18398 A'•r1PPI.ICANT TO FILL IN,INFORMAT,ION WITHIN RED LINES - USE BALL POINT'PEN ONLY,
BUILDING PROJECT IDENTIFICATION zPERMIT NUMBER
BGILOING I APPLICATION &PERMITADORrSS _ 18398
'z 1.L6 -STS VI-c4/ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL .i�.
OWNERS -" PLAN CHECK VALIDATION ' -
NPF1E I OTY. ELECTRIC PERMIT FEE'
d'S A f ✓ - IDA 2 fP 370 3�drd i
NDAMnERAcroRs 'OUTLETS-SWITCHES-RECEP 10.00/1.00
AC ucn0. 3y 3b5go GHTING FIXTURES10.0011.00 C
ADDREIss rocs (,��r� APPLIANCES-RESIDENTIAL 4.00 ' + -
-{-��
PHOrvE -dy' v PANELS _ 10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE •P.C.NO.
on - ,( PANELS IOVER 200 AMP) 20.00
ENGINEER - • �1'
- LIC.ryo. SIGNS TRANS. 3.00
.. ARCH,UR ENG. .. . , PER T VALIDATHEN
ADDRESS - SPECIAL CIRCUIT
500 "• /yy
IIP EMP.METER OR POLE INS. 20.00
APPLICANT s MOTORS SEE FEE BCH.
ADDRESS
S`"ti`96 - I�C�v✓L`. SERVICE CHANGE - 20.00
w09 LICENSED CONTRACTORS DECLARATION
rt u- 1 hereby III TNG that 1 am licensed under provisions of Chapter Am
ISSUANCE GATE
m G w (commencing with Section 7000)of Division 3 of the Business and B DGG ELECT., PLG. MECH.
H y z Professions Code,and my license i in full force and effect.
z O - License Class 1 (j -'Lia Numhcr _L�j$
w El..J , ❑
2 z 1-w Date-_;? ;,-al Cmuractor$ .G,✓ t✓w•. -
a u s ' + BUILDING PERMIT
, w ¢ OWNER-BUILDER DECLARA'T'ION - +
0 a ° MISC. RTO ORD INFORMATION
X g ,� r I hereby affirm that I am exempt from the Contract.,',License --- VALUATION $/FT.
F LL 0 a Law for the following reason.(Sec.7031.5,Busamessand Professions PERMIT ISSUANCE
Code:Any CHY Or courtly which requires a permit to constmeL alteq /nom///J
improve,demolish,or repair any structure,prior to its issuance,also ELEO,CONTR. LIC,NO.
dD 6 rey111rCs the appI1CJN for s11C11 pCOIDt IO file a signed statement that TOTAL PERMI
PrO
w 0 w' he is licensed pursuant to the provisions of the Contractor's License - ,
rz >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING,PERMIT ,FEE
as r o the basis for the alleged exemption.Any violation of Section 7031.5 .STORIES .TYPE CONSTR.
A - by any applicant for a pemnit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of nut more than five hundred dollars(S500)dr -
"❑ 1,as owner of the property,Or my employees with wages as ggCK F LOW PROTECT. DEV ICE 4:00 -
their sole compensation,will do fire work,and the structure is not 'OCC.GROUP RES,UNITS
intended or offered for sale (Sec. 7044, Business and Profession 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 so_.Fr.FLooR AREA TOTAL ACREAGE
i.� rivaclfre not
hde ownemployees,ees,provided ever,hat the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 -
mems are not intended or offered for sole.If,mpleveq the budding
.r improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
EH,vv f will have the burden of proving that he did not bulb or int- BUILDING USE
-,`0 for owner of salo). - INDUSTRIAL WASTE INTER. ' 30.00 RES IND CON Pe oma,
-ce d as owner of the property,he exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project La 7094,Business LAWN SPRINKLERS-1 INC 5 V.B. 6A0 ASSESSORS PARCEL NO. "
and n owner ns Code The Contractor's license Law does not;ywho - - -
to contracts
owner of property who builds or improves thereon, sua who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
On,Co is for such projects with n comrnctor(sf licensed phrsuum t0 SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's exempt
License Sec.' TRACT N0. PARCEL N0.
❑ lam exempt under Sec ,B.&P.Glnr this WATER HEATER W/VENT 6.00 +
reason
Owner ( Q Dom 713/' WATER,SYSTEM 5.00 = ACC.DATE'- ACC.FILE NO. -
WORKERS'CONIPENSATION DECLARATION WATER TREATING EGUIP. .5.00 ,
o
1 hereby ateirf thatWoo I have a certificate of consent to a certified
ZONING ENG.SITE NO.
or o certificate( ec Workers'Compensation Insurance:or a ccrlifieU
copy therenl'[Secpang 1.
Co e - ,
Policy No,-Company _ .IRE
" Z 'O Certified copy isherebyFiled famished. FIRE SPRINK ENERGY T34
Z Z' ❑ Certil red copy is Filed with the city ins-eni.n division.
MISC - REFER TO ORD. "
0 Applicant ' _ ' Y ❑ "N❑' Yo. IN
H m PERMIT ISSUANCE 10.00
- UJ CERTI PICACEP017 FNSXF.MI'TINSURAN WORKERS' FLOOD ZONE- A.L.u.C.
W � � COMPIiNSATION INSURANCIi'' PLG,CONTR. LIC.N0. PLG, _
0.0 1Thi5 section need not be Completed if the permit is for one TOTAL - Y❑ N❑ Y❑ N❑
hundred dollars IS 100)or less.) -
U O 1 certify that in the perfunnmnCe Of the work for which this per DTV. MECHANICAL PERMIT .FEE r FEE,SUMMARV
W H mit is issued,I,inti not employ any person in any manner so as to
- 0 w become suhject to the Workers'Compensation Laws of California.
y , Date Applicant ALTER OR ADD TO MECH. 5.00 Bl11LDING- 45:�
} to NOI ICE TO,APPLICANT: If,after making this Certificate of Ex-
F. 2 cm-tion,you should becona subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you most forthwith comply with FEE -
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10,O00C.F.M.) 4.00
CONSTRUC'PION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6:00 .SEISMIC FEE i.SO
Ihereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH-DUCT) 5.00 - ♦.
the.performance of the work for which this permit is-issued(Sec. MICROFILM
3097,C,.C.). _ - HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
N " HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Names ' ELECTRIC �'�P el:�)
I I certify that I have,cad this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree tog to b with all city and o.unly BOILER-COMP(3-H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and elate laws Debiting to building C enter upon
ami
hereby authorize ropertyfor ins'ofet this City to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEESCH. : , MECHANICAL
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'wh.... CONST.TAX '
may in any way accrue against said City in consequence of.the. 'PERMIT ISSUANCE 10,00
of this permit, ' MECH.CONT. LIC.NO. MECH. - - ' n
TOTAL TOTAL tSV
Si f of Applica [ onlractor Date -
OFFICE COPY
POSTTHIS CARD NEAR FRONT OF BUILDING '
�- , •^ PERMIT NbklBED
CITY OF CUPERTINO 1839�V
INSPECTION DIVISION
JOB INSPECTION RECORDE.
`
PERMIT EXPIRATION
JOB'ADDRESS � T UN�# _LOT# .
,p q - / ,}. �} / PERMIT.`EXPIq ES IF WORK
o NER' N��(F—/ � t'4—, � 1, CONTRACTOR' H-C� GIJ�, 1 IS NOT STARTED WITHIN
• INSP CTION DATE INSPECTOR INSPECTION RECORD -180 DAYS OF.PERMIT ISSU:,+
FOUNDATION NOTE: ;5 ANCE.OR•180 DAYS FROM
UFER ' - _ ALL GRADING'AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTIONi
PREGUNITE - - • TO COMPLY WITH THE APPROVED PLANS AND CITY OF T1,I71M,T VALIDA nON
CUPERTINO STANDARDS. -
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING � y1
• ELECTRICAL U;+ _ q IssuANce DATE
MECHANICAL' • - +Loa, ELecr, PLO. MECR.
.. ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
' WOOD FLOOR, - ,�'. INFORMATION
PLUMBING VVALUATII.ONN- SIFT.
MECHANICAL r 'x. Q
ELECTRICAL PERMIT TO
E
FRAMING
+ Ci INSULATION - - s+oRI to ivrE CONSTR.
Occ,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF- ' - NOTE.NO FINAL INSP.SHALL BE MADE BEFORE sorer,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION,TAX IS PAID
ROOF SHEATHING DBUILDINGLON USE
HC,$ IND CON PB 0,,.•,
0 El
APPLY NO ROOFING-UNTIL ABOVE HAS BEEN.SIGNED. FINALS
DATEINSP. AsssssOHS PARCEL No
ROUGH .i SAN.#
PLUMBING - ELECT.ENERGY -
• TRACT NO. PARCEL ND'.'
TUBS&SHOWER PAN PLUMBING E _
MECHANICAL - MECH.EN
ELECTRICAL . BUILDING ENERGYACC,DATE ACC.FILE.NO
In 4
-• FRAMING ELECT:FINAL TEST
INSULATION - - PLUMBING ZONING , , ENG.SITE NO.
'GAS TEST- - GAS - - •,-
MECHANICAL , _ FIRE SPRINK i ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ; ,rr'
FLOOD ZONE A.L,U,C. -
..
EXTERIOR SHEAR ELECTRICALRELEASE -
INTERIOR SHEAR FIRE DEPT.' - .Y ❑ : N[3' v ❑ No
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH - - BUILDING - -
INTERIOR LATH - 'd' • 'TEMPORARY APPROVALS BUILDING
SCRATCH.COAT ELECTRIC PLAN CIA ECK•' •.
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE •j(,I
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING F.INALISSIGNED BY BUILDING INSPECTOR: MICROFILM ,
.�
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
19
r H ONE'WORKING DAY'BEFORE REQUIRED INSPECTION. ..PLUMBING
z PLEASE GIVE;JOB.ADDRESS WHEN PHONING. '
' — SEE PERMIT,FOR-EXPIRATION DATE. - MEc AwcAL
' IMPORTANT! CONST. TA
PLEASE READ`REVERSE SIDE BEFORE TOTAL
CALLING FOR.FINA TINSPECTION:
OFFICE COPY