14494 (2) APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN ONLY. .
BUI LDI NG PROJECT I DENTI FICATION - 1EERMITNUMBER ,.
Ao^o°I $ APPLICATION & PERMIT-' Q
BUILDING-ELECTRICAL-PLUM BING' MECHANICAL 11449,4
CANER'S PLAN CHECK VALIDATION
"nme ELECTRIC PERMIT rr- FEE •,
t6v.\F Vt-W V, SALIN Eye 881 0
CONTRACTORS
NAME .. OUTLETS-SWITCHES-RECEP 10.00/100'111"A C1
0.00/100't1"►G LIC.No CJj r' LIGHTING FIXTURES 10100/1.00
CONTRACTOR s .. - PPLIANCES''RESIDENTIAL'- 4.00
ADDREss
AS�GG�'j�^
11 �K r PHONE 9to,4U0 PANELS - 10,00 ..T1GATE OF APPLICATION
ARCHITECTPLAN CHECK FEE , P.C.NO.
OR. T. . PANELS (OVER 200 AMP) 20.00
• ENGINEERLIC.NO- SIGNS TRANS. ' . ' 3,00 •i
ARCH.OR ENO, , '.PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT - 5.00 ,
'
ZIP, TEMP.METER OR POLE INS. 20.00 .1
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
'.
SERVICE CHANGE 20.00
C o, _ LICENSED CONTRACTORS DECLARAaTION
: .
Q U.U' I hereby afllM Section
I am licensed under n 3 17the of Chapter 9 - .e ' ISSUANCE GATE -
N Q.y-. (commencing with$tt'lion 7000)of Division 3 of Tile Business and BLDG. ELECT. PLG. "MECH.
H z Professions Cod,,and my-license is in full force and effect ❑ ❑ ❑
z o - License Class Lic.Nuber - -
o m - Dale mContractor
¢ -' BUILDING PERMIT
r 0 w ¢ OWNER-BUILDER DECLARATION: - '
° MISC.- 'REFER TO ORD INFORMATION'
w3 IL y I hereby affirm that em-exec.7 from the icessacmr•r License VALUATION S/FT.
H =o j Law fur Die following reason.(Sec.7031.5,Ifusiness and Professions PERMIT ISSUANCE - 10.00
Code:Any city or county which requires a permit m consimd,alter, /��
QQQD Improve:demolish,Or repdn any Structure,prior to its Issuance,also ELEC.CONTR. LIG NO. ELEC. • tl�TlrOl1 r�1�� "
R requires the applicant for such permit to file a signed statement that - - - TOTAL PERMITTO
a cam he is licensed pin uurt to the provisions of the Contractor's License "'" •••777���
Law(Chapter 9(commencing with Section 7000)of Division 3 of the C
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE' ;
¢ H m tire basis for the alleged exemption.Any violation of Suction 7031.$ _ STORIES TYPE CONSTR.
US by any applicant for a permit subjects file applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 '
of not more than five hundred dolldrs(b500).): -
❑ I,as owner of the properly,nr my employees with wages as BACK F LOW,PROTECT.DEVICE^ 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and thv'xftuelum is not -
"__-_--.- intended or offered for Sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does and apply to an owner of
properly Who builds or improves thereon,and who uhres such work FIXTURES-PER TRAP 5.00 'SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 INC.4 Ol1TL ETS 6,00
ments are not intended or offered far sale.II,however,the building
of improvement is sold within one year of completion,(lie owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that lie did not build or int BUILDING USE
Prose for purpose ofsale.).. INDUSTRIAL WASTE INTER.' 30.00 HES .IND ' CON PB' other
--10 I,as owner of the property,ani exclusively citntractin,with 11 El El 11licensed contractors to construct lire project(Sec. 7044,1lusiness LAWN SPRINKLERS-1 INC 6.00 ASSESSORS PARCEL NO,
and Professions Code:The Contractors License Law does not apply
fit an)wart of property who builds or immovee thereon,and who LAWN SPRINKLERS-OV ER 5(EAJ 1.00
contracts forsuch projects with a conlractor(s)licensed pursuant toSEWER-SANITARY-STD 0 t
tlIe Contractor's License Law. TRACT N0. PARCEL NO.
❑ I at,exempt under Sec.` e,&P.C.for this WATER HEATER W/V B 6.00
reason
Owner - Dale WATER SYSTEMACC.DATE ACC.FILE NO.
I WoRKERS'COMPIiNSATION DECLARATION WATER TREATING EQUI . " 5.00
• I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a cerified ZONING_ ENG.SITE N0. e
copy thereof(Sec.3800,Lao C.).
Policy No. Company _
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T24
Z Z ❑' Certified iupy is filed with the city impaction division. MISC.- REFER TO ORD.
p - Applicant - _ .' . V ❑ No V-❑.,1N❑ +
P: y " .0000-
PERMIT ISSUANCE 10
CF-RTIFICAI'1'Oil EXEMPTION FRONIVORKF,RS' .O FLOOD ZONE' - A.L.U.L. f
LU COMPENSATION INSURANCE - � PLG,CONTR. . LIC,NO. PLG.
CL Z (This section need not be Completed if the pcnnil is for one TOTAL - V❑ N❑ Y ❑ N❑
hundred dollar.61001 r lose,) - -
L) O 1 certify that in tire performance f the work for which this Per OT MECHANICAL PERMIT FEE FEE SUMNIARV
LL I- mit¢Issued,I shall not employ an Person" my manner so as to ,
O W beeape sl�yeul��fg�,yth Worker: Con 11yVii ws of Cvlilnrmv - -
y
Date 14=311AI tilicenf a ALTER OR'ADD TO MECH. 5.00 BUILDING
} W NOTICE TO APPLICANT If,afar...akin s Certificate of Px
Z emptioncyou should become subject to the Worker.Compensation APPLIANCE t 5.00 PLAN CHECK
provisions of fire Lubar Code, you must forthwith comply with - FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00
CONST'RUCTION LENDING AGENCY , - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ,
I hereby affirm that there is a constriction'lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
I the performance of the work for which tit is permit is issued(Sec. - MICROFILM
3097,Civ.C.).' - HEATING UNIT(TO 100,000 B.T.U.) 8.00 • _
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
- Lenders AJAress - ELECTRIC
I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 -
'� information is correct. I agree to comply with all city I'H county - PLUMBING ,
ordinances and stat, laws relating to building construction;and BOILER-IX3MP.(3 H.P.or 100,000 B.T.U.) 6.00
' hereby authorise representatives of this city to-,nter"upon file '+
atove-mentioned property for inspection pur;1H, S.Y BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL
�(We)Agree to.eave_indemnify and keep harmless the City of ° MISC.- REFER TO ORD_ . -
_�._ Cupertino against'liabilities,Judgments, costs and expenses which - CONST:TAX
may Rin-any w accrue against said City in consequence of thL PERMIT ISSUANCE 10.00
•ram) o`ihia pe O y MECH.CONT. f' LIC.NO. MECH.
�^� TOTAL 'TOTAL
TgMfurc of Applicant/Contractor Dote - - -
OFFICE COPY:. '
• •POST THIS CARD NEAR FRONT OF BUI,LDING`'
• • PERMIT NUMBER
CITY.' OF CUPERTINO '
—
INSPECTION-DIVISION �`��"4
JOB'INSPEC'TION-RECORD',
PERMIT EXPIRATION.
��oeADDREss 2161`5 STEVENS CREEK BLVD uviTu - _Corti
PERMIT EXPIRES IF,WORK,
OWNEa ..•:'HOME STATE SAV'TNGS ` CONTRACTOR• .. JOMIND INC , - IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM'•
' FOUNDATION NOTE: - "
UFER - ' ALL GRADING AND DRAINAGE SHALL BE'INSTALLED '.LASTCALLED INSPECTION.
- -
PREGUNITE' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMrt VALIDATION
CUPERTINO STANDARDS. . . -
GARAGE SLABS -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /4`. 1'
UNDERGROUND /SLAB
PLUMBING,
,• ELECTRICAL' ' ' ISSUANCE DATE
MECHANICAL- - , , PLUG ELECT. I PLG. MECH
4
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ., - - _ BUILDING PERMIT
' WOOD FLOOR, •,�. .,� INFORMATION
PLUMBING -t; - VA,.UAIIDN " " $TFT.
i MECHANICAL , r�A "•�,
ELECTRICALPERmn TO
Gm OT loulm",
.FRAMING '
I INSULATION - . ,t - STORIES • Terry CONSTR.• .
' .00C GROUPRES:UNI TS
�-, `•` ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF' ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE' "Ir IT rEooR AREA TOTAL ACREAGE
DIAPHRAGM HC
THE CONSTRUCTION TAXIS PAID ,
BUILDING USE
`'��;..' ROOF SHEATHI NG : '• s IND CON PB - Oma,
I. APPLY.NO ROOFING UNTIL ABOVE HAS-BEEN SIGNED FINALS - DATE INSP. El El ❑ � ❑
ROUGH SAN.Nr
_ ASSESSORS PARCEL NO ,
I 'PLUMBING ELECT.ENERGY - -
TRACTNO.' PARCEL NO
TUBS&SHOWER PAN - - PLUMBING ENERGY' -
MECHANICAL MECH.ENERGY -
AC .DATE.' ACC.FILE-NO.
ELECTRICAL - r . 'BUILDING ENERGY �? -
FRAMING - ELECT.FINAL TEST ,,ENc.SITE No.
'INSULATION PLUMBING +
GAS TEST - GAS
MECHANICAL EWE SPRINK . ENERGY T.14 i.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED _HEATING - •- Y ❑"'ti�' Y E] N❑
EXTERIOR SHEAR ELECTRICAL RELEASE . . FLoou zorve .'aL Uc.,
❑ .No L N❑
,INTERIOR SHEAR •+ - �F.IRE DEPT:
SHEETROCK GRADE'`, FEE SUMMARY
EXTERIOR'LATH BUILDING + -
INTERIOR"LATH .. - TEMPORARY APPROVALS BUILDING
a +P
"SCRATCH COAT;: ELECTRIC LAN.CHECK- ,-
' GAS FEE . r.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, SEISMIC FEE, ,
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUI LDING INSPECTOR. 'MICROFILM
ARRANGE FOR. INSPECTION'BY PHONING 252-4505, ELECTRIC
an Fw-� ONE WORKING .DAY BEFORE REQUIRED"INSPECTION. PLUMBINGt '
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
! f f ` - MECHANICAL
SEE PERMIT FOR.EXPIRATION_ .DATE —
IMPORTANT! CONST.TAX
PLEASE READ-REVERSE SIDE BEFORE °` TOTAL '
CALLING FOR FINAL INSPECTION.
00FICE COPY