13284 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED-LINES'- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATI . PERMIT NUMBER
RUILDIrvG; • , APPLICATION & PERMIT'
ADDREss// �iPf C ILDING- ELECTRICAL-PLUMBING-MECHANICAL 11
3 2 8 4
STEv�,vs
c g PLAN CHECK VALIDATION
rvnME - _ QTY. ELECTRIC PERMIT 'FEE
I e e /vo
rvTR TORS 3 UTLETS-SWITCHES-RECEP 10.00/1.00
NAM /
r/C L � LIGHTING FIXTURES 10,00/1,00 7
rvTRAcaons - ,f APPLIANCES TRESIDENTIAL 4,00
AO ESS
i.//C�••ruv� PHONE _ PANELS . 10.00 OCHEOF APPLICATION
AORRC TECr - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
SIGNS TRANS. 3:00
IARCH.SENG. - - - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
_ -
a,P TEMP.METER OR POLE INS. 20.00
A - - MOTORS SEE FEE SCH.
ADDDRESSDRESS
SERVICE:CHANGE 20.00 - i❑ W,4,
w LICENSED GN'I'RAGTORS DECLARATION o
.7
rt v I hereby affirm that I ;un licensed under provisions of Chapter 9 - ISSUANCE DATE
a z w
H (Commencingwith,Section 7000)of Division 3 of life.Business and - T PLG. .MECH.
❑ ❑
r'D Z Professions Code,;Ml�lot ensu is in fulPfor 1 ': - I TffO)
Z o o License Class G 1, N inber - +
O w r o Date�J// ntrac[oI 'f
Q`- q p����� r/ Q - BUILDING PERMIT or Wu OWNER-BUO,DF,R DECI,AR TI ( INFORMATION
a0A MISC.- REFER TO ORD
X 3 LL H 1 hereby affirm that I amexempt from the Contractor's License
u o ¢ Law for the following reason.(See.703 LS,Businessand Professions PERMIT ISSUANCE -10.00 ��--rI VALUATION SIFT.
� y J Code:Any city or county which requiresa permit mconstraCT,alter,CS Il
ce 4 0 improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONT". LIC.NO. ELEC.
rt 0 LL requires the applicant for such permit to a signed statement that TOTAL - PERMIT TO
w m he is licensed pursuant to the provisions of the Contractor's License -- ' F.. -
Hii Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
OTYPLUMBING PERMIT FEE PPP------ 16---••�E�J i F =.i'
a Business and Professions CodeLor that he is exempt therefrom and .
r e the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penally - ALTER-DRAIN&VENT-WATER IEA) 5.00
of not more than five hundred dollars($500).):
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE" 4.00 DCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Codlin The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO FT.FLOOR AREA TOTALACREAGE ,
himself or through his own employees,providedthat such improve-
ments are not Intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS .6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA:) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or owner-
RES IND CON PB Oeber
Prove for purposcofsalc.l. " INDUSTRIACWASTE INTER. 30.00 '
[37,as owner of the Property,am exclusively contracting with ' ❑ ❑ ❑ ❑ ❑
licensed contractors ID construct file project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 -
contracts for stich projects with a COotracrorts)licensed Pursuant t0 SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ Iumexcmplurider Sea BAP.C.for this WATER HEATER W/VENT 6.00
reason
0. Date Uate - WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO.
NORKkiRS'C)MPF:NSATION Of CLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a cern ficale r f consent to self-insure, ZONING ENG.SITE NO.
or a Certificate of Workers'Compensa nsurance,or a certified
copy LhercoflSee.3 00,CmopemyC 11 Ic I 1
Policy Na Company' /�✓r7U LJ
,0 ❑ Certified Co y hereb fished. FIRE$PRINK ♦ ENERGY TQ4
Z ❑ Cerli th n Cil Inspection division. MISC.- REFER TO ORD.
O APPIiCenT - Y❑ N❑ Y ❑ N❑
F" w PERMIT ISSUANCE 10.00 FLOOD ZONE L.U.C.A.
� CEHTIIICATE 01- iXCM PTI 'ROM WORKERS'
W > COMI ATIONI SURANCE PLO.CONTR. LIC.NO. PLG.
Ed�' O I'This section need iot be completed if The permit is for one TOTAL v❑ N❑' Y ❑ N❑
Z hundred dollars(S100)or less.) '
.U O 1 certify that in the performance of the work for which This per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F 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.
y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING
} DO NOTIC17 TO APPLICANT: If,after making this Certificate of-Ex-
F Z eruption,you should became subject to the Werkers'Cma,co ution APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, yorr must forthwith comply with FEE
U such provisions or this permiT shall be deemed revoked - AIR HANDLING UNIT(TO 10,000C,F.M.) 4.00
CONSTRUCTION LENDING.AGENCY, - AIR HANDLING UNIT(OVER 10,000C.EM.) 6.00 SEISMIC FEE
I hereby al'finn that Iherc iS onstruction lending agency for EXHAUST HOOD (WITH DUCT) _ 5.00
the fic'm m.nee of the work o which,This permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's AddHEATING UN IT(OV ER100,000 B.T.U.)9.50 ELECTRIC
ress -
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is co rrect..I agree to comply,with all city and'county PLUMBING
ordinances and stale laws relating To building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorim representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
.(WC) agree to save, indemnify and keep harmless the City of MISC.- t REFER TO ORD.
Cupertino again; liabilities,judgments, costs and expenses which CONST.TAX
may m wo nee a• nst sa'I GOV in consequence of the PERMIT ISSUANCE -,10.00
gran a ;`PC n' MECH.CONT: LIC,NO, MECH.
L ' •`'Q. TOTAL TOTAL �j •�
Sig atureof APPlican t ontractor ate
FFICE COPY - -
POST THISCARDNEAR' RONTOFBUIL--DING
- ,PERMIT NUMBER +'
'IT :OF: CUPERTINO . :
INSPECTION DIVISION,
13284._
JOB INSPECTION RECORD
i ' '• ' . PERMIT EXPIRATION-
,': JOB ADDRESS 2O;I9S1'STEVEN$ CREEK 'BLVD UNIT# 200 LOT -.PE RMIT EXPIRES;IF WORK
OWNER W D T'.''. CONTRACTOR REDWOOD CITY ELECTRIC IS NOT STARTED WITHIN
INSPECTION `DATE I INSPECTOR INSPECTION RECORD '180.DAYS OF PERMIT ISSU_:
FOUNDATION _ - i ANCE OR 180 DAYS FROM
UFER
PR EGUNITE p�S7CAL LED I NSPECTI ON.
- iJPERMIT VALIDATION
� • " �{ - •
MAR 7:='198a. FM1i
POUR NO CONCRETE.UNTIL ABOVE HAS BEEN SIGNED:' •_,
UNDERGROUND /SLAB' ".�Clfy fCU(1Dflfli� �il`�
' . PLUMBING - + _` .., ' ,
a ELECTRICAL , '. "� ISSUANCE DA ,-a
MECHANICAL - - - BLDG.' ELFCT. PL -MECR.
DO NOT POUWFLOOR UNTIL ABOVE HAS BEEN SIGNED' rl. : BUILDING FERMIr
- WOOD FLOOR INFORMATION ,
PLUMBING vAwnnoN
P ).
x '' 'MECH AN ICAL -
,; - PERMIT TO `
'I ELECTRICAL
FRAMING. '^ .
, STORIES •TYPE corvsrR:
INSULATION
"-.,• L .M� OCC,GROUP RES,UNITS
` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
�% ' ROOF •. 50:FT FLOOR AREA •TOT•ALACREAGE •
w• DIAPHRAGM ' -
BUILDING USE
' t `•. - HES IND 'CON PB Omer .
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ❑ ED, .❑ ❑,
e ASSESSORS PARCEL NO.
''..ROUGH
PLUMBING
GAS TEST'. ,
TRACT NO. PARCEL NO,
+, . ^-
MECHANICAL-
AL ACC.DATE ACC FILE NO.
ELECTRIC
/v FINALS DATE INSP.
FRAMING S SAN #' t'
INSULATION —�u PLUMBING TzoN`Nc ErvG7sIrE No:
.. GAS .t
_ ♦FIRE SPRINK ENERGY L]4, _
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATINGFLOEl, �� ' r NEI
.+ LATH—INTERIOR ELECTRICAL . zoNE`, , A.L.0 c.
LATH—EXTERIOR FIRE DEPT !�❑' NQ . v �] - ru❑
SHEETROCK - .% GRADE'- FEE SUMMARY
SHEAR.INTERIOR+,', . 5 , -' N '• BUILDI TEMPORARY'APPRO • s x
EAR'EXTE R IO FI • VALS "^ BUILDING,
SH ,
FIREWALLS - '- ELECTRIC • `: •.. ;r. i t PLAN CHECK .
- GAS - t'.. FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. I, ;SEISMIC FEE '
OCCUPANCV,OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED'BV BUILDING INSPECTOR. MICROFILM
. '.� ELECTRIC
-ARRANGE'FOR INSPECTION BY PHONING 2524505J' .. F ONE WORKING DAY BEFORE REQUIRED INSPECTIPLunnewG <
OPLEASE GIVE,JOB ADDRESS WHEN PHONINGZ 'MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! coNsr.raxPLEASE READ REVERSE SIDE.BEFORETOTAL .
CALLING FOR,,FINAL INSPECTION.•
- .,OFFICECOPVr' '