18402APPLICANT TO.FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTI FICATION•
"
'APPLICATION &PERMIT, _
- ` -
BUILDING -ELECTRICAL -PLUMBING -MECHANICAL
,PERMITNUMBER
'
18402 +
BUILDING
ADDRESS -
2 �
OWNER'S -'
NAMES I
OTY. ELECTRIC PERMIT ,FEEI
PLAN CHECKNALIOATION
-
��
DNA
NAME,
UTLETS-SWITCHES-RECEP 10.0011.00
LIGHTING FIXTURES 10.00/1.00
,Gr+ -G LIC.IsO
'
ADDRHAcrGR's -
ADDRESS -
APPLIANCES -RESIDENTIAL 4.00
PANELS 10.00
PO .4 PHONE2
'.. DATE OF APPLICATION
OORcI TET
PANELS (OVER 200 AMP) - ,20.00
PLAN CHECK FEE P.C. NO.
-
ENGINEER
uc.NO!
SIGNS TRANS. '. 3.00,
ADDRESS ENG
SPECIALCIRCUIT 5.00
PERMIT VALIDATION
A/O C S {^
EMP. METER OR POLE INS.' 20.00
Ars
ADDRESS -• -
oREs'
JoR7 Pooet-;jZe.-G f'
MOTORS '- SEE FEE SCH.
SERVICE CHANGE 20.00
LICENSED CONTRACTORS DECLA RAT ION.'
-
' I hereby affirm that I am licensed under provisions .(chapter 9
(contmenning wish Section 7000) of Division 3'.1'tire business and
Professions Code, and my license is N full force and effect.
License Class Number
ISS ANCE DATE
BLDG. ECT. PLG:' MECH.
❑ 0 El
Dulc � � - Conl rector
Con
� � � pp - Qo
/,1'ja U!' 1984
. OWNER -BUILDER DHCLnRA710N
I hereby affirm that I am exempt from the Cont lector s License
Law for the following reason. (Sec. 7031.5, Business and I'mcessions
Code: Any city or county which requires a permit In const rucg alten,
- -BUILDING PERMIT
.INFORMATION
MISC.= - REFER TO ORD
-
PERMIT ISSUAN 10.00
VALUATION'
$/FT. -
ELEC. CONTR. LIC. NO. _
.'
ELEG "
TOTAL
improve, demolish, or repair any structure, no, lU its issuance, also
requires the applicant for such pertttn to file a signed Statement that
he is licensed pursuant to the provisions of the Contractor's' License
Law (Chapter 9(commencing with Section 7000)of Division 3 ofthe
Business and I'ro(cssions Code) or that he is exempt therefrom and
�^ E^R M�IT TO' '
U'✓V
QTY. PLUMBING PERMIT FEE
the basis roi the alleged exemption. Any violation of Section 703 LS
by any applicant for a permit subjects the applicant too civil penalty
of not more than five hundred doll... (S500)d'.
STORIES
TYPE CONSTR.
ALTER-DRAIN&VENT-WATER (EA.) -
❑ 1, as owner of the property, or my nnployces with wages as
their sole compensation, will do the work, and taw structure is not
.
BACK FLOW PROTECTDEVICE 4.00
OCG GROUP
RES. UNITS -
_
DRAINS -FLOOR, ROOF, AREA,COND. 5.00
intended or offered for sale (See. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
"
FIXTURES - PER TRAP 5.00
- ,
GAS-EA.SYSTEM-11NC.40UTLETS 6.00
SD. FT. FLOOR AREA
TOTAL ACREAGE
property who buildrior improves thereon, and who does such work
himself or through his own employees, provided that such improve-
merits are ina intended or offered for sale. If, howcbeq the building
or improvement is sold within one year of completion, the owner-
builder will have the harden of proving that he did not build or Inn-
GAS - EA. SYSTEM - OVER 4 (EA.) '2.00
BUILDING USE.,
prove for purpose of sale.). "
❑ I, as owner of the properly, um exclusively contracting with
RES IND CON PB Other
INDUSTRIAL WASTE INTER. 30.00 -
licensed contractors -to construct the projeci (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
LAWN SPRINKLERS- 1INC'5 V.B'.' _,6.00
- -
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
'
contracts for such projects with a emttraclorfs) licensed pursuant to
the Contractor's License Law. v
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO,
PARCEL NO.
❑ 1 um exentpi under Sec. ,R.&I'.C. for this
remail_
WATER HEATER W/VENT - _ 6.00
Owner Date -
WATER SYSTEM 5.00
ACC.DATE
ACC. FILE NO.
WORKI:RS'COMPIiNSAT10N'DECLARATION*
WATER TREATING EQUIP. t `' 5.00
I hereby uHlRn that I have a'certificate of consent to wi Finsure.
-
ZONING
ENG. SITE NO.
or a certificate of Workers' Compensationl nsurance, or a certified
copy thereoffSee. 3800, Lab,CJ.
Policy No. - Company
❑ Certified copy is hereby furnlsluxl.
CI Certified copy is filed with the city, inspection division.
MISC.- REFER TO ORD
FIRE SPRINK
y � N
ENERGY TY4
V �' N[]
C17RTIFICAI'I. OF E%ESIPI'ION FRO.NI WORKERS'
PERMIT ISSUANCE 10.00
FLOOD ZONE
A.L.U.C.
- COMPENSATION INSURANCE
1'1'Ili, section need not be completed if the permit is for one
Y O N �
V ❑`.. N �
PLG. CONTR. LIC. NO.
PLG.
TOTAL
hundred dollsrs IS 100) or les.,)
,
I certity that in the perfonnance'o1' the work lit which this per-
mit is issued, I shall at employ any person in any nmnner m as to
OTV. MECHANICAL PERMIT FEE
-
- FEE SUMMARY .
BUILDING y. '',
q, OLD
become subject to the Workers' Compensation Laws of Califomia.
Dale "' Applicant - -
'
ALTER OR ADD TO MECH. '5.00 -
NOTICE '1'O APPLICANT: If, after making this Certificate o1' Lx -
APPLIANCE 5.00
AIR HANDLING UNIT (TO 10A000.F.M.) 4.00 .
PLAN CHECK
FEE
enmtion, you should become subject to file Workers Conmem,tion
provisions of the labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked. -
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a cunstrnalion lending agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.L
MICROFILM
HEATING UNIT (TO 10 0,000 B.T.U.) '6.00
Lender's Name
Lender's Address -
HEATING UNIT (OVER 100,000B.T.U.)9,50
ELECTRIC
.,
I certify that I have read this application and state that the above
VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with al city and county
ordinances and state laws relating to building'L'onstnslion, and
-PLUMBING
-
BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00
hereby autiorizn,d property forinspat this
hereby authorize representatives ec this city e, enter upon the
purposes.
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
(We)agreeto save,. indemnify and keep harmless the City of
MISC. - - - REFER TO ORD.
upertin, against Iiahilili",'judgments,'cost, and expenses which;
may in any way accrue against said City in consequence of the
ranting Of this permit.
P..
PERMIT ISSUANCE '10.00 -
CONST. TAX
,
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL ...
5 .
Signature of Applicant/Contractor Dare -
OFFICE COPY
POST THIS CARD. NFAR FRONT OF BUILDING '
CITY OF.CUPERTINO
PERMITNUMBER
181402
INSPECTION DIVISION,
r
JOB. INSPECT ION 'RECORD
mac'/ � :1 .
•
- -. '....
/
, /' / p l��j
` .I ! ',S/l/MS,:'
IPERMITT E�T115N
JOB ADDRESS UNIT#'• _LOT#pERM1T
EXPIRES IF WORK
i
owNEa'•�/' - CONTRACTOR - 'w+."
•'IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
INSPECTION DATE INSPECTOR
INSPECTION RECORD
FOUNDATION_t
-
NOTE:, - `
ALL'GRAOING AND DRAINAGE SHALL BE INSTALLED
•TO COMPLY; WITH THE APPROVED PLANS AND CITY70F
LAST CALLED INSPECTION.
_
UFER
PR EGUPJITE'
r . PERMIvvnLlDnrlaN
CUPERTINO STANDARDS.'
- IT
Y
ISSUANCE GATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
-
.. i.-UNDERGROUND/SLABAAS�I'
PLUMBING _
'!/!'Yf�1��'.
ELECTRICAL "'
MECHANICAL
.eLECT.
PLO. MecR.
Ej
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
' . City 0( Cupp".
- -
BUILDING PERMIT
INFORMATION
_
- WOOD FLOOR
VALUATION
$JET.
PLUMBING
MECHANICAL
ELECTRICAL +. ''
--
•ERmIr tD
T�f Mpg
FRAMING
INSULATION r .• -
-
STORIES
TYPECONSIR.
OCC, MHOlill
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED'
ROOF - - •.
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
CONSTRUCTION TAX IS PAID.
,DATE
SO. FT, FLOOR AREA
-
TOTAL ACREAGE,
DIAPHRAGMTHE
,-BUILDING
ROOF SHEATHING`
-
USE
riesIND CON PB on.+•
❑'''❑ , L ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED "
'FINALS - - INSP."
ASSESSORS PARCEL NO
ROUGH
sANA
PLUMBING -
ELECT. ENERGY
TUBS &SHOWER PAN
PLUMBING ENERGY
rHACT No.
PAHceL No
MECHANICAL - - - r
MECH. ENERGY
ELECTRICAL
'BUILDING ENERGY
ACC. GATE
'"
Acc. FILE70
FRAMING
ELECT. FINAL TEST
INSULATION
PLUMBING
ZONING
ENG. SITE NOf
,
GAS,TEST -
GAS '
FIRE SPRINK
N�
ENERGY 124
NE]
'
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING' +
EXTERIOR SHEAR .,ELECTRICAL
RELEASE
.FLOODZONE
❑ ' N
A.L.U.0
r L N❑
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK
GRADE..
FEESUMMARY
EXTERIOR LATH
BUILDING J
BUILDING
5-7 'og
.INTERIORLATH ,
TEMPORAR APPROVAL
SCRATCH COAT.-
ELECTRIC
PLAN CHECK
FEE ,
'1/
.
..
..
GAS �
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
SEISMIC FEE
OCCUPANCY'OFBUILDING ISNOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
'MICROFILM'
.�
.ARRANGE FOR. INSPECTION BY PHONING 252-4505,
ELECTRIC
F� ., ONE WORKING DAY BEFORE REQUIRED INSPECTION.,
PLUMBING
0 -PLEASE GIVE JOB ADDRESS 'WHEN PHONING. '
MECHANICAL
— SEE PERMIT FOR EXPIRATION'DAT.E —` ';
coNsr. rax
IMPORTANT!
TOTAL
PLEASE READ REVERSE SIDE BEFORE'
CALLING FOR FINAL INSPECTION.
OFFICE COPY