17159 . ' POST THIS CARD NEAR'FRONTOF'BUILDING ;
PERMIT NUMBER
. CITY :OF CUPERTINO All 59
INSPECT{ ,I'ON:D'I V ISI ON:.
" T4.
P • •I N RECORD.
:'JOB INS E T O -
•PERMIPIRA
T EXPIRATION
JOB ADDR ESS
'* 2 u � 'NI Y .0
' �� UT# LO% T# �)
RM1T..EXPIRES IF WORK t
owriEA' - �' VW t, coNTraacroa; FS NOT STARTED WITHIN.
INSPECTION DATE INSPECTOR - INSPECTION RECORD 180'DAYS DF PERMIT.ISSU-.
• FOUNDATION ' t< ''I "�. - - ANCE OR 180 DAYS FROM
.NOTE:- • + LASTCALLED INSPECTION.
UFER ' . . NOTE'
AND DRAINAGE•SHALL BE INSTALLED
T, Ta TO COMPLY WITH THE APPROVED PLANS AND CITY-OF , PERMIT VALIDATION
PR EGUNITE r ' CUPERTINOSTANDARDS.
GARAGE SLABSr + - , ' , ',L � •J f
POUR NO CONCRETE UNTIL'ABOVE HAS BEEN SIGNED , ,
7-
UNDERGROUND /SLAB.'
PLUMBING -
_" ELECTRICAL - - ISSUANCE OAT
MECHANICAL BUTG. ELECT, PEG. MECH:,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
' .INFORMATION
"WOOD FLOOR' 'r - vALuanoN siFT.
PLUMBING
MECHANICAL P t• - < Y✓�
PERMIT i0
' ' - ELECTRICAL
FRAMING
-'
INSULATION .STUHIES TYPE CONSTH.
' � '- ' ' � '. * '
: OCCGROUP RES UNITS
• PLACE NO SUBFLOOWUNTIL ABOVE HAS BEEN SIGNED
i E SO FT.R�a'EA OF nCV Ea GE
` '•
ROOF , ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' '�qq,�,,
DIAPHRAGM THE CONSTRUCTION TAX IS PAID. 1001
�I [] C O use
ROOF SHEATHING" � 1 .. 'HSS INRDCON PB 011,ri
APPLY NO ROOFING.UNTIL ABOVE HAS BEEN-SIGNED FINALS' "' <DATE INSP, El 11 El ED ❑
ROUGH. . ' SAN.#:,. "
ASSE550R5 PARCEL NO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN : �� � _ - PLUMBING ENERGY . T.TACTNO. PARCEL NO
_
.-' MECHANICAL . - .MECH.ENERGY
ELECTRICAL _ BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING ELECT.FINAL TEST'
ZONING ENG.SITE NO,
r' INSULATION PLUMBING
GAS TEST. ' T• GAS
MEC HANIDAL'Y' FIRE SPRINK - ENERGY LO<
c COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ' _ +, El' N - - . ❑ N❑
EXTERIOR SHEAR ' - ELECTRICALS RELEASE FE000 zorvE A.L U,C.
• .Y❑ N❑
'��1pITERIOR'SHEAR - � '; FIRE DEFT,' Y L7 NF]
-
'SHEETROCKf .i GRADE . FEE SUMMARY -
EXTERIOR.LATH 'W" BUILDING' '
,INTERIOR LATH' ,� .TEMPORARY,AP,PRO,VALS - euILDING, 49 i
SCRATCH COAT ELECTRIC'.' PLAN-CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. - SEISMIC FEE • }r_.
OCCUPANCY OF BUI LDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM '
"ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'
I� o� ONE WORKING'DAY BEFORE REQUIRED INSPECTION PLUMBING .
Z PLEASE GIVE.JOB''ADDRESS WHEN PHONING
SEE-PERMIT, FOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CAL'L'ING FOR,FINAL;INSPECTIONIIF
\ TOTAL -
i� ;: OFFICE COPY '
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
BUI LDI NO PROJECT I DENTI FICATION - '" ',PERMIT NUMBER
BUILDING /�Q APPLICATION & PERMIT , e 17159I.
ADDRESS�) &2 C,1� ROE Yfl�
(�. UI/�V"N BU I LD.ING-ELECTRICAL-PLUMBING-MECHANICAL u` ie:
0 NER'S - , PLAN CHECK VALIDATION
NAME'
rQTV...SN /, 7
ELECTRIC PERMIT FEE ,
/PHONE
CONTRACTORS •- ,
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 -LO 1 2
uc.No, LIGHTING FIXTURES 10.00/1.00 f 1 J
• dooeess TORS „ APPLIANCES-RESIDENTIAL 4.00
- PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEEP.C.NO. .
DR. PANELS (OVER 200 AMP) 20.00 ..
ENGINEER , -
LIC.Nor - - 'SIGNS TRANS. 3.00
ARCH.OR ENG. "f-PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION
w r
¢o a_ I hereby Bolan that l 000)of under nprovisionsthe of Chapter 9 ISSUANCE DATE ..
w' (commencing with Section my l ena,i or Division 3 a]the Business and
¢ n .BLOC: ELECT. ,PLG. MECH.
H m p Pmfese Cla COAu,:md my license is in full force and efl'eH.
z o H w License Class Con Number
L �wo Dalc - Contractor ` -
¢ m s 'BUILDING PERMIT
¢ O u o OWNER-OUILI]ERDIiCLARATION " INFORMATION
-w I hereby affirm that 1 am exempt]real the Coluore nr's License MISC.- REFER TO ORD
3 a'� VALUATION $/FT. "
HALL0a Law fomite billowing reason.(Sec,7031,5.Buainessind Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter, D O
¢ ¢¢0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIG N0. ELEC.
a w0 u requires the applicant for such permit In file a signed statement Batt TOTAL PERMIT TO,
m m he Is licensed pursuant to the provisions of the Contractor's License
Love(Chapter!)Leo mmencingwilh Section 7000).[Division 3 of the
4 o Business and professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE h.
¢ i-m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
bf not more than five hundred dollms(5500).) _
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sale compensation,psation,will do the work,and the structure is not OCG GROUP 'RES.UNITS
intended or offered for sale (Sur. 7044, Ousiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contmmor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOG AREA TOTAL ACREAGE
himself or through his ownemred fors,provided, ,ho ever,the
improve- GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 ,
meals are not intended oroffered
on for sola If,mplev.q the building OQ.-�
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will Imve the burden of proving that lie did not build or int- .RES IND CON. PB ONer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
*used
as owner of the property,am exclusively contracting with .1-1 ,0 - El 0'
it
rased contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PAR CEL
.NO.:
rad Professions Cade:The Contractor's License Luw tinea nal apply _
t.an owner ol-property who builds or improves thereon.uad who LAWN SPRINKLERS-OVER 5(EA.) 1.00 - -
contracts for such projects with a conlractorts)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. " PARCEL NO.
O lam exempt undei Sec. ,tl.&I'.C.for this WATER HEATER W/VENT 6.00
"j T"soil
Owner Date - WATER SYSTEM 5.00
ACC.DATE ACC.FILE No.
W'ORKIi RS'COA1I'1 NSAT N DEC LARAT ON WATER TREATING EQUIP. 5.00
I hereby.(firm that 1 have a certificate of consent to sell-insure, ,) ZONING ^
or a...ificate of Workers Compensation Insurance.or a certifier) ENG.SITE NO.
--' copy.thermlf lScc.3800,Lah.C.l. Qt1
r Policy No. Company
0 ❑ Certified copy is hereby furnished. I 'Jv FIRE SPRINK ENERGY T 24
z z ❑ Certified copy is filed with the city inspection division.
Q Applicant MISC.- REFE RD.
Y N V N�
' Y WF TPERMIT ISSUANCE Ols'_
', C, R'1'IPILCOMI'ATF GNSATON INSURANCE ORKIik- PLG.CONTR. LIC.NO. P V. -,P FL000 ZONE A.L.U,C.
ELI Z
IThis section need not be completed if the permit is'for one TOTAL Y O N� Y 0 Ni[]
hwNrcd dollars(5100)or Ices,)
00 1 certify that in the performance of the work fur which this per- QTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL"F Init is issued, 1 shall no[employ anY person in unY m:mner so as to
0 W ^ hccomesuhjlet lo lhe,Wnrkers'Compuiiealion Law,of Caliku ia.
v C. Dam Applicant - ALTER OR ADD TO MECH. 500 BUILDING
} m NOTICE'1'0 APPLICANT: If,after making this Certificate of E . .
x-
F Z creption,you should become subject to the Workers'Compensation - APPLIANCE 5.00 PLAN CHECK
provisions of the Labor COLIC, you must forthwith comply with FEE
U' such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 QF.M) 4.00 ' '-
CONS'I'NUC'I'IONLIiNDINC.AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 ' SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec.' "'MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 5.00
Larder's Nome HEATI NG UNIT 100,000 B.T.U.)9.50
Lauicr's`Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to compty.with all city and county ',PLUMBING
ordinances and state laws related to building construction, and BOILER-OOMP(3 H.P.Or 100,000 B.T.U.) 6.00
above- authnrieu representatives ec Ibis city.to enter upon the BOILER+COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL '
hereby
above-mentioned properly forinsp of th i purposes.' '
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any wayaccrue against aid"City in consequence of the
ranting oCfhis cnniL - MECH.CONT. LIC.NO. 'MECH.
TOTAL . TOTAL
Signature of A&cant ntr Date 't•' '
OFFICE'COPY
" " by �..• Y f
I I ),•. OF DATECITY
_
CUPERTINO f r-'-,0l�1
TRANSMITTAL SLIP
TO
- ��claN��ic ,. i •
FROM
ill l lb�
' i I I-U�1� ISI �T� ��✓I�� II{ a ,
L� )
TAI &))Hq- IYU -
1= • t1. 71
COMMENTS
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