10881 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUI LDI NO PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 10881
ADDRESUv Z i LUp'� o C
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S QO PLAN CHECK VALIDATION
NAME o QTY. ELECTRIC PERMIT FEE
i!S PHONE q6-YY,"?
CON RACTOR'S
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
_e5�Gl/YyJ Z ..I r , e LIC.No YY ZZ)
LIGHTING FIXTURES 10.00/1.00
CONTRACTORS -RESIDENTIAL 4.00
ADDg S T - /y�1/`
LL�I y/ / lV a PHONE C/�� (J/ '/J PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 -PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00 PAID
APPLICANT MOTORS SEE FEE SCH.
ADDRESS�� Jy
f/Gliv) Z -�Pi(jI')7i/e SERVICE CHANGE 20.00 g
Gw S o LICENSED CONTRACTORS DECLARATION gg.�{pp��
a u U I hereby affirm that I am licensed under provisions of Chapter 9 �f CUpY99UG1 CE DATE
Q u (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT, PLG. MECH.
r w Z Professions Code,and my license is in full force and e�hey. ❑ ❑ ❑ ❑
o z m W License ass $_ Lie.Number
Date -y Contractor
x f BUILDING PERMIT
Be < OWNER-BUILDER DECLARATION INFORMATION
X 3 LL y 1 hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD VALUATION $/FT.
F u m j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
er0 Code:Any city orcounty Which requires a permit to construct,alter, J
2 rt Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �-
i -O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
wm he is licensed pursuant to the provisions of the Contractor's License
rii
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER.
CITY OF CUPERTINO 10881
INSPECTION DIVISION
JOB INSPECTION RECORD
((////������//''��,,�� � yy��,, ', �I///,+���7,/�j'� PERMIT EXPIRATION
JOB ADDRESS" I:.�'t� 71� ' N�ofiG�UNIT# LOT#
,/' . PERMIT EXPIRES IF WORK
OWNER CONTRACTOR �j 1, IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
- ISSUANCE DATE
MECHANICAL BLDG. ELECT I PILO. .MECH,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING e p
MECHANICAL 54)6
ELECTRICAL PERMM TT T
FRAMING ( It%
INSULATION STORIES Tv E O T
TR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SQ FL fIOOR AREA TOTAL ACREAGE
ROOF
DIAPHRAGM
aUILDING USE
RES IND CON PB 00...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑
ROUGH
ASSESSORS PARCE L NO.
,
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL11 1
- ACC.DATE ACC.FILE N0.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN #
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGYT-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ "❑
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.0 C.
LATH—EXTERIOR FIRE DEPT. v.❑ "❑' y ❑ "❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE J
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC
'• O
LU 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 "1
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY