14609 (2) APPLICANT TO FILL IN:INFORMATION WITHIN RED LINES USE'BALL POINT-PEN ONLY.
R, BUI LD1 NG PROJECT I-DENTI FICATION PERMIT NUMBER i
APPLICATION & PERMIT
!� At
ualn NG t C
ADDRESS .F/-���/. 1 [Aj O /y�
ABUILDING-ELECTRICAL-PLUMBING-MECHANICALITOVOwNEPS J PLAN CHECK VALIDATION
NAME jiff�n L"/ QTY. ELECTRIC PERMIT FEE'
� Mld / HON' -S - ..
CONTRACTORS OUTLETS-SWITCHES-R ECEP:.10,0011.00
NAME
LIC No, LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL • 4.00
. ADDRESS - • -
PHONE - PANELS '"' 10.00 IgDATE OF APPLICATION •-•
ARCHITECT PANELS (OVER 200 AMP( 20.00 PLAN CHECK FEE ' P. No.
ORO
,. '
ENGINEER - r +
Lc.sO, SIGNS TRANS. _ 3.00 r
AR CH._QR ENG.- - d PERMIT VALIDATION
ADDRESS ? SPECIAL CIRCUIT• 5.00 .
zip ' EMP.METER OR POLE'INS. .20.00 1
ADDRESS MOTORS 'SEE FEE SCH.
ADDRESS _
^ SERVICE CHANGE r• .20.00 ,
0 0 o LICENSED CONTRACTORS UECLARA'1'ION
a v I hereby affirm that I an lirenown under provisions of Chapter 9 ISSUANCE DATE
H rt w (commencing with Section 7000)of Division 3 Of the Business and - - BLDG. PLG. - MECH.
H H z Professions Code;and to,license is in full force and effect. - ❑
Z D m - License class - Lic:Number - rN
-
N f W Dam - Contractor F
f
IS a u OWNER-BUILDER,DECLARATION - ORMATIONT
E.
w•; LL I hereby ulfnn that I am exempt from the Contructor•s'Lwrmse MISC.- - REFER TO ORD
w VALUATION f/FT.
F u 0 j Law for the following reason:(Sec.,7031.5,Business and ProfessionsPERMIT ISSUANCE 10.00
Code:Any city or county Wit ich requires a pe rte i l to co nal rue L alter, G '0
¢ ¢a improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO.• - ELEC. �•' '
a wDLL requires the applicant for Such permit to file a signed did,nicel that 1 TOTAL - PERMIT TO
m he is licensed pursuant to the provisions of the Contractor's License _
H z Q; Law(Chapter 9(conimencingwith Section 7000)o(Division 3 of lhc' CZr� ^�V
m D Business and Professions Code)or-that he is exempt therufrmn and QTY. PLUMBING PERMIT 'FEE I - J
ricr m . the Innis far the alleged exemption.Any violation ofSeellon 7031.5 - '- •, STORIES TYPE CONSTR.
.n by any applicunl horn permit subjects the applicant to a civil penally gLTER-DRAIN& VENT-WATER IEA.)•'5.00
of not more than five hundred dollars(S5000.) ,(
❑ I,as Owner of the property,or my,employees with•wages as ;BACK FLOW PROTECT. DEVICE 4.00 1 OCC.GROUP RES.UNITS
their sole compensation,will do the work,-ond the structure is not - -
'" intended or offered for sale (Sec. 7044, Business and I}ofeseions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law does not apply loan owner of _
property who builds or improves,thereon,-and who docs such work FIXTURES-PER TRAP ' 5.00 SD.FT.FLOOR APER ,TOTAL ALOEAGE
himself'or through his own employees,provided that such improve- GAS-EA:SYSTEM-1 1NC.4 OUTLETS 6.00 '
merits are not intended or offered for sale.If,however,fire building
or III of is e b within one year of completion,the owner, GAS-EA.SYSTEM-OVER 4 (EA.) ZOO BUILDING USE
EuiIII will have the burden n proving that he did not build w er,
_ pove for propose ofsaa.). INDUSTRIAL WASTE INTER. 30.00 RES IND. ' CON Ps Omen
_ I,as owner of the property,am exclusively contracting with _ ❑ - ❑ ❑ ❑ 1:1licensed contractors to construct the project(Sec.7044,Business _ LAWN SPRINKLERS-1 INC 5,V.B. 6.00 ASSESSOR B PARCEL NO:
wul,Professions Code:The Contractor's License Law does not apply q
toanowner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 51EA.1' 1.00 7�.�•,Q�'- j / '
contracts for such projects with a contractors)licensed pursuant to - SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law." TRACT NO. PARCELNO.
❑ 1tenexemptunder Sec. ,R.xp.C.tn ithis WATER HEATER W/VENT 6.00
Own -
. \/ reason .. .•
er_ - c -- WATER-SYSTEM - 5.00
-ACC.DATE ACC.FILE N0. '
'Iv ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. - - 5.00 ,
I hereby afbrm that 1 have a certificate ofeatisciii I s If insum' - SZONING
or a ceRdlade of Workers Compens_etum Insurance,or a codified j " ENG.SITE NO.
copy Iliemot'(Sce,3800,LaRC.). _
Policy No. Company
0 ❑ Ccrlil'icd copy is hereby furnished. - _FIRESPRINK ENERGY T 24
Z_ Z ❑ Certified copy is fled with the oily inspersion division. MISC.- , REFER TO ORD.
O Applicant V El"'NEI Y ❑ ' ,N❑
~ rn PERMIT ISSUANCE - 10.00 r
LU CliliT'IPIGYPE OMAXION INS FROM WORRIiRS' 11111111E A.L.U.C.
CL COMPIot be completed
if the
PLG.CONTR. LIC.NO. I.G.Pr YO' N❑ 'Y ❑ NQ
CL Z.' ridhis Scc)iris S10 not be completed if Ihc permit is far one TOTAL
hundred dollars IS 100)
or less.)
U Q 1 certify that in the performance of the work for which this per- QTYMECHANICAL PERMIT FEE 'FEE SUMMARY
LL. I- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California. .
U i Date � Applicant^ - BUILDING /7 J"a'
} N NOTICE 'I'O APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00
emplion,you should become subject to the Workers'Compensation 'APPLIANCE. 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE'
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10OWCRMJ 4.00 '
CONS'I'RUCTION LE ND INC AGENCY AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 tSEISMIC FEE 'dam
I licreby affirm that there Is a construction Ieniding agauuy fir EXHAUST HOOD(WITH DUCT) 5.00 „ • .
the performance of Bre work for which this permit in joined(Scc. 'MICROFILM' "
3097,Civ.C.). , HEATING UNIT(TO 100,000 B.T.U.) 8.00 u:
L,Lender's Nam° HEATING UNIT(OVER 100,000 B.T.0.)9.50
-- -"' ndcr's Nan, ELE6TRI0. -,✓ - 'I
Pertly that l have read this application and state that One above VENTILATION FAN (SINGLE) 4.00
udnnances a wta tl I agree to comply with all my and county PLUMBING
Ordman sand stat Laws agree
relatingC to building cant anNnn, unJ BOILER-OOMP(3 H.P.Or'100,000 B.T.U.) 6.00
hnevc- aufluorimtioned representatives Pori s oftect this city es color upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property formspednon purposes.e
(We) agree ID save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
' - - upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in consequence of the
ting Of(his ennit - 1 MECH.CONT. LIC.N0. MECH.-
TOTAL G
TOTAL 0
19lig-nidLem of Applicant/Contractor Date
l '
OFFICE COPY
POST THIS CARD NEAR FRONT OF,BUILDING
�_ .. PERMIT NO MBEH
CITY OF CUPERTINO 14609
INSPECTION DIVISION
JOB INSPECTION RECORD .
q ' I PERMIT EXPIRATION
(FYemont Open')
JOB ADDRESS_RECNART RD,_i'C2 ye UNIT# _LOT,4 '
A ` - PERMIT EXPIRES IF'WORK
. . OWNER` Mill enlnsul. 0 en S pace '• coNTRACTOF ,- IS NOT STARTED WITHIN
_ - INSPECTION DATE INSPECTOR, - INSPECTION RECORD-. - :180 DAYS OF"PERMIT ISSU-
FOUNDATION. . ANCE OR 180 DAYS FROM
- - _ NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING.AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - ,,TO COMPLY WITH THE APPROVED PLANS AND CITYOF - PERMIT.VALIDATTON
CUPERTINO STANDARDS:
GARAGE SLABS " ' - - - .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - (_•�«,,
• UNDERGROUND /SLAB - ♦T P.
'
-T PLUMBING - 'n,� t ji'
' ELECTRICAL - - 1Q O ♦
�- \J�ISSUANCE DATE
MECHANICAL LOG. ELECT. PLG- .MEC'."
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT". -
WOOD FLOOR - -,. : INFORMATION D
PLUMBING
VALUATION SIFT.
' � � J
MECHANICAL - - -
,
ELECTRICAL - PERM/IT TO
FRAMING
INSULATION - - STORIES ; TYPE coNSTH.
'OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED' '
SO.FT.FLOOR AREA 'TOTAL ACREAGE
.. )
- ROOF NOTE:NO FINAL INSP SHALL BE MADE BEFORE _
DIAPHRAGM THE CONSTRUCTION TAX IS PAID.
�• BUILDING USE
ROOF,SHEATHING' RES"• IND CON PS Ov,,.rt
''APPLYINOROOFINGUNTIL-ABOVEHASBEENSIGNED FINALS,,, DATE. INSP. .- '' E. -11 ❑ E) ❑ d `
ASSESSORS PAHCEI.NO.
' ROUGH SAN.H
.. PLUMBING} * ELECT.ENERGY
• o TRACI NO-. PARCEL NO
't TUBS&SHOWER PAN'. - - ,PLUMBING:ENERGY
MECHANICAL MECH.ENERGY-(, �• ,
ELECTRICAL, ! '` - ♦ gULDNG'ENERGY " ' '' ACC.LATE s,;,ncc.FILE NO,
, 'FRAMING; - ELECT:FINAL TEST `
ZONING, ENG SITE NO. ,;
• ` INSULATION .� PLUMBING - •
f a ,
GAS TEST GAS -
4
MECHANICAL FIRESPRINKn+ SNEHGYT24-
- '•' • - '- : . ' • ' � '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ °• '"❑,
EXTERIOR SHEAR 'r- - - ELECTRICAL RELEASE - FLOOD ZONE ,
-
INTERIOR.SHEAR ,• - FIRE DEPT. _ ❑' "❑ �v ❑ •"❑
.' SHEETROCK: - •a • GRADE - • FEE SUMMARY
EXTERIOR LATH . BUILDING,
INTERIOR LATH TEMPORARY IAPPROV,ALS, BUILDING - -0
SCRATCH COAT ELECTRIC PLAN CHECK
FEE-
NO TAPE OR-.PLASTERUNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL,BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR'.
.MICROFILM
ARRANGE FOR INSPECTIOWBY PHONING 252-4505, ELECTRIC
Iw— ONE WORKING-DAY BEFORE REQUIRED INSPECTION , v I PLUMBING.
-
PLEASE GIVE JOB.ADDRESS WHEN.PHONING.
—SEE PERMIT FOR EXPIRATION DATE —' A MECHANICAL r
IMPORTANT!' coNsr.rnx
PLEASE READ REVERSE SIDE BEFORE
Z CALLING FOR'FINAL INSPECTION. TOTAL . /r% '—v—
.OFFICE COPY