17604 (2) f
PLICANT `f0 FILL,IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION &PERMIT 17604
ADDRESS r
922 f�� r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL m
OWNER PLAN CHECK VALIDATION
NAME e •QTY. ELECTRIC PERMIT FEE
'�A cal L.F.'R PRONE
CONTNAME�RACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
'PIb LIC.NO. L/7"/41 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRESS CIdG S.T PPLIANCES-RESIDENTIAL 4.00
PHONE 1'17 L 01 Jo PANELS 10.00 DATE OF APPLICATION
ORCNnEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .C.NO.
OR
ENGINEER
LID.No. ISIGNS TRANS. 3.00
ADORE6 EUG. SPECIAL CIRCUIT 5.00 - PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00AWN
` 1
ADDRESS 1�,
1PPLICANT$ MOTORS SEE FEE SCH. �- n Nw^�1
q
SERVICE CHANGE 20.00 4112. 18�
o o LICENSED CONTRACTORS DIiCI-ARATION, -
A o U I hereby affirm that I am licenud under provisions of Chapter 9 ISSUANCE DATE
h< w (commencing with Section 70001 Of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
of z Professions Cole n license is in full,fore a�c/r-7 I ❑
z 0 so o License Class_ Lic.Number 6 7 APR l , � E IWVI
Dmc Contractor__
a u 5 BUILDING PERMIT
¢ ¢ a OWNER-1I UI LDIiR DECLARATION
¢ w u INFORMATION
wa N I hereby affirm that I am exempt lion the COntraclor's License MISC.- REFER
O< Law forthe followingreason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1000 VALUATION
Cale:Any city orcounly which rrquiresa permit to construct,alter, -
aaa<O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
La
aI O M requires the applicant for such permit to file a signed statement that TOTAL PERI�qMT TO
w 9 - he is licensed pursuant to the provisions of the Contractor's License PE IM 1
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the lV-+
a Business and Professions Code)or that he is uaempt thtnefrom and OTY. PLUMBING PERMIT FEE
¢ 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s ; by anyapplicantto,is permit subjects the applicunl to a civil penally ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
Their S le compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions Z DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 AM
Code:'fhr Contractor's License Law does not apply to an owner Of
property who builds or improves thereon,and who dos,such work FIXTURES-PER TRAP 5.00 AREA TOTAL ACREAGE
himul arethrough de ownemployees.for
sale.IF.huwcsuch improve GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
menta are not it is sold or thin on for sale.IL however,the building
or der will have
is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
holder will have the burden of proving that he did not buil)or im- BUILDING USE
prove for purpose ofsale.)' INDUSTRIAL WASTE INTER. 30.00 RES. IND CON PB osber
❑ 1,as owner of the property,am exclo,ively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professiuro Code:'1'lie Contractor's License Ww docs not apply
to an owner of properly who builds or improves thro,n,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a cOnllactor(s)licensed pursuant t0 SEWER-SAN EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I um exempt under Scc. ,B.&P.C.I'or thi y _
mason ) WATER HEATER W/VENT 6.00 Li
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORT:ERS'COMPENSA'rION DECLARATION WATER TREATING EQUIP. 5.00
1 hetcby alfirrn that I have a certificate of consent to 01-insurc, -
or a certificate of Workers'Compensation Insurance,or a arlilied ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). iroO✓r C
A /
P o.
Company-
0
ome ny-_ "s
❑ �ynifed 'opY is hereby ft nishd, FIRE SPRINK ENERGY T-24
ZO AI�'(;c,tilieJ L is-file kith he- city imlrection divixion. MISC.- REFER TO ORD. Y N v N
CC w CER'TIIICATI'OP EXEMPTION IsROM WORKERS• PERMIT ISSUANCE 7P.'BS TEC I F NE A.L.U.D.
tL > C0.1 ENSA1'ION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL Z, 1 (This section need not be completed if the permit is for one 17-. P[G `/G TOTAL N❑ Y ❑ N
P 1 hundred du l lars(S 100)o r less.)
U O O I certify that in the performance Of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H brit is issued, I shall not ebgiloy any person in any manner st as to
O w become oldnict m the WOrkcri Cmnpcnmtion Laws of Calitornin
Date Applicant BUILDING
a (, ALTER OR ADD TO MECH. 5.00
} m emption.TO APPLIshould Cern If,after making this Certificate of Ex-
2pr1 rmpUon,you the Labor
to the workers'Ccomply with
APPLIANCE 5.00 PLAN CHECK
-0 provisions of the Labor nit shall
you most forthwith comply with FEE
U O such provisions or this permit shall b<deemed revoked. AIR HANDLING UNIT(TO 10,OODGF.M) 4.00
10 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER I0)000O.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
01 3097,Civic.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
V Lender's Name HEATING UN IT 100,00-0 B.T.U.)9.50
3 hander's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 Qd
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OOMIP(3 H.P.or 100,000 B.T.U.) 6.00
by authorize representatives of this city to enter upon the BOILER-COMP (Over 100,WOBTU)SEE FEESCH.
ZMECHANICAL
e;mentioned property for inspection purrVoI
(We) ego, to save, indemnify and keep hamless the City of MISC.- REFER TO ORD.
upsnino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way aceto, against said City in consequence of the PERMIT ISSUANCE 10.00
Inun tip f this permit MECH.CONT. - LIQ NO. MECH.
t)/_/z�q TOTAL TOTAL
tgnaturc all A plican C ntractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF, BUILDING ,
PER mITNUMBER
CITY OF CUPERTINO
" INSPECTION DIVISION ��04
j / I JOB INSPECTION RECORD .
\� _( '^ �OK r PERMIT EXPIRATION
JOB ADDRESS
UNIT# LOT PERMIT EXPIRES IF WORK
1 OWNER 'CONTRACTOR IS NOT.STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
LIFER ALL.GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - ISSUANCE DAZE
MECHANICALAPR RLuc ELEcr. PLG. mECH.2 b ❑ ' o El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - city BUILDING
PERMIT
N FO
WOOD FLOOR VALUATION y, siFr.
PLUMBING'
MECHANICAL - T �.l
• ELECTRICAL - Pevmn ro
FRAMING
INSULATION - — 6 O.0 _ y_�y STORIES TYPE CONSTR:
OCCEGHOUP `RESS.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4—yci i
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.F�eIEooR AREA TOTAL ACREAGE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING ,' - RES IN cory PR o.n- '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS - - DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY -
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY I _
MECHANICAL MECH.ENERGY
ELECTRICAL . - - ACC,DnrE ACE.FILE No
BUILDING ENERGY
.FRAMING ELECT.FINAL TEST
ZONING , ENG.SITE NO.
INSULATION. PLUMBING _
GAS TEST GAS
FIRE SPRINKENERGY r.24
MECHANICAL
Y,[:] Nv ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE F`LDDf ZONE A.L.U.C.
INTERIOR SHEAR - FIRE DEPT. IL Y ❑ NE] Y ❑ N❑
SHEETROCK - GRADE 'FEESUMMARY
• EXTERIOR LATH. - BUILDING - .
INTERIOR LATH - TEMPORARY APPROVALS BUILDING -
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ELI WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING r.
PLEASE GIVE JOB ADDRESS WHEN'PHONING.
— SEE PERMIT FOR •EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX `
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY