16327 API-,I-,,ICAIV-I TO DILL IIV,II hpflA-IIUIV WITHIN HED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDEN I TI �� PERMITNUMBER,
RUILDING -L F APPLICATION & PERMIT
Ap°FESS z 16327
C1A.pC-YCTIWo YJ�O� 4- BUILDING - ELECTRICAL-PLUMBING -MECHANICAL il
c
oNrvE1r5
AMC � ' l3Ni c,
ry5LJ7-r ¢V D - PLAN CHECK VALIDATION
C.� (� y QTY. ELECTRI PERMIT FEE `j� </,�y'1.
�/ f L.1 6-"Ir- N -RHONE I l -0�(L• Li- 43 - `lit 6 1 1 -
CONTRACTORS
NAME TeYZVCy 1-320"I"' OUTLETS WITCH REC 10.00/1.00
Co .-1 S'TyL sn C T I O/J LIC.No. Sa � If LIGHTING FIXTURES 10,00/1.00 f
CONTA ACTOR'S / r r
AOOrr ESS �t({E,�,t- 6Y(CNx; C-r-p 4-0 PPLIANCES-RESIDENTIAL 4.00 7� {
Cv%fiLFyiTING [ �:�`gPHONE F�j ��37� PANELS 10.00 - `wD fn'l�I't •I
OAT OF APPLICATION
ARC,OiFCT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
Yv L C-1'L Ic.No. SIGNS TRANS. 3.00
AItC11.OR ENG. T T�/�� /.
ADDRESS 1 LMLsa•/L LLt/gzl,zs SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
tl p rvP G\ CA TEMP.METER OR POLE INS. 20.00 /\\ _
AYVLICANT'S
AOORESs 2.1 1 G �1 YG�=p1 t'-T MOTORS SEE FEE SCH.
CNekixT I NDcor 01 SD14- SERVICE CHANGE 20.00
v 0 i !
Foo LICENSED CON'1ltACTORS UECLA I<A"I'ItIN
a i w I hereby Ali.... that I ao licensed under provisions of c1la nc,1 ISSUANCE DATE
w Q w H,omno,im.g will)Section 7000)of Division 3 of the Bush....and BLDG. ELECT. PLG. MECH.
o z LiccPa. scions Cole,a my license is in lull forte m J cl I}}•t
z o h- License Cluss_�__I.iC.NUlnber .�S,;_��•
Dale Contractor
¢ ¢ w u OWNER-BUILDER D17CLARATION BUILDING PERMIT
x 3 LL 1 hereby affirm Ilial I all,exempt from the Caliracmrs License MISC.- REFER TO ORD h INFORMATION
F .. Oj Law lar lire following reason.(Sec.7036.5,gnsinasunJ Professions PERMIT ISSUANCE VALUATION $/FT,
wd Code:Any enyor coo my which requiresa permil to construct,alter, 1Q'�
¢ ¢ 4 p improve,denmlisb,or repair any 51rtlClore,prior lu its isauunce,also ELEC.CONTR. LIC.NO. ELEC. /� ` �'�a�
num¢ ng0ins the 4PPicanl Tool such pennil to file a signed slalmnenl IhW TOTAL U PERMIT TO
he is IicenacJ Pursuant Ro the provisions of tine Comrmrors Ucmuc
rzi
Law(Chanter')(comnencou with Section 70001o1"Division Solthe
E P o flushness and PIUHe IiOlis Coda)or Ilial be is C.0 npl theeliogi nod QTY. PLUMBING PER I yp FEE ✓'lN�---
CE r m the basis fort the a11Cgcd exemption.An,violation of SC,l ion 7031.5 L F STORIES TYPE CONSTR.
I by ally applueral IRs pCnnil]objects DICYPPUanni tracivirw,alty ALTER-DRAIN& VEN ATER (EA.) /
Of Ful mon than live lmnAed dollars 15500).): S/v/y'/�
❑ I,as owner uI fire property,or city employees with wages Rs BACK FLOW PROTE DEVICE 400
their sole compensation,will Jo the work,and thF . ,
e structure is
ul OCC.GROUP RES.UNITS
intended or offered for sale IS", 7044, Rusincs,and DRAINS-FLOOR,R F,AREA,GOND. 5.00 3 r
Code:'I Contractor's License Law Joe,not apply Io an owner Go,
PH`PenY who builds or improves thereon.and who floes such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE
• hinoelf Or do.u,h his owo"Uployces,provided Ota[such improve.
cents arc not Uncured or uNereJ I'ur sale.It,however,the Undoing GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 3 GQ
or improvmnenl is sold willing one Year of congnfine a owner- O
builder will have IbC burden of proving idol hie did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 pw LDINc usr
Il for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PE, Omer
I,as owner of fire pnipertY,aIII usivcly cool rolling wish �'
licca vl ronvualor to cunnnot 1 reject ISec. 7044,liwinws LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Pro fessions Cl c:'Ihe C'oN s License Law docs out apply
tO al4,iORK
f openly win.
u' ,Or improves Thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 3 / ._4"O Q
CaHforprojcc nh coo rumonsl l iceoc for""nR to IP
IbC Ciec w. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ S-. U.&P.C.for Ihis reasoF' WATER HEATER W/VENT 6.00
OwnWATER SYSTEM5'00ACC.DATE ACC.FILE NO.
ERS OMPENSAI'ION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm That I have a Certificated totem lo,ol�inuu,,
or a cenil1C.C of Workers'Commu
pensation Icdne.,or a CCHified ZONING ENG.SITE NO.
COPY thereol(Sec.3800,Lub.C.L
\ Policy No. Company
z- ❑ Certified copy is hereby furnished.
❑ Certified co is filed with the cit inspection division. FIRE SPRINK ENERGY LZO
�"Z PY Y Pec.
iz j / Applicant MISC.- REFER TO ORD. �j Y� N� YF] N�
x y�-)C` CERTIFIC'ATi:Of,ExEMPTION 17I10M WORKERS' PERMIT ISSUANCE 10:00 FLOODZONE A.L.u.C.
L COMPI,NSA'LION INSURANCE PLG.CONTR. LIC.No. PLG. //
ZCL a Il'his a.clidn need Ful be conlpCled it life p.mil i, fur one TOTAL I�l' V❑. N� Y N�
U O hundred dollar,I$100)or le,,)
I cagily dol in the performance of ...work for which this per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL F .,fit is issued,I shall not roors'Y om p.noo in any nm neer so as w
O W becolne subject IO ihC Workeri Compensal ion Luws of Calil'omiu.
C. O-WNOT ICANIum ALTER OR ADD TO MECH. 5.00 BUILDING /1�S-�)
} 2 NOTICE TO AI'I'LICANI': If,after nuking His C'etlil icam of Lx- JJ
I- - eruption,You should become subject to life Workeri Cmnpensaliou APPLIANCE 5.00 PLAN CHECK
provisions of life Labor Code, you nnol Ion iwilb comply will,
U
such Provisions or this pencil shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE
I.
CONSTRucTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000QEM.) 6.00 SEISMIC FEE x07.1
1 herby a1'I'inn tial RICO, is a CoostumRiog lending,agency for EXHAUST HOOD(WITH DUCT) 5.00
the I edonnmee OI'the work In,which Ihis pennil is ioucd ISC,. MICROFILM
Lende iv.Un; LXL UC 1. N HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lend.Ci Name
Lenders AJdress qy_¢ C.fL HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC 7 �
CA'e 4+'STI H N
I c.ritia Thai I have real ree 1.plleu ion an store I IRI tln above VENTILATION FAN (SINGLE) , . 4.00
. inronauge" is street.I ogres tO g toplY with ill city nodi n and BOILER PLUMBING L '7 Qfl
ordinances 4.ri state Ido$ elating to building con col I,n, and (3 H.P.Df 100,000 B.T.U.I 6.00
hcaby au lhuric. rcprcunlul fives of Ihis City to crier upon Ile BOILER-COMP (Over 100,000 OTUI SEE FEE SCH. '�7 dU
4buve-mentioned property lilt inspection purposes. MECHANICAL
(We) agree to r indemnify unit kelp hannlm the Cil,of MISC.- REFER TO ORD. C 'a�'3 r(
Cupenii agains bililies,judgments, costs and cilpenses which
guy I any 4CCrue a:ainst and ity "I CrluequcnCC .1 Hie PERMIT ISSUANCE 10.00 ` I(� CONST.TAX "7 0�
- goon g0 Ilmil' MECH.CONT. LIC.NO. MECH. /.�-
��ng �( 'al,�J TOTALC (fin TOTAL
ISI n4Runo Applicant/C n rcWr 1- );,t. 1- I l- ,��
OFFICE COPY 1
POST THIS CARD NEAR FRONT OF„BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 16327
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
1�v JOB ADDRESS a2 Z3 UNIT# _LOT#
PERMIT EXPIRES IF WORK
owrveR o .u�T ME � �;*INSPECTOR
croR IS NOT STARTED WITHININSPECTION DATINSPECTION RECORD 180 DAYS OF PERMIT ISSU-i
FOUNDATION - NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLEDLAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIUAUON
CUPERTINO STANDARDS.
GARAGE SLABS 1 4'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .,
UNDERGROUND /SLAB
PLUMBING '
ELECTRICAL
E
ISSUANCDATE
MECHANICAL BLuc Eu.cr. Pu;. MET:
�IOc1_VtAl� Sows F1 A1-0 ❑ ❑ ❑ 0.,
w L
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED r.� ,Y I, O12'ly•Q� W.D.a, BUILDING PERMIT ,
WOOD FOOR '."._•`I INFORMATION
PLUMBING VALUATION 5/FT.
MECHANICAL (�'C'` N _ FbvL fl,{A(LU
IIR_S n�'
ELECTRICAL ro
FRAMING
INSULATION STORIES IYPF CONS7R.
tiCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFSO.I T.I Loan AREA. TOTAL ACREALL
R. NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
• DIAPHRAGM THE CONSTRUCTION TAX IS PAID V OG
ROOF SHEATHING uwul UNuse
1115 IND LUN Pp Ulna
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS..-' DATE INSP. ❑ ❑ ❑ ❑
ROUGH nsSESSORS PARCEL NO.
SAN.p Se Ac71
PLUMBING [�-6 - ELECT.E ERGY `'
TUBS 8 SHOWER AN C.�'Z, PLUMBING ENERGY TRncr No. rARCEL No.
MECHANICAL y.-yr._ ,7 MECH.ENERGY '30 '
ELECTRICAL DUILDING ENERGY Acc DATE - ACC.PILE NO
FRAMING - - ELECT.FINAL TEST
INSULATION PLUMBING ZONING. LNG.SITE NO,
GAS TEST �26-�`� GAS
MECHANICAL EIRE srawK ENERGY rza
COVER NO WORK UNTIL ABOVE-HAS BEEN SIGNED HEATING v ❑ N❑ Y ❑ N❑
EXTERIORSHEAR
OR ELECTRICAL RELEASE -» cLOuu mNe n.l.u.e.
INTERISHEAR `
FIRE DEPT. / Y❑ IN v ❑ N❑
MINTERIORLATH
�'� ! GRADE FEESUMMARY
TH BUILDING
TH S TEMPORARY APPROVALS BUILDINGTELECTRIC PLAN CHECK
GASPLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEEOF BUILDING IS NOT PERMITTE DUNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR.
MICROFILM
,
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC D 0
LET
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING �
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. p-
- SEE PERMIT FOR EXPIRATION DATE — MECHANICAL 0
IMPORTANT! yI 11 CONST.TAX
PLEASE RE.hD REVERSE SIDE BEFORE tf µa: 1 ,; 6) II
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY