14375 (6) -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -'USE-BA LL POINT PEN ONLY `
BUILDING PROJECT IDENTIFICATION " " PERMIT NUMBER,•
NLDING 5_. /L(p!�' APPLICATION& PERMIT
-14 AG.DOE55 14375 '
.v� ID'S BUILDING - ELECTRICAL-PLUMBING -MECHANICAL"
OWNER'S / - ' PLAN CHECK VALI TION '• _
N ME G(IN ���� - 'Z
1 T. DTV. ELECTRIC PERMIT •�. •� FEE
sly vu
` .J CONTRACTOR'S
.yt NAM / '1, l$n60, [OUTLETS-SWITCHES-RECEP 10.00/1.00 -
� f rittl ILIGHTING FIXTURES 10.00/1.00 -
CONTRACTOR 9F,uo ,y fs,� APPLIANCES-RESIDENTIAL 4'.000 W AtIA DAL
'.00DWAtIADAL QLZ(p1HON437_X-74ti-1 '.PANELS 10.00 DATE OF APPLICATION
- ARCHITECT - PLAN CHECK FEE P.C.N0:
on PANELS (OVER 200 AMP), 20.00 -
ENGINEER - ,
'uc.No.2 SIGNS TRANS.q - 3.00' ';r '
ADDRESS ENTSPECI'ACCIRCUIT 5.00 PERLIhEV/]4tp AT10N.
zw- TEMP.METER OR POLE INS .•x'2000
nooeess TS - t •'
MOTORS , - SEE FEE SCH ""� M, t
SERVICE CHANGE2000 p �•q'' tt
w o O LIChNSED CON"TRACTORS DECLARATION 4I Of WJpB In�
Ix ta U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
wrtvat (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT.' PLG. - MECH.
r m Professions Code,and my license is in full forCe�2gg22.6�
License Class Lie.Number rr 77 .. O 0' El 'f -
r'--t Date Contractor
H _ �/�/
¢ y f I BUILDING PERMIT
s ¢o M OWNER-BUILDER R-B UILDT:R DECLARATION . - INFORMATION,
E:
3 ticLL N I hereby affirm that 1 am exempt from the Contractor's License MISC:- REFER TO ORD
u o a Law for the following reason.(Sec.7031.5,.Business and Professions pERM1T ISSUANCE' - 10.00 VALUATION 5/FT.
� - Code:Any city or county.which requires a permit to construct,alter,
' ��nr�o
'
¢ Q improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTR. L /t
IC.N0. - ELEC. L 1.fl
La
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m he is licensed pursmau to the provisions of the Contractor's License
i
Low(Chapter 9(covumeucing with Section 7000)of Division 3 ofthe
¢- Business and PR1fessions Code)or that he is exempt therefrom and MIT FEElPl
¢'r o the basis for the alleged exemption.Any violation of Section 7031.$ QTY. ,PLUMBING PER' '
STORIES TYPE CONSTR.
by any applicamfor a permit subjects the applicant to a civil Penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
- _ of not more than five hundred Jollurs($500)J:
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 x,
rf
their sole compensation,will do the work,and thmstncctum is not OCC.GROUP RES.UNITS
intended or ollerad for sale(Sce. 7044, Business and'Pmfassions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
7 Code:The Contraclor s License Low does not soPf ly to rot owner o
I property who builds or improves thereon;and who does such work F IXTUR ES;PER TRAP '„' 5.00 So,FT.FLOOR AREA TOTALACREAGE
himself or Through his awn employees,provided that such int prove -
nuu,are not intended motored for sale.If,however,the building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS'6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or im- _ > .BUILDING USE
prove for purpose of sale:). INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PR Omer
❑ I,as owner of the'property,um exclusively contracting with ❑ ❑ ❑ ❑ ❑`-
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who huilds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contracts lin such projects with it contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO: PARCEL NO.
❑ I am exempt under Sec.-,B&P,C,for this WATER HEATER W/VENT .6.00 '-
reason
Owner - ';Date WATER SYSTEM 5.00 ACC.DATE ACE.FILENO.
WORK17R S'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ,
I hereby allirm that 1 have a certificate of consent to self-insure, ZONING' ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.l. -
PIZW
any
0 by furnished. - .'FIRE SPRINK _ ENERGY T 24
Z Z ed with Jim city inspection division.
Ot A - MISC.- REFER TO ORD. Y.O NO. - yO -.r N
I y � PERMIT ISSUANCE 10.00iXli ' TON PROM WORKERS' FLOOD,ZONE A.L.U.C.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. . PLG, -
fTlus,section need no,t be completed if the permit ii.for one TOTAL V❑ N❑ �V ❑=,.N❑
` hlmdre I dollar (S I00)or less.)
V O 1 certify [hit[ in the performance of the work for which this per, DTV. 'MECHANICAL PERMIT' •,
LL F mit is issued,I shell not employ any person in any manner so as to ?FEEa ..FEE SUMMARY
U become subject to the Workeri Compensation'Laws of California. _. ..r
y' Datc Applicant ALTER OR ADD TO MECH. "5.00 BUILDING I '
} m NOTICE TO APPLICANT': If,after making this Certificate of I!x- - _
f- ? emptier,you should become subject to the Workers' m
Copensation 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 10PMC.F.M.) 4.00
coNsfRUCI ION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE
I hcreby'affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 '
the'performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cie.C.). - HEATING.UNIT(TO 100,000 B.T.U.) 8.00 _
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.) '
Lender's Address ELECTRIC
I C
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 t
information is correct. 1 agree to comply with all city and county PLUMBING'
ordinances and slate laws'relu[ing to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby•uuthorire representatives of this city to ententiPon (lie
above;mentioned property for inspection purposes. veBOILER-COMP (Or 100,000 BTUI SEE FEE SCtI. - - 'MECHANICAL'
.r
` (We) ago" to save, indemnify and keep harmless the City of MISC.- _ REFER TO ORD.
Cupertino igai ' liabilities,judgments, costs and expenses which -r CONST.TAX
in nay ay ceruu agalnst'Vid NCity in consequtnw of the
PERMIT ISSUANCE 10.00 ' t^
•rant, 6 if is per tit MECH.CONT. LIC NO. MECH
_ 7 � To.nL h ` -TOTAL
Sign n rc ofAPPla:ml/ n rector' Date ,,1;, ,) . •�� � `"1
OFFICECOPY,:'=. ;,.'
I
R - PERMIT NUMBER -
1
. ,
UIVISION :
NSPECTION'R ECORD '
' PERMIT EXPIRATION
'20195 rSTEVENS CREEK BLVD. 5 511�
ADDRESS- UNIT T# PERMIT EXPIRES IF WOR K'w `
OWNER UNITED CENTENNIAL MORT. CONTRACT6R HUETTING & SCHROMM - ISNOT STARTED WITHINJ' '-
INSPECTION DATE" INSPECTOR' INSPECTION RECORD 180,DAYS OF PERMIT ISSU
FOUNDATION. •' ANCE OR. 180 DAYS FROM '
< _ NOTE: LASTCALLEDINSPECTION,''
s LIFER ALL GRADING AND DRAINAGEsSHALL BE INSTALLED.
PREGUNITE,- TO COMPLY WITH'THE APPROVED•PLANS AND CITY OF PCI+MII VALIOnnCrN
CUPERTINO STANDARDS. '
GARAGE SLABS :
...
1 S
' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
. ,UNDERGROUND /SLAB ,
PAI®
PLUMBING - -
. ' ELECTRICAL - — 19 IR ' ISSUANC:E DATE .
MECHANICAL- . .. BLDG. ELECT. PLO. . MEC... ;
Cjjy of COper ink E 0-
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ auILDwG PERMIT -
WOOD FLOOR. - INFORMATION
VALUATION SIFT.
" 'PLUMBING -
MECHANICAI . . `a.. v,- �...• - a
ELECTRICAL . - - PERnur TO / ,I
> . FRAMING
INSU LATIONs:, �� - - �STOrncs TYPE CONSTR,'r
OCC,GNUUI, FIE S.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• 90 I T.P LU(1II ARCA TOTAL ACREAGE,.♦
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE'
DIAPHRAGM' - THE CONSTRUCTION,TAX IS PAID-
ROOF SHEATHING .� tics IND
LLOCON
:, FIE. Oma, .
APPLY NO ROOFING UNTIL'ABOVEAAS BEEN SIGNED - FINALS ' DATE INSP. El El ❑ - ',E) ❑ '
.ASSESSORS PARCEL NO. „
ROUGH SAN.il
PLUMBING _ ELECT:ENERGY -
' TRACTNO. -PARCELNO.
TUBS B SHOWER PANPLUMBING ENERGY
MECHANICAL - - MECH:ENERGY: y,)- �. -'
ELECTRICAL = 0-}jb"' - ACC.DATE ACC.FILL No
BUILDING ENERGY .>.
' FRAMING ELECT?FINAL TEST zoN1Nc ENG.SITE NO.'�
.�•�.INSULATION•. - -.�p PLUMBING • 3—�8- - -
. GAS TEST - GAS
. - FIRE SPRINK ENERGY T@4
MECHANICAL
' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,�� ,-8 -
EXTERIOR SHEAR ELECTRICAL RELEASE • FLOOyrorvE ' qL.0 C',
]INTERIOR.SHEAR'. FIRE DEPT. '� Y QNt Y,L] No
SHEETROCK . ,�• _/p= . GRADE;', - FEESUMMARY
EXTERIOR,LATH"- - BUILDING - .:�„ '' �,,..•
,INTERIOR LATH -TEMPORARYAP.PROVALS 'BUILDIING ,
SCRATCH COAT = ' ELECTRIC -PLAN CHECK„ -
FEE
NO TAPE ORTLASTER UNTIL ABOVE HAS BEEN SIGNED P OCCUPANCY - SEISMIC FEE '
I
OCCUPANCY OFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM'' '. '.'
.. ARRANGE.FOR INSPECTION'BY-PHONING -4505, ELECTRIC
LEI ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE',PERM IT.FOR EXPIRATION DATE;' MECHANICAL
CONST, TAX'
''IMPORTANT! ' `
PLEASE READ REVERSE SIDE BEFORE ` _� TOTAL "
CALLING FOR FINAL INSPECTION.
„}. OFFICE COPY