1714 (2) CITY OF CUPERTPiO L-;SPE:CTIO:? RECORD (OLfica Copy)
1714 11249 Redondo Ct.
PEP2IIT i40. Set?iITARY DIST. :;0. LOT NO. ADDRESS
Elect. J.P. Youmans 253-4539
PPOJECT OFTNLP JOB SITE PHONE NO.
Date ELECTRICAL
BuildineDate Insp.
.
Electrical 4-14- Power Pole
Plumbing Under,^,round
:[echanical P.ou h Miring
Temn. Gas/Elect. ?.a11s
Solar Ceiling
Fire Sprinkler Fixtures In UFFx
Sign i[otors
Grounding
?fisc• Temp . Power
Other
FI`iAL INSPECTIONS iot Approved
Date Insp.
GF.s
Electric '
PLUMBING
Plumbing Date Insp .
nicai Backflow
SolarUnderground
Boon- Lnderr.loor
Pool _. Partial. Rough' Gr.annin Rough Complete
Planin^ —
Solar Rough
Ire-iDent. Water & Insulation
Health Dept' ?Iain Drain
Auildina- R/of/S Drain
Other Gas
l
Other
STRUCTURAL Not ADnroved
Date Insp,
Pad Certification `IE CHA27TCAL
Foundation
Pre-Gunite Date Insp.
Beam Underfloor S.`i.
Bond B
Bond- eal.1 Ducts a Insulation
Fire Dampers
Underfloor.Stee Girders Fireplace
TiedoFlooruns Steel _ Grease Duct
DiaBhram One Hour Shalt
Seismic B Condensate Drain
Seismic Bracing
cnuipment Anchorage
Falls-Panels Flues & Como . Air
Frame
TOther
nth `lot Approved
Wallboards Int/Est.
Firewalls
0 Other
Not Approved
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL_ POINT PEN,ONLY�
4� BU I LD ING PROJECT IDENTIFICATION • APPLICATION & PERMIT,. _ (:!!:;1sABER
1714
r .•noloacss .
•ZQ' bO . p� BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'5 - - - y PLAN CHECK VALIDATION
NAME.� . CITY. ELECTRIC PERMIT FEE~- • O��/a1ry5 PHONE
CONTRACTOR'S
NAME JOUTLETS-SWITCHES-RECEP 5.00/1.00
- LIC NO. LIGHTING FIXTURES 5.00/1.00 -
DNTRACTons
ADDRESS APPLIANCES-RESIDENTIAL - -4.00
PHONE PANELS', 5-60 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR - ' SIGNS 6.00
'ENGINEER
LIC.No. . SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 15.00' -
APPLICANTS. - MOTORS' - SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00 (y '
2
'0
o D LICENSED CONTRACTORS DECLARATION L/✓
a u v I hereby effrm that I am licensed tinder provisions of Chapter 9 ISSUANCE DATE
m (colnnencing with Section 7000)of Division 3 of the Business and
G ¢ m BLDG. ELECT. PLG. MECH.
H z Professions Code,and my license isN full force anA effect. -
o i In o License Class - Contract.,
Date' Contractor
Ity $
¢ m ¢ OWNER-IIUILDER DEf.LA RATION BUILDING PERMIT
a o a INFORMATION
w ; H I hereby,al firm that I um exempt Iron the Contractor's License MISC.— REFER TO ORD
.. O ¢ Low for the followingreason.(Sec.7031.5,Business and Professions VALUATION $/FT.
� —
Code:Any city orcomty which reyuiresn peFmitmcnnsvud;altce `PERMIT ISSUANCE, 6.00 -
R, m� ELEC.CONTR. LIC.NO.
x ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.
d'w m LL requires[lie applicant for such permit to file a signed statement than - TOTAL PERMITTO
he is licensed pursuant to the provisions of the Contractor's License _
HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
_ Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ F m the bears for the alleged exemption.Any violation of Section 7031.5 • STORIES - TYPE CONSTR.
by any applicant for a permit subjects the applicant ui a civil penalty ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages-as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their role compensation,will do the work,and the 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 in ownerof
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP .4.00 - so.ET.FLOOR AREA TOTAL ACREAGE
mentsfor not hrough
ownnemred for
providedthatsuch improvN GAS-EA.SYSTEM=I INC. OUTLETS 4.00
meats are not intended or offered for sole.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1,00 BUILDING USE
builder wilLhave the burden of proving that lie did not build or im-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER;' 20.00 RES, IND CON Pe omnr
❑ I,as owner of the property,.um oxclussely contracting with, ,❑ ❑ ❑ ❑ ❑
l ironsed contractors In construct the project(Sec. 7044,Rusinesi LAWN SPRINKLERS- INC 5 V.Beg 5.00 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'SPRINK LERS VER,5 (EAR 1.00
contracts for such projects with aeon,racor(s)licensed pursuant to SEWER-SANITARYV- R . f[/8. 0
(lie Contnetor s License Law. N+]_EA0TRACT NO. PARCEL NO.
um ex m t w'dcr ec. &I'.C.for this
rca�soii't '�✓,y - WATER HEATER W/VENT y 4.00 +. .
Dxro_ "Z WATER SYSTEM Z 4.00 ACC.DATE ACC.FILE NO. .
W'ORKIi RS 'OMpl3N'SA1'ION UGCLARATIDN WATER TREATING EQUIP, - 4.00
1 barehy affirm that 1 have a certificate of consent to self-insure, 20NING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified ZONING
copy Iloromf(Sec.3800,Lab.C.).
Policy No. Cnmpary
0 ❑ Certified copy is hereby,furnished. FIRE SPHINK !ENERGY T-24
Z Z ❑ Certified copy is Filed with the city inspection division. MISC.- REFER TO ORD.O Applicant - V.❑ No N ❑ N❑
~ w - - PERMIT ISSUANCE' 6.00
LU CIiRT1PICCOGOI'SATIOTINS PROMW'ORKIikS' FLOOD ZONE A.L.u.C.
W � COMPIiNSATION INSURANCE PLG.CONTR. LIC.N0. 'PLG. '
d O (Phis section need nut be'eonmleed if it,, pcintil is for one - - TOTAL.¢ Y❑ ry❑ Y ❑ N❑
Z -hundred dollars IS 1000or less)
U O 1 certify thal-in the performance of the work for which this per- DTV, MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not en.ploy any person in any manner so as to E
O W become subject to the Workers'Compensation Laws ofCalitornia.
Dmu Applicant BUILDING
} tan NOTICE TO APPLICANT'! If,after making this at
Certitice of Ex- ALTER OR ADD TO MECH. 4.00
Z - einption,you shmdd bec-tmic subject In the Workers'Conipensation APPLIANCE 4.00 PLAN.CHECK
provisions of the Labor Code, you must forthwith dimply with FEE.
U such provisions or Ibis permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTR UCT'ION L.ENDING AGENCY. AIR HANDLING UNIT(OVER 10MC.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD IWITH DUCT) _ 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM -
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name ' - HEATI NG UNIT ER 100,000 B.T.U.)7.50
Lender's Address - ELECTRIC
1 certify that 1 have read this application and slam that the above r VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances andlateaws relating to building construction, and BOILER;COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives natives of this purposes,
es,enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL -
ohovcrnentioned property for resp of this
Purposes.
(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 3.00 CONST.TAX
e in any way rue against said City inconsequence of the
gran
in
s p il. MECH.CONT. -LIQ'NO. - MECH. "
. CScvvr� 4/ CI_�� OTAL TOTAL
hamr of App' ant/Contractor ' d tc—
' OFFICE COPY