4405 (2) �.�IPLICANTVFO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
. PERMIT NUMBER
�. BU I LDING PROJECT IDENTIFIC APPLIC'ATIO19 & PEOT
AU LDIN BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -
BU1Lp1NG 4 405_
/ OwrvER'S PLAN CHECK VALIDATION
`. NAME'li(/OOLLllm�12Y✓l� QTY. ELECTRIC PERMIT FEE
.rVe-. PHONE o L
S CONTRACTOR OUTLETS-SWITCHES-RECEP 5.00/1.00 O
NAME ACTORS
NST. le _ _1C.NO / LIGHTING FIXTURES 5.00/1.00 O-
y' AODflE55 r�G' ✓L) SAA/ -7�•5 APPLIANCES-RESIDENTIAL 4.00
_# /,0 PHONE Se. s0 J PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE PO NO.
cFw
OF �`
/JPYb.LGF /f�/ S,0CND. el-Ir SIGNS TRANS. 3.00
ARCH.OR END. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDRESS e
Sd �.tl p / jZ EMP.METER OR POLE INS. 15.OU ��'D
APPLICANT'$ JB1 /,�rdS MOTORS SEE F
ADDRESS
/pN/d SERVICE CHANGE 10.00 A) 6��n1
T o LICENSED CONTRACTORS DF.CL RA r O�..j { vY 0
A u w I hereby affirm that I am licensed under provisions of Chapter 9 1611
N a H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PL CH.
F H z I'mfvsaions Code.,y'y d my license is in full forty'81 f •' City Of� IIS�II II��}} ry
z o u, - License Class_,(j Lie.Number) ICI. l^J, Ll�
Q Ua[e CoNmttnr/fL(i9
a Y s QoNST• !o� -res .. BUILDING PERMIT
ac w¢ OWNER-BUILDER DECLARATION INFORMATION
Dao MISC.- REFER TO ORD
wS m I hereby affirm shut I um exempt lion, the Contractor's License VALUATION $/FT.
H IE o v, Law for the following reason.(Sec.7031.5.Busiaessand Professions pERM1T ISSUANCE 6.00
Code:Any city or county which requiresa permit to Construct.alter, �/a OOO
¢ R ¢ 2 improve,demolish,or repair any slmctore,prior to its issuance,also ELEC.CONTR. LIC.IN ELEC. (�
O¢ requires the applicant for such pennil to file a signed statement that TOTAL '��U PERMIT TO
wLL he is licensed pursuant to the provisions of the Contractor's License s/�
w 0i Law(Chapter 9(commencingwith Section 70000of Division3 oflhe r+-�E l�xl/L.
¢ Business and Professions Code)or that he is exmnpt Therefrom and DTV. PLUMBING PERMIT FEE
¢ r oo the basis for the alleged exemption.Any violation of Section 7031.5
STORIES TYPE C STR.
by any applicant for a permit subjects the applicununaceilpenally ALTER-DRAIN&VENT-WATER (EA.) 4.00 1--
o1'not store than live hundred dollars 1$5001.1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC,GROUP RES.UNITS
their sale compensation,will do the work,and Ole structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code'.The Contractors License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 14 SO.FT FLOOR AREA TOTAL ACREAGE
himself re Out
rote his own employees,Provided that such improve- _
mrnts are not intended own
employee,.ered for Hoid i thatSlhe building GAS-EA.SVSTEM-11NC.40UTLETS 4.00 3365'
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of moving that he did not hail)or in,- RES IND CON PB Olner
prove for purpose cfsalc). INDUSTRIAL WASTE INTER. 20.00 El ❑ ❑ El
1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec 7044, Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds nr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts fornlCII procCTN With a c)draC(OHO limnscd pu,,,Lni to �.
Ole Contractor's Llan...Law. SEWER-SANITARY-STORM ft/8.00 TRAcTNo. PARCEL No.
❑ lam exemptmldcrSec .B.&P.C.lirr pis WATER HEATER W/VENT 4.00 69)3
Teas n
Ume Owner WATER SYSTEM 0 ACC.DATE ACC.FILE NO,
WORK ERS'COMPENSA'IION UFCI.ARATION WATER TREATING EQUIP, 4.00
1 hereby affirm that I have a certificate of consent to sell-ituurc. ZONING ENG.SITE NO.
or a certificate of Workers'Compcnsat ion Insurance.or a certified
copy tiler l 38n0i0.,,,�j��¢y 1C.)nn__•• /�� .Q l
Policy N�e�jdy31y- f F/��
O ❑ Certified 'opy'is I by'fujjnisIt it FIRE SPRINK ENERGY T 24
Z Z Cort iOu % y is O J Witt' he $ i s t' + iv ' MISC.- REFER TO ORD. y N y N
0-14 A plies ❑ ❑ ❑
F- = CI:R I'0'ICATIi Olt EXIT IP[ION FROM WORKERS' PERMIT ISSUANCE 6,00 FLOOD ZONE A.L.U.C.
W > CON INSURANCE PLG.CONTR. LIC.No. PIE
d ❑ (This section need riot be completed if the permit is for one TOTAL 9Q Y❑ N❑ v ❑ N❑
D Z hundred dellms(SIOO)or less)
U O I certify that in the performance of Iu,work forwhich this par- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LLI- mil is issued, I shall not employ any 1)sun in any nmnner so as to
O O become subject to the Workers'Compensation Laws of Calitornia. �/ 'J •�
BUILDING
Date Applicant ALTER OR ADD TO MECH. 4,00 J
NOTICE 'I'O APPLICANT: If,after making[]is Certificate of Ex-
Z nuptien,you ehochl becarine subject In The Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Iahnr Code, you unlst forthwith comply with FEE
L) such provisions or this permit shall be deemed revoked. AIR HANDLING UNITPA CF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC FEE �9
1 hereby affirm that there is u construction lending agency far EXHAUST H I DUqR3 2.00
th3097,Ce performance of The work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 / MICROFILM
S.N'a .
Lender's Name �_ HEATING UNI�'JT.U.)7.50 ELECTRIC
Lender's Address ��/��'(1' p�
I certify that l have read tl p(mI:RTRf1 JITtl 11,9d flic above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county BOILER-COMP13 H.P.or 100,000 B.T.U.) 4.001PLUMBING
hereby ccs and state laws relating to building consuuet ion, and _
hereby authorize representatives of this city m cnmr upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCR. MECHANICAL �7
abovententioned properly for inspection purposes.
(We) agree to-snve, indemnify and keep hnnnlcss the City Df MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which .� CONST.TAX
may in any way accrue gainst said City inconsequence of the PERMIT ISSUANCE 3.00
g titin f this pennil. MECH.CONT. LIC.NO. MECH. q p�
/ •�. TOTAL / 7 TOTAL
i mtnre of Applicant/ n clor Date
OFFICE COPY
J CIOOF CUPERTINO INSPECTION RECO
_
/ (OFFICE COPY) - •
4405 10069 Oakleaf Place H 16
ER SS O--=O..—
Single Family Dwelling Woolworth Construction
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
ui ing
e.anca
Plumbing Power Pole
Mechanical Uner roun
Temp as ec ou h Wiringg
So ara s . .
1-ire rT' e Srin�_le_r Ceiling
bign Fixtures nt xt
otors
Misc. Grounding
Temp Power
Other
FINAL INSPECTIONS DATE INSP, Not Approved
Gas
Electric
Plumbing PLUMBING DATE INSP.
ec anica
Aar Backflow
ol r un
ra in er oor y_y y
Planning Partial Rough
Fire De t. Tou=gompiete
efeaith Dept. oar Rough
Rui ater ' r Insulation
er Main . ain ! ��
o ain
,as
tC Fe—r
BUILDING DATE INSP, Not rove
Pad Certification -F "`� `
roan anon -2-�3 ELE RIC DATE INSP.
re- unite
Slab-Membrane y- Underfloor S:M. �y 3
n emn Ducts nsu anon - --.;2_
Underfloor Girders Tire Dampers
V's it Fireplace
ie owns urease ct 4 How
Diaphrams s e Hour Shaft
eismec Bracing Condensate Drain
Walls-Panels Equipment Anchorage
rame4 Ikedtll Fiues 4 Comb. Air
-h Other
11boards Int/Ext. of rove
'�Firewalls
Other J ve�- L�. &31-2 v
G.vcc.... n..c..L.cQ
Not
Approved _
. BUILDING
ELECTRICAL
r
PLUMBING
MECHANICAL
MISCELLANEOUS