18360 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES =EU. . BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIF[CATION ' � '— -PERMIr NUMBER
SoILGING - 'APPLICAI-ION PERMIT
.� oR E" 'F / U ft H - 18360
OO I BUILDING—ELECTRICAL—PLUMBING—MECHANICAL '
r^ OWNER'S
'v` NnmE A PLAN CHECK VALIDATION
CITY. ELECTRIC PERMIT FEE
CONTRACTOR'S �}'- _0 nn/. n�
NAME T( c,I TOUTLETS-SWITCHES-RECEP 1
Llc.Na. LIGHTING FIXTURES in=Ae90 ,20
CONTRAs'oR's APPLIANCES-RESIDENTIAL 4.00
'HONE {} PANELS - 10.00 DATE OF APPLICATION -
OPCHITECT PANELS (OVER 200 AMP) 2"0 PLAN CHECK FEE P.C.NO.
ENGINEER ,J, /
Y`7 OU0 ua ND, .•Q— SIGNS TRANS. 3.00 s
ADDRESS eN¢ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zIP EMP.METER OR POLE INS. 20.00
APPLICANT Ss MOTORS SEE FEE SCH.
SERVICE 00
9 F
0
000 LICENSED CONTRACTORS DECLARATION '
au I hereby affirm that 1 am licensed under provisions of Chapter 9 '
2 w ISSUANCE GATE
H < y (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r N z Professions Code,unitmy licenin is n full(Duce and effect.Nm
oi w o License Class Lic. uber
m I- Date.Contractor 1\
a x - BUILDING PERMIT
¢ ¢w se OWNER-BUILDER DECLARATION INFORMATION
_ V
r ;a y I hereby affirm that I am exempt from the Contractor's License MISC.— OflD
Law for the following reason(Sec 7031.5,Nusines and Professions PERMIT ISSUAN �1 VALUATION $/FT.
44i > Code:Any city or county which reunites a permit to construct,aher, �/Jr89 LFOJ� eV
¢a a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ED
wa¢ requires the applicant for such permit to file a signed smlemm�l that TOTAL �J�J PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)(ifDivision 3 ofthd r
f 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I-$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSVI.
a ; �
by any applicant for
ve loundred dojecls S5001.licam toaciin penalty 2 ALTER-DRAIN&VENT-WATER (EA.) G�0(T Q
of not more than five hundred dollars the applicant
❑
I.as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE ' 490
their sole compensation,will do the work,and the x cc into is not OCC.GROUP RES.UNITS .�
intended or offered for sale ISec. 7044, Business and Professions 3 DRAINS-FLOOR,ROOF,AREA,COND. 5.88 101
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5eeo f SG FT.F OR AREA TOTALI,CREAGE
himself or through his own employees,provided that such improve-
I�f7J cents are not intended or offered for sale.If,however.the building .Q' GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 J / � 'P7 4j6tl-
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) r 2.00 BUILDING USE
a prove for purpose of sale.), RES IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with -W- INDUSTRIAL'WASTE INTER. 30.00 ❑ ❑ ❑ 11 ❑
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
_ and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a comracton s)licensed pinatas to
the Co inctor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 / TRACT NO. PARCEL NO.
❑ lam exempt ander Sec. ,B.&P.C.for this WATER HEATER W/VENT
Eason
owner Date 48` WATER SYSTEM 5.00 ACC.DATE ACC.FILE No,
WORK F-RS'COMPENSATION DECLARATION .A— WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cerlil kale of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z U Certified copy is riled with the city inspection division. MISC.- REFER TO ORD.
Applicant Y N Y [:] N[3
~ rn PERMIT ISSUANCE O
CERTIFICATE OP EXEMPTION IO TION PROM WORKERS' D �y..�
LPL? COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG, yr 4-s. ❑ ❑ ❑ ❑
CL 0 [Thiyy section need not be completed if the permit is for one TOTAL SCJ Y N Y N
hand. dollars I S 100)or less.)
U O 1 certify that in the.performance of the work for which this per, OTY MECHANICAL PERMIT FEE FEESUM Y
.%k H mitis issued,1 shall not employ any person in any manner so as to
O W becrime subject to the Workers'Compensation Laws of California.
y DAA Applicant ALTER OR ADD TO MECH. 5.00 BUILDING(p�
} m NOTI CF. 10 APP I.ICA NT: If,after making this Cert ificme of 17x-
F 2 emplion,you should become subject to the Workers'Compensation ,Pf APPLIANCE 5.00 PLAN CHECK _
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.NL) 4.00
CONSTRUCTION LENDING AGENCY .(r AIR HANDLING UNIT(OVER I0,000CEM.) 6.00 SEISMIC FEE Z. �-
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)
the performance of the work for which this permit is issued(Sea
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Leader's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9,50 ``,
Lender's Address ELECTRIC
1 certify that I have read this application and stale Thal the above VENTILATION FAN (SINGLE) 4.00 SQ -
information my correct. 1 agree to comply with all city and counlY PLUMBING
ordinances and slate laws relating to building construction, BOILER-COMPI3 H.P.Dr 100,000 B.T.U.1 6.00 .� ,bU
hereby authorize representatives of this city to enter Upon the BOILER-COMP(Over 100,000 BTU[SEE FEE SCH. MECHANICAL a�.r
F. above-mentioned property for inspection purposes. L OC Z
A (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 CONST.TAX rte_
may in any way accrue against said City in consequence of the
grant Ibis ens MECH.CONT. LIC.NO. MECH. G
7_ TOTAL.3'` " TOTAL 0 `
re of Applicant/ oalmetor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUIlt_`I�,
' 'PERMIT NUMBER
CITY SOFTION CUPERTINO�' 18360
DIVISION
JOB INSPECTION RECORD
"PElm I FXPIBATION'
• JOB ADDRESS L�.O (1UNIT# v LOT ^
PERMIT-E%PI ES IFF WO WORK
OWNER _ _ CONTRACTOR 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
PREGUNITE TO COMPLY WITH THE.APPROVED PLANS AND CITY OF PBHMU VAuua TION
GARAGE SLABS CUPERTINO STA ARDS.
cl �QiS
POUR NO CONCRETE UNTIL ABOVEHAS SIGNED 20 QJ t QK,— 65to 15
_
UNDERGROUND /SLAB
PLUMBING g
ELECTRICAL '" ISSUANCE DATE -
MECHANICAL BLDG ELECTPLG. MECH
El El El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR - VALUATION aiRT.
PLUMBING _ \
.y MECHANICAL'. \N j`rt ) �r zTl ' •�
ELECTRICAL. PERMIT TO
FRAMING •� '( i r _ - ^ n
INSULATION, STORIES r TYPE CONS*n.
a o
. C GROUP RES UNITS
� 2—I-70 %r1!) Pce
., PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED i -'
(^ #` _ " SO.FT 1�.00F.PlA T TAL.ACHFAGE
ROOF NOTE:NO FINAL INSP. HALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID �v w '= '• �'
BUILDING USE ,I
ROOF SHEATHING HES IND CON PB 011—
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO .�
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT no PARCEL NO
TUBS 8 SHOWER PAN - � PLUMBING ENERGY
MECHANICAL _ MECR ENERGY
ELECTRICAL Q BUILDING ENER - ACC DATE Acc.FILE No.,
FRAMING - aly' ^C^ �J ELECT.FINALT T
ZONING' `ENG.SITE NO,
INSULATION Z_ O PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T-24MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN S GNEO HEATING Y ❑ N❑ Y ❑ NO
HOOD ZONE A,L u c.
A7 EXTERIOR SHEAR ELECTRICAL RELEASE v N� w I] N❑
INlRIOR SHEAR FIRE DEPT.
►a SHEETROCK — GRADE FEE SUMMARY
`� E TERIOR 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 fifRT ,I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
.ri I_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING (�
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
_ -.SEE PERMIT FOR EXPIRATION DATE - o(i
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE.BEFORE TOTAL �1� I
CALLING FOR FINAL INSPECTION.
OFFICE COPY