16147 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
13U EDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER
^�°AE�� I°S`l0 fJ . TAIJ �p,v APPLICATION & PERMIT I �+� �
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I o
OWNERa `T'an1 DEM Got�P�T E(�-S
PLAN CHECK VALIOATIO
NAME QTY. ELECTRIC PERMIT FEE
PHDNE PL CJ-) � �3
A.i✓qp NAMECONTRACTORA*J Ds GON S'I', UTLETS-SWITCHES-RECEP 10.00/1.00
LC,NO ILIGHTING FIXTURES 10,00/1.00 "
CONTRACTOR'S t 110 GO L£MAN
ADDRESS T Q� PPLIANCES-RESIDENTIAL 4.00
St `, / I �j
,N p GL h? & PHONE IS PANELS 10.00 DATE OF APPLICATION
ARCHITECTr4k,RK� �(C� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR DESIGN
ENGINEER
GREG 8vN1T0kIG.nD.c l(o SIGNS TRANS. 3.00
ARCH DR ENG. /r Oq p,�fl1NGS DR SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS L 'J _
MTQ • V I E_W Z 4 1r EMP.METER OR POLE INS. 20.00
APPLICANT'S Sa/V1 F MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
o x Geri�i�
F
02 LICENSLD CONI'RACI ORS DECLARATION
az U 1 hereby affirm that I ani licensed under provisions of Cheptc,9 ISSUANCE DATE
<-d
(Commencing with Section 7000)DI Division 3 of rhe Businee.and BLDG. ELECT. PLG. MECH.
r
Pro]esium CuJc,ppl my lin•nu i.in fulliul w•vu/1 fi•cl
a o 'u� - License�;la, Lic.Num her ��:_"_I ❑ ❑ ❑
4 z r or
O DateCant- I - FC' Cunt newt ii. .
rf C •'.'.
a a OW'NE R-BUILDER OECLA RA BUILDING PERMIT
A T
0 o Cr INFORMATION
w I fetch,'Iona that I uio es<ngn from the Conlraewl's Lioeine. MISC.- REFER TO ORD
Aoj Law fur lire following r...HH.(Scc.7031.5,Ru,inessand ProlcIiins VALUATION S/FT.
. - PERMIT ISSUANCE 10.00 /Y��
Code:Any city'or county which requlmaa permit to conwmn.alter. 110 "�^-'
punprose,deloOlish,or repair any NURIemn',pour to its isisOanre,Asia ELF.C.CONTH. LIC.NO. ELEC.
_ O S, rcquinti the'aP plieant lo,such penal)to III,'a x,91111 v(m eiacnt Thal TOTAL PERMIT TO
u se $ he is licensed punuanl to the R.,oi.Rs ul the Canrtaclm's Litt'nx �rq
r ¢ Q Law(Chaptcr 9 l coinmrncing with lection 7000)of Iris nion i of rise I 1� Fit
F x a Business and Protes,lois C,10 or that he is 11'111111 Ihrlrf(aln and DTV. PLUMBING PERMIT FEE r-� `-
r the basis for[lie bus, exemption,Any va,flia11 ntoa.ll J 7031.5 STORIES TYPE CONSTR.
d ; by any Runic than
lion unocddollar, S500r)ieam wacivil laenulty ALTER-DRAIN VENT-WATER IEA.) 5.00
of nor nmro-ne live[In, H. Julian(ny nip
❑ I,av ownrr of the progeny,or my,induyee,with wages:, BACK FLOW PROTECT. DEVICE 4.00
their xtle CJnlPemarian, will to tic soli,,and tiro xr meturc a sol DEC.GROUP HES,UNITS
intended or olered lar sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cale:The Contractors Licens,Law does not apply to on owner of
propeny who builds or;monis,,thereon,and who Joey such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
himxlf or through his own engduy'eero.Pt m'iJed that cod,imps...
menu arc not in[ended or or l or sale l f,howrvcr,Die building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or hnpruveincnr is sold within one year of completion, rhe owncr-
builder will have the burden of pro ing Dur he did nor build or int- GAS- EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
RES IND CON PB Oma
prove for purPow of sAc.1.
❑ I,as INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
owner of the Pmt'L'ny,unl uclusivcly ont crust log with
lies sed contract.,, Io construe the project(Sec 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Profession,Code:Thr Contra......License Law Joe,nut apply
to an owner of progeny It,,builds or inpmves thcr.un.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for suer projects with a eontnnous)llevnttd punomn[[i. SEWER-SAN EA.200h/10.00
the Con Dartar's License Law. TRACT NO. PARCEL NO.
❑ Ism eaennpr under Scc ,R.SP.C.ITN Otis WATER HEATER W/VENT 6.00
rcawn
0''." Ual'' WATER SYSTEM 5.00
ACC.DATE ACC FILE NO.
N'ORKERS'CONPENSAl'ION DECLARAROfN WATER TREATING EQUIP. 5.00
I hrraby at fro trial I bare a art ilii re at conx•m la wIiim,i e,
oraeernlhedle of ACorkers'Componwdon Insunncq or a certil'ieJ ZONING ENG.SITE N0.
copy 0iemollSee.3800.Lah,C.).
Polio No. CompunY /1=
b ❑ CN-( led ropy'is hereby lunnixI cd' FIRE SPRINK ENERGY T 24
Z Z e Certili J spy isi riled irll rbc 'I' iispcaiun Jicision.
07 alp"pTcam f Ut_rr.'" -'-�) ` MISC. - REFER TO ORD. Y ❑ N❑ Y ❑ N❑
CRTI FIG" "OOP'EXEMPTION
AIIPTI OI FROM WURKIikS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
W > CO.%I1'ENSAI'ION iNSURANCI?
PLG.CONTR. LIC.NO. PLG. E] ❑ [:] ❑
CL Q This section nerd no, Iia compicied it the Renoir is for one TOTAL Y N Y N
L 2 hundred dollars(S1001 nr less.)
U O I cerlill mat in the Rcrfonnonec w the work iia which OIi,per' QTY. MECHANICAL PERMIT FEE FEE SUMMARY
U_ 1- coir is ,a,d, I doill nut employ oily purwn in any n,nncr s0 ax w
O w h,,.RHl wbjen to[Ile\lbrkrri C'.mpenm[iun Law,of Cabin...i,. -
a .are ,y+ph:am BUILDING
} In NOTICE TO APPLICANT: Il.after nuking Doh C,Rdicatr of IG- ALTER OR ADD TO MECH. 5.00
F 2 anplion,you dmuld become subject to Thr WHC,,,('aiapeisatou APPLIANCE - 5.00 PLAN CHECK
Oropermit
of rhe Labor Code, you Inust forthwith comply with
U such prosbaone or this pert shallm
be deeed AN
res.ked_ AIR HANDLING UNIT(TO 1000C.F.NL) 4.00 FEE
CONS I'RUCI'ION LENDING AGENCY AIR HANDLING UNITIOVER 10)0000EM.) 6.00 SEISMIC FEE
I hereby anion that there is a construction lending agency Iia EXHAUST HOOD WITH DUCT) 5.00
rhe perl'ormuncr .1 the Anti, fur which this panni, i,issued(See. MICROFILM
3097,Civ.C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
LcnJrrS Numc H EAT I NG UNIT 10 V E R 100,000 B.T.U.)9.50
Lender',Addn,s ELECTRIC
I certify that I hose read rhisappliclawn and state But rhe above VENTILATION FAN (SINGLE) 4.00
intonation is eor,T..1. 1 vg,,e to comply with Al city and county BOILEA-OOAM 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordran"s and state laws relawlg to building cunt/nmllmt, and
limey authorise rcpresn foriins inspection
this cip' es cone upon rhe BOILER-COMP (Over 100.000 RTU)SEE FEE SCH. MECHANICAL
Trude-mentioned property for Otse,p of tri purposes.
(We) agree to save, indenutily and keep harmless the (-it, of MISC. - REFER TO ORD.
'ujvr.into ignin,t Lido irin, iiR1,,lncnls, costs and ealmnxs which PERMIT ISSUANCE 1000 CONST.TAX
ay in any ata) acerae ay tM said Cry' in Ruw,.cN,, .1 rbc
.1thisRenniLl MECH.CONT.
LIC,NO. MECH
_J C' L-'Ic,.. =I / OTAL TOTAL
% '':'.
igrururc al ApplicuntlC'mlruclur Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF'BUILDING
PPR&lIT NUMBER
f "CITY,OF CUPERTINO 16147
INSPECTION DIVISION '
4. JOB`INSPECTION IRECORD r-
.
PERMI T EXPIRATION`
JOB ADDRESS�""T.Q N 76-V71- y /t ✓L UNIT# LOT#
^� n PERMIT.EXPIRES IF WORK
OWNER TRNCTOR (/ OSC' CeIVr7 IS NOT STARTED-WITHIN
INSPECTION DATt INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- -
FOUNDATION ANCE-OR 180 DAYS FROM
.NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITHTHE APPROVED PLANS AND CITYOF ReRMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
�� � � ..—•�'. �_.`;
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED q-Ivi4ei
/✓ '
• UNDERGROUND /SLAB 1=20koto Z 3 "a&TROCAC
PLUMBING . - I I �5%
ELECTRICAL _ ISSUANCE DATE
MECHANICAL - DG ELECT PLG. MECH.
i El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT,
PLUMBING
MECHANICAL
PEHNIH TO
ELECTRICAL
FRAMING IIIN T\ l(��,
'INSULATION
STOHICS TYPE CONSTH.'�
OCGGHOOP RES UNITS
' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF -NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SIT. T'`L°°I'nl�cn ioTal.aau;ar.e .
DIAPHRAGM •? ' THE CONSTRUCTION TAXIS PAID
j
BUILDING USE
ROOF SHEATHING Ics IND Ic ❑ LON Po 011111
❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO.
ROUGH SAN.p
PLUMBING ELECT.ENERGY '
TRACT NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY -
MECHANICAL - Y7 MECH.ENERGY
'ELECTRICAL' -sy BUILDING ENERGY Acc,DnTE Acc.FILE No.
FRAMING ELECT.FINAL TEST
ZONING ENG SITE NO.
'INSULATION PLUMBING -GAS TEST - GAS -
MECHANICAL - FIRE SPRINT: ENERGY T 2
•COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ v 0 NO ❑ N�
. .
IE ROODZONE ALLLC.EXTERIOR SHEAR, , ELECTRICAL RELEASE �.
.INTERIOR SHEAR' FIRE DEPT. '3-.� rEj NYL NF]
'SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
4 'INTERIOR OATHTEMPORARY APPROVALS �7
:SCRATCH COAT JELrCTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILOING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE:FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE 'WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
I0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
• - CONST.TAX
IMPORTANT!, p
PLEASE READ REVERSE SIDE BEMIRE. TOTAL
CALLING FOR FINAL INSPECTION.'-
-OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY =
UILDING PROJECT IDENTIFICATION PERMIT NUMBER.
BUILDING APPLICATION & PERMIT 16147
ADDRESS I a gq O �I .TA�I'Ca V
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNERS PLAN CHECK VALIDATIOtf-
NAME Tp^1JDEM GOMPUT��-S OTY ELECTRIC PERMIT FEE �y/�/ "FJ.3
PHONE - PL CT) 305 +-
�` NAMERAcroR's ahl OS GIN S'I'. UTLETS-SWITCHES-RECEP 10.00/1.00
LIC.ND.Ir2-Osvl LIGHTING FIXTURES 10.00/1.00
ACONTRACTORS loth AOqL'EAmhN t P� APPLIANCES-RESIDENTIAL 4.00
5b.n1 A -GL RFS{ PHOME �S PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE .C.NO.
oR D�dSIG NMa.RK! PANELS (OVER 200 AMP) 20.00 -
ENGINEER.
GREG BvrJT`okIC.�N.C* SI GINS TRANS. 3.00
ARCR.OR ENG. /003 A W VINGS I]r SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ADDRESS f
µTL V (Ew ZIP 3 EMP.METER OR POLE INS. 20.00
ADDRESSsF - MOTORS SEE FEE SCH.
SERVICE CHANGE '20.00 /'
C o LICENSED CONTRACTORS DECLARATION 044
a U u I hereby affirthat I am liceed under provisions of Chapter 9 ISSUANCE DATE
m ns
-
m Qa (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H Professions Code.trod my license is in full fur ❑ ❑ ❑
z o'„{' - License la F>- Lic Number
9 a r w DatC �' Contractor
m E o BUILDING PERMIT
wa a
F.
; OWNER-BUILDER DECLARATION MISC. INFORMATION
- REFER TO ORD
. H I hereby affirm that I am exempt from the Contractor's License VALUATION S/FT.
uoLaw for the following reason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permit loconstruct,alter,
R ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
LL
s- requires the applicant for such penin to file a signed stmemeRl that TOTAL PERMIT TO
d w m he is licensed pursuant to the provisions of the Contractor's License _ I`1 �
F z Law(Chapter 9(commaneingwith Section 7000)of Division 3 ofthe
a I'x(l
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR:
n , by any applicant for a permit subjects the applicant to_a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(551X)).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE m 4.00 oee.caouP RES.UNITS
their sole compensation,will Jo the work,and the structure is nut
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 builds or int proves Whereon,and who dna such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
hintmlf or through his own employee ,provided that such ilnprove-
mentsurenotimcndedonl
(it for sale.If,however,the build'mg GAS-EA.SYSTEM-J1NC.4OUTLETS 6.00
• or improvement is sold within One year of completion, the owner- GAS-EA.SYSTEM'-OVER 4.(EA.) 2.00
builder will have the burden til'proving that he did not build or tin- BUILDING USE
RES IND - CON PB Osber
prove for purpose owner of sal,).thep INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ 0 11 ❑
❑ d as owner of the property,he exclusively ec (Sec.
contracting with
licensed contractors to construct the projectse Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's o License law Joos not apply
no frowner of property who builds orimprovesthereon.and who LAWN SPRINKLERS.-OVER 5(EA.) 1.00
conthe Cochforsu LoreaodswinharnntracmAs)licensed pursuant no SEWER-SANITARY-STORM EA.20th/10.00 - TRACT NO. PARCEL NO.
the Con tractor a License Law.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COM PYNSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00
_ I hereby affirm Ihan I have a curnifitale of consent lir sell-insure,
a a certificate of Workers COmpco.saran Insurance,or a v died ZONING ENG.SITE NO.
copy thereof(Sec.3800,LA.C.).
Policy No. Company
O ❑ Certified copy,is hereby fuTlxt d. FIRE SPRINK ENERGY T 24
Z Z /�Cemfed `op is triad�Ynh�y e ci ns coon divisions -
O Kp T,a,I IN/t',t�sc-�-✓�^ e- MISC.- REFER TO ORD. -Y � N❑ Y ❑ N�
CC LO CERTIFICATI-OP E EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00Tylo
OR ZONE A.LUC.
W > COLIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. N YN
EL O (This wedon need nal be completed if the permit is for one TOTAL
0 Z hhni dollars(SION)or less,)
U O I ccNily than in the p,rtcrnnriee of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY"
IL I- oil is issued,I shall not employ airy puma...in ahiy torn..Mh as to
O W become subject to the Workum'Ooopen atiun laws of Culifonhia.
a Dale Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING 67
>_ 0NOTICE;TO APPLICAN 1': If,after making this Certificate ul lix�
F. ? sorption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cale, you must forthwith Comply with FEE
U such provisionsor this permifstall be deemed revoked. AIR HANDLING UNIT TO 10AODC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=CF.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 the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Na
Lender's Address me HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Icertify,that ,have mad thisap,Mahon and stale that lire above VENTILATION FAN (SINGLE) 4.00
•. intirnratiom u correct. 1 agree lir comply with all city and county PLUMBING
ordinances and slate laws relating no building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to Save, indemnify and keep harmlee the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
ay in.any way ace a ages' st said City in cmLse Ince of the
a li O(lhis unit. MECH.CONT. LIC.NO. MECH. q /
0- --1 b9,6 TOTAL . TOTAL L
Signature of Applicant/Contractor Dille
OFFICE COPY l