16726 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POI N1 PEN ONLY= ,
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER APPLICATION.& PERMIT
^ eu�-olrvc I U 1 G
ADDRESS
%�wl A"A�/L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S P LAN CHECK VALIDATION
h NARE k:5//1j0 q ZI_7 CITY, - ELECTRIC PE RMIT' - ' FEE. ; ,
T [ ` V/Ir/�� PHONE4 �U / .
CTORS
NAME --
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 `•
� uc NO,'?J04 I ' LIGHTING-FIXTURES 10,00/1.00 '
GODRE NTRACTOR's
AD . 1 APPLIANCES-RESIDENTIAL. 4.001
ow���� / �yJ
-o i i PHONE2-o�,'Z, - PANELS + la; 10,001 DATE OF APPLICATION' ;.
ARCHITECT r PLAN CHECK FEE P,C.-NO.
'-OR PANELS (OVER 200 AMP) ' 20.001
ENGINEER - `
" LIC.NO SIGNS TRANS. - _ .3.001
ARCH OR END SPECIAL CIRCUIT $.BB .- PERMIT VALIDATION
ZIP I TEMP.METER OR POLE INS. 20.00 --1• �fN 1'T(1(�1 Y`/r '
' APPLICANT'S
ADDRESS MOTORS SEE FEE SC - aJ / V`( IlJ( IIJJ•-- '
- .
w ¢ z SERVICE CHANGE , �VUV I J' V
I N ii)S
H LICENSED CONTRACTORS DECLARATION
0 0 . �5 ( U,• .
- Q u w 1 hereby affirm that I um licensed under provisanis of Chapter 9 " 1' q ISSUANCE DATE t
Nay (commencing with Section 7000)of Division 3 of the Business and VIry lr DO. ELECT PLG. M-EqH., .
H h- License Co aorl�ry licenLi n m lull fa �I yct� ❑ ❑ xl A/1J
z o.y - Licensu Class Ct! Con Number ! J T
O y Dale CallrunurL .
< s,2 - - - BUILDING PERMIT
rc ¢ w
OWNER-BUILDER R-BUILDER UECLAkAT ON INFORMATION
w ; ° y I hereby affrnn4hm I am exempt from the Contractor's License I MISC.- REFER TO ORD
to U_ Lawl'orthefollowingreaaon.(See 7031.5,BUsmce,jud Prolesslons 'ERMIT ISSUANCE 10.001 VALUATION 5/FT.
-Code.Any city or county which re fares a permit in construct,alter,
°• ��
re ¢ ¢p' ....prove,demolish, I repair any structure,prior to Its issuance,also ELEC CONTR LIC.NO ELEC
¢ ¢ retWVCs the applicant for Such permit to file a Signed staterllent(hat TOTAL f
w m° he Is licensed pursuant to the provisions of the Contractor's Lrcrnw - fyy PERMIT TO
� .a -
Zi Law(Chapter 9 fcammencing with Section 7000)ofDlvistou 3 ofthe rl •M�+/1
L Business and Professions Code)or that he is exempt therelronh and OTY. PLUMBING PERMIT, t FEE. ' "I'I-- c
¢1- the basis for the alle and exemption,An
°w 6 p itea,ption of Section malty STORIES TYPE CONSTR.
u ;_ by any applicant fora herds dollars(he applicant via civil penalty
of not more than five hundred Jollars(b500)). ALTER-DRAIN& VENT-WATER (EA.) 5.00
,
❑ I,as owner of the Property,or my umployi,"with wages as BACK FLOW PROTECT. DEVICE 4.001
Their sole compensation,w'dl do file work,and the structure is not
OCC GROUP RES.UNITS
intended nr offered for sale (Set. 7044, Business and Professons DRAINS-FLOOR,ROOF,AR EA,CON D. 5.00
Code.'rhe Contractor's License Law does not apply ro an owner of
` -PmPolly who builds or miproves(hereon,and who.dous such work FIXTURES-PER TRAP 5.001 -So FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided stmt such improve-
I r_ menu are not intended or oternl for sale If,however,the building GAS-EA.SYSTEM-l 1NC.40UTLETS 6.001
1 ( or improvement a sold within one year of complet an,(he owner- - ,
`n•Lr;e, ! -hwlder will have the burden of proving that he did not build or rat- GAS-EA.SYSTEM-OVER 4 (EA.) 2.001 BUILDING USE
prove for p urpow o f sale I. .RES IND CON PB Other
ywitrecnn,with I (INDUSTRIAL WASTE INTER. 30.001
❑licensed as nfo cl of the Rnsboct :tin cxclusrvel - ❑ � 0 ❑ 1 t
find P essa sc inn to ronstruct the LILcct IScc 7044, Business 1LAWN SPRINKLERS- 1 INC 5 V.B. 6.001 ASSESSORS PARCEL NO
and n owner of Code,The Conbuildor's Lcense Law Does nu[dwho
(o an owner of property who builds yr improves thereon,and why ILAWN SPRINKLERS-OVER 5(EA.) 1.001
contracts for such prouects with a cuntractor(s)licensed pursuant t,. '
(he Contractor's License Law SEWER-SANITARY-STORM EA.200ft/10.001 TRACT NO� PARCEL NO.
0 I ant exempt lade,Sec. _ B..tPC for this (WATER HEATER W/VENT 6.001
reason
Owner .Date I I WATER SYSTEM 5.001 1 ACC DATE ^ACC.FILE NO
WORK.ERS'COMPENSATION DECLARATION WATER,TREATING EQUIP. 5.001 I I'
I hereby affirm that I have a certificate of consent to self-insure,
- or a ceiltl]cate of Workers'Cympensalnin Insurance,or it certified ZONING ENG SITE NO
policy No oflScc 3A00,Lab C.1;' A,T /���� I
I'nhuy No Company • �!C ,; t
O O Certified cops is hereby furnished FIRE SPRINK ENERGY T-T4
z Z �_�'Cendu•d op i> fled with the City inspec Nun dlv.Flan. y
F 'O,sE�y1'55rnt Il . MISC.- REFER.TO ORD. , y� N y-Of,i N�l
� 4 CIiRTIITICA'1'EOI:EXEMPTION FROM WORKERS: .1 ' PERMIT'ISSUANCE .-10,00 11 iFLOOO ZONE A.L.u.c.
W >thecorre COMPHNSAT10N INSURANC17 PLG CONTR, LIC.NO. PLG.(This section need not be completed if the prnnnis far one (TOTAL is V❑,• NQ' V❑ Nhu dyed Job...(S 1001 or less.I U 1 certify that in the performance of the work for which thu per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL nt a issued',I sliall nut cmpluy any pursuit Ib any amiv so as subject to the Workers'Compensation Laws of Callforma 'E
' O y Dmc Apphcat BUILDING
>_ rn� NOTICE. TO APPLICANT 11,after making this Certificate of'P' I '(ALTER OR ADD TO MECH. , - 5.00
In
F ? NOTICE 10
you should become subject the Workers'Comp"'alron 1 1 APPLIANCE '.5.00 ' PLAN CHECK
Cllirovrsain of the Labor Cute, you must (urthwith comply with
U such proWOon,or thus perms shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY i 1 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 I SEISMIC FEE
I hereby affirm that there is a construction lending agency far 1 EXHAUST HOOD (WITH DUCT) '.5.001
r,hhe perk urn..ime ul the work for wh tall thus permit Is'nuu•d(Se. MICROFILM
3097,CIv.C.I. HEATING UNIT(TO 100,000 B.T.U.) 8.001 I
Lender's Nam^ " ' HEATING UNIT 100,000 B.T.U.)9.50 i
Tr''� Lender's Addr^•• ELECTRIC
'k,,, Y - I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.001 '
nifnnumhon is correct I agree to comply with all city and county I, ry�� PLUMBING
P+'� 'onlaances and slate laws rclahnk to building mnstruufimi;um�� BOILER-CUMP(3 H.P.Of 100,0008.T.U.) 6.001-IiV�
hereby authorvu representatives oertyficn a, this city to enter upon the 1 BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. + MECHANICAL I l 1
V.-
'�..,-', abovo- ned properly for mspecNUn purposes
( 1 agr a to save, ind ify and keep harmless the City of 1 MISC.- REFER TO ORD. .•
ZCup rtKfgApp1tuL'Ur!tnfCoa2t'a' hl' :it gonads, costs ad expenses seluc CONST.TAX
i l a St said City in consequence of the PERMIT ISSUANCE
goinhi s en if MECH CONT. LIC NO. MECH. -
//�� p TOTAL
Slgoat inractor Onto, - a, �1,�!I ' TOTAL _,IhL�
'OFFICE COPY Lf
POST THIS.CARD'NEARFRONT OF BUILDING:r
C •-J^,I• ` ` PERMIT NUMBER '1
CITY . OF CUP.ERTINO ` : ` 167'
INSPECTION DIVISION
.SOB INSPECTION RECORD
( r f( {' 1{ /� PERMIT EXPIRATION
!i JOB ADDRESS v' "O - t `�' aU,-UNIT#k-, _LOT# -
I �1 • ' :PERMIT EXPIRES,IF WORK.T
OWNER. CONTRACTOR ' F ' s.; IS +NOT STARTED WITHIN
INSPECTION, DATE , INSPECTOR INSPECTION RECORD, 1 180 DAYS OF PERMIT ISSU>„
FOUNDATION ANCE OR 180 DAYS FROM
`r' NOTE: LASTCALLED INSPECTION. '
..I UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED I 1
I PREGUNITE - - I TO COMPLY WITH THE APPROVED PLANS AND CITY OF PI RN+n vAI,IDATIDN
GARAGE SLABS I I CUPERTINO STANDARDS. 4 {I
! POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED IT. _
I. UNDERGROUND /SLAB •' .' PAI (
!PLUMBING'
I 8p
!dV 2 9
IELECTRICAL � I '- I - ! � Issun"cE DATE '
[MECHANICAL - - -- - " I . ,
tltDG, EL❑I 11.1 PLC MEeR
f ty Of ell 8 rR
'❑
„! DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I - BUILDING,PERMIT,
I WOOD FLOOR • ' INFORMATION
PLUMBING., vawnn ON STET
- IMECHANICAL
I IELECTRICAL
(FRAMING I I I �' _ .I �,I) •i:�.] ,
E CON STR
1„ RIES' TYPE. ,
- „( INSULATION I I I � -
STO
OCC GROUP RES UNITS iI
4 I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
I' I SO IT FLOOR AREA TOTAL ACRLAGL
I•' ROOF ' ( NOT 'NOFINALINSP�SHALLBEMADEBEFORE
I��IDIAPHRAGM . _ THE CONSTRUCTION TAXIS PAID -
SA .-1.� ! . ,! ,R tll11LDINNIISE
Vw' ; ROOF SHEATHING. . ' • I I ;,Is INUI CON PEI,"'om— ;l
I 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS I DATE INSP. ❑ ❑ 2 ❑ ❑
ASSESSORS PARCEL NO;
11 '' . • ROUGH SAN# 1 I I I ' I
PLUMBING IELECT,ENERGY •- I TRACT NO . PARCEL No
(TUBS B SHOWER PAN I PLUMBING ENERGY I.• I t
IMECHANICAL IMECH.ENERGY- II -
•, I ELECTRICAL..• I BUILDING ENERGY ,I •.I I ACC OATe ACC PILE NO ,
!FRAMING ' - I ELECT FINAL TEST ! I
! INSULATION - IPLUMBING I - - �C"I"G - 'Ell SITE NO.
I . IGAS
GAS TEST, I I . . . .
I
IMECHANICAL ��y, � .:I E'RE SP* D ENERGY Tea
I COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED (HEATING I IIIf� I ` 0 � "�
(EXTERIOR SHEAR ! - IELECTRICAL RELEASE FLOOD ZONE ALU,C
y -I INTERIOR SHEAR IFIRE DEPT. I I Y0 "E •` ❑
No
' ISHEETROCK IGRADE - I I , I FEE SUMMARY, i
[EXTERIOR LATH I - I'BUILDING I I ,
I INTERIOR' LATH I I• TEMPORARY APPROVALS - I BUILDING,
!SCRATCH COAT (ELECTRIC I I PLAN CHECK
IGAS• - FEE
NO TAPE-0R PLASTER UNTIL ABOVE HAS BEEN SIGNED (OCCUPANCY ! • ' I 1 I SEISMIC FEE
(OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.( MICROFILM' I -
ARRANGE'FOR INSPECTION BY PHONING 252-4505,
€ I ,ELECTRIC
{" 1�- ONE.WORKING DAY BEFORE REQUIRED INSPECTION. I .PLUMBING
I PLEASE GIVE JOB'ADDRESS WHEN PHONING.
c - , MECHANICAL
- SEE PERMIT�FOR EXPIRATION DATE - I `
IMPORTANT! yl CONST TAX I'
' o .PLEASE READ REVERSE SIDE BEFORE �' } TOTAL '
'CALLING FOR FINAL INSPECTION. V 'I' IJICf1
OFFICE COPY