17417 APPLICANT TO FILL IN INFORMATION WITHIIV�RED LINES USE BALL PdINT XEN.O�LY
BUI LDI NG PROJECT I DEN TI FICATION PERMIT NUMBER
BUILDING— -
BUILDING APPLICATION &,PERMIT' ; I' 1
-y Ao^Ess .ELECTRICAL—PLUMBING—ME �J A 7
CHANICAL FS I I `{.' I 1
OWNER'B - PLAN CHECK VALIDATION
NAME TV.' ELECTRIC PERMIT -F'FEEEnomeflacTOR�sT ; UTLETS-SWITCHES-RECEP 10.00/10U LIC.NO.y(JLIGHTING'FIXTURES 10.00/1.0ADDRESSrofls - APPLIANCES-RESIDENTIAL 4.0CDOREsS 5 PANELS 0.0DATE OF APPLICATION
ARCHITECT PLAN CHECK FEEP,C.N0.EDR NG PANELS (OVER 200-AMP) 20.0 _ENGINEEfl - t
'
LIC.NO. SIGNS TRANS. 3.00
ARCH OR ADDRESS ENG., SPECIALCIRCUIT, 5,00 - PERMIT VALIDATION -
ZIP TEMP.METER OR POLE INS. 20.00 3, .22—
APPLICANT - MOTORS .SEE FEE SCH.
SERVICE CHANGE- 20.00 -
F o osjo
LICENSED CON'FRACTORS DECLARATION x
- a v LL, - I hereby affirm Thal I all,licensed under provisimPS of Chupter.9, ISSUANCE DATE
y w
(commencing with Section 7000)of Division 3 of the Business and "
< S _ BLDG. ELECT. PLG. MECH.
y'w Professions Codaanal 'cense is in full forey, n eff'cj„ MAR 2
z o m License Class_ Lie.Number_`.. ,El El
'o_ r Dee 'Contractor
J - •/, BUILDING PERMIT
O NE: BIIILDIIR DECLARAT ON
a a u INFORMATION '
w ; N I hereby ulfinn that 1 ani exempt Imm the Contractor's License MISC.— " REFER TO ORD
u O a Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
Code:Any city ,,County which mqui,.apv,mit to,mea act,altcr; PERMIT ISSUANCE 10.00
rtrot ELEGCONTIT LIC.NO.
SE a 0 improve,demolish,or repair any strudurC,prior to its issuance,also ELEO. '
a ¢ requires the applicant for such permit to file a signed statement that _ TOTAL
E:
m w Ile is Cliapc r.9(comtl to the provisions of the Contractor's 3Licenseofthe PERMIT TO
E:a Law SinesspteE9(cosions Code)or that
7000)ofDivision3oCthe
F 4 D Business and Professions Code)or thus he is tion of ec ion 70 sod DTV. PLUMBING PERMIT - ' FEE I Dwl.
¢ r o the basis fur the alleged exemption.Any violation oto a cion malty _ STORIES VPE CONSTR:
t•d?roby any hymn aomthan five
hundred
dolla[s $500 plicant maeivil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00 ^
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sale Conepensatien,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:'File Contractor's License Low does not apply m an owner of (-
property,who builds or improves thereon,and who does such work FIXTURES-PER TRAP _ 5.00 SG.FT.—FLOOR AREA TOTALACREAGE
means line
not inhroughtended
his own employees,for
rssle lidI that improve- -
mentsarenotimhidedoroften'oyees, moved that suhebuildie. GAS-EA.SVSTEM+I INC.40UTLETS
orrimprovement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or in. GAS'-EA.SYSTEM-OVER 4 (EA.) 9 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB Other
to 9,as owner of the properly;and exclusivCly.contracting with • INDUSTRIAL WASTE INTER. 30.00 ❑ 0 ❑ 0 ❑
licensed contractors to construct the project iSec. 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 build's or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.)..1.00
contracts for such projects with a oontmCtunt)licensed pursuant to "
the Contmetor's Lice nse Law: ) ' SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
O l an,exempt under Selz. ,B.&P.C.lie this
WATER HEATER W/VENT 6.00
reason
'
reason
Oner Date WATER SYSTEM '• 5.00
• wACC.DATE ACG FILE NO,
WORKERS'COMITNSATION UECLARA'I[ON WATER TREATING EQUIP. ; 5.00 x
T I hereby affirm that I-have a certificate_of consent to svibi[nssure, t - ZONING ENG.SITE NO.
or a �ertlftnate of Workers Compensatio easel e I -4L 1 .,
L
r f ■f O
O' P 0 Ce rti led -op is I,ereby I Ic a� - - - P •.
Z-2 M Ce li ie o wit 'ilei bisiop. FIRE SPRINK ENERGY L24
Oz Appil MISC. REFER TO ORD. .
~ rn ' PERMIT.ISSUANCE
� —' CLIffIFICOMOPSATION INS FROM W'ORKIiRS'. FLOODZONE A.L.0 c.;,
LLI a,0•' �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- 0 (ibis section need not be completed if the permit is for one TOTAL V❑ NF] V ❑ N❑
mmdoed dollars(S 100)or bets,I
V'0 II certify that in the performance of the work Ii..which this per-_ CITY. MECHANICAL PERMIT FEE FEE SUMMARY .
mit is issued, I shall not employ any person in any manner so as to
OLlbecome subject to the Workers'Compemation Laws of California, -
G, Dec ApplicantgLTEROR ADD TOMECH. 5.00 BUILDING`•`
} Do NOTICE '1'0 A1113LICANI': If,after making this.Certificate of Ex-
F 2 t emptlons you should become subject to the WOrkes Compeasaiimi —'APPLIANCE5.00 PLAN-CHECK=
provisions of the Labor Code, you must forthwith comply with, FEE
U such provisions or this.permit shall be dcenled'mvnked. ,. ' 'AIR HANDLING UNIT TO 10,000GF.M.) 4.00
. CONSTRUCTION LENDINGAGENCV AIR HANDLING UNIT(OVER10p00C.FM.) 6.00 , SEISMIC FEE
I�hereby affirm that there is a Construction lending ageney'for 1 EXHAUST.HOOD (WITH DUCT)' 5.00 _
the performance of Ihe'work for which.this permit is issued(Sec. MICROFILM
3097,Civ.CJ. r.. HEATING UNIT(TO 100,000 B.T.U.) 8.00 _
Lender's Name
HEATING UNIT(OVER 100,000 B.T.U.)9.50
----- �r Lender's Name ss - ELECTRIC
-
I certify than have read this application and sthte`Bmt the above VENTILATION FAN (SINGLE) .4.00 - ,r
information is correct.I agree to comply with all city and county PLUMBING •l, r-QI/
ordinances and state 15ws relating to building construction, and BOILER-COMP(3 H.P.Dr 100,000B.T.U.) 6.00
hereby entimned roperty For ins of this rp to enter upon th° BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. . I' MECHANICAL'
above-mentioned property For inspection this
purposes.
(We) agrce m savO indemnify,un cup harmless the City I { MISC.- REFER TO ORD. -
_. upertmo against haMlities,j dg nts, sts and expenses which - ,PERMIT ISSUANCE 10 00 . CONST.TAX '
m m ny way acct st old CLL in ..Selluevice of thL - -
•an Ing this Pcnnt 4/ MECH.CONT. LIC.NO. MECH
CZµ CSC TOTAL 1 , TOTAL, fOD
Signatumof Applicant/Contractor Date -
y OFFICE COPY .
POST-THIS CARD NEAR FRONT OF BUILDING PERMIT'NUMBER
:CITY OF CUPERTINO17417"
INSPECTION DIVISION
h y.. JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 1 —7
Lam' ff VILUNIT# - -_LOT#
'^ ``. PERMIT.EXPIRES IF WORK
OWNER.:• n, !�� �l\; :e -CONTRACTOR (�,.�" -ed.. ISNOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPEC ION'RECORD ?80 DAYS.OF-PERMIT ISSU.•
FOUNDATION' - ANCE OR 180 DAYS FROM
NOTE: -LAST CALLED INSPECTION.
UFER' ALL-'GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE,,: - - TO COMPLY.WITHTHE APPROVED'PLANS AND CITY-OF PERMIT VALIDATION
_ CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "'2 2_4�— 1
UNDERGROUND /SLAB • . MAR 2 Z .1",
' PLUMBING - -1u . .Q����MM.�{��.�.�� • o e 11•A 4t:VEC-,.�
ELECTRICAL CIY. at��y!wYYM IssuaNCE DATE
MECHANICAL` - BLDG. .ELECT, PLG. MECH.
D _0 ., E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING _ +r VALunrloN ,.SiFr.
MECHANICAL-
ELECTRICAL' - - - //,� ` .PEBnR?ro
• FRAMING' IV\
INSULATION I sroeus c nor.cgNsnv,
OCC.,GROUP - RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE.HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSPsSHALL BE MADE BEFORE s°.`T,rLaol+AREA `TOTA,.Aca encE
DIAPHRAGM . I THE CONSTRUCTION TAX IS PAID.
BUILDING USE
tcK4' ROOF SHEATHING. -; . + - . • , . RES IND CON PB omrr
El 0!❑! ❑ 111:17" „ .
' APPLY,.NO ROOFING UNTICABOVE HAS BEEN SIGNED ' FINALS DATE INSP: +r AS5esso sPARceLNo, .,
ROUGH .' SAN.N
PLUMBING - ELECT.ENERGY
_ TRACI NO . . PARCEL No
TUBS 8 SHOWER PAN - PLUMBING ENERGY n
MECHANICAL - MECR ENERGY -
ELECTRICAL ACC.DATE ACCFILE NO
BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING, ENc.srte NO..
INSULATION. PLUMBING - •
GAS TEST.. GAS
MECHANICAL _ FIRE SPRINK ENERGY,T"24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING' Y ❑ N❑
'EXTERIOR SHEAR.. - .ELECTRICAL RELEASE - _ E - FLOODZONE A :;. ,.r..:
INTERIOR SHEAR; FIRE.DEPT. Y❑ N❑ Y'❑'�N❑
SHEETROCK ` + • GRADE - FEE SUMMARY
EXTERIOR LATH - BUILDING -BUILDING
INTERIOR LATH TEMPORARY APPROVALS -
SCRATCH COAT ELECTRIC. s 'PLAN CHECK '
- -
GAS
FEE
" . NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . SEISMIC FEE
OCCUPANCYOF BUILDING.ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BV BUILDING INSPECTOR: MICROFILM
;ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC,'
til' H ONE WORKING DAY BEFORE REQUIRED'INSPECTION. PLUMBING Dd
o� PLEASE GIVE JOB:ADDRESS WHEN PHONING
Y Z MECHANICAL
SEE PERMIT FOR EXPIRATION DATE =
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE.B.EFORE, TOTAL '1
CALLING FOR FINAL INSPECTION.
OFFICE COPY `