14544 (2) J .
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE;BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION &'PERMIT '" '
BUILDING 11454.4 '
>• AD ' •
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL -
NE 'S • �• - - PLAN CHECK VALIDATION
N ME O Y. ELECTRIC PERMIT FEE:
ONE
ONTRACTORS a -�
N '+ O UTLETS;SWITCH ES-RECEP 10.00/1.00
' 0111111111,
LIC.. LIGHTING FIXTURES ,10.00/1.00 - -
o
TRA.
R ACTORS
71 DOR s APPLIANCES-.RESIDENTIAL
rPH • PANELS 10.00 DATE OF APPLICATION
A CHITECII'e - ♦ :PLAN CHECK FEE -', P.C.NO.
- OR PANELS (OVER 200 AMP) 20.00
ENGINEER
_
Lie NO SIGNS TRANS. 3.00
ARCH OR
ADDRESS ErvG. I - SPECIAL CIRCUIT 5.00 . PERMIT VALIDATION
-. ZIP TEMP.METER OR POLE INS, 20.00
APPLICANT'S MOTORS SEE FEE SCH.
D E
SERVICE CHANGE 20.00
Foo LICENSEE CONTRACTORS DECLARATION
a o w 'I hereby of ino that I am,licensed under provisions of Chapter 9 - - ISSUANCE DATE
z (conni0ncmg wish Section 7000)of Division 3 Of the Business and
ELECT. ;PLG. MECH.
N i I'rrlcssions CWNER-BUILIDERDECLARATION
sc is in tat]fore - ❑ '
'z o m - Liccns IILic.Numbs _
0 w r ; DulaCnnlra" -
x �e l G of(
E,¢ w a - BUILDING PERMIT
.w D " - INFORMATION
g LL w 1 hereby affirm that l am exempt from the Contractor's License MISC. REFER TO ORD '
uoIA Law for the following rva,.G.(Sec.7031.5,Business and Professions VALUATION S/FT,
-' • Code:An PERMIT ISSUANCE 10.00
fw�rP Ycitynrcounyir Ay structureperminots islnret,ahcm Q y -
¢ ¢ O¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.DONTR. LIC.N0. ELEC. 't �j{/
m¢ requires IIIC applicant for such permit to file v Signed Slat,menl that TOTAL
n w he is licensed pursuant In the provisions of the Contractor's License -- PERMIT TO
H z< Law(Chapter 9(commencing Willi Section 7000)nf Division 3 ot:tl,c EG�
4 D Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE
M r m the hasis for the alleged exemption.Any violation nt'Section 7031.5 STORIES' TYPE CONSTR.
a 5; by any applicant for a permit subjects the applicant to.eivll penalty !ALTER-DRAIN IEA.) 5.00
of not more than five hundred dollar,($5001): -
❑ I,as owner of the properly,or,my enlployees Willi wages as BACKFLOW PROTECTDEVICE ,4.00
' their sole compensation,will do the work,and the 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 nnl apply to a11 ownerol' '
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his Own employees,provided that such improve. -
memsare not intended or offered fur sake.Il;however,It,,building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 .
or..improvemenl is sold within one Year of completion, the owner- :I
build,,will have the burden of proving that he did not build or all. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for 1,aso nee of sada.). INDUSTRIAL WASTE INTER, 30.00 RES IND - CON PR Other
❑ d as owner s the property,he exclusively. 7044,ling with' ED' 0 ❑ ❑ ,❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.,
and Professions Codegrope ty honbuildsr s Liccns,Law docs nand why - -
lo frowner ofproperlywho buildsor improves rased uand who LAWN SPR IN KLERS-OV_ER 5(EA.) 1.00
contracts for such projects with a emrtruclorl s)licensed pursuant lo, - -
Ow Contractursl.icense Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 ,) TRACT No; PARCEL No.
T ❑reaso ii lam exempt under Sec ,B.&I'.C.for Ibis WATER HEATER W/VENT 6.00
s.- Owner
Owner Date WATER SYSTEM Y 5,00 ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. .•5.00 ,
1 hereby affirm that 1 have a certificate of consent to self-insure,-
or a certificate of Workers'Compensation insurance,or a certified ZONING, ENG.SITE N0.
J5 coliche c„�50�1-a;W ,-
PolicyCC SLC pa _ Slt It,-
0
's �/•�N�2LT/e- - -
U ❑ Cetlil led copy is hereby furnished. RE SPRINK ENERGY T Z4
Z Z ❑ Cenil"y��y Ick with the city inspection division. -
F LD Applicant/�/�idl,�� MISC.- REFER TO ORD, y E] N E r Q , N�
- 0: rn_ Cf::/}�F/I/n rr.OP- Ex EEMIl'I_O-N FROM WOItKERS'. PERMIT ISSUANCE 10.00 FLOODZON6 A.L.U.C.
W > COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG. '
- �d fl'his scalion need not be c'rm,lcled it the permit is for ane TOTAL V N .,V
::I Z hundred dollars(S 100)or less,) -
U O 'I certify that in the performance(if lire work far which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
. LL.U' mil is issued,I shall 1101 employ any person in any manner Y,as In
become subject to the Workers'Comaa
paliou Laws of California.
U y Date Applicant ALTER OR ADD TO MECH. 5.00 - BUILDING
} to NOl'ICE'Ib AI'I'LICANT: If,alter making Ibis Certifleulc of nix-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK +
provisions of the Labor'Code, you must forthwith comply with
U such provisions or this permit shall lie deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.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 lire work for which this permit is issued(Sec. MICROFILM
3097,Civ CA 't - HEATING UNIT(TO 100,000 B.T.U.). .8.00
Lender'i Name
w Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Rc,rtif Ilial Ilr v'e � -
Y a_ read to
and.11 cityal the aunty BOIL CATION FAN (SINGLE) 4.00
ordinaation n correct. I agree ti comply ldiefill ulc oily mW county BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 PLUMBING
heriby ar and elute laws alive ng to building construction, and
hereby authorize representatives mauves of This oily 10 soler upon Jhe BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
abovc�menlinned property far inspection purposes.
(We)"agree to save, indemnify and keep-harmless the City of MISC.- ` > REFER TO ORD. ..
upertino'against liabilities,judgments, costs and expenses which CONST.TAX
may, in.any way,acCL a against said Cuy'in consequence -am PERMIT ISSUANCE 10.00 -
•n �'
its en - ECH.CONT. LIC.NO. MECH.
\ - TOTAL TOTAL
uureal pplicant/Contractor
OFFICE COPY
POST THIS CAR D'.NEAR FRONT OF BUILDING ,
.
PRN1NUMBER
CITY OF CUPERTINO .. , r
INSPECTION'DIVISION 54.4
JOB,INSPECTION RECORD
6.
• .? ,I .PERMIT EXPIRATION (' !
22'303 REGNART RD. UNIT
T
JO ADDRESS' # _LO
O #
_ .. • - a.,. PERMIT EXPIRES IF WORK .
owNER GEOFFORY WRIGHT CONTRACTOR .ATL ELECT..' mIS NOT STARTED WITHIN
INSPEC ION DATEINSPECTOR .INSPECTION RECORD 113o DAYS OF PERMIT•ISSU-
FOUNDATION '"' - ANCE OR 1130 DAYS FROM t
NOTE: LASTCALLED INSPECTION. .
LIFER / ALL GRADING AND DRAINAGE SHALL' BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF, "Pl:IMl1 YALI DAI ION ,
CUPERTINO STANDARDS.- .."'s
> �
• .GARAGE SLABS r, -
POUR NO CONCRETE UNTIL-ABOVE HAS BEEN SIGNED
UNDERGROUND /SL-AB !
PLUMBINIff
ELECTRIQAL- ISSUANCE F.
MECHANICAL` - ^ ILDG. ELF PLO. MLCH�`
DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATION � siPT.
PLUMBING'" _
` MECHANICAL _
ELECTRICAL - - - .. PERMIT TO
FRAMING
INSULATION" - - STORIES TYPE CONsi R.
OCC GROUP Rl:S UNITS
II .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED O,FT FLOOR AREA TOTAL ACREAGE
- 'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE _
DIAPHRAGM THE CONSTRUCTION TAX IS PAID f
BUILDING USI!
ROOF SHEATHING . _ RES .IND CON PB 0....,
-APPLY NO ROOFING UNTIL ABOVE�HAS BEEN ISIGNEO•;a„ , G, FINALS„ ,,,� rz aDATE'�_ .ANSP.:�„, "� El Q "� 0
_ � , n55ESSOHSPAHCELNO-
ROUGH SAN.#� '
PLUMBING ELECT:ENERGY '
_
. TUBS 8 SHOWER,PAN� PLUMBING ENERGY � TRACT NO . PARCEL NO
'
MECHANICAL - MECH.:ENERGY T
ELECTRICAL - - BUILDINGENERGY ACC,DATE ncC.FILE NO,
E FRAMING. " ELECT.FINALTEST -
INSULATION.' _ PLUMBING ' ZONING' ENG.SITENO.
GAS TEST - - GAS "
' MECHANICAL FIRE SPR INKL, ENERGY i z4
o �
- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N� Y N
0.
• EXTERIOR SHEAR:`, - �- ELECTRICAL RELEASE PLOOD20NE L.O C.
INTERIOR SHEARFIRE DEPT. :>' ff', N❑ ° L] D'
- SHEETROCK.', - GRADE FEE SUMMARY
EXTERIOR'LATH BUILDING
INTERIOR,LATH TEMPORARY APPROVALS :" BUILDING
SCRATCH COAT - - ELECTRIC N PLAN CHECK'
• GAS' - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEO,j OCCUPANCY SEISMIC FEE OCCUP.ANC.YOF BUILDING ISNOTPERMITTED UNTILBOILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY'PHONING 252-4505„ . ELECTRIC
Gay:' �,� ONE WORKING DAY BEFORE REQUIRED INSPECTION. } bLUMBINc
PLEASE GIVE JOB ADDRESS'WHEN PHONING.
- z' - MECHANICAL
'a SEE PERMIT,FOR EXPIRATION DATE,. . '
IMPORTANT.!!
CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION."
OFFICE COPY