16127 AOF1,.ICANT TO FILL IN'INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY'
BUILDING PROJECT IDENTIFICATION - i
PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1 �� ��
ADDRESS
d'9 STz�1 r✓`1S C-Q IG QL��, BUILDING - ELECTRICAL-PLUMBING-MECHANICAL f. I
OWNER . , •• ' PLAN CHECK VALIDATION
NAME `
Moore v 1
CITY ELECTRIC PERMIT FEE 1
sTn AssoCPHDNEILZ-2b3o j'e. • CaU. `7J
CONTRACTOR'a •
NAME e �- OUTLETS-SWITCHES-RECEP, 10.00/1.00 a70 C
- `rQ
0"'M.10 IkrC LIC.No,B 483`ISS .- ' LIGHTING FIXTURES `� , a:•'"` 10100/1,00
CONTRACTORS
DRESS PPLIANCES-RESIDENTIAL::' 4.00 "
LI*-Ilia F}STIe'2'f;1 C PHONE&f,,(,-gW. PANELS 10.00 DATE OF APPLICATION
ARCHITECT . f 20.00 --PLAN CHECK FEE P.C.NO..'
OR - PANELS (OVER,200 AMP)
ENGINEER
LIC.NO: ' SIGNS TRANS.' - 3.00
ADDRESS E.G. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLIDDRCESS NT's
ADDRES - MOTORS SEE FEE SCH.
SERVICE CHANGE
wo o LICENSED CONTRACTORS DFCLARATION 0 Qa
¢U v 1 herehy allirm that I am licensed under incisions of Chapler.9, •q•.. - ISSUANCE DATE 3'
Z "' (emm�uncmg with Section 7000)of Diskion 3 0l the Business and
a a {- BLDG. ELECT. PLG. - MECH.
H wo i Licenselo l Code,and my license Is in lull torte and ul tett.'
Z o m- Date Class Lim.Number
Q N H Delc Conlructy
BUILDING PERMIT
¢ ¢ a OWNER-BUILDER IIBCLA RATION
¢ w u , - - I FORMATION
A ;n_N - I herby affirm that I am exempt from the Contractor's License MISC.— - 1REFER TO ORD N
w r� L'U TION $/FT.
F LLNj Code:Aryanylowingreason.(Sec.70)15,Business Professions PERMIT ISSUANCE' P
Code:Anyciiyor countywhich requiresa permit 'construct,ler. °'
Tce¢0 improve, or repair any structure,prior to ifs issuance,also ELEC.CONTR. LIC.'NO� ' ELEC. III '
O ¢ requires the applicant for Such permit to file a signed statement that - TOTAL vC
a w m" he is licensed pursuant to the provisions of the Contractor's License - - I PERMITTO
rz,Q Law(Chapter 9(commevcingwilh Section]000)ufDivision36fthe .1
4 D Business and Professions Code)or thin he I,exempt therefrom and DTV. ( -PLUMBING PERMIT' FEE
¢ H $ file basis for the alleged exenhption.Any violation of Section 7031.$ - .. - STORIES TYPE CONSTR.
ow. ; � by any applicant fora permit subjects lhbupplicaN toucivil penally - ALTER-DRAIN -WATER IEA.) 5.00 '
,fact it arm than five hundred dollars($500).):
❑ I,as owner of tllc propcity',or my enlployces'seith,wages as BACK FLOW PROTECT. DEVICE' - .4.00
their Sole compensation,will do the work,and [tic structure Is not OCC.GROUP RES.UNITS
intended ar 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. fS,66 a' SO,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffered for sale.If,however,the building GAS=EA.SYSTEM-i INE.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS EASYSTEMOVER 4 IEA) -200
builder will have the burden of proving that he did not build or im- - . : . .
BUILDH,G USE
p[pyl for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON pe - Omer
1,as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the ploieat(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 un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) - 1,00
contractsforsuch projects witha contractocs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 s
the Conlmctnr's License Law. TRACTNO. ,PARCEL NO.
rl:IDI]' I:un "m}t under Scc. .&P.('D him His WATER HEATER W/VENT' '6.00
M —y�
Owner- Unto9` WATER SYSTEM 5.00
ACC.GATE ACG FILE N0.
WORKERS'COM PENSA ' )N DCCLARATION WATER TREATING EQUIP. 5.00 .
I hereby affirm that 1 have a certificate ofconsent to self-insure, -- ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC- REFER TO ORD. - Y❑ N❑ Y ❑ N❑
~ vaPERMIT ISSUANCE `t9':00
W > CERTIFICATE COM OF EXEMPTION
ION IINSURANCWORKERS'. PLG,CONTR. LIC.NO. PLG Io'�' PLOOD ZONE A.L.u.C.
. CL 0: Z (Pols section need.not be cunmleled if the permit is four one - TOTAL L Y❑ IN C1 V❑ '_N❑
Il lilt I doI as($100)orless.) _
U O 1 certify that"In mm
the purranee of the work To,which this per- OTY MECHANICAL PERMIT FEE - FEE SUMMARY
LL F r it is issued.I shall not employ a y Pomo I4ny nannerso us to ,
O 6 "a, I e pth PPorkers�C_o_l nWt m a fCaliforni - - �
} W NOI ICE TO APPL CAN1: If,a�making this Ccrlllicate of Es- ALTER OR ADD TO MECH. `_ BUILDING.
F ? emption,you should become subject to the Workers'Compensation _ APPLIANCE - 5.00 PLAN CHECK (—
provisions of the Labor Cade, you oust forthwith comply with k.
U FEE
such provisionsor this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=r-F.M.) 4.00 U
CONSTRUCTION LENDING AGENCY, AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE (j
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 - r
the perlbrmance of the work for which this permit is issued fSec. MICROFILM
3097,Cie.C.). - - 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 Addr... - ELECTRIC ' D�
Icertil'y that l,have'read this upplic;dioil and state thn�lhc ahovc VENTILATION FAN (SINGLE). 4.00
Information is correct. I agree to wnlply with all city mlil county PLUMBING L� .
ordinances and state laws Nlaling 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 -
1 13bove mentioned property for inspection purposes. (�.
_ f (We) agree to save, inferiority and keep harmless the City,of MISC.- REFER TO ORD,
--_ _ -Cupertino against liabilities,judgments, costs .,,it expenses whichpERMIT ISSUANCE' 1 CONST.TAX
.may in any way ccrue against said City in consequence or the -
ranting fp tlfjs p r 't. MECH.CONT. LIC.NO. - MECH. 1 j
'1-A\` 0-IO-Se TOTAL�(Oi; TOTAL /CI�
Sigma.Sigmit.ff of Applicant/Contractor .Date
OFFICE COPY . -
POST THIS CARDINEA'R FRONTO F'BUIL DING. PERh,IrNDMBER } '
"CITY' OF, CUPERTI'NO- 16127"
INSPECTION DIVISION
JOB.INSPECTION RECORD
' 4 •T .�L ✓J,. �PERNIIT EXPIRATION`) j
J013 ADDRESS - d�6'o9 'S/�`'y�- 5 �^UI # 'LOT#
t' PERMIT,.EXPIRES IF,WORK
OWNER - p' r, dC, - '-CONTRACTOR ,�- ; �., IS NOT STARTED WITHIN -
INSPECTION DATE" INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.'I
FOUNDATION "' ANCE OR 180 DAYS FROM!
NOTE: " � ', LASTCALLED INSPECTION.
' UFER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED ]i
-PR EGUNITE.' - .TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION +
CUPERTINO STANDARDS.
GARAGE SLABS'' - - f/. -•.^^ ,W :�
POUR NO CONCRETE UNTIL ABOVE HAS.BEEN SIGNED' ICGa'>T'a OX 2I(e •y// "'J
UNDERGROUND'/SLAB . - - f�,r �•t�
.. PLUMBING
J`
ELECTRICAL' - - Issuarvce unre
+ MECHANICAL - ILuc. ELECT, '. PLC, E
. MCRra .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1• • BUILDING PERMIT
WOOD FLOOR �G .
ORMATION -
PLUMBING - CV LIAnON 51Fr,
MECHANICAL +.: • ``•��.. �'Z F*%•:U. �`^W.
ELECTRICAL ' - PERM T TO
pp
•
FRAMING
.INSULATION - - STORII:S TYPE CONSTR.
OCC-GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /--
_ $O.FT.FLOOR AREA - TOTAL ACREAGE ..
_ ROOF NOTE: 0 FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM. THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING . REs IND CON PB •Orv.,
- - APPLY NO ROOFING UNTIL ABOVE HAS BEENL SIGNED "'FINALS '"""• `` DATE `" 9 INSP."F ED , I] ID - EY 0
ASSESSORS PARCEL NO.'
ROUGH SAN.q ... ;
PLUMBING ' ELECT.ENERGY -
ITACTNO LARGE.L NO
TUBS 8 SHOWER PAN 'PLUMBING ENERGY ,
. . MECHANICAL 39-FMECHrENERGY'.
ACF DATE ACC.FILE NO
ELECTRICALBUILDING ENERGY I.
FRAMING - - ,ELECT,FINAL TEST
INSULATION PLUMBING .• - •-ZONING ENG.SITE NO.
GAS TEST. - GAS-
• FIRE$PRINK ENERGY T,24
MECHANICAL- O' . �f' . YE) . NF y,p N❑,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOR ZONE A.L.UC
' EXTERIOR SHEAR - � � .- � � ELECTRICAL RELEASE .�
INTERIOR SHEAR - FIRE.DE PT �' I''/jYRCJ Y ❑ "� � ❑ -
SHEETROCK, GRADE FEE SUMMARY
EXTERIOR ,LATH BUILDING
INTERIOR LATH , - TEMPORARY APPROVALS
SCRATCHCOAT ELECTRIC - - PLAN CHECK '' ((
.. GAS- . FEE I, ILI rI W�'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
- - OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM I
ARRANGE'FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
o� :ONE WORKING.DAY'BEFORE REQUIRED INSPECTION awMBINc
Z PLEASE GIVE JOB ADDRESS WHEN,PHONING.
—'SEE PERMIT.F0R EXPIRATION DATE MECHANICAL
IMPORTANTI " CONST..TAX:
PLEASE READ REVERSE SIDE BEFORE TOTAL ( �
CALLING FOR FINAL INSPECTION.
OFFICE COPY "