0608APPLICANT TO FILL IN INFORMATION
WITHIN RED LINES -USE BALL POINT PE
LY
"BUILDING PROJECT IDENTIFICATION
APPLICATION &PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NOMgER
O 6 O 8
,a"ta+ / � � J S/rZ'�F1 rsg'•K
PLAN Clat CK VALIDATION
:oiHs
t tl wf rr ra e k /i r
OTY. ELECTRIC PERMIT FEE
urAcw";
wu
UTLETS - SWITCHES -RECEP 5.00/1.00
LIC NO
LIGHTING FIXTURES 5.00/1.00
oowLsi to"%
PPLIANCES•RESIDENTIAL 4.00
PANELS 5.00
rHONE
DAT! OF APPLICATION
IIlr r
on
SIGNS 6.00-
PLAH C.CCK FEE PC NO
SIGNS TRANS. 3.00
SPECIAL CIRCUIT 6,00
Ncwl Mt
Llc No
.00DH EH°.
lHlEss
PERMIT VALIDATION
EMP. METER OR POLE INS. 16.00
issMOTORS
SEE FEE SCR.SERVICE
o
9,�
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CHANGE 10•(10
LICENSED CONTHACLORS UEfLAHATIOV
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1 herchy affirm That I am Licensed under Dru,iNun+of C'hapl<r v
l+ammrnrrng 'ith srrnon 70001 of UI,'aan 3 f the Rusrnri+anJ
i fol fol �p+t r(3
Lrc nu C' (+��-1,¢_ Lic, Ku hr vr`L 7
Pro&uw ('oJS r for
(lN'NI-.HRUILUI:R DECLARATION
I hereby alrlm That I a e mp1 from the ('on Ha.lui s Licrn+r
Law for the following reaw ISec. 7031.5. Rmmra and Yn,fesuon+
('nJeAHY enYu county which rcRwre+a r<nnn la+onsl n,cl, alter,
Impravr.J+•mulnhr reran any +Irn+lnrc. rllm to it, n+W n: r, alw
rrnu,res the applicant for such permit to elle a+igneJ snlrm<nl Ihal
he n hcenseJ runuanl to the rrov siuro of the Contractor', Ucrnse
L.I. I Charter 9lcommenc,ng wllh se+t ion 7GW I or Dn--,von 7 0l the
Rm na nJ Prolesvum ('oJrl or that hen <+emrl Ih<relmm and
'he lhesn(or lht alleged exemption. Any v,onnon o(Srcliun 7011.5
n>an>arrlmam h+r aprnml ,nhiecl+u,r arrnc,nnoacod pe"ally
of nut nuxr "OnNse hunJreJ Jol Wrs ISSlpl. 1'.
I. a n of u,e rroraty, o my rmrlo>rr+ w,m wage+a,
Ihcu wle ,.,oma Nan, well Ju Ihr rwork, and the structure n nut
unrnled or aOcrrJ for +ale ISc+. 7osa. HlDinu+ and Prof<+vom
('Wr Il,e fnnlrarlari Lic<nu Law Jur+nol arrly to an uw nee or
prwrrty was nudJ+or impro rs thereon. mJ who Juc„ach work
hrmsell ar Ihruugh hl, own employ res. rru+IJeJ that wch nnrrosa•-
,rmsarrnolmmnJrdaroueredrar+alr IL huwe+rr. me nmwing
red
n Inprovr,nrm i+ wm wnhin one Yue of von,plrnon, m< awnrr
nmlJrr well hAe the burden or rrusing that he JiJ not hunt or im
rune roe parPrw If valr.l_
(1 1, a wore ul Ihr property. am exJumcly moth. nog wllh
h,r •J ++,mucor+ to on+noel u,r protect Ise+. Twp. Rovmm+
uo
anJnl'rules m Code. Thr C'nnlnclor: Ll+rnu Law Jnes not arrly
n, ar, owner or pror+'rlr woo nndJ+ or ,mrune+ mercon. mJ woo
omni+ roe wJ, projrrl+with a vminclon,l hn•nsa•J punuam lu
nmfar,lra+wr:LmenseLaw.
❑ I .m exemrl under s<c . g 6Pe. her u,.+
ISSUANCE DATE
ELOG. ELFCr. PLG. MECH
❑ ❑ ❑ TJf
BUILDINGPERMIT
INFORMATION
MISC. REFER TO ORD
VALUATION
PERMIT ISSUANCE 6.00
ELEC. CONTfi. LIC. ND. ELEO
TOTAL
Pk HkllT TO
� Qt/✓
/)'«�'•:
OTY. PLUMBINGPERMIT FEE
STORIES
TYPE CONSTR
ALTER-DRAIN&VENT-WATER IEA.14.00
BACK FLOW PROTECT. DEVICE 2.00
OCC GROUP
RES UNrtS
ORAINS-FLOOR, ROOF, AREA,COND. 4.00
FI%TURES•PER TRAP 4.00
wFr.FLDOH ARu
rorAL A<REACE
GAS SYSTEM -11NC.4OUTLETS 4.00
GAS • V EM -OVER 4 (EA.) 1.00
AEW 20.00
BUILDING USE
RES IND CON Pg O++••
N ERS- 1 INC 5 V.B. 5.00
LAWN SP ER R 5 (EA.) 1.00
LLA
ASSESSORS PARCEL NO
SEWER-SA ITARYSTORM EA. 2001[/8.00
TRACT NO
PARCEL NO
WgTER H /VENT 4.00
_owner_.__.-_
WATER SYSTEM 4.00
ACC. DATE
ACO FILE NO
NORKF.HS'cONIPfFSAiIOS UIi�LARATION
WATER TREATING EQUIP, 4.00
1 hereby alfirm that I have a reel ifical[ of con+cnl lu wlflmurc,
mPrmincalr of N'Orkrri famprnunon Insurance. or a se Hrl N•J
Y+lherco(Isec. JXf10. Lan e.1. ��ff�•rler�
Nn.Company_r
ZONING
ENG. SITE NO
Z 2
h u0-
Q
Policy -__- -
Ll Cerner J+opy is hereby furnished
A kCeRincJ rY I-V yy I the uI non Jls luno.
lmam-_ S� ((yy��1't _
�R'•"" [�% Z�_
('h RTI ATI-ol' h. -.MPT ION tNDsl K'OHkI.�N'
�COSIPL
FIRE SPRINK
v 0 N�
ENERGY T la
v ❑ N❑
MISC.- REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOD ZONE
ALUC.
PLG.COniH. LIC. NO. PLG.
TOTAL
ELI
G. O
2
U o
LL U
(� W
} N
F z
U
NSATION 1\SURANC'I-
11'h,+ ,ectwn need or he romrleleJ J the prnnrl i+ for one
hunJreJ Julnn 1 S 1 00 1or les+.l
I ,.Airy ma; in he per(brm,ncr or u,r work for wort, uli+err-
mn I, Issued. I ""llnut emplu) any{•<I s. n i ,any mann �r • ac t••
hernme suhlrcl to the N'ork<ri Comr<nsallan L-II ('alnorn'a'
Umr- - ArN,cam
Y � N�
v � N❑
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
ALTER OR ADO TO MECH. 4.00
NOTICt. IU APPLICANT: If. aNrr making lhu Cen locale of t+-
empNon, )-should hreomr ,unjr+l to the workeri ('omrenMlron
pms,von+ of Ine Lahur Code. You most fmlhwnh ,ply wllh
+od, err,v,wrn+or, mi+r<rmit shoo he deemed reroteJ.
APPLIANCE 4.00
PLAN CHECK
FEE
AIR HANDLING UNIT(TO tOpODCF.M) 3.00
AIR HANDLING UNIT (OVER IOJ]COGEM)5.00
SEISMIC FEE
CONSTRUCTION LPNUINf, AfeNcv
EXHAUST H000 (WITH DUCT) 2.00
MICROFILM
I herehy affirm nnl men• I a conMrunion lemm"g agen.} Lor
the prrfunnan+e of Iht work for whrh This fermi[ n ivucJ Ise.
tool. c,v f.r Nv ��
LrnJcri Name
HEATING UNIT LTO 100,000 B.T.U.) 4.00
HEATING UNIT (OVER 100,000 g.T.U.17.50
ELECTRIC
Lcmler's nJJn•,s ------
I crndy ma 1 hour had ud. appnc,non and +ote uw Ihr ano,e
intoe nation n rrccl. I agrcr m comply wnh all city and roomy
nrJlnanrn and+sole law+ relating to huJJing . ,In +Iru<non, and
n<rrn> a�mon,e reprewnwNrrs of Inn dl> w <m<r neon u'r
ano,c-m<mmntd rrnpeny for m+rrcNon pnrpou+.
I NeI after to vara indemnify and tap harm H+v he oily al
raprmm, again+l lianimka, jaJgmenn, cods and <x Penn wind'
maY it anY way a e against uiA filY in wnsrqucnccs of the
goon 1 of lh,s permllru
a,...•-�
VENTILATION FAN (SINGLE) 3.00
PLUMBING
gpILER•CONIP I3 H.P. or 100,000 B.LU.) 4,(10
BOILER-0OMP lore.IW.000 e7Ul SEE FEE SCR.
�
MECHANICAL
MISC.- REFER TO O'
_
CONST, TAX
PERMIT ISSUANCE 9,00 �
MECH. CONT. LIC. NO.
�790�1
MECH.
TOTAL
-
TOTAL
S
OFFICE COPY
awrr or nrnuoanufmm�clar Unr
CITY OF CUPERTINO INSPECTION RECORD (Office Copy)
i
_ 19665 Stevens Creek
_0608
IMP11IT tic). SANITARY DISI. NO.
LOT 110. ADDIIESS
2 new air conditioners
G. Yammaoka
PROJECT
01-WER JOB
SITE P11014E NO.
PERMIT ISSUED
Date
ELECTRICAL
nuildine
Date Insp.
Electrical
flower Pole
_
Plumhin
Underground
llcchanical
- -
PouF;h Wiring_
'Peng. ('.,IS/!acct.
TTails
Solnr
Ccilin
FCrc Sprinkler
Fixtures Int/Ext
Sign
Notors
Grounding
Ilisc.
Temp. Power
Other
_ i
FINAL INSPECTIONS
Not Approved
Date
Insp.
s _
PLUMBING
Electric
Date
Insp.
Plumbing
Backflow
Mechanical
Underground
Solar
Underfloor
Pool
Partial Rou h
Crmling
Rough Complete
11 Innning
Solar Rough
Fira Dept.
(dater & Insulation
Health Dept.
!fain Drain
nuildin
R of/S Drain
Other
Gas
Other
BUILDING
Not Approved
Date
Insp.
Pad Certification
MECHANICAL
Foundation
Date Insp.
Pre-Gunite
Underfloor S.M.
Slah-Membrane
Ducts & Insulation
Bond Beam
Fire Dampers
Underfloor Girders
Fireplace
Floor Steel
Grease Duct & hood
_
Tiedo,,ms
One (lour Shaft
_
oinphrams
Condensate Drain
Seismic nracinR
Equipment Anchorage
halls -Panels
Flues & Comb. Air
Frame
other '
Lath
Not Approve
Wallboards Int/Ext.
Firewalls
Other
Not Approved