18734 (2) BUILDING PROJECT _
•r�APRi1CANT TO FILL IN.INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY-
r
CT I DENTI FICATION - -PERMIT NUMBER
BUILDING APPLICATION & PERMIT, r�
ADD R 5y�f - I
X310 Fl7VIC_2 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL '
34
OWNERS
'PLAN CHECK VALIDATION
. NA E _ .
II f( rC�/�ryy 9r�..9sS7 OTV ELECTRIC PERMIT FEE
1 PHDNEOI I
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
• Lc.No, LIGHTING FIXTURES, -'10.00/1.00
CONTRACTOR
ADDRESS
- PPLIANCES-RESIDENTIAL 4.00
CO
a PHONE PANELS ',1 '10.00 DATE OF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
an PANELS (OVER 200 AMP)'-'. 20.00
ENGINEER
LC.No. SIGNS TRANS: 3.00 '
ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. ,.20.00
APPLICANTS is - MOTORS - SEE FEE SCH:
'
ADDRESS
SERVICE CHANGE I. ,20,00'
woo LICENSED CONTRACTORS DECLARATION '
Q•u I hereby Infirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
yz w (commencing with Section 7000)Of Division 3 of the Business and'
¢ r. - -BLDG. ELECT, PLG. MECH.
H o z Professions Code,and my license is in full force and effect. _ _ ❑ ❑ ❑
z D to - License Class Lic.Number
0 z H o„ Datc Contractor
OCT BUILDING PERMIT
¢ OWNIiR-BUII-DER DECLARA'I'[ON
A. o a u - INFORMATION
A.
�,u H I hereby affirm that 1 am exempt from the Contractor's License MISC.- REF TO ORD
u.O¢ Law for the following reason:(Sec.7031.5,.Business and Professions PERMIT ISSUANCE alp 00 VALUATION $/FT.
H - y ,,.. Rf Cqn'1'{i
fw 4 Code:Any city or county which requires a permit luconstruct,alter,
I[ no ¢O improve,demolish,or repair any structure,prior la its issuance,also ELEC.GDNTR, LIC.NO.- ELEC. -
To KO u requires the applicant for such permit to file a signed statement that TOTAL _ P
n w mhe is licensed pursuant to tha provisions of the Contractor's License
H z r
Low(Chapter 9'(commeneingwith Suction 7000)of Division 3 Grine
¢ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
E i D
¢ H$ the any
a for the alleged exert)prion.Any applicant
of Section malty' STORIES TYPE CONSTR.
by otmor the fora permit subjects $500U.licanl lnucivil penally ALTER-DRAIN 5.00
of not more than five hundred Dollars fmy amp - +
❑ Las owner at the properly,or my,and gees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS
inter sole compensation,will(S e, work,ell the structure is not
Intended or offerer) for sale(Sec, 7044,nosiness and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law docs nm apply to an owner of
property who buih ,ur improves thereon,tad who docs such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or Through his own mered 16,s,provided that such improve'
-
meatsarenotintendedorol'feral l'or sale..)1,however,the building GAS-EA.SYSTEM=I:INC.40UTLETS 6.00 '
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or ins- BUILDING USE
- prove for purpose of sale J. ' - RES IND CON PB Other
❑ I,as owner all tire property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑, ❑
licensed contractors to construct the project(Sec..7044,Business LAWN SPRINKLERS,-1 INC 5 V.B. - 6.00 ASSESSORS PARCEL NO.
and Professions Codi The Contractor's License Law does not apply
to an owner al'properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for sr rojecis with a contractor(s)licensed pursumn to
the Camra U, ''ease Law. SEWER-SANITARY STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
I am c t under Se ;BAP.C.far this WATER HEATER W/V,ENT'-' 6.00
nn ^
Owner _ Time -- WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP.' 5.00 - 't
s ' Ihereby alfirm that l have n certiticote of consen bio selhiroum;
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. -I
copy thereof(Sec.3800r,Lub.CJ. -
Policy Nn. Compmly , - -
Q ❑ Certified copy is hereby furnished. - FIRE SPRINK ENERGY T-24Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O' Applicant _ 1. - F - V❑ Not V ❑ NE]'~ In - PERMIT ISSUANCE 11p.110 '
LU Clik'I'I FIC(70 OF I A'6 1,1'INS FROM WORKERS' + . FLOOD ZONE A.L.U.C.
' l1J_> COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG.
CL a CL z 1'I'nk section need not be completed if the permit is for one 'TOTAL ❑ N❑ Y ❑ N❑
hundred dollars(S I(10)or less.) ,
U O 1 certify that in the performance of the work for which This per- OTV. MECHANICAL PERMIT _ FEE FEE SUMMARY
LL I- mit is issued,I shall not enmloy any person in any marines as to -
O W become subject to the Workers'Compensation Laws of California. - 1
Date Applicant BUILDINGOR
>_ N NOTICE' f0 APPLICANT: If,after making this Certificate of Iix- ALTER ADD TO MECH. 5.00
H 2 emption,you Should become subject to the Workers'Compensarou APPLIANCE 5.0.0 - 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 1Q000C.F.M.)• 4.00 , { '
CONST RUCTION 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 wurk'for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's NamAddress . - HEATING UNIT(OVER 106,000 B.T.U.)9.50 ELECTRIC
' '-
I certify that I have rear)Ihis•application and state that the above VENTILATION FAN (SINGLE) - 4.00
information is,corract. I agree to comply with all city and county PLUMBING
'ordinances,and state laws relating to building'constmetion, and BOILER-COMP(3 H,P,or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, lndemliify and keep harmless the Cify'ot MISC.- REFER TO ORD.
uperhma 'Last liabilities,judgments, costs and expenses which PERMIT ISSUANCE + . 10.00 CONST.TAX
May in a By accrue a^ Id City in consequence of the
ranting Ia pennitr MECH.CONT. LIC:NO. - MECH. 'I
CC. Ir/^� TGTAL; TOTAL ' 1'
Sig lure of Applicen t/Coo tractor Dale
'OFFICE COPY
- . I
.POST THIS'CARD-.NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY `OF CUPERTINO " R
• INSPECTION DIVISION B?34 '•
JOB INSPECTION RECORD
PERMIT•EXPIRATION .
JOB ADDRESS -'((fofv UNITLP LOT#
p PERMIT EXPIRES IF,WORK
OWNER /g%` / /rL�{ / CONTRACTORS ' /LG /�' / ' ' r$JNOT�STA IT� WITHIN
NSPECTION DATE INSPECTOR INSPECTION RECORD 15B DAYS OF PERMIYISSU-
- ANCE OR 180 DAYS FROM.
FOUNDATION i.,, NO LASTCALLED INSPECTION.
-UFER 'ALL GRADING AND DRAINAGE SHALL BE,INSTALLED .
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PR EGUNI7E _ C.—LY
STANDAR S. ,
-� GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL I - .SSu.N"unr
' MECHANICAL - BLDG., ELECT. PLG. MECH
❑ ❑ �..� ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ./ r , _ BUILDING PERMIT
o INFORMATION
WOOD FLOOR ' VALUATION, SiPT:
PLUMBING .r - '
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING ^PAID. - '»J ,1*.n•L;Sr,,f�'.TLf".: .{: IIF�'7! ,
- STORIES TYPE CONSTR,
INSULATION - ea 198G9
OCT:V O _ OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED �DpPrtIRO
SO.Fr.FLOOR AREA TOTAL ACREAGE
. . ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE _ -
• - - THE CONSTRUCTION fAX IS PAID ,- - -
DIAPHRAGM.
_ BUILDING'USE
ROOF SHEATHING'. RES IND CON PB 0n..,
APPLY NO ROOFING UNTILABOVE HAS'BEEN SIGNED FINALS' DATE, INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.k
ASSES SOHS PARCEL NO.
L• . . �
_ PLUMBING - ELECT.ENERGY .
TUBS A SHOWER PAN " -
PLUMBING ENERGY , TRACT NO, PARCEL NO
MECHANICAL - MECH.ENERGY --
ELECTRICAL. p-
BUILDING ENERGY ACC DATE! ACC.FILE NO
FRAMING 6. ELECT,FINAL TEST'-
INSULATION
PLUMBING,
ZONING, -ENG SITE NO,
GAS TEST GAS,
•'. '
MECHANICAL FIRESPRINK, ENERGY T-74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - .Y ❑ .N❑ 1,C] N❑
EXTERIOR SHEAR I ELECTRICAL RELEASE - FLOOD'ZONE A.L,u C.
INTERIOR SHEAR - FIREDEPT. - - Y❑: IN Y L N❑
SHEETROCK - GRADE ' .. FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR ,LATH I TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC - PLAN CHECK "' '
- '• GAS ., - FEE'.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYSEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
I' ONE WORKING DAY BEFORE REWIRED INSPECTION.
F-• PLUMBING
o� PLEASEGIVE,JOBADORESSWHENPHONING.-
L Z •; MECHANICAL
''- SEE PERMIT'FOR EXPIRATION DATE•
IMPORTANT!
CONST.TAX
PLEASE READ,REVERS,E'SIIE BEFORE. TOTAL
INAC INSPE TI
LL
ING
FOR FIN
C ON.
• CA ,
k OFFICE COPY „