18052 r
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Gj I LDING PROJECT IDENTIFICATION .PERMIT NUMBER ,
BUILDING APPLICATION & PERMIT
/,DURESS (� r 18052
• oZ S�v�n EJ s �/; B
UILDING-ELECTRICAL-PLUMBING-MECHANICAL ;o-.
O�W�yNN..ER'S PLAN CHECK VALIDATION
N` 0 ^ '� PH0 ELECTRIC PERMIT FEE
t`� CONTRACTORS E•v ' N€T'�/',-.e,/ ' UTLETS-SWITCHES-RECEP 10.00/1.00
4wA.9 LC.No. `/� LI TING FIXTURES 10.00/1.00
CONTRACTORSAOORPSS PPL NCES-RESIDENTIAL 4.00
�,TJ E /.�/��`1 �Ia PANELS 10.00 DATE OF APPLICATION
1 ARCHITECT PANELS (O ER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
E� sac.NO. SIGNS TRAN 3.00
An 08" l AOORESS ENG. SPECIAL CIRCU '5.00 PERMIT VALIDATION
ZIP EMP.METER OR LE INS. 20.00
,DDRESS ^ �/1� MOTORS SEE FEE SCH. Z�,,
AOOREa_ -Q..� (* as �(OI' 11.�L1/Ll)�')
f�-[•��C ( SERVICE CH NGE 20.00
Foo LICENSED CONTRACTORS DECLARATION _
4c,u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w (commencing with Section 7000)of Division 3 of the Business andJUL ,
_BLDG. ELECT. PLG. MECH.
i. 1'rn4ssions Cod• nd I license is in full 0aev
z o u, ca License Class Lic.Number _
LD m- � IJum-1/p/7/ p_Cnnlrucmr_ Aj/s� .
a Y BUILDING PERMIT
¢ a OW' 'li R-tl UILDIiR DECLARATION
a o d u INFORMATION
w ; w I hereby affirm that I am exempt from the Contractor's License MISC.- .REFER TO O
H r. o ¢ Low for the fallowing mrsoo.(Sce.7031.5,BusiFessend P,.ficsuons PERMIT ISSUANCE 10.04vgLugnoN S/FT.
Code:Any city or county which requires a permit to construct.alter.
al¢ improve,demolish,or repair any structure,prior to its nwante,also ELEC.CONTR. LIC.NO. ELEC.
ca O , retpums the applicant for such penult to rile a Signed Statement that TOTAL PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License _
r ¢
Law(Chapter 9(cummendng with Seetiou 70W)of Division 3 oflhe 1�L'G{�Aly lel
ALS
i
44
0 Business and Professions Code)or that he is exempt therefrom and .PLUMBING PERMIT FEE
¢ r the basis for the alleged exemptinn.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty LTER-DRAIN&VENT-WATER IEA.) 5.00
of not more than live hundred dollars($500).)
❑ 1,as owner of the property,or my employces with wages as g K FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is nm OCC.GROUP RES.UNITS
intended or offered for sale (Sec 7044. tlmimss and Professions DRA S-FLOOR,ROOF,AREA,CON D. 5.00
Cale:'rhe Contractor's License Law dols not apply to an owner of
property who builds or improves therean,and who does such work FIXTU S-PER TRAP 5.00 SO.ET FLOOR AREA TOTAL ACREAGE
matshimself re through his own employees.provided that such improve"
monis are throughot his or offered employees,
or provided that such
building GAS-EA. STEM-11NC.40UTLETS 6.00
or improvement is sold within mw year of completion,the owner- GAS-EA.SV EM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or ire- BUILDING USE
prove for purpose ofsale.). INDUSTRIAL W STE INTER. 30.00 REs IND CON PB Caner
❑ 1,as owner of the property,am exclusively contracting with Q Q El El
licensed contractors to cons@ic1 the project(Seo. 7044, Business LAWN SPRINKLE -1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Prof scions Code:The Contractor's Licenx Low does nor apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS VER 5(EA.) 1.00
nntracls for such projects with a ContructOms)licensed pursuant Ni SEWER-SANITARY-ST MEA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
O I um uumpl under Sec. tl.&I'.C.far Ihls WATER HEATER W/V EN N6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORK ERS'COMPENSA'rION DECLARATION WATER TREATING EQUIP. 5.00
I hereby attimi that I have a certificate of consent to self-ins1u1m,
or a certificate of Workers'Compensation lnsura ZONING ENG.SITE NO.
Co py thevgi��y�TSO n.c.)n,'�a
Policy NeV.&V_;Z 'Jmpany�Y��vs
O ❑ Certified copy is hereby forms d. FIRE SPRINK ENERGY T-24
Z 2 Certified Eppy iT fled with the city inslxetion division. MISC.- REFER TO OR EI EI [:] EI
O Ap cant_ (L� v N Y - N
Q N
CERTIFICATE OP(EXEMPTION FROM WORKERS' PERMIT ISSUANCE _ 10.00 FLOOD ZONE A.L.0 c.
LU > COMPENSATION INSURANCE PLG.CONTR. LC.NO. PLG,
CLZ (This section need not be Completed if the penal is for one TOTAL V NE] Y NE]
U O hundred dollars(S100)or lest
I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
mit is issued, I shall not employ any Person in any manner m as to
become subject to the H'orkers'Compensation Laws of California.
a Datc ApplicantBUILDING '
} to NOTICE TO APPLICANT. 11,after making this Certificme of Ex- ALTER OR ADD TO MECH. 5.00
F ? emption,you should became subject to the Workers Compensation APPLIANCE - 5.00 PLAN CHECK
provisions cif the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10f.100C.FM) 4.00
CONSTRUCr1ON LENDING AGENCY AIR HANDLING UNIT(OVER IQOWQEM.) 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 as swed(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address I ELECTRIC
I certify that I have read this ata kation and slate that the ulwve VENTILATION FAN (SINGLE) 4.00
information n wlate 1 , relating
comply with all city and county PLUMBING
information
and state Liths relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.)bsGQ
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL �•
hereby
above-mentioned Rh.,i, property for vesico t ion purpuws.
(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 way accrue against said City in��quent-e of the
nl�8Q�I�bis permit. / MEC..CUNT. LIC.NO. MECH.
_CI`� y S APAS 4555, 6 TOTAL / � TOTAL
'g)tetlrn/of Applicant/Contractor Date
OFFICE COPY
} POST THIS CARD NEAR FRONT OFBUILDING
- PERMIT NUMBER
. . CITY OF CUPERTINO
INSPECTION DIVISION 8U52
JO INSPECT ON RECORD
%ll�Oo� Ic�! �p�i,� GY�re
PERMIT EXPIRATION
JOB ADDRESS UNIT}* LOT#
r /I nak I ' , 1 ' PERMIT EXPIRES IF WORK
owNER .' !tel nl TRACTOR �/1"N`�i 'I LW. il,.'ml IS NOT STARTED WITHIN
' INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE CUPERTINO STANDARDS. ,
GARAGE SLABS
- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TAr�vn�u,/l✓M
UNDERGROUND /SLAB y
PLUMBING /A�I`� I' -
ELECTRICAL -ISSUANCE DATE
MECHANICAL - _ BLDG I ELECT. PLc MECH.-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING PERMIT
INFORMATION
WOOD FLOOR: VALUATION SIFT.
PLUMBING - JUI q ee . . - _ ._ .,
MECHANICAL - ` 03 1989
PERMIT TO
ELECTRICAL' - M
FRAMING- ,Y
• STORIES TYPE CONSTR
INSULATION'-
OCC.GROUP RES:UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,FT.FLOOR AREA TOTFL ACREAGE
ROOF _ NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HEs NO CCN PB om•.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. �
ASSESSORS PARCEL NO.
ROUGH SAN,4
PLUMBING - ELECT.ENERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACC.FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST .20NING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY L2<
MECHANICAL • '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '' ❑ N❑ . ❑ NE]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,L UC.
INTERIOR SHEAR FIRE DEPT, Y NEI YI] N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING -
INTERIOR LATH - TEMPORARY APPROVALS FELECTRIC
SCRATCH COAT ELECTRIC
r
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL . OD
IMPORTANT! CONST.TAX .
PLEASE READ REVERSE-SIDE BEFORE /!d9
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY '
CITY OF CUPERTINO i
50300 Torre'Avenue Telephone 252-4505
INSPECTION NOTICE
(l .\ BUILDING DIVISION (] -
JOB 1J- Uf u DAT
ADDRESS v 1 TIME N n
DAILY REPORT ❑ CORRECTION NOTICE VIOLATION❑
TYPE INSP.: BLDG.-g� . ELEC. ❑ PLBG.❑ MECH. ❑
(' A
KAF
-74
y
1 r\
WEATHER a A INSP. \��