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18542 •' . AP{'LOCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Y BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BWI,DING ?2 , ,�& APPLICATION & PERMIT w' 18542 A ej ADDRESS I LF (, 2667v) y9,,1ES7eA,.3 � BUILDING- ELECTRICAL-PLUMBING-MECHANICAL L. OwNER'a t I�� PLAN CHECK VALID TION NAME - - OTY ELECTRIC PERMIT FEE O�`5C �SJ� • PHONE /•E J NAAMEERADTORs UTLETS-SWITCHES-RECEP 10.00/1.00 (L\ gSy SA MGG LIC.ND. / 76Y'7e LIGHTING FIXTURES 10.00/1.00 �OI .2rJ CONTRACTORS ` CAj A$ APPLIANCES 4.00 ADDRESS A✓/i 5•S- F-IA14 Cfl'ECCI-- A GAgDE.✓ PRONEIf7 3 V PANELS 10.00 DATE O`FAPPLICATION ''M ORRCRrtECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0 ENGINEER LIC.No, SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 �•/ �J ADDRESSTS MOTORS SEE FEE SCH. �v1 �I SERVICE CHANGE 20.00 1 11 p, ,, J,J...V� F o O LICENSED CONTRACTORS UECLARA'fION �lVl /, a v v I hereby of un that I am licensed under prm'isimhs of Chapter 9 Z N (commencing with Section 7000)of Division 3 of the Business anA ISSUANCE DATE BLDG. ELECT. PLG. ME_CI{ D z Professions Code lend my license is in full force and effect. ❑ IVx/-,1�1/e' Zo i n o Licenu Cl ss /J Lic.Number L 51741 m R w Uatc _ _�iy Contruetor ���V 0 (9 1983. w a OWNER-BUILDER DECLARATION V JU BUILDING PERMIT a Oe, " INFORMATION X 3 y 1 herehy affirm that I am exempt Door the Conlractor's License MISC.- aR FER TO ORD u O j Law for the following reason.(Sec.7031.5,Nosiness and Professions VALUATION $/FT. - PERMIT IS ANCE 10.00 E "i Code:Any city or county which requires a permit to construct,alter, Cr ac ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. as 6 m LL requires the applicant for such permit to file a signed statement that TOTAL n whe is licensed pursuant to the provisions of the Con tractor's License PERMITTO Fzi Law(Chapter 9(commencing with Section 7000)ofDivision 3 oftle r�.VO'yIIIV_'111� x o Business and Professions Code)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE I-C, file basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. La ; _ by any applicant for a permit subjects the applicam to a civil penolhy ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars(55001.1: ❑ Las owner at theon,property,or my,and tires with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will(S the work,and the structure rs not Calintended or offered for Luce (Sec. 7044, not Business and Processions DRAINS-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 Se,FT.FLOOR AREA TOTAL ACREAGE himself nr Itimugh his own cmPloyees,provided tint sack ingnovc- Centsarenotintendedoruffered forsalc.If,however,to building GAS-EA.SYSTEM-I INC.4OUTLETS 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 hit- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale,). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ 1,as owner of the property,am exclusively contracting with �. licensed contractors to construct the project(Sec. 7044,dustman LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 El F1 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. to an owner of property who builds or improves Ihercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with it conlractoris)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 --TRACT NNO. PARCEL NO. ❑ tole exempt under Sec..,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. for, J6JKI'RS'COMPENSATION'DECLARA I'ION WATER TREATING EQUIP. 5.00 1 r' C/ fl hereby affirm that I have a certificate of consent to sell-insure. or a certificate of Workers'Compensation Insumnev.or a certified ZONING ENG.SITE NO. copy thereof(See.3800,LahC.1. p n� h Policy No, Com Pa n y LRel J-'f9 O Certified copy is hereby furnished. Z Z ❑ Certified��opyy s filed with tile city' inspection division. FIRE SPRINK ENERGYT oa F, O nPPlicaut-{4LC- /-'MA.�--_fl7.fjGJ�-/w/ N115C.- REFER TO ORD. Y 0 NEI Y N EI LU y CERTIFICATE EXEMPTIONFROM WORKERS'. PERMIT ISSUANCE - 10.00 FLOOD ZONE . A.L.u.C.W > COMIENSA1ION INSURANCE PLG.CONTR. LIC.NO. PLG. CL O (This section need not be completed if the permit is for one TOTAL - Y❑ N 0 Y 0 N Z:) Z hundred dollars IS 100)or less) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. OU n D•It` Almluadt ALTER OR ADD•TO MECH. 5.00 BUILDING q } m NOTICE TO APPLICANT: If,after making this Certificate of fix- L 2 f��- ? emptlon,you should become subject m the_Workers Compensation App LIANCE 5.00 PLAN C provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permt•shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000GEM.) 6A0 SEISMICF E r '�`'� 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 The performance of lite work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00 '� Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Iceuit,lust l have read ttsupplicatlon and stale that file above VENTILATION FAN (SINGLE) 4.00 • information is correct. I agree in comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-ODMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby ant oriee representatives of this city to enter upon the above-mentioned property for inspection purposes. 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cu Perrino against liabilities,judgments, osis al expenses which' - CONST.TAX may in any way a crus ag net Said City i consequence of the PERMIT'ISSUANCE 10.00 rami ofthis 'r hI. ! MECH.CONT. LIC.NO. MECH. �G Q/S I,'9 TOTAL TOTAL _ Signature of Applmaul/Contractor Date - Orn OFFICE COPY V 'F'• POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 85�2a INSPECTION DIVISION JQ13 INSRECTION RECORD ` -r 1 JOB ADDR ESS�147U 7 / Y7'�P ,I �d ( , !PERMIT EXPIRATION, �1_O , 4�UNIT# '1 _LOT# Ll EXPIRES IF WORK OWNER 1 S CONTRACTOR 1p�Q Tl�d `PL IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION R CORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS F96CT NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. ��® GARAGE SLABS l _. 7 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - F UNDERGROUND /SLAB NOV 0 9 1963 PLUMBING � �,•.� L' s`V _ ELECTRICAL Cit, CF ? no- ISSUANCE v ISSUANCE DATE / MECHANICAL BLDGELECT PLG. NIECH E] ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION6 SIFT, MECHANICAL _ UV ELECTRICAL - PERN I TO f FRAMING F INSULATION STORIES TYPE CONSTR. OCC GROUP . RES UNITS ' u PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE'NO FINAL INSP.SHALL BE MADE BEFORE so.FT FLOOII AIIEA TOTAL Ace EncE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING ' BUILDING USE IVES IND CON PB Go.... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH . A SSESSORS PARCEL No SAN.N PLUMBING ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT No PARCEL No MECHANICAL MECH.ENERGY. - ELECTRICAL BUILDING ENERGY - ACC.DATE ACC FaE No FRAMING - ELECT.FINAL TEST INSULATION PLUMBING - zoNmG ENc.srtE No. GAS TEST GAS MECHANICAL -- ECHANICAL FIRE SPR INI ENERGY T,24COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING c� Y ❑ "❑ Y ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A,Luc. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE ' EXTERIOR LATH FEE SUMMARY BUILDING • INTERIOR LATH TEMPORARY APPROVALS BUILDING Zzfi®, SCRATCH COAT ELECTRIC PLAN CHECK ,.• GAS FEE ....tea NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occupgNCY SEISMIC FEET"' >._ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE— MECHANICAL IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE TOTAL r. •L CALLING FOR FINAL INSPECTION. Q OFFICE COPY < < / POST THIS CARD NEAR FRONT OF BUILDING nMlr NUMBER ¢ / CITY OF CUPERTIN INSPECTIONDIVISION E JOB'//IIIVSPECTION RECORD J013 ADDRES 6)G71 .7,/? _ _/ ' (I VA -' TF PERMIT EXPIRATION - / �� / J `-�UNIT It _LOT PERMIT EXPIRES IF WORK OIYNER f �'A'� r r'r s CONTRACTORS ,P IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTIO RECORD 180 DAYS OF PERMIT ISSU I OUNDnr1ON ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFF:11 ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR F GUN TF TO COMPLY WITH THE APPROVED PLANS AND CITY OF rE unU I VAL RIAT ION GARnGf. St.nr15 P _ CUPERTINO STANDARDS. ID F, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .5 arc>i.. ;l oG 7p _ _ _UNUE RGROUND /SLAB W !!L) Oj Ia: .�Qti4�y Cite Irfino ISSUANCEOAtE M F:CH ANICnI_ RLUG I ELECT I PLC. MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;'BUILOINO PERMIT* 1 , r r.;, f. WOOD FLOOR , INPORMATIONrrn" PLUMBING bAUlAtI11Ne S/F i. MECHANICAL UVV ELECTRICAL FRAMING -Q-._ 1 INSULA rION sO GEs TYPE CONSTN OrmcmGNOOP RES.UNI IS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED T _ ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE Fn n TL°`RI+Ru tnl+L AcnT Anl • DIAPHRAGM THE CONSTRUCTION TAX IS PAID Iw r SI TEAT HIIJG BUILD,NG USE 1Its IND CON PB OIIn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ' ❑ El ❑ ❑ aROUGH SAN.H �— ASSESSORSPARCEL NO ELECT.ENERGYV&n PAN PLUMBING ENERGY IRACT NSI, PARCEL NO L - .r-3 MECH.ENERGYL ACC DALE ACC FILE NO BUILDING ENERGY ELECT. FINAL TESTN PLUMBING ZONING ENG.SITE NOGAS FIRr SPRINK ENERGY T)f MECHANICAL COVER NO WORK UN IL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NO EX rFRIOR SHEAR ELECTRICAL RELEASE FLOOD?ONE AL UC. INTERIOR SIIEAn FIRE DEPT. Y❑ NEI, Y N SITFE rROCI( GRADE •/,:'. 4'. •;.,•; FEE SUMMARV�' .+'vi EXTERIOR LATH BUILDING IrJ rE RIOR LA T7,',- TE MPO RARY APP 0 ALS BUILDING 0 SCHA ICH COAL ELECTRIC PLAN CHECK r GAS - FEE ......._ . . NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE QCCUPANCYOF RUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDB Y BUILDING INSPECTOR. MICROFILM _-.... ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC • i-- ONEONE WORKING DAY BEFORE REQUIRED INSPECTION. vI✓ PLEASE GIVE JOB ADDRESS WHEN PHONING. vt z — SEE PERMIT FOR EXPIRATION DATE — M IMPORTANT! CPLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. APPLICANTS POSTING COPY