C 8488 POST THIS,CARD NEAR FRONT.OF BUILDING
1 ,t 'PFRMITNVMBER-
C1TY OF" CUPERTINO8�-S
INSPECTION DIVISION
JOB'INSPECTION RECORD :
PERMIT EXPIRATION '
JOB ADDRESS` �l/� ( �L �l'� UNIT,# LOT'-;ft '
.PERMIT EXPIRES IF WORK
OWNER CONTRACTOR - $' IS NOT�STA RTED WITHIN
INSPECTION DATE INSPECTOR' •-. 1NSPEC I NRECORD, , 18o,DAVSOFPERMITIssu
FOUNDATION _ Z.,,Q W " yi FP �,�„�� ��d+' 'ANCE OR 180,DAYS FROM
LIFER
.� , BLAST CAL L ED INSPECTION.
PREGUNITE r "- .
P�RMIT VALIDATION
�O.
' - POUR NOCONCRETE UNTIL ABOVE HAS BEEN SIGNED � �
r
UNDERGROUND /
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.W
' - t " - �r• N ���.�
ISs ua NCE Da TE
- - a ELEc*. PLc. MECH,
OH UNTIL A80VE HAS BEEN,SIGNEDBUILDING PERMIT
WOOD'FLOOR'. INFORMATION
AION. $SFT4"'/T-SrS� - q, II A
MECHANICAL - w
ELECTRICAL'* ' E
'FRAMING
INSULATION / O, r - ,STORIES TYPE CONSTR.
-OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
:ROOF _ SO,FT.FLOORAREA TOTAL ACREAGE
*; DIAPHRAGM
BUILDING USE. 1
•ZL
RES IND CON, .PB Oln,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑° '� ❑ ❑".
.ASSESSORS PARCEL Np.
ROUGH I
PLUMBING .� _I - I J S/�"' f�'#:'r}.:v 1C'. -
GAS TEST , _ TRACT NO. , PARCEL NO.
MECHANICAL • ' '
ELECTRICAL _ FINALS DATE INSP. ACC.OATE ACC.FILENO:
' FRAMING15SAN # -
ZONING ENG.SITE NO. 'x
INSULATION :? -- _ PLUMBING
_ MECHA ICA FIRE SPRINK "ENERGY T-24
I:Trr 'COVER NO-WORK UNTILABOVEHAS BEEN SIGNED HEA7I G Y E '"� -`..Y-O "O
LATH—INTERIOR"
.—ELECT IC •FLDOD ZONE '.A.LU.O,
LATH—EXTERIOR - FIRE DEPT. _ Y❑ "❑ "' ❑' N❑
SHEETROCK GRADE. FEE SUMMARY `
SHEAR INTERIOR - BUILDING
- SHEAR EXTERIOR - _ TEMPORARY APPROVALS, BUILDING,
FIREWALLS - - - ELECTRIC PLAN CHECK„ ,
GAS - FEE ' •.�"....,. f
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED ICCCUPANCY SEISMIC FEE.., .p
UCCUPANCYOF BUILDINGISNOT PERMITTED UNTIL,BUILDING'FINAL ISSIGNED BY BUILDING INSPECTOR. - '
BUILDING.
- - - MICROFILMS r
LU .ARRANGE FOR'"INSPECTION BY PHONING 252.4505,';" ELECTRIC
� O NE WORKING DAY BEFORE REQUIRED INSPECTION PLuneIJG
Z PLEASE;GIVE JOB ADD RESS WHEN,PHONING.
,'—.SEE PERMIT FOR.EXPIRATION DATE — MECHANICAL z
LJ
k
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING'FOR FINAL.INSPECTION. TOTAL.
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENT[FICATI ON PERM NUMBER
BUILDINGAPPLICATION & PERMIT
ADDRESS^^ �nf// q ((''��
dGt✓tK Ov BUILDING-ELECTRICAL-PLUMBING,-MECHANICAL 8488
oyv R's
PLAN CHECK VALIDATION
NAME 52 ELECTRIC PERMIT FEES
1 , Mk 4 Nr2I (fNeNAN PHONE✓�/IJ"-24V
CONTnqCTOfl'B ��.
NAME tom, �1, q UTLETS-SWITCHES-RECEP !19;00/1.00
LIGHTING FIXTURES _10,80/1.00
4oDISOSS TORS PPLIANCES-RESIDENTIAL - 4.00
ARCHITECT
PHONF PANELS ,1 10.00 DATE OF APPLICATION
}•� 1�N Co-• �� :N
OR 3 1FY��1 PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.00.
EF
FNGINR QIG4t AJZYI ��i/m1g"1E No. - SIGNS TRANS. 3.00 -
ARCH.OR ENG. /rv"lE PERMIT VA 1 I
..� ,AooRFss ^ R�( ' .rJ SPECIAL CI RCUIT 5.00 �yD���(
- 7JJ Jv U F zIP SQL$ EMP;METER OR POLE INS. 20.00 ['//� v ,
APPLICANT'B 1
r ADDRESB ').EGGI 5 '^'^✓•.w O✓, MOTORS SEE FEE SCH. ill// �EyyUBRI II(d1F 11
[•� w-r4 ono SERVICE CHANGE 20.00 1985
0 0 0• LICENSED CONTRACTORS DECLARATION - TEMP.POLE 30.00 - �tIBO
a u w I hereby affirm that Sec I n licensed under n 3 of the of Chapter 9 -
City Of Cupe
m 2 w ISSUANCE DATE
Q N (commencing with Section 70se of Division 3 of the Business apd BL C. ELECT. PLG. MECH.
H y Professions Cod ad I license is in(all fort ut,• ec a / ❑ ❑ O
zo i w G License Class Lac.Number
to.
II,• O
I-w. Date_ Contractor 11/'n
a'y J D E t'I �.5 BUILDING PERMIT,
rc p w a OWNIi R-BUILDIiR DECLARATION
wD o MISC.- - - �P T 'ORD INFORMATION
,; a w I hereby arra. Ihut I am exempt from the Contractor' License
u O j Law for the following reason.(See.7031.5,Business and Professions VALUATION $/FT.
t - PERMIT ISSUANCE
f w�f Code:Any mulish county which structure,
u tune,p rmit to construe[,alter,' 2-1,
/ Af��7s
2 ¢ 4 O improve,demolish,or repair any stnmlure,prior to its issuance,also ELEC.CONTR. LIC.NO. (J(1 Cl
D¢ requires ilia applicant for such permit to file a signed statement that TpTq'L �f
a, oC
w$ he Is licensed'pursuant to the provisions of the Contractor's License PERMIT,0
Business
(Cs and Professions
ode) lh Section is exempt theon3af
E z o Business and Pe alleged
lle ed Code)or that he is exempt therefrom and OT S'. PLUMBING PERMIT FEE (�
e, H$
the basis for[healora permit subjects
Any violation t too a ion 703L$' - STORIES. TYPE CONS'TR/.6
i;_ by any applicant fora permit subjects $500).licam toacivil penally ALTER-DRAIN -WATER (EA.)�6.86-
' of not more than five hundred dollars(5500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE - 4.00
their sole compensation,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,'CON D. 5.00 R- /
Codd The Contractor's License Law does not apply to an owner of -
pmoperty who builds or improves thereon,and who does such work FIXTURES-PER TRAP .6:00 W 50,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 6.00
of improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or on. GAS-EA.SYSTEM-OVER 4 (EA.) _ 2.00 ' BUILDING USE
prove for purpose of role.). INDUSTRIAL WASTE INTER. 30.00F" IND N PS
Care,❑
0 1, ❑as owner of the property,am exclusively contracting with
licensedd contractors to construct the project(Sec. 7044, psx LAWN SPRINKLERS-1 INC{B 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not of aappply A 11 ❑
G` ys
to anowner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00 3 f'/ + �{� -oa
contracts for such Projects with a cool rto actot(s)Iic.s
icA pursuant to _ -
theContructor'sLicenseLess SEWER-SANITARY-SVAE .20 t 1'0'00
r(�, TRACT NO. PAR EL NO.
❑' I am exempt under Sec. ,B.&P.C.for this WgTER HEATER W/VENT - 6.00 '
reason
Owner
Data WATER SYSTEM
' C(` OF 60 .ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
-/-7I I herehy aRirm Thal I have a certificate of cousend to wif-instire, .ZONING
or a certificate of Workers'Compensation Insurance,or a certified - ENG.SITE N0.
copy Cher ( ec.3-Q p.ny 1. �j
Policy No. ompany_ 17
0- ❑ Certified copy Is hereb furnis " FIRE SPRINK ENERGY T-24
Z O7 ❑ Certifie py is f wit ci iRspeciion division MISC.- REFEArTOORD. y N� v N�
F p. Apnucam- -� ddi
� N
CER'I'I FICATE OF EXEMPTION FROM WOR K1iRS' PERMITISSUANCE "71QB0 PL000 ZONE A.L.U.C.
Lu COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. - (Jct
�• (This Section peed not he completed if the permit is for One _ TOTAL 6 V-� N� Y 0 No
Z hundred dollms(SI00)ortess.)
U O 1 artily that in ilia performance.of ilia work for which this pc ,. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any parson in any manner so as to
U become subject to the Workers'Compensation Laws of California. PAID
}
0 n Date Applicant _277ALTER OR ADD TO MECH. BUILDING /
Z NOTICI: TO APPLICANT: If,after..king this Certificate of Ei -
I- emphon,you should become subject to the Workers'Compensation qpp LIAN 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwithi comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT TO 10,000C.F.M.) 4100
'CONSTRUCTION LENDING AGENCY AIR HAND I C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST H OD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sea MICROFILM
3097,Civ.CJ, HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender'l Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
.010
1 certify Ila,1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
. information n correct. I agree to comply with all oily and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6,00 PLUMBING '
aromatic" and state laws relating N building construction, and
hereby authorize representatives for ins inspection
this city to an
upon the BOILER-COMP (0ver 100,000 BTU)SEE FEE SCH. MECHANICAL +
abovo-mentipned properly for ins'pectinn purposes. '
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,j ants, costs and expenses which PERMIT ISSUANCE eT9.60 a ` CONST.TAX
may in any ay accruevdt!'9=
aid City in consequence of the
grantingpf spermil / MECH.CONT. LIC.NO. MECH.
�1. �N 6C TOTAL/S�7• TOTAL
alar I'Applica /C ate
OFFICE COPY