8602 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
k
,.JK BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT 8602 pry molten°ess _ LOT 30 �J O Z
FLAN 11 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
X OWNER PLAN CHECK VALIDATION
NAME :"k GDeAnzaCGioup,QA(Ga1,fforn CITY. ELECTRIC PERMIT FEE
NTRd. / PHONE
AME-croRs
NUTLETS-SWITCHES-RECEP 10.00/1.00
NAME
The
.r uc. ,r
LIGHTING FIXTURES 10.00/1.00
ADDRESCTOR'S .,411..Bore1JAVe, Ste. 410 PPLIANCES-RESIDENTIAL 4.00
CONTRA
' PHOrvE _ PANELS 10.00 DATE OF APPLICATION
AORCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER •� _�
Lm, SIGNS TRANS. 3.00
ADDRESS SPECIAL CIRCUIT 5.00 PE ATION
2070gBuaiti s's�`"Ctr„�$220
��i rl" .',n..ry-. n•r' i zip ' , a EMP.METER OR POLE INS. 20.00
APPLICANTS"- "t' F'- - MOTORS SEE FEE SCH.
ADDRESS 411 -Sorel Ave, Ste. 41U JUL 2 9 1985
SERVICE CHANGE 20.00
` TEMP.POLE 30.00 City Of Cupertino
� 00 LICENSED CON TRACTORS DECLARATION p rima
a wow I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE `
y G w (commencing with Section 8000)of Division 3 of the Rusin 55 and BLDG ELECT. PLG. MECH.
r H z Pmfesimns Code,and my license is in full force feet.
z O m - License Class __ -R Lia Nwnher
g o L w Contractor
BUILDING
- -
¢ a s 7--'r-� BUILDING PERMIT
¢ ¢w� OWNF:R-BUILDER DECLA RA INFORMATION
w O^ r Ihereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
¢y VALUATION $/FT.
F LL O j Law for the following reason.(Sec.7031.5.Booriessand Pmfceeions PERMIT ISSUANCE 10.00
.. Code:Any city or county whichrequiresapermittoconst ruct,dtcq n l
¢ ¢ a 0 improve,demolish,or repair amy structure,prior 10 itsisshance,also ELEC.CONTR. - LIC.NO. ELEC.
OLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w m A m he is licensed pursuant to the provisions of the Contractor's License `
ca z Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
EEO Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ F. the basis for the alleged exemption.Any violation of Section 7031.5 STORpES_ TYPECONSTR.
by any applicant for apermit subjects to applicannoacivil penalty ALTER-DRAIN -WATER IEA.) 5.00 - /A{-
of not mare than five hundred dollars tiro applicant
,
❑ I,as owner of tire 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. OUP S.UNITS
intended or offered for sale (Sec. 7044, Business and Professions OR A I NS-FLOOR,ROOF,AR EA,CON D. 5.00
Code:The Contractor's License Law docs not apply 10 an owner of -
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TEGACREAGE
himself or through his own employees,provided that such improve-
••' ments are not intended or uttered for sale.If,however,the budding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-.OVER 4 IEA.) 2.00 BUILDING USE
prove for purpose of sale.). E IND CON pe -Other
❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ' ❑ 'D ❑
licensed contracmrs 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 builds or improves thereon.and who• LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts lit Itch pmjccts with a rUntrnCtOul)lierrord pursuant n' SEWER-SAN EA.200f[I10.00
the Contractor's LicenseLaw. TRACT NO. PARCELNO.
❑ lam exemptunder See. ,B.te for tris WATER HEATER W/VENT 6.00 �jJ�
reason / `-��
t , Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
• WORKERS'\COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby,teof Ihhl IltavcaP,certificate ,.m,entmc,ht . ,rtsum' ZONING
or a earli(icate of Workers'Cnmpensationd nsu once,or o cert ilial -'- ENG.SITE NO.
copy t1womf(Sec.3800,Lab.C.). ,
Policy No.C<yp¢¢��fi t iY
Q / ❑ CIvIIRPd'Nd'pyk c y' u' r' FIRE SPEAK ENERGY T2
Z Z DtlQ•rlified copy i f d i h he city inspection dion.
O �p ant MISC- REFER TO ORD. Y � N� YO N�
~ w PERMIT ISSUANCE 10.00
fr - C F R'I'1 P ICA'f li °I.X:M PTION PROM WORKERS' FLOOD ZONE A.L.U.C.
Lu > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. ❑ ❑ ❑ ❑
CL Z (This section need not be completed if the permit is for one TOTAL Y N Y N
hundred dollars IS I 00f.,less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner so as 10
U become subject to the Workers Compensation Laws of.California.
0.LU Date Applicant" ALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE:'r0 APPLICANT: If,after making this Certificate of E.-
F. ? crption,you should become subject to the WorkersCompensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
CJ such provisions or this permit shall be deemed revoked.' AIR HANDLING UNIT(TO 10JMC.F.M.) 4.00
(ONSTRucrION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of Jhe work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Namen
nRa �e.>a�C$Y, �� HEATING UNIT(OVER 100,000B.T.U.)9.50
Lender's Address 'ELECTRIC
l iertify thatlhavr.read Wes application:mJ stpyai�(Iyrlc above VENTILATION FAN (SINGLE) 4.00
• information is correct. 1 agree to comply with al c t county BOILER H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over t00,000BTU)SEE FEE$CN. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino agar' t li; ilities 'uEl " .1s, costs mrd expenses which PERMIT ISSUANCE 10.00 CONST.TAX /1
may in any } o rue u. ins[ said Cify in consequenic of the (�
granting of 11 p tL MECH.CONT. LIC.NO. MECH. '
TOTAL TOTAL
Sigmture o(. I t/Corer clot eI
INSPECTOR COPY
x
K
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO R
INSPECTION DIVISION
PERMIT
NUMBERri
IiS Qfa
JOB INSPECTION RECORD
3 ecce i! h rJOBAKESS UNIT# LOT#
OWNER ie /, ZIP,, di LL, CONTRACTOR iNen ,
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LAST CALLED INSPECTION.
INSPECTION D&E INSPECTPR INSPECTION RECORD
FOUNDATION
LIFERO s
PERM ON
JUL 2 9 7995
PR EGUN ITE
2 / 02 ° k-
POUR NO CONCRETE UNTIL ABOVE A BEEN SIGNED
UNDERGROUND/SLAB
VALUATION
City Of oupo iiaoPLUMBINGQ.
PLUMBING
ISSUANCE DATEELECTRICAL
MECHANICAL
BLD ELECT. PLG. ME
MECHANICAL
G .
OFFICE COPY
DD NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNERauI DING ERMIT
I FORMATION
WOOD FLOOR VALUATION IFT.
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
FRAMING
sroRlEs TYPE CONSTR.
INSULATION
s
OCC. GROYP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
0. FT. FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
BUILDING USE
ESQIND CON PB Other
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH
PLUMBING //
GAS TEST
TR NO
cr f!
PARCEL NO
MECHANICAL 'l
a" V r
ELECTRICAL y FINALS 0 DATE INSP.
ACC. DATE ACC, FILE NO.
FRAMING SAN #
INSULATION PLUMBING
ZONING ENG. SITE NO,
GAS
MECHANICAL
FIRESPRI K EN ERG T.$4
Yo N V C] No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH -INTERIOR ELECTRICAL
FLOOD ZONE A.L,U C.
r E] N v L-] NE] LATH -EXTERIOR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING#'2 BUILDING
SHEAR EXTERIOR ri-.Z TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
IMPORTANT!
CONST. TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
ALLIIVG FOR FINAL INSPECTION rG .
OFFICE COPY