:TIES IND , CON . PB umr
>u'I" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 1-1
ASSESSORS PARCEL
., ROUGH' SAN:k NO
PLUMBING - - - - ELECT.ENERGY f
TRACT NO. PARCEL NO ,
.:
TUBS&SHOWER PAN - PLUMBING ENERGY
` MECHANICAL MECH.ENERGY '
-oll - ACC�CATE - ACC FILL NO.
ELECTRICAL - BUILDING ENERGY -
FRAMING - ELECT,FINAL TEST _ znNING ENG.SITE No.
INSULATION - PLUMBING -- _
GAS TEST - GAS
• - - MECHANICAL ' EIRE SPRINK ENERGY T.24
COVER N_ 0 WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NQ "�
.
" EXTERIOR SHEAR � �• ELECTRICAL RELEASE -
FLOOD ZONE ALLLC.
INTERIOR SHEAR FIRE DEPT. °❑ N[] Yh N❑
' SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING. _ - - lvl,,r -
INTERIOR LATH - - TEMPORARY APPROVALS6141BUILDING
SCRATCH COAT. ELECTRIC ' PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE, 3� -
,. OCCUPANCY OF BUILDING IS NOTPERMITT.ED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
_ ARRANGE.FOR.INSPECTI-ON BY PHONING 252-4505, ELECTRIC'
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING -.
O PLEASE 'GIVE JOB ADDRESS WHEN PHONING.
Z �. - MECHANICAL ,.
- SEEPERMIT FOR'EXPIRATION DATE'- `
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE " TOTAL m
CALLING FOR FINAL INSPECTION.'
` OFFICE COPY