17150 (2) ` -d\P,PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERMIT NUMBER
BU I LDING PROJECT I DENTIFICATI ON - -
aUILDING APPLICATION & PERMIT
ADDRESS /, 1/c� - 1 1
--'-- ?14 48 �1 Z. IS 1+ �I- t BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1 7 1 50
OWNER'S PLAN CHECK VALIDATION
NAME
�` TQu1z0
v11oNE TY. ELECTRIC PERMIT - FEE
1 n) /-(p
CONTRACTOR'S -
rvaME f OUTLETS-SWITCHES-RECEP 10.00/1.00
ok -
-- - - tC (M�TCIe � , L,p�r�� LIGHTING FIXTURES 10.00/1.00 E -
cOrvrRAcroR's //11 APPLIANCES-RESIDENTIAL 4,00
'(S�I < •,
PRONE I ( PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) _ 20.00 PLAN CHECK FEE PC.No.
OR
' ENGINEER LIC.No. SIGNS TRANS. 3.00
ARC".OR ENG. $pEGIAL DIRCIIIT - 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
AMOTORS SEE FEE SCH. -
ADDRESS
DRESS
- SERVICE CHANGE - 20.00
,00 LICENSEDCONTRACTORS DECLARATION
a u I hereby affirm that'-I am licmmse I under provisions of Chapter 9' _ ISSUANCE DATE
H a w (Conunencing.with Section 70001 0l'Division 3 of the Business and BLDG' ,ELECT. PLG. MECH.
Z F y z Preen.ca Code d my license isN full force unJ el feet. 1
iw 0 I-Iccnu Clus LIC No her '
w H,w DJIL` - 1 Contractor y ❑
C�4i' i
a u s BUILDING PERMIT
¢ ¢ a OWNER-B UILUf.R DECLARATION -
o d u - INFORMATION
w ; LL N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
r LL O a Law for the following reason.(See.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 ^ vaLUATION S/FT.
Cotte:Any city or county.which requires a permit to construct,alter, 1E�
le ¢¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO.. - ELEC,
Is ¢ requires the applicant for such permit to Ne a signed statement that TOTAL
n w m u
he is licensed pursuant to the provisions of the Contmcloi s LieCnSe PERMIT TO
H z'a Iaw(Chapter 9(commencing with Section 7000)of Division 3 of the
F i O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
the basis for lire alleged exemption.Any violation of Section 7031.5 - STORIES - TYPE CONSTR,
by any.pphcant for a permit subjects the applicant loo civilpenalty ALTER-DRAIN -WATER IEA.) $.00
.fuel more than five hundred dollars(55001.):
❑ Las,owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 400 '
their sole compensation,will do Om work,and lite structure is not - . OCC.GROUP RES UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:-The Contractor's License Law does nor apply In on owner of - - ` -m 1
' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP' • 5.00 170 S0:Fr.FL„OOR AREA TOTAL ACREAGE
m !dShimself re through his own employees.provided ever,t h improve- a'
hire not intended or emend for ployees,
lalidedth I:,uhe building GAS-EA.SY$TEM-i INC.4'OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA'.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or ire- BUILDING USE
prove for purpose of sale.). INDUSTRIALWASTE I INTER. 30.00 RES IND CON .PB .mer-
'- - 0 I,as owner of the property,am exclusively contracting with .❑ ❑ ❑ ' O Q
licensed Contractors to Construct fire project(Sec.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 ofproperty who builds or improves Iheraon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contructorls)licensed pursuant 1. gEWER-SANITARY-STORM EA.2001t/10.00
the Contractors License Law. TRACTNO. PARCEL NO.
. ❑ 1 um exempt under Sec. ,B.&P.C.fm Omis WATER HEATER W/VENT 6.00
Oson
wn`'r _ Date WATER SYSTEM' .5.00 -ACC.DATE. ACC.FILE NO. '
WORK ISRS'COMPENSA'I ION DECI.ARA1'ION- WATER TREATING EQUIP, . 5.00
hereby affirm that 1 Have a ccrtificme'of cnnsent v,Self-insure, _•i "'
nr a cerlificme of Workers'Compensation Insurance,of a certified' - ZONING ENG.SITE NO.
-copy tIIcomt(Sec-3800,Leb,C.L
Policy No. Company - - - •. .° .
t 0 ❑ Certified copy ishemby furnished. FIRE SPRINK ENERGY T-24
_z 2 ❑ Certified copy is Bled with the city inspection division' MISE- REFER TO ORD.
D Applicant i y ry[J y 0 NE] '
~' w PERMIT ISSUANCE 10.00 e2L _111 111E A.L.U.C.
� CISRTII°ICATEONSATI N INSUROAIW(lRK1iR5', L �
W � COMPENSATION INSURANCE - PLG CONTR. uc.No. PLG. -
EL Z( 'Ibis section need not be completed if the permit is for one `OTAL t.3400 Y 0 N Y❑ N❑
hundred dollars($100)or Iew.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEESUMMARY
.UL I- our is issued,I shall not employ any person in any manner so as to
O W bceol ell a A'e Workers' twt���yy ",
'�y'pr�fm
d Dalc Rd�5 (Applicani.Sl_IIA�-Iv'�k L.fL ALTER OR ADD TO MECH. 5.00 BUILDING
} rn NO'1'IC i TO/AT'PLICANI': If,after making this Certificate of Ex-
FZ emphon,you should become subject tothe Weikers''Compensmum APPLIANCE,' - 5.00 'PLAN CHECK
provisions of the Labor Code, you muss forthwith comply with FEE -
U such provisions or this permit shall be dewnad revoked. AIR HANDLING UNIT(TO 10AMC.F.M.) 4'.00
'CONSTRUCTION LENDING AGIiNCV AIR HANDLING UNIT(OVER 10ACC.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.L HEATING UNIT(TO 100,000 B.T.U.) .8.00
Lenders Nunn HEATING UNIT l00,000B.T.U.)9.50 �3• eCJ
Lender's Address - ELECTRIC
1 certify that I have read this application and state that He above VENTILATION FAN (SINGLE) 4.00 -
information is correct. I agree to comply with all city and county BOILER•CDMP13 H.P.Df 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
h6reby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCM. MECHANICAL
ubbve-mentioned property for inspection purposes.
�' l u) agree to save, indemnify and keep harmless the City of MISC.- - REF ER,TO ORD.' -
Calm lino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
Ili n any wa m against said City in consequence of the - -.
' •ranfi lg of mi. p i MECH.CONT.I .LIC.NO. MECH. J `
'I NAI.O t'/y TOTAL
Signe
'Coll pp"can[ on actor Data D - TOTAL <101 {J
OFFICE COPY
;��•.� I POST THIS CARD NEAR FRONT OF BUILDING '
PERMIT NUMBER
CITY -OF CUPERTINIO
INSPECTION DIVISION .'', 1715,0
JOB INSPECTION RECORD
j'�( PERMIT EXPIRATION
" JOB ADDRESS 4=_I��!_ET P UNIT# _LOT# '
PERMIT EXPIRES IFWOR K'
OWNER ' �C,V CONTRncroR - IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD. THU DAYS OF PERMIT ISSU- '
FOUNDATION _ ANCE OR 180 DAYS FROM
NOTE: , . .LAST CAL L E D I NSPECTI ON. .
UFER - -ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
PREGUNITE - - CUPERTINO STANDARDS.
GARAGESLABS ,- 't "' �`-+"'T.•+�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'UNDERGROUND /SLAB
PLUMBING ' -
ELECTRICAL '.ISSUANCE DATE'
-
MECHANICAL. - BLDG. ELECT.I PLG. MEC.,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT -
'� INFORMATION
WOOD FLOOR VALUATION . $/FT.
PLUMBING ., - "
MECHANICAL
ELECTRICAL - - - _ PERMIT TO
FRAMING ' '
INSULATION '1 - .. , STORIES TYPE CONSTR .
OCc"GROUP RES.UNITS
APLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•SD,FT,FLOOR AREA TOTAL AC.EA(.E '
, ROOF 'NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
(DIAPHRAGM - THE CONSTRUCTION TAX IS'PAO, :• " 4
( - BUILDING USE
•!�'i ROOF SHEATHING ," RES ,. IND CON PB am.,
' — "APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS , ' DATE INSP. ❑ ❑ ❑ ` ❑ ❑ '
ROUGH SAN.N - ASSESSORSPARCELNO
,.
PLUMBING• ELECT.ENERGY ^' •.
TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. - -PARICEL,NO
MECHANICAL - MECH.ENERGY
ELECTRICAL % BUILDING ENERGY ACC OnrE ACC,FILE No
"FRAMING. ELECT.FINALTEST
PLUMBING ZONING ENG. ITE NO.,i
—INSULATION — — • .
GAS TEST. - GAS
- MECHANICAL` FIRESPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑. "❑ ❑ "❑,
EXTERIOR-SHEAR`, . ELECTRICAL RELEASE ` FL.00D zorvt: A.L u.c.
• INTERIOR SHEAR FIRE DEPT. - - Y❑ r"❑ ° ❑ 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 ABOVEHASBEENSIGNED OCCUPANCY ' SEISMIC•FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BOI L DING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ELECTRIC
- - ARRANGE FOR INSPECTION BY PHONING 252=4505, 3,' S "
+� LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
F PLUMBING I
o�, PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
SEE-PERMIT-FOR, EXPIRATION DATE,
' I
IMPORTANT! CONST TAX p
PLEASE READ REVERSE SIDE BEFORE TOTAL 6
CALLING FOR FINAL INSPECTION: c2 .
,; :. OFFICE'COPY