18498 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
pppgE� 1n� APPLICATION & PERMIT
'- �b �J/'. G��PNE` p�/ItTi BUILDING- ELECTRICAL-PLUMBING -MECHANICAL9
r
GRAINER'S - PLAN CHECK VALIDATION
NAME d �/
JAy-/ G 6'z D TILT IAC' 7 4,07 JY• ELECTRIC PERMIT FEE ,
NAME QY nUTLETS-SWITCHES-RECEP 10.00/1.00
J kT' -7 ,S LIGHTING FIXTURES 10.00/1.00
ADFs
ADDRESS
�,�� - PPLIANCES-RESIDENTIAL 4.00
AZORESS
I PHONE7
71 PANELS 10.00 DATE OF APPLICATION
ARCM CT PLAN CHECK FEE P.C.NO.
ORt, PANELS (OVER 200 AMP) 20.00
ENGINEER �O 7 JI
�V sec.rvo. SIGNS TRANS. 3.00
ARCH.OR ENG. - PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5,00 p L]
ZIP EMP.METER OR POLE INS. 20.00 71c)f5- R,
APPLICANTS
ADDRE9$- MOTORS SEE FEE SCH. C6
/U7�-f e'er SERVICE CHANGE.. 20.00
woo LICENSED CONTRACTORS DECLARATION _
¢U w I hereby afMn that I am licensed under provisions of Chapter 9 ISSUANCE DATE
H z (commencing'with Section 7000)of Division 3 of the Business and G n BLDG. ELECT. PLG. MEDIC.H m i Professions Code,and my license is in full Force and effect.
i ❑ ❑ ❑
o un o License ClassLic.Number -
Date Contractor
a m - BUILDING PERMIT
¢ ¢ w a OWNFR-BUILDER DECLARATION -
a O a o - INFORMATION
w LL I hereby at Bret that I am exempt from the Contractor's License MISC.- REFER TO ORD
rn VALUATION §/FT.
iso Law for thefollowingor co reewn.(Sec. uiresa,BusinessandtIc",sions
H _ g = PERMIT ISSUANCE 10.00
m� improve,demyshcounty which structurep prior
ocomvua,attu,
¢ ¢ <o improve,demolish.or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC
o LL requires the applicant for such permit to fik a signed statement that TL r
n w he is licensed pursuant to ILe provisions of the Contractor's License PERMIT TO
F z s- Lew(Ch xpter9(comme mgwith Sect{on7000)of Division3afthe
- a Business and Rofession Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
R F the basis for the aIle c excmplion.Any violation of Section 703 LS STORIES TYPE CONSTR.
c
by any aPPlicam Cur parotin subjects the aPPbcum too civil Penalty
ofnot mora than five hundreddo11urs($5001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00 _
❑ I,als owner of the progeny or my employees with wegsas BACK FLOW PROTECT. DEVICE 4:00 DCC.GROUP RES.UNITS
their wle compensation,will do[lie work-and the Structure is not
- intended or offered for sale (Scc. 7044; Business and Pmfenions DRAINS-FLOOR,ROOF,AREA,COND: 5.00
Code:The Contractor's License Law does not apply to an owner co
/^` property who builds or improve thereon.and who dos such work FIXTURES-PER TRAP 5.00 $O.PT:FLOOR AREA TOTAL ACREAGE
himself re through his own employees, le If.ho that such int building
mems are through
ot o,offerednemplo veeor,provided that r.such
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
- builderwill have the burden of proving that be did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Orhe
❑ 1;as owner of the property,am exclusively contracting with O ❑ *❑ ❑
licensed Contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'he Contractor's License Law docs riot apply
to an owner of properly who builds or improves thereon.sod who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such prnjccn with a contructons)licensed pursuant to
(lie Contract sLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am mot tinder Sec. ,H.&P.C.frit this WATER HEATER W/VENT 6.00
ruawn
Owner Duts � WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
ofERS'C ,09ifN5AT1ON Ed,CLARARON WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a«rtificate ofennsent Io self-insure. - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a ecrtified
copy thereof(Sec.3800,Iab.C.L
Policy No. Company '
U ❑ Certified copy is hereby furnished.
Z Z ClCaniOed .'opy I, liltd with the city inspection division FIRE SPEC INK ENERGY T2
O Applicant MISC:- - REFER TO,ORD. Y NY ❑ NE] -.
~ Ha PERMIT ISSUANCE FLOOD ZONE A.L.U.C.
LU - CERTIFICATE COMPE I AX IOTINS FROM WORKERS' � �'�-�
" W � COh1 PENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need not be completed if the permit is Cor one TOTAL x+— Y� N Q Y NE]
Z hundred dollars(S 100)or les.)
U O 1 certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
U_ I- mit is issued.1 shall not employ any Perron in any ma pact ro as to
U W become subject to the Workcri Compensation Laws of California.
a Datn Applicant BUILDING
} N NOTICE '10 APPLICANT': It,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
f" =
eruption,you should heconw subject to the Workers''Compensation APPLIANCE 5.0.0 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he dcemed,revoked. AIR HANDLING UNIT(TO 10MCF.NL) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C,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
3097,Civ.C.E HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I,rc,lify that I have read this application and stare that the above VENTILATION FAN (SINGLE) 4.00 nn�r�--ss
information is correct. I agree to comply with all city and county PLUMBING IO
y ordinances and state laws relating to building construction, and BOILER-CCAW(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorise rgrmsuntatives of this city to enter upon the g01 LER-COMP (Over 100,000 BTU(SEE FEE SCH.
above-mentioned property for inspection purposes. MECHANICAL
----- - --(We) a x to-save, indemnify add,keep,hemOLv the City of MISC.- REFER TO ORD.
open gain,( liabilities,judgments, c0 is and expenses which- CONST.TAX
may y way accrue a I sac y in ccrueruence of the PERMIT ISSUANCE 10.00
runt fthis CuL rl ECH.CONT. LIC.NO. MECN.
�— TOTAL TOTAL LAW
Si azure Applies ontrxctor Date rr
OFFICE COPY
POST THIS CARD-NE AR FRONTOF BUILDING PERMIT NUM bER�/
CITY -OF CUPERTINO 1849
'T
.INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT,EXPIRATION
JOBADDRESS I oil 't- _ UNIT#, LOT#
- �(2. PERMIT EXPIRES IF WORK
OWNER Q 1 \� corvrancToa Z. •-V \ IS NOT STARTED 'WITHIN
INSPECTION DATE. INSPECTOR .INSPECTION RECORD' 180 DAYS OF PERMIT ISSU-
FOUNDATION,' . - - ANCE OR 180 DAYS FROM
NOTE: - LASTCALLED INSPECTION.
UFER ,.' ALL GRADING AND•DRAINAGE SHALL BE INSTALLED
PREGUN ITE. I? - TO COMPLY WITH THE APPROVED PLANS AND CIN OF POVLIIT VAI.m I N
GARAGESLABS - CUPERTWO STANDARDS.
Cr . .
POUR NO CONCRETE UNTIL ABOVE HAS BEENSIGNED - T
UNDERGROUND /SLABU �
PLUMBING - -
ELECTRICAL t - - ISSUANCE DATE
MECHANICAL BLDG, ELECT, PLG. M,CR.
' ❑ ❑ " ❑
DO NOT POUR UNTIL BUILDING PERMIT
FLOOR U L ABOVE HAS BEEN SIGNED
r•
INFORMATION
.
WOOD FLOOR vnwnnoN siFr.
PLUMBING- _ _
MECHANICAL - PERMIT TO-y.-t-
ELECTRICAL � - -
FRAMING
11
INSULATION' - - STORIESTYPETR.
= A- - occ cHouP RES uNlrs
- PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /�
_ ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sa Fr,rLooR AaEA ,TOTAL ACREAGE
DIAPHRAGM
A THE CONSTRUCTION TAX IS PAID
\� ,. - bUll.p WG USE
_ ROOF SHEATHING +E INo coN Pb um„
❑ .❑ ❑
. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ASSESSORS PARCEL NO.
ROUGH. SAN.N
PLUMBING ELECT,ENERGY -
IRACTNO. PARCEL NO
TUBS 8 SHOWER PAN - PLUMBING ENERGY - -
MECHANICAL MECH.ENERGY
ELECTRICAL• r
BUILDING ENERGY Acc.DATE. ACC.FILE No
FRAMING .y.
T' ELECT.FINAL TEST
ZONING'
INSULATION ,Sy ENG.SITE NO.
PLUMBING '
GAS TEST ` GAS
FIRE SPHINK ENERGY i}E
MECHANICAL
- . COVER NO WORK UNTILABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y IN
, .
,. EXTERIOR SHEAR � - � � � � ELECTRICAL RELEASE . FLOOD ZONE A:LUC.
INTERIOR SHEAR_' - - FIRE DEPT. Y ❑ N❑ Y ❑ N❑
SHEETROCK GRADE ' FEE SUMMARY
' EXTERIOR LATH - BUILDING
. �
INTERIOR LATH- _ 'TEMPORARY APPROVALS BUILDING,
SCRATCH COAT' ELECTRIC PLAN CHECK
GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC-FEE _
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY,PHONING 252-4505,' ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING.,
t z 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 !�•c co
OFFICE COPY