14573 (2) JT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
ILDI NG PROJECTI DENTI FICATION - - PERMITNUMRER
GING APPLICATION & PERMIT q A ���
ODIN - I LF
o?CS6�j7 SUNRISE jJ (�•(� UILDING—ELECTRICAL—PLUMBING—MECHANICAL
RES
OWNER'S - - -
A. NAME PLAN CHECK VALIDATION.
P�d(LR' QTY: . ' 'ELECTRIC PERMIT - FEE O 'y,C,-Il/'/\7
y4BiZs1+,n �, PHONE -rvE 359
y ONTRACTOR'5
ei,�Lf.• , NAMEI��-`G. . ': �• n 6 OUTLETS-SWITCHES-,RECEP 10.00/1.00
OW'�F Imo.. LI0.N0. ./p qQ14 LIGHTING FIXTURES' - '10:00/1.00 ,
ADDRESS runs APPLIANCES-RESIDENTIAL4.00
' PHONE PANELS 10.00 _ DATE OF APPLICATION(
ARCHIrecT�LVjJQR - PANELS (OVER 200 AMP) t '20.00 PLAN CH ECK FEE P.C.NO. -
OR.
1� ENGINEER - t
.LID.No. SIGNS TRANS, . o ' 3.00
' ARCH.OR ENG' - PERMIT VALIDATION '
ADDRESS,; - SPECIALCIRCUIT ' - 5.00
• zIP EMP.METER OR POLE INS. 20.00
Ars. I
AGGRESSDDRESS s - - MOTORS 'SEE FEE SCH:
eZO,Eg1`7 'S'VH atsa ros O SERVICE CHANGE - 20.00
. 'Wo �L]CENSIDCONTRACIORSDE LARATION ��
,Q o w I her byraffimt that Cam licensed under provisions of Ch,mlc,9 ' ISSUANCE GATE
(commencing with Section ]000)of Divismn 3 of the Business and _ BLDG E ECT. PLG. .MECH.
Professions C n at d li Li is in full fur a d eCfyscct f�
z o H License Clays AdH.d I Lic. o f hef¢g F jj 1�
9'y H G Uale��!: Cnnttuclur'd{'}�f —�I� IJ_ ' ' fft VJ�
P r M 4 BB{{ ING PERMIT
¢ 0 n OWNER-BUILDER DECLARATION - � AIOp RMATION
w ; u v, '. I hereby affirm tial I am exempt from the Contractor's License MISC.— - REFER TO ORD
a- VALUATION t Law I.,the following reason(Sec.7031.$,Business:md Professions � / I VALUATION $/FT.
s- —in PERMIT ISSUANCE BO O
Code:Any city or county which requirese permit to construct,also
a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC.
i w m LL requires the applicant for such permit to File a signet)sluColcul that TOTAL S�°� P PERMITTO s
he Is licensed pLonntt t0 the provisions.1 the Cou,a,,tm-s License '
.Hzi La..(Clldpter9(commencing with Section 7000)of Division 3 of(lie
¢ Qo Business and Professions Code)or that he is exempt therefrom and QTY. ' PLUMBING PERMIT 'FE /E' - e,
¢.r-$ the basis for the alleged exemption.Any violation of Section 7031.$ - STORIES TYPE CONSTR.
a 3 by any applicant fora permit subjects the applicant In a civil penalty
of not more than five hundred dollars(5500).)'. +' ALTER-DRAIN&VENT-WATER'(EA.) 4.90
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 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 not apply,to an owner of
property who bullies or improves thereon,and WllG dOL'S SnCI Wark FIXTURES-PER TRAP Fl B6 $O.FT.FLOOR AREA TOTAL ACREAGE'
`
himself t, or of inti his own employees,fors,provided that such improve- ,
himse are not intended or offered forsale.If,however,the building- GAS-EA.SVSTEM-11NC.40UTLET_56r66 .�5�• .
or improvement is sold.wilhin one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA'.) 2.00
builder will have the burden o1'Proving that he did not build or inn _ BUILDING USE
prove for purpose nl sale.). INDUSTRIAL'WASTE INTER.. 30.00 . RES IND �coN Pe oma,
❑ 1,as owner of the".Perry,a"I exclusively contracting wilt El 1:1, 0 O ' ❑
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 ofprolfcrty who builds Or improves thereon,andwho LAWN SPRINKLERS-OVER 5'(EA.) 1.00
contracts for such princely wilt a eonlrnctods)licensed pursuant to '
the Contractor's License Law. ' SEWER-SANITARY-STORM EA.200f1/10.00 . TRACT NO.- PARCEL No. '
❑ 1 am exempt under Sec.—,BAP.C.for this
reason 1 - _ - / WATER HEATER W/VENT .•B:B6 a —�
Ownc [)aleWATER SYSTEM 5.00 ACC.DATE, ACC.FILE NO.
WORKERS'COMPENSATION OfcLnRATION- WATERTREATING EQUIP. 5.00 -
,I herehy affirm film I have a certificate Of consent to self-insure, -
or a certificate of Workers'Conpensatinn Insurance,or a certified - ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
Pohcy No. Company - -
O ❑ Certified copy is here by'furnished. RE SPRINK ENERCYTI4
FZ Z -U Certified copy is fled with the city iah mibn division., ,
O - Applicant - MISC.- -'!' REFERLTO'ORD: Y❑ N n'Q N[
y - - PERMIT ISSUANCE - •1960
jr CIiRTII COMPENSATION
POF ENiAEION INS PROM WORKERS' FLOOD ZONE' A.L.U.C.
i W COMPENSATION INSl1RANCliPLG.CONTR. LIC>NO. PLG, -
CL'Z This section need not'be completed if the pennit is lis.one - TOTAL ,02• v.❑ - N�, v,❑ ry�
hundred d llars(S 100)or less.)
U O I c ndy that in the Performance of the work In,which this per QTY. MECHANICAL PERMIT' FEE FEE SUMMARY
LL H it I ed.l shall nut employ any Person in any manner so as to -
O w b co 'th3ecl to the Worker m
CopmluI two
tam s fCalif r iia
naLL Applicant - ALTER OR ADD TO MECH. 5.00 - BUILDING �-
}.vii NOTICE TO APPLICANT: If,after making this Cenifieate of Ex.
J' emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK'
provisions of.the Labor Code, you nnnt forthwith comply with FEE
U such provisions or this permit shall he decnmd revoked." AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 may,
CONS'I'RUC1'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10;MC.F.M.) 6.00 SEISMIC FEE .,3 J v
I hereby affirm ftat.there is a cotrstn¢tion,lending agency for EXHAUST HOOD(WITH DUCT) s 5-.00
llie'perfnnnance of the work far which this per it's issuc,]HScc. �_ MICROFILM' "•p' -
3097,Civ.C.0 HEATING UNIT(TO 100,000 B.T.U.19.8:80 -
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9,N
Lender's Address ELECTRIC '
I eerlify that l have read this'ppllalioa and state that the above eZ -VENTILATION FAN (SINGLE) •-F.66r
Information is correct I agree to comply with all city and county - PLUMBING _ p�
ordinances and stale laws relating to building construction and BOILER-COMP(3 H.P.or 100,000 B.T.U.)' 6.00 / �1
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE 7FEE MECHANICAL Jv
bove-men Uoned property for inspeUiun purposes• s
(We) agree to save; mdenmlfy and keep hanulcss the City of MISC. REFERsTO ORD.
• Cupertino against liabilities,judgments, costs and expenses which •1 CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE ��
r 11 11 P ii[. . MECH.CONT. CIC.NO. MECH. -
TOTAL 'yL/(''Q
Z.Signatumof pplican/Contractor Date
`+ a, TOTAL'
✓ OFFICE COPY
t
'POST THIS'CARD.NEARFRONT-OF BUILDING., .
PERMIT NUMxeR
00
--CITY- 1 . 1.4573
INSPECTION D,I,VISION
r..NER
JOB INSPECTION.RECORD� ERMIT'EXPIRATIONRESS=FST JUN.�:r.Pc� �_ UNIT# -• ` LOT# ' ''' - - PERMIT'EXPIRES IF WORK-
fir.' �- Q CONT , pT' I&� NOT STARTED,WITHIN'
INSPECTION DATE' INSPECTOR INSPECTION•RECORD _ 180 D4YS OF PERMIT ISSu-'
ANCE OR'180'DAYS FROM
FOUNDATION NOTE: -
LASTCALLEDINSPECTION.
LIFERALL GRADING AND-DRAINAGE•SHALLs BE INSTALLED % "
PR EGUNITE w TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAuoanoN •tiwY,,,„ '
`• CUPERTINO STANDARDS - - - ,1< •TM^""" 11' H,
GARAGE SLABS .'r. F � I •!r. , �I�'`�Vk.t,..o�ti. :,
•_ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEC
'UNDERGROUND /SLAB tiXGt TgcaZZ% (r, i' ,;,.;>, • �r
•'. PLUMBING'.
.- ELECTRICAL„
MECHANICAL!, 1331—B 5T xEOc, ��' O.
t ;I,uo p
g i. ogT3
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I��CC� ^L' � '�jR� - BUILDING PERMIT
WOOD FLOOR - 1. b • mom E �. j RMATION
PLUMBING T` Awn II. SrF T.
MECHANICAL 110 �0O �.A7 ^�. K..`O FC '.•' ':J'r
ELECTRICAL - - PERMIT To
• FRAMING
INSULATION STORIES TYPE CONSTR;
„ - - OCCLGROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
r T A TAE cRCAeE
� PROOF ` .NOTE NO AL`INS S LL BE ChD I�� pyo
DIAPHRAGM _ 1 .. THE CONS RUCTION TAX IS PAl o�15�' Y E^
a r rn Inc<.. IL ING usE
ROOF SHEATHIN , L r (7-}:-cb� (. I ' raN Pe ow..
APPLY NO ROOFING UNTIL ABOVEHAS BEEN SIGNED FINALS'% DATE INSP. 0
ASSESSORS PARCEL ND,
ROUGH SAN.a 1 .
PLUMBING - ELECT.ENERGY `.•_'� -
TUBS 8 ROWER P •-''S�],'3PLUMBING ENERGY TRACT NO. PARCEL No,
MECHANICAL �/, MECH.ENERGY
ACC DATE ACC F "E NO.
ELECTRICAL 1' " BUILDING ENERGY
FRAMING ELECT.FINALTEST - -
INSULATION '- PLUMBING - ZONING ENG SITE NO.
GAS TEST GAS A -
„ 191F.SPRINK ENERGY T.24
MECHANICAL ffFL.O�()[)
N� Y 'Q ' NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LONf: A.L.l1,C.EXTERIOR SHEAR ELECTRICAL RELEASEINTERIOR SHEAR - FIRE DEPT. NL YL; ,NL
• SHEETROCK" GRADE FEE SUMMARY
e EXTERIOR,LATH - BUILDING BUILDING '
INTERIOR LATH - TEMPORARY APPROVALS ,. � "
1- SCRATCH COAT , ELECTRIC PLAN CHECK 'f
'- GAS - FEE' '
'. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- - -SEISMIC FEE,
OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ' M'ICROF I LM
ARRANGE FOR INSPECTION BY PHONIN6'2524505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED"INSPECTION PLUMBING
O PLEASE-GINE JOB ADDRESS WHEN PHONING /—
r.�( Z MECHANICAL'' S7
r — SEE PERMIT FOR EXPIRATION DATE.
" CONST TAX'
IMPORTANT!
• t', _ . . ; ' /
PLEASE READ REVERSE SIDE BEFORE : TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY.