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11771 APPLICANT TO FILL IN INFOP ATION WITHIN RED LINES - USE BALL POINT PEN ONLY '. -SU�ILDING PROJECT I DENTIFIC PERMIT NUMBER BUILDING APPLICATION & PEST ADD ESS 11771 �1��/ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION j' �OGLGi/ORTH w.VSjlt?UL'f/O/d /3',U4 CITY. ELECTRIC PERMIT FEE \. +• PHONE4N .9700 CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.0 fr9c��.oen+ G,o is7Ru�9ioJ� tNU ��"� n UCpNG, % 09b LIGHTING FIXTURES 10.00/1.00 CONTRAD)is �..aryv/7A/TOnI/0 ae 0,;�{/ SAPPLIANCES-RESIDE NTIAL 4.00 ' ADDREAD/1 $/YL OS 9/><OJ'PHOrvE - 700 / PANELS 10.00 "� DATE OF APPLICATION ARCHITECT {/�f/ PANELS (OVER 200ENGINE. AMP) 20.00 'PLAN CHECK FEE P.C.NO. ARCHITECT /„�jgDn/5 UC.No .30/ SIGNS TRANS. 3.00 ARCH.OR ENG. q PERMIT VALIDATION ADDRESS-1/ac; ✓AN GC/REN SPECIAL CIRCUIT 5.00 ,4d ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S - ^ ADDRESS MOTORS SEE FEE SC -,j ///S-Ss�NANTaN:p�O ,fE/S� SERVICE CHANGE 20.00 / Cos ALT YY woo LICENSED CONTRACTORS DECLARATION ¢u v I hereby affirm that I am licensed under provisions0of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 o(the Business and BIOG. ELECT. PLG. MECy1. z w y Ix'cYTA! ItcTRd H w z Professions Cod and my license is in full fare and effect. z o m Licens las Lac.Number 9 z r Dale - - Contraeto S' a so f BUILDING PERMIT ¢ ¢w¢ OWNER-BUILDER DBCLAR ION INFORMATION License MISC. REFER TO ORD w 3 LL H I hereby affirm that I am exempt from the Contractor's - UATION SIFT, ^�H w0 a Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requires a permit to construct,alter, re ¢rt o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.NO. ELEC. 100 - D¢ 'requires the applicant for such permit to file a signed statement that TOTAL - PERMITT4 wm he is licensed pursuant to the provisions of the Contractor's License zi FLaw(Chapter 9(commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and OTY, PLUMBING PERMIT FEE ¢I C, the basis for the alleged exemption.Any violation of Section 703 L5 ST IES TVP CONSTR. by any applicant fora permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more Ihnn(Iva hundred cotters(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00O G OUP R S.UNITS their sole compensation,will do the work,and the structure is nut _ intended or offered for sale(See. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 ` Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work / FIXTURES-PER TRAP 5.00 , SD TF'GO AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 / -mems are not intended or offered for sale.If,however,Lite building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 LLOING USE _ builder will have.the burden of proving that he did not build or int- purposeofsale.). R IND CON PB Other prove for INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the property,am exclusively contracting with ❑ ❑ ❑ El- licensed licensed .subors to construct the project(Sec. Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions CCode:The Contractor's License Law does docs not apply // toan trowner of property who builds trimproves enseduand who LAWN SPRINKLERS-OVER 5IEA.1 1,00 3b.�-/ 7--OQ13 the Cont forsu Licenects Lwithacontractogs)licensed pursuant to SEWER-SANITARY-STORMEA.2001t/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ' ❑ lam exempt under Sec. ,B.&P.C.for Otis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION'S WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a Certified copy[her (Sec 38 dBC)Policy No y ,e - ' O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 z Z �g Cie ified is filed ith the city inspection division. •�- 0 Applteant •:' , e4w, F-u MISC.= REFER TO ORD. v[] N❑ Y ❑ No rn CERTIF LATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 ','� FLOOD ZONE AL.U.C. W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. LL ❑ This section need not be completed if the permit is for one TOTA Y❑ N❑ Y❑ N❑ Zi Z hundred dollars(SIO0)01lcs1.) L) 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. Ow. Date - Applicant BUILDING �/ ✓' C. ALTER OR ADD TO MECH. 5.00 - W NOTICE TO APPLICANT': If,after making this Certificate of Ex- 2 emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 j PLAN CHECK / provisions of the Labor Code, you most forthwith comply with FEE U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ' 1 hereby affirm that there is a consnuctaon Icnding agency for EXHAUST HOOD(WITH DUCT) 5.00 the performanceof the work for which'this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.G). - - . Lender's Name HEATINGUNIT(OVER 100,0008.T.U.)9.50 ELECTRIC , Lender's Address 1 certify that 1 have read this application and stale that lire above VENTILATION FAN (SINGLE) 4.00 information is correct. I agreeto comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, Lou hereby authorize representatives of this city to enter upon the BOILER-COMP tout,100,000 BTU)SEE FEE SCH. MECHANICAL m above- entioned property for inspection Purim.... _- -_ (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, Costs and expenses which CONST.TAX may in any way accrue,agaaust said City in consequence of the PERMIT ISSUANCE 10.00 granting of thix permit. MECH.CONT LIC.NO. MECH. /[�pyfn e& iz ti''�'eNBo.y�� TOTAL / TOTAL i,.t/rfof ApplicmtjCmunictor Drte / low- OFFICE OFFICE COPY • POST THIS D NEAR FRONT OF BUILDING „ERn+ITNu'C CITOF CUPERTINO 11771 P 7 ,. INSPECTION DIVISION ' JOB INSPECTION RECORD - c y PERMIT EXPIRATION JOB ADDRESS ILI.JXXJ(iiill/V/ UNIT# _LOT# -PERMIT EXPIRES IF WORK OWNER (/ CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INS ECTIONR RD 180 DAYS OF PERMITISSU- ANCE OR 180 DAYS FROM FOUNDATION ' �. 26 V la' 6 LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION S c -16 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL' SLOG ELECT. PLG. MECEL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING PERMIT INFORMATION• WOOD FLO R VALUATION SIFT. . PLUMBING MECHANICAL I $ PERMIT I 1 . ELECTRICAL i• 1 FRAMING i l,� STORIES/ — TYPE CONS._ INSULATIONt . •\` OCC.GROUP RES.UNITS ^ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT,FLOOR AREA TOTAL ACREAGE z OI APHRAGM�S`.uvrt- �( V BUILDINGUSE • RES.MND CON PS Olnn ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED � ,'� ❑ }� n55ESSORSPARCEL.NO. r ROUGH (.iU PLUMBING T,,e, -RL-87 3 TRACT NO. PARCEL NO. GAS TEST 7W '-A MECHANICAL7j- -$ ACC.GATE ACF FILE N0. ELECTRICAL aJ '3 '87 FINALS DATE INSP. , - FRAMING 7 SAN a zONI NG ENG.SITE NO. i NSU CATION - 'j-y Ab'I PLUMBING & Aq GAS f 7 MECHANICAL , FIRE SPRIrvK ENE RGV T.pa COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ? -° N . F L000 zoE ` C] "�aL.0 c. LATH-INTERIOR - . ELECTRICAL ` ❑ LATH-EXTERIOR 9,�-�] FIRE DEPT. - vNE] y N❑ ISHEETROCK 'S� _ o-g GRADE i - FEE SUMMARY - SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROV LS BUILDING 1 FIREWALLS - ELECTRIC PLAN CHECK ✓ ' „r GAS FEE- . NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ',SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM . 252-4505, ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC • UiI,ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING !;.PLEASE GIVE JOB ADDRESS WHEN PHONING. G - MECHANICAL 1 - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. .I OFFICE COPY G. CITY OF CUPERTINO P opyE. GAS SERVICE NOTICE �dvnc � 6 9 �7 To You are hereby authorized to connect the GAS service for ! Owner or Tenontp 9 At New Service— No. ervice No. of Meters Reconnect No. of Add. Meters Move Service 41 Move Meter PLUMBING INSPECTOR fiu ©„ ELECTRIC SERVICE NOTICE P.G.B E.COPY BUILDING INSPECTOR'S NOTICE CITY OF CUPERTINO To You are hereby authorized to Connect electrical service for Owner or Tenant_/�e;e-/<wGt/` T/2 1191- At �' / i> G No.of Wires Size of fresG? . Size of Switch Motor Load Voltage Phase Heating Load K.W. Voltage `1 Llght 110New Service _Reconnect No.of Meters Hem 170_Three Wlre More Service No.of Add. Meters Power Three Phase Move Meter Qr ELECTRICAL INSPECTOR y i Cupertino Ditopy rY BUILDING INSPECTOR'S OFFICE CITY OF CUPERTINO ,❑ Bockflow Device Sanitary Permit No. {,,7((11 Sewer Connection Plumbing Permit No. /1771 6z-plumbing Final Lot No. Owner or Tenant Gt107 nr 7fIf/ Cf Tract Date Connected 19_Date Final 6 19 0'/ vtvi I BUILDING INSPECTOR'S OFFICE Bldg.Dept. CITY OF CUPERTINO Office Copy ❑ Backflow Device Sanitary Permit No. 7/ ❑ Sewer Connection - Plumbing Permit No. /t EI—Plumbing Final Lot No. �I Owner or Tenant Tract /1 y ' Dare Connected 19Date Final 19 -PLUMBING INSPECTOR OFFICE I , CITY OF CUPERTINO COPY GAS SERVICE NOTICE 19 VI To You are hereby authorized to connect the GAS service for �L Owner or Tenant At New Service No. of Meters Reconnect No. of Add. Meters Move Service P . Move Meter '/ PLUMBING INSPECTOR - -"'"� '-'� ED II ELECTRIC SERVICE NOTICE OFFICE COPY BUILDING INSPECTOR'S NOTICE ` CITY OF CUPERTINO , 1.9 To _ You ore herebyr authorized to/Connect electrical service for 1 Owner or Tepn�o nt / " U/w At No.of Wires .Size of Wires Size of Switch Motor Load Voltage Phase I 1 Heating Load K W Voltage GqM 110_New Service X Reconnect No.of Meters Heat _ 120Three Wire More Seivice No.of Add.Meters PowerThree Phase Move Meter �• ELECTRICAL INSPECTOR '— �7 CERTIFICATE OF COMPLETION BUILDING INSPECTOR'S OFFICE �OTC.1 / CITY OF CUPERTINO DATE n - 2-IO' 19 r�i BLDG.. PERMIT NO. THE BLDG. LOCATED AT -7X / ?�'C' �" ^0 OWNED BY \A/01) C MPLETEDI FOR USE AS h HAS BEEN AL'TEREDT` 1 r BUILDING INSPECTOR `"