18804 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
46UILDINGPROJECT-IDENTIFICATION. -APPLICATION & PERMIT PERMITNUMBER .
eD,LDI„G A
ADDRESS
rA0 BUILDING'- ELECTRICAL-PLUMBING-MECHANICAL 88L}
OWNERS PLAN CHECK VALIDATION
NAME I mo• OTY. ELECTRIC PERMIT FEE
VHONE O
CONTRACTORS _
NAME OUTLETS-SWITCHES-RECEP 10.0011.00
uc.No. LIGHTING FIXTURES 10.00/1.00 7
CONTRACTOR
AONTRAS PPLIANCES-RESIDENTIAL 4.00
1 PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT ^A y ESI PLAN CHECK FEE P.C.NO.
lI (p�� 7 PANELS (OVER 200 AMP) 20,00
R ER c.uo.0 SIGNS TRANSJJCU U 1�P�) 3.00
A LH.OR ENG. �a� �,x PERMIT VALIDATION
AODRESs `H� GL.?.(1?i4 SPECIAL CIRCUIT 5.00
.7 EMP.METER OR' OL_E INSyPrtInQ 20.00 111 �L r
APPLICANTS L..pC. ZZq •O4 MOTORS - ' SEE FEE SCH.
AP UCAS - `i!
SERVICE CHANGE 20.0001
o ¢ z
r o o LICENSED CON'IL RACI'ORS DECLARATION
¢ u u 1 hereby affirm that I am licensed under provisions of Chapter 9 / ISSUANCE DATE
tiz o leomommu g with Section 7000)of Division 3 of the Business and
¢ BLD ELECT. PLG. MECH.
I- 2 i LNor icense Gla Code,and my license is in full farce and effect. ❑ ❑ ❑
Z o - License Class Lie.Number
o z r� Dale Contractor
a m BUILDING PERMIT
¢ ¢ a
OWNERBUILDERDECLARA DON
¢ w u INFORMATION
I hereby of Orin that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION $/FT. .
FLL0< Law forth,fo0owm,masom(Sec.703IS.13usinessand Professions PERMIT ISSUANCE . 10.00 6
Code:Any City or County whichrtleires a arrant to construct,alter,
re rt¢ p improve,demolish,or repair any structure,prior to its issuance,ago ELEC.CONTR. LIC.NO. ELEC. VL VV
aO¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO.
E
Leis Iico pte pursuant to the with Sions of the Contractor's License th - '
Hai Law(ChandPr(commenCde)orSuction is exem00) pt
a Business and Professions Cale)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE �VL rd
zzo
¢ I-F the buffs for the alleged ad exemption.Any applicant
otoaclion malty STORIES T PE CONSTR.
n , by aoyecore than
lira hundred
m500).)camtoacivilpenally ALTER-DRAIN&'VENT-WATER (EA.) 5.00
of not marc than five hundred dollars 155 amp
❑ I,as owner et the willdo Property,or my employees with wages a BACK FLOW PROTECT. DEVICE 4.00 WOCC. RES.UNITS
their sole compensution,will Jo the work,and the structure is notintended or offered for sale (Sec. 7044. Husinun and ProlL•ssiom DRAINS-FLOOR,ROOF,AREA,COND. 5.00Cale:The Contractor's License Law does not apply to an owner ofprogeny who builds or improves thereon,and who Jas such work FIXTURES-PER TRAP 5.00 TOTALACREAGEhimself or through his own employees,provided tlwtxuch improve GAS-EA.SYSTEM-11NC.40UTLET58.00
�" mems are not intended or uttered for sale.F.however,the building
or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im RES IND CON PB Omer
Prove for Durk of the.d: t - . INDUSTRIAL WASTE INTER. 30.00
❑ d as owner of the properly,oro exclusively contracting with ❑ ❑' ❑ ❑ ❑
licensedssum,CodmeCcunet the project,La does,cd apply LAWN SPRINKLERS- 1 INC5 V.B. 6.00 ASSESSORS PARCEL NO.
and.cows,ns Cal¢The Contractor's License Law does not apply
co an owner of h projects
s with
co ofimproves rased n,and t to LAWN SPRINKLERS-OVER 5.IEA.) 1.00
the Co is for such projects with a cantractnd sl IittnuJ pursuant m
the Contractor's License Luw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT No. PARCEL No.
O Dara exempt under Sec, ,B.&PC.her this WATER HEATER W/VENT 8.00
reason
Owner Dale WATER SYSTEM5.00 ACC.DATE ACC.FILE NO.
W'ORKFRS'COMPEN'SA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to xf&insure' ZONING ENG.SITE NO.
Nr o certillcat,of Workers Compensation hu,nemee,or a Certifies
Copy thereof(Sec.3800,Lad,C.).
1'olicsNo. Company-
O ❑ Cenrisd copy is hereby famished. FIRE SPRINK ENERGY T 24
Z_ Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD.
Y ❑ N❑ Y ❑ N❑
F.y PERMIT ISSUANCE. 10.00 FLOODZONE A.L.U.C.
LU CIiRT1E1G\Tli OF EXEMPTION FROM WORKERS'
W need net
t be ION INSURANCE PLG.CONTR. LIC.NO, PLG. Y❑ N❑ Y❑ N❑
� Z hundred
section Sued or he complete) if the permit is Ibr one _ TOTAL
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work lorwhich thisper. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.I shall not employ an,person in any manner w as to a
O w tire
ate Appcant become subject l0 Workersmpe
'Convtiun LTwx of California. - BUILDING / lYr1Y
DliALTER OR ADD TO MECH. 5.00 ( l
} W NOTICE '1 m
'O APPLICANT. If,atter making this C,Nifice of Ex: -
Z caption,You Should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the "hot Code, you must forthwith comply with - FEE
U such pruvisions ur this permit shalt be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M,) 6.00 SEISMIC FEE r-
1 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, - ICROFILM -
3097.Civ.CY HEATING UNIT (TO 100,000 B.T.
Lende'r's Name H EATI N G U N IT(OVER 100,000 B.
Lender's Address ELECTRIC
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
a information u correct. I agree to comply with all City and county PLUMBING
ordinancesand state lows relating to building construction, and BOILER-ODW(3H.P.Or100,000B.T.U.) 6.00
hereby an l horizc repma,matives of Ran city to enter upon the BOILER-COMP (Owr 100,1X)0 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(we) agree to sure, indemnify and keep harmless the City of MISC.- REFER TO ORD.
'opertlno against liabilities,judymcnts, costs and expenas which PERMIT ISSUANCE 10,00 CONST.TAX
may y way rue a ain mid .icy iC conuyuentt of the
re linea this MECH.CONT. LIC.NO. MECH.
\ TOTAL OTAL S�
Si ature of Applicant( nl ,tor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY .OF CUPERTINO 18804
INSPECTION DIVISION
•� JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADD SS • m� _ 'UNIT LOT# Jj 7
pERM T EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
IN PECTION DATV I INSPECTOR - INSPECTIO RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ANCE OR 180 DAYS FROM.
NOTE: - LAST CALLED INSPECTION.
UFER - ALL GRADIN(i7A��11I)��DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WIT}i`I'aIfAPPROVED'PLANS AND CITY OF PERnin VALIDATION
CUPERTINO STANDARDS. +N `
GARAGE SLABS D".(v 06. 98.9
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDp
UNDERGROUND /SLAB Cit., pF rTmnlfirtP
PLUMBING - -
ELECTRICAL - - ISSUANCE DATE
MECHANICAL \BLD6 .ELECT.I PLG. VECR
/,� ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .. BUILDING PERMIT,
INFORMATION
WOOD FLOOR VALUATION SIFT,
PLUMBING
MECHANICAL _f� I c C 7
ELECTRICAL PERyn To
FRAMING _f
INSULATION - - - STORIES TYPE CONSTR.
r„occ.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID'
BUILDING usli
' ROOF SHEATHING � TIES 'IND CON PB Co.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. '11 L L L 10
ASSESSORSPARCELNO.
ROUGH SAN:#
-
PLUMBING T ELECT.ENERGY ,-Gp,. ry TRACT NO. 'PARCEL No
TUBS&SHOWER PAN• PLUMBING ENERGY
^
MECHANICAL MECH.ENERGY 4 O
ACC.DATE Acc.FILE No
ELECTRICAL BUILDING ENERGY 4
FRAMING ELECT.FINAL TEST ZONING ENG.SITE No.
INSULATION ' }' PLUMBING , r✓
". GAS TEST GAS
MECHANICAL
FIRE SPRINK ENERGY 1O4"
' — L y L
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [3 N N
EXTERIOR SHEAR <' ELECTRICAL RELEASE -4- FLOOD ZONE A.A.1-U.C.
O
•V ,
INTERIOR SHEAR � FIRE DEPT. ' Vc NL •L NL,
SHEETROCK GRADE - FEES MARY
EXTERIOR LATH BUILDING
�ry
INTERIOR LATH ` `TEMPORARYAPPROVALS BUILDING �1I7 ' .
T SCRATCH COAT• ELECTRICPLAN C K
' - GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC EE '',`-`• ,
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR' RO M
ARRANGE FOR INSPECTION BY PHONING 252-4505; G
�� ONE WORKINGOAY BEFORE REQUIRED INSPECTION.'-. UMBIN
O PLEASE GIVE'JOB ADDRESS WHEN PHONING.s.
Z M kHAN CAL
— SEE PERMIT FOR EXPIRATION DATE
CONST. AX �Ir ♦ �
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE OT L
CALLING FOR FINAL INSPECTION.
OFFICE COPY
PGST THI ' D NEAR FRONT OF BUILDING �`:n_'.
CNukIll,11
IrKF CUPERTINO }
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIHAri
JOB ADDRESS' --_ _ - _ __--UNIT 11— -_LOT 1! -_ WOP1K
OWNER comrHAc,a� IS NOT STARTED WI1'iiiN
PECTION DA INSPECTOR INSPECTIO RECORD 180 DAYS OF PERMIT SSU
FOUNDATION ANCE OR 180 DAYS F11f)M
NOTE: LAST CALLED INSPECI,(:^I.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AlND CITY OF ��i 1p"'i
GARAGE SLABS 'UPERTINO STANDARDS. !� 1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED v AUI
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
MECHANICAL ✓j G�L�. s'sUnmu i.-.i, _
�.3. 77 /�,II,
SII CM&OLec, 1LY\ Q-( (t',,k,- ckc r-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEO wr n.aaLo-' �;� r.,- _ E—1 -
m� INFORMATION
WOOD FLOOR �`-' r1WO�,J> ✓1 1 hf Cis^(i-1U�
PLUMBING ;•a,.UAnnN
MECHANICAL
ELECTRICAL 1.1 HIM I I,I ----
FRAMING
INSULATION --- ,i•.i,n , ,,, ,,,, --
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
--
H NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING — wnurm.<,,,:.i �-
M!, mu .I'll ,•li
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEQ I FINALS DATE INSP. ❑ ❑ ❑
ROUGHSAN.II ncsi�5v uu raui.ii u.,
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY '� NO VAH(I'-"
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY '"'` UArf ACC 'it.
f
FRAMING ELECT,FINAL TEST
INSULATION PLUMBING U C�, 'fN1Np I:Nr. sill
GAS TEST GAS
MECHANICAL _ ._[ rw! sHr rt,n [mi.iat� a— j
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ ':._1
EXTERIOR SHEAR _ ELECTRICAL RELEASE _Gj "-"-
INTERIOR SHEAR FIRE DEPT. ..i�Q ` ❑ N❑ ❑
SHEET'ROCK _-
EXTERIOR LATHGRADE - "'--
Z - ( BUILDING FEES MARY -
INTERIOR LATH "' U
TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN 'K
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
CRO -M
ARRANGE FOR INSPECTION BY PHONING 252-4505,
F- ONE WORKING DAY BEFORE. REQUIRED INSPECTION. —
PLEASE GIVE JOB ADDRESS WHEN PHONING. uM81 c
_ Z xl
— SEE PERMIT FOR EXPIRATION DATE — KrI M CHA ICAL
CONST. AX
IR
TOT --
c;:. Fitt nvr:P: L: t UN. TOT L