13551 APPLICANTTO FILL IN INF�MATION WITHIN RED LINES — USFA&LL POINT PEN ONLY
`- �BUILDING PROJECT IDENTI FI N PERMIT NUMBER
BUILDING _/o APPLICATION & PIT
AD REss 1
BUILDING—ELECTRICAL—PLUMBING—MECHANICAL -
OWNER'$ I FiE - PLAN CHECK VALIDATION
AME / QTY. ELECTRIC PERMIT FEE
PHONE �I ^ 32-
CxmTHACTORs - OUTLETS-SWITCHES•RECEP 10.00/1,00 16'. o[ V
C.1,10.3)3M LIGHTING FIXTURES- 10.00/1.00 U —
CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00
ADDREss
,jk '1 PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 20.00
ENGINEEPLAN CHECK FEE P.C.NO.
OR "
,/
L uc.No. SIGNS TRANS.' 3.00 7A n IT.
ARCH.DR ENO. - SPECIAL CIRCUIT 5,00 " PERMtLVALIDATION
o�l1--n Un12G Z- , TEMP.METER OR POLE INS. 20.00
APPLICANT SNs - MOTORS SEE FEE SCH'.
ADDRESS
J
SERVICE CHANGE 20:00 ,JrJ Ca, ',f�O.l� r
jrfr ��
w,o o �LICENSED CONTRACTORS DECLARATION
r t w I hereby affirm first] am licensed under provisions of Chapter 9 C'f) .' •�_._ ISSUA CE DATE
(commencing with Section 7000)of Division 3 of the Busi ess and" ..r r, BLDG. ELECT. PLG. MECH.
D e Professions Code,and my license is in full for '
z o w• Licf,I a lug Lie.Number - pertl
Or,
L Datu?s—i r�Contractor_�3�k9'f p}hl (1 CUy
rt a,f V•7 BUILDING PERMIT
a w u OWNER-BUILDER DECLARATION _ INFORMATION
wo w I hereby affirm that I am exempt from the Contractor's License MISC.— - REFER TO ORD
3 u y P VALUATION $/FT.
u N¢ Law for sire following reason.(Sec.707 L5,Business and Professions PERMIT ISSUANCE '10.00
Code:Any city or county whichrequiresa permit foconstruct,.1br, -
EC K Q o Improve,demnhsh,or repair any StroCture,prior ID its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
O E, requires the applicant for such permit to file a signets statement that TOTAL U L— PERMIT TO
E
$ tie is licensed pursuant to the provisions of the Contractor's License nn
t z¢ Law(Chaptei9(commencing with Section 70001 of Division3Of critic IA17�'-Rja.� //%,D
i o Business and Professions Code)or that he is exempt therefrom and' DTV. PLUMBING PERMIT -.FEE
tel-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil t penalty -gLTER DRAIN&VENT-WATER (EA.) 5,00
of nomore than five hundred dollars -
❑ 1,as owner of the property,or my employees with wages al BACK F LOW PROTECT. DEVICE 4.00
theinsule compensation,will da work,ork,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 Law does not apply to an owner of - s
property who builds or improves thereon,and who does such work FIXTURES v PER TRAP 5,111) SO,IT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meats arc not intended or Offered for safe.R,however,the building
or Improvement is sold.withio ono year of completion,theowner- GAS-EA.SYSTEM OVER 4(EA ) 200
builder will have the burden of proving that he did not build or im- . . BUILDING USE
prove for purpose of sale.). ' INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Omer
11I,as owner of the properly,and exclusively contracting with ❑, ❑ ❑ ❑ , Cl
licensed contractors to construct the project(Sec.7044,limbless 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 fLAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ Iamexemptunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Date WATER SYSTEM . 5.00
ACC.DATE ACC,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING:EQUIP. 5.00
I hereby affirm Thal I h•ve a c eple�s onsem LL+self-insure. ZONING
or
"Otificote'If Wor + ItiFn ln�trace,or a certified ENO.SITE NO.
copy tiler•o —y m/SlwriUl
Policy No C mpanyFir
Wl+.l x.' yv�_n••n
0 ❑ Cerlifa o he Rb furnished: x FIRE SPR INK ENERGY T-24
�C`erfc vi ih t n division. MISC.- REFER TO ORD.Z 0 Applicant_ V❑ N❑ Y.❑ N❑
CC - • PERMIT ISSUANCE 10.00
CCrn CERTIFICATE E EXEMPTION PROM WORKERS' FLOOD ZONE A.L.U.C.
W COMI'E
� NSA'1'ION INSURANCE PLG.CONTR. LIC.NO.� PLG. .
CL O (This section need not be completed if lire permit is for one TOTAL _ Y❑ N❑ Y❑ N❑
Z) Z hundred dollirs(SI00)arless,)
0 O 1 certify that in the performance of lire work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. DUE is issued,I shall not employ any person in any manner so as to
U became subject to the Workers'Compensation Laws of California. Q
O w Date Applicant - 1m,OA){(C5.00 � � BUILDING t7 0 '�
a ALTER OR ADD TO MECH.
} to NOTICE TO APPLICANT: If,after making this Certificate of li x- ,_ -
H ? enlplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Lobar Code, you must I'orlhwdh comply with FEE
'C) such provisions or this permit shall ba deemed revoked, AIR HANDLING UNIT(TO 10p110QF.M)A_4=
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10b0 C.F.M,) 6.00 SEISMIC FEE 70
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITWDUCT,),.of Q116:OQ no
the Pert'orrnance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,0009:T.U.) 8.00
Lender's Name HEATING UNIT(OVER 1 D0,000 B.T.U.)9.50
Lender's Address ELECTRIC �Q
• 00
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and countyPLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
herehy authoriie representatives of this city,to enter upon the BOILER-COMP lover 100,000 BTU)SEE FEE SCH. - MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -
Cupertino against liabilifies,judgments, costs and expenses which PERMIT.ISSUANCE - 10.00 Q CONST.TAX
mayNy way accrue agaipyt said sty in consequence of the gIt x /Y/� '] MECH.CONT. LIC.NO. MECH. 'TOTAL — TOTALf Applicant/ContractorDafe
•OFFICECOPY
POSTTHI RD NEAR FRONT OF BUILDING • PfRA TNLMBE
- -
CI 'OF, CUPERTINO`
4 INSPECTION DIVISION 3551
JOB INSPECTION RECORD `\
. eF 1 '•• , „ f PERMIT EXPIRATION -
JOB ADDRESS 217.30 Stever Creek Blvd UNIT# LOT# 1
-„+ PERMIT EXPIRES IF WORK
OWNER
" FIELDS (BXHOME$�NTRAcroR '} AAS HOMRS. INC. IS NOT STARTED WITHIN . '
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS o'F.PERMIT ISSU-
y., _ 'ANCE OR i80-DAYS FROM
FOUNDATION - - LAST CALLED INSPECTION.
..
LIFER -
PREGUNITE . i•' - - PER MIT,VALI DATION
, -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - afii
-UNDERGROUND /SLAB
PLUMBINGt �� n c�� •[/ /6 t(
c U
ELECTRICAL' - - '- "� '•�~� _.IISSUANCE LATE
MECHANICAL.', ' - . - �+� ,'d}' LECT. , GLC. MECH. '
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUINFILDING PERMIT
_ ORMATION
' WOOD FLOOR - vALu�AnoN siFr.
PLUMBING.. :
' MECHANICAL p
ELECTRICAL' PERMIT T'
�/✓� /OIQ /�/�/�.
•? FRAMING .
< INSULATION'. - � ,STORIES TYPE CONSTR.
. , OCCIGROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
ROOF t. ,. •. , 50.1'T:FLOOR AREA TOTAL ACREAGE
DIAPHRAGM`.
_ .. BUILDING USE
-M„ HES IND CON rPB Omer '
L,
APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.ROUGH ;
,+ PLUMBING
GAS TEST .. - a TRACT NO. PARCEL NO.
MECHANICAL
•.ACC DATE• ACC FILE NO,
> ' ELECTRICAL. FINALS - DATE INSP.
FRAMING - .'(�. SAN -
^' ZONING ENG:SITE NO.
INSULATION • - PLUMBING
- �167 - GAS . 'E �•'
• ' MECHANICAL FIRE SPRINK, ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING, - Y � ' "� Y ❑ ,'��
' LATH,-INTERIOR 'ELECTRICAL 7, 3 e FLOOD ZONE A.OVC.
LATH-EXTERIOR FIRE DEPT. Y❑'_ N❑ Y ❑ N❑
SHEETROCK GRADE ` - FEE SUMMARY
SHEAR INTERIOR - BUILDING >-r tj BUILDING
SHEAR EXTERIOR TEMPORARY APPROVA
FIREWALLS•,• - - ELECTRIC -' PLAN CHECK '
GAS " FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED ocCUPANCY' ' SEISMIC FEE /!I
OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL.BUILDING.F(NAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM' '
ARRANGE FOR',INSPECTION BY'PHONING 252-4505, ELECTgIcLU
, tr''�
ONE WORKING DAY BEFORE REQUIRED INSPECTION
PLUMBING
z PLEASE GIVE'JOB ADD RESS'WHE,N,PHONING.
1.
SEE-PERMIT FOR EXPIRATION DATE— r• MECHANICAL
• n, -- Ai�' 'CONST:%TAX.
y. IMPORTANTf
PLEASE'READREVERSESIDE.BEFORE "' "`
CALLING FOR FINAL.INSPECTION.
` TOTAL
OFFICE COPY