16274 -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES --USE BALL POINT PEN ONLY
"
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
RLOINc . C - APPLICATION & PERMIT, r�
ADUIUREu I
O� V ING - ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
AMONE Milt U
CONTRACTORSTUTLETS-SWITCHES-RECEP '10.OD/1.00 ( / t
�Q IC N,6 PO LIGHTING FIXTURES 10.00/1.00
CONTRACT 15 PPLIANCES-RESIDENTIAL 4.00 "
ADDRESS '1 ✓ a/9/9
�� vHONE PANELS 10.00 DATE OF APPLICATION --
aeuIIECT P
ENs.- ANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
' GINEER- /� � -
' LIC.NO, (.J SIGNS TRANS. 3.00
AARCIA.OR
ODRESS ENG. f SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
APPLICANTS
MOTORS SEE FEE SCH.
ADDRESS
Q SERVICE CHANGE 20.00
'09 LICENSED CONTRACTORS DECLARATION
c 1 hereby uUwn that I um licYnwd under prtwidiuns of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Basin ss and LOG. ELECT. PLC. MECH.
FD i Professions Code,and my license is in full force and effect JAN 2, Q 19
. ❑ ❑ ❑
z o - License Class Lie Number'
o r Date Contractor
Y -.y BUILDING PERMIT
a a OWNER-BUILDER DECLARATION CII GADO
F a a,v INFORMATION
w LL H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
ygLUALaer the following Tason.(Sec7035,BusinssandProfsons T0N
o a PE10.00
Code:Any city or county which requires a plmmit to construct,are /DI
Qa,a impuwc,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
ar is ic requires Snml
fes the applicant for ch pelt 10 file a signed U.1conCnt that TOTAL PERMIT TO
w� he is licensed pursuant to the provisions of lite Contractor's Licen ,
aii Law(Chapter 9(commencing with Section 7000)of Division 3 of the
a BlssinLss and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE X170/19
t$ the basis for the alleged exemption.Any victor ion ofSection 7031.5 - STORIES TYPE CONST)
byany applicmd fora pcnnit subjects the applicmv tnucivil pcnrty ALTER-DRAIN&VENT-WATER (EA.) .5.00
of not more than five hundred dollars(5500).1
❑ 1,es owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole cmnpeasatica,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon.and who dors such work FIXTURES-PER TRAP 5.00 So.FT,FLOOR AREA TOTAL ACREAGE
himself or through de own employees,provided that such improve-
menfsarenofimhhis or offered for employees.
provided
thathowever,uthe mpro ng GAS-EA.SYSTEM-11NC.40UTLETS 6.00
of improvement is cold 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-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property.am exclusively contracting with ❑- ❑ ❑ ❑ ❑
iMlice wd contractors to construct the project (Svc 7044,Baoinvxs LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCELNO.
and Professions Code:1'h Conlractoh License lawdocshof apply
Qto an owner of property who builds or improves thereon.and who LAWN SPR IN KLERS-OV ER5(EA.) 1.00
Qcontracts for such projects with a cornractods)licensed pursuant to
Q tit Contractors License Law. SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
Es ❑ I.umcxsmptundc,Scc. B.&P.C.for this - WATER HEATER W/VENT 6.00
reason
q, o"'ncr _ Date WATER SYSTEM 5.00 ACC.DATE nee.FILE No.
WORKERS'COMPENSA'IION DECIARA'I'ION WATER'TREATING EQUIP. 5.00
I hereby affirm that 1 have a cer ific,Ue of consent fu self-insure. -
or a certificate of Workers'Comperisation Insurance,or a certified ZONING ENG.SITE NO.
- copy thereof(Sec. Company
Policy No 00,Lany_r-m
❑ Centrist]copy is hereby.fumished. " FIRESPRINK ENERGYT24
Z 2 lC Certified copy is Filed with the city inspection division.. MISC- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.II.C.
10 COMPENSATION INSURANCE PLO.CONTR. LIC.NO. TOTAL. r❑ NE] Y❑ ry❑
a a hundrred dollar,(S 100)m IcvS)('flits scciiun need not be c mpleted if the �nnd is for one _
U O 1 certify that in the performance of the work for which the per- CITYMECHANICAL PERMIT FEE FEE SUMMARY
LL F mit u issued,I shall not employ any person in any manner so as to
O L) (ecome subject to the Worker Compensation lawsof California BUILDING p
a
Date Applicant ALTER OR ADD TO MECH. 5.00 -
} m NOTICE TO APPLICANT: If,after making this Certificate of Ia-
�•? erupion,you should become subject to the Worked Compensriun APPLIANCE _ - 5.00 PLAN CHECK'I
provisions of the Lather Code, you must forthwith comply with -�
such provisions or this permit shall be demned revoked. AIR HANDLING UNIT(TO.10=C.F.ML) - 4,00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IOX0C.F.M,) 6.00 SEISMIC FEE SSti�-
I hereby affirm that there is a conMnsation lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -------
the
cr3097, f Cane of the work tie which this permit is issued(Sec - HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Na
Under',Address
me HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify Ihat I have read this implication and State that the uhove VENTILATION FAN (SINGLE) .4.00 -
information 9 correct.1 agree to comply with all city anJ county PLUMBING ,
ordinances and state laws relating to building constm 'to" and BOILER-OCIfvP(3H.P.or100,000B.T.U.) 6.00
hereby aufhnrize repfeacntativm of this city to enter upon the BAILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpo"
(We) egress, to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
0ring of this permit. H.CONT. , LIC.NO. - MECH. t/
TOTAL TOTAL 7� 6
Signature of Applicant/Contractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF'E UILDINGPr.nmIr NUMBER,
CITY OF CUPERTINO 16274
'INSPECTION DIVISION �l ( uVvI(
'JOB INSPECTION,RECORD a
7lPVEf�MIYEXPIRATION �.
JOB ADDRESS ` Q� CYI'l U #
NITII LOT.# PERMIT EXPIRES IF'WORK .
' OWNER `'� ' KC4 ,CONTRACTORPCOad IS NOT STARTED WITHIN
INS TION 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
PREGUNITE TO COMPLY.WITH THE APPROVED PLANS AND CITY OF PERMIT VALIOATTCN
CUPERTNO 5 ANDARDS.
GARAGE SLABS - : Iff
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' .1p.,,�„ "•� G .`
:.UNDERGROUND /SLAB. 1 OK ?-"� W' a•
PLUMBING
ELECTRICAL yb — ' i7 IssuANc O'XfE�^'�'L-
MECHANICAL - �NLDc ELECT. .PLG. mECH,
J ❑ ❑42 116
❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDe. i , BUILDING PERMIT
INFORMATION
WOOD FLOOR - - VALVAI ION SBFT. -
PLUMBING
MECHANICAL
ELECTRICAL - PERMIT TO
FRAMING
STUHIES TYPE CONSTH--
INSULATION -
OCC GROUP .RES.UNITS
PLACE NO SUBFLOOR�UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSR SHALL BE MADE BEFORE so..T aaaH An Ep TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
„ ROOF SHEATHING RESIND CON PB Orn.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE' INSP. ❑ '❑ ❑ El ' Q
ASSESSORS PARCEL NO,
ROUGH SAN.N Scj. ,
PLUMBING - ELECT.ENERGY -
TRACINO. PARCEL NO
TUBS&SHOWER PAN;. PLUMBING ENERGY
MECHANICALMECH.ENERGY
ELECTRICALACC.OATE ACC.FILE NO
BUILDING ENERGY _
FRAMING ELECT.FINAL TEST
INSULATION
ZONING ENG.SITE NO.
PLUMBING
GAS TEST GAS
4IRE SPq INK ENERGY T.24
MECHANICAL '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ IN[] "�
FLOOD ZONE A.L U C.
EXTERIOR SHEAR ELECTRICAL'RELEASE I '
INTERIOR SHEAR FIRE DEPT: v❑ ND v �- N❑
SHEETROCK GRADE - 'FEE SUMMARY
EXTERIOR LATH BUILDING —Z i
.INTERIOR LATH TEMPORARY APPROVAL BUILDING lip
SCRATCH COAT ELECTRIC PLAN CHECK
• GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
s
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, '" ELECTRIC _
F_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING —
/ Z PLEASE GIVE JOB ADDRESS WHEN PHONING,
SEE PERFOR EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX.
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
•OFFICE COPY
No. 783
(bra f iratr- of orrupaury
THH of Tuirrrtino
111plittrimput of Atitding 3nopution
This certificate issued pursuant to the requirements of Section 307 of the
Uniform Building Code certiing that at the time of issuance this structure Mu
in compliance with the various ordinances of the city regulating building
construction or use. For the following:
.Atrium
Use Classification Interior Remodel (Break Room Only) Bldg permit No 16274
Group 3N Type Construction A 2.1 Use Zone_Planned Development
OwnerofBuilding Apple Address 20705 Valley Green Drive
Building Address_ 20705 Valley Green Drive Locality Cupertino, CA 95014
By: Joe Antonucci
Date: 3/23/89
Buil mg Official
POST IN A CONSPICUOUS ►LAC[
row..0 .,