16060 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PI-N ONLY
BU LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT
ADDRESS 16060
COLI) U"� BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S
PLAN CHECK VALIDATION
NAME A OTY. ELECTRIC PERMIT FEE /�
/"�� PHONE 6�IG �4,3.'(
XrkNAME
".I'. OUTLETS-SWITCHES-RECEP 10.00/1.00 �-
L "FR LC.Nos Qy2. LIGHTING FIXTURES 10.00/1.004�2
nooliess roR's ,I�f APPLIANCES-RESIDENTIAL 4.00
//0 rT PH°NE y.[ PANELS 10.00 DATE OF APPLICATION
ogcwrecr - PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
ARK VUN adI E/Lflc.No SIGNSTRANS. 3.00
ADORE°Ss ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
nP rrEMP.METER OR POLE INS. 20.00
ADDRESS Ts MOTORS SEE FEE SCH.
D¢ i SERVICE CHANGE 20.00
' rO o LICENSED CON]'RAC"f ORS I11(('LARA'I'ION
IF u W I hereby affirm that I am licensed under provisiwn of Clwpe,9 ISSUANCE GATE
„ y 2 (coaunenecng wile Secliun 7000)of Doisiun 3 of rm Itusimss and �- BLDG. ELECT. PLG, MECH.
r N z Prulessiarn Code,'J�rl my license n in full knee n G_,,l ❑ ❑ ❑
o0 n o License Chs r--r-Lic.Number_ /V7
Datel�+ Cnml«<IDr a�«r,� W0 V 1 988
a Q w OWNER-BUILDER DECLARATION BUILDING PERMIT
u'x ;u m I hereby of tion That I am exempt front the Contractors License MISC.- REF TO ORD INFORMATION
LL O j Law for the following reason.(Sec.7031.5,BusinessanclProfessions 0 IB VALUATION
PERMIT ISSUANCE Q E)Fr.
Fri Code:Any city or county
which«quimsapemli_tucanstrucl,aBee ,�f1 ��YY''yy��
< 0 im Plm e,demolish,or repair any structure,Prior lu its issuance,also ELEC.DDNTE, LIC.NO. ELEC.
- DLL requires the applicant lar such permit to file a signed slalcmmI.that TOTAL
w m he is licensed pursuan.In the pruvilon,alIsor s
e CurunoLicense PERMIT TO
r _ QLaw(Chapter 9(commencing with Section 7000)ol0ivisiun 3 of lee //�� ZG`O
z D Business and 1'rofessiunn Code)or Ill.[ lie xi
e is emtpl therefrml and OTY. PLUMBING PERMIT FEE x-iA V
I- o Rte basis for the alleged exemptimt.Any violation of Section 7031.$ STORIES TYPE CONSTR.
n ; m by any applicant for a Permitsubjeets the applicant In a civil penalty
.four more than five hundred dollars($500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,as owner of the properly,or my mnployees with wages as BACK FLOW PROTECTDEVICE 400
their sell,compensation,will Jo the work,and the Structure is not . .
OCC.GROUP RES.UNITS
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 improves thereon,and who Anes such work FIXTURES-PER TRAP SAM SO,FT.FLOOR AREA TOTAL ACREAGE
himself or through bis own employees,provided that such imProve-
menuare art intended ur offered for alle.I I;however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold will in one year of complelim',the ovanr
builder will ILse'tile burden Ptf novas•that lie did ion build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
1 6 BUILDING USE
prove lorpurpose of said.)' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
131.as owner of Inc properly.am exclusively:onlncli
licensedd ascon NaclBrs inconstruct tileBrag with
prefect(Sec. 7044, usiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and PmfessiunS Code:'I'he Contractor's License Law does not apply ASSESSORS PARCEL NO.
10,111 Owner PI property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
Contracts for such Projects will'a conlructuflbl licensed pursuant to
Ate CmRmclors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am excnlpl under Set. ,It.&P.C.fin Ibis
reason WATER HEATER W/VENT 6.00
Owncr naw =WATERTREATING
5,00
ACC.DATE ACC FILE N0.
WORKERS'COMPENSATION DI CLARA'HON EQUIP. 5,00I hereby all our .hot I hove a cerlificeleOI consenta eerlificwe of Workeri Cmmpeasalin Insurance,or a cerliliedl ZONING ENG.SITE NO.
opy Ibe¢uf(Sec.3K00,Lab.C.).
Policy No. Company
0 ❑ Certifiedcopyisbore by fumiehed.Z Z ❑ Ceritied cup, n Ided with the city inspretinn division. FIRESPRINK ENERGY T-24
0 Applicant REFER TO ORD. Y� N� Y ❑ NC:]
ir Ln CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
LU > COMPIMATION INSURANCI: PLG.CONTE. uc.No. PLG, FLOOD 20NE A.L.U.C.
Ole
be completed if the permit is fur one TOTAL Y N Y ry
�' O IThis'�uclidn need n
2 sundreddullars($100)in-le"')
U I is iss y That li rhe t c,i nun«of Ihl,work I'ur whidl This per- O
TY. MECHANICAL PERMIT FEE FEE SUMMARY
U.0 H mil is issued,I shall nm emplDY' IY pea II in In.......so W t0
becun yplylLane Workrr' en m al unuu. ��. O(J
0 i HO-1161 iCANCu111 L� ER OR ADD TO MECH. 5.00 BUILDING
} m NOl'ICIi TO AI'I'L ate
A pips,': It,.1ter nmking this Cor il'icale of fix-
F- Z PRIPliot,you should became subject to the Workeri C'nmpensutionLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forlhwi ll comply with FEE
U such provisions or This permit shall be deoned«yoked. HANDLING UNIT(TO 10, 00 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY ANDLING UNIT(OVER 110MOOF.M.) 6.00 SEISMIC FEE , $ O
I hereby uffnm that Isere is a constructiun lending agency furAUST HOOD (WITH DUCT) 5.00
the permorn ice of tire work lin which this permit is issued ISec.
3077,C'iv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI IGUNIT(OVER100,000B.T.U.)9.50 ELECTRIC
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
inommlon is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating Io bolding construction. and BOILER•IXMM I3 H.P.Dr t00,0008.T.U.) 6.00
hereby malimenti.nira reperty la.ives of .his city Ira enter upon the BOILER-COMP 10,n 100,000 BTU)SEE FEE SCH.
above-menlioneJ properly fur inspection purposes. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, cults mW expenses wbiAl CONST.TAX
*Sir',,,,
in an way uccrur I• J city in con'q u'um OI the PERMIT ISSUANCE 10.00
iLMECH.CONT. LIC.NO. MECHTOTALTOTAL arc of Appscanlrent.I r D:dc
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
.VUI LDI NG PROJECT 1 DENTI FICATION .PERMIT NUMBER "
BUILDING APPLICATION & PERMIT 16060
ADDRESS
L'
- � 6�D A R/ 0'✓ BUILDING —ELECTRICA —PLUMBING—MECHANICAL
OWNER'S All PHONE
CHECK VALIDATION
NAME � PNONE _��/ OTV, ELECTRIC PERMIT FEE C
\
CNTRACTORS dtUTLETS-SWITCHES-RECEP 10.0011.00 �"� Y
L PFR LIC.Nos Qy2 LIGHTING FIXTURES 10.00/1,00
CorvrRAcrDRs - APPLIANCES-RESIDENTIAL 4.00
ADDRESS
7yy0 #16 H IT PHDN o2 PANELS 10.00 DATE OF APPLICATION
AORRCmTECT PANELS�IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER -
/'111K VOAla fA.CIc.No. SIGNS TRANS. 3.00
ADDRESS ENc' SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT 5 MOTORS SEE FEE SCH.
ADDRESS
SERVICECHANGE '20.00
o O LICENSED CONTRACTORS DECLARATION
a i v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
in a y (commencing with Section 7000)of Division 3 of the Business and
BL G. ELECT. PLG. MELH.
r w z Professions Code,;yyl any license is in full force u I d'fe t ❑ ❑ ❑
z o w — Licansc Clan��'yy--��P-yyy�T—�Lic.Numhcr 1
o wd7Date �7 Cmuraclor t
NOV Y1 1JOp
¢ y s
¢ ¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT
- o d U INFORMATION
wI hereby aft un.thm 1 am exempt Crum the Contractor',License MISC.— REF TD ORD
LL o¢ Law for the following reason,(Sec 7031,5,Businessand Plol'cssin,, VALUATION $/FT.
H _ PERMIT ISSUANCE 0. IIID _
Code:Any city or county which requires o permit to construct,alter,
¢ ¢ ¢ £O improve,demolish,or repair any structure,prior to its issuancq also ELEC.CONTR. LIC,NO. ELEC.
—O LL requlies the applicant for such permit to file u signed stalemdnt that TOTAL
e w m he is licensed pursuant to the provisions of Ilse Contractor's License - PERMIT TO
H 2 r
Law(Chapter 9(commencing with Section 7000)of Division3o(Ihe AZbO
¢ o Business and Professions Code)or that he is exempt therefrom and DTV. - PLUMBING PERMIT FEE �-I/� G
¢ H$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a � by any applicant for a permit subjects Ilia applicant Ilia civil penalty gLTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):'
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP
' - their sole compensation,will do the work,and the structure is not RES.UNITS
intended 0,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
pnuperly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5,00 SQ FT.FLOOR AREA TOTALACREAGE
himself or through his own offered
yeas,provided that such improve-
menls are nor intended or employees,
lee sa provided
that r.such
he building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) ' 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose ol's:deJ' - INDUSTRIAL WASTE INTER. - 30.00 RES IND CON PR Omer
❑ 1,as owner of the property,am exclusively contracling with El
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Prafissions Code:The Contractor's Lwanse Law does not apply
to an owner of property who huilds or improves Ihercon,xnd who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for suctrproje L with a contractor(, licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor s License Law. TRACT NO. PARCEL NO.
❑ lam exempt under Sea ,tl.&P.C.for this yygTER HEAT ER W/VENT 6.00
limn
Owner UateWgTER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent in selhiusour,
or it certificate of Workers'Compensation Insurance,or a certifted ZONING ENG.SITE NO.
---f copy Ihereoftsee.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby luroisheJ. FIRE SPRINK ENERGY T-24
z Z ❑ Certified copy is filed with Ota city inspectinn division. MISC.- REFER TO ORD.
O Applicant Y � N E] Yo No
~ rn - PERMIT ISSUANCE 10.00
LU CIiRT'IIICATII F EAIIOTINS PROM WORKERS' 'FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLR.coNTR. LIC.No. PLc.
a' 0 aThis section need not be completed if the permit is I,,,ane TOTAL Y❑ N� Y[J IN
Z hundred dollars IS 100)or lcs,J
U _O1 1 Certify that in the Petro rnwnce of Ilio work In,which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
.. W )- mit is issued,1 shall not employ y pars a in nanner so as to
LLLrrr"��V becorubi4��Worker enyytyio reu,—mi.. 4-3, 00-3, 00
W Date 7 Applicant/!"f!� BUILDING
} tai! NOTICE '1'O APPLICANT: If,eller making this Certificate of Ex. ALTER OR ADD TO MELH. 5.00 '
F Z eruption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTIONIENDINGAGENCY AIR HANDLING UNITIOVER10=C-F.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 Name H EATING UNIT(OV ER 100,000 B.T.U.)9,50
Lender's Address ELECTRIC
. 1 certify That 1 have read this application and aIle that the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with uE city ucti county BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
harshAces and stale laws relating to building ranter tion, and
hereby authorise representatives ec this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to Stec, indemnify and keep harmless Ilia City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in i way accrue a ''1at e 'd City in consequence of the PERMIT ISSUANCE 10.00 _
Pontin 's permit MECH.CONT. - LIC.NO. MECH.
TOTAL TOTAL 6�
Sign' are of pplican[Contrucl r Use,
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
~ CITY- OF CUPERTINO 16060
INSPECTION DIVISION
JOBANSRECTION RECORD
� /� ,,)�� • � - i 'PERMIT EXPIRATION
JOB ADDRESS NIT# _LOT# ' /q$RMIT•EXIiES IF WORK
OWNER coNTFACTOR Q1�L" dt�...t IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU�
FOUNDATION . ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
•CUPERTINO STANDARDS.
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB tJINIXl�/•[A�LE•ctL.
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL - BLDG. ELECT. I PLG. MEC.
DO NOTPOUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
VALUATION SIFT.
PLUMBING
MECHANICAL - - - 'a - I oev
ELECTRICAL - - PERMn IU
FRAMING - PAID t/,4_�'.
INSULATION • .• ,I 7" STORIES TYPE CONSTR.
NOV
y
OCC GROUP RES.UNITS
IIPLACE N0 SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 'CRY Of CU Brt100
r ' - ROOF" NOTE:NO FINAL INSP.SHALL BE MADE BEFORE S°'Fr.FLoon nRUA ro TAL Acrlenr.E
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
• ROOF SHEATHING DES' ND CON PB om-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ROUGH SAN.N Assessrnls vARceL No.
PLUMBING ', - ELECT.ENERGY
TUBS 8 SHOWER PAN ' PLUMBING ENERGY - ' TRACT NO. PARCELNO
MECHANICAL - MECH,ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC.FILE NO I
FRAMING - ELECT:FINAL TEST
SITE .
INSULATION - � - PLUMBING ZONING ENG. . NO
GAS TEST. - GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ NE ° N�
• EXTERIOR SHEAR - ' ELECTRICAL RELEASE
FL000 zoNE' A.L a c..
'INTERIOR SHEAR FIRE DEPT. • Y.� "❑, ❑ "❑
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH - - BUILDING _
- INTERIOR LATH ; - TEMPORARY-APPROVAL BUILOwG &4�.
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' F
OCCUPANCYOF BUIL DING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION'. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE• TOTAL ��gI
CALLING FOR FINAL INSPECTION:
OFFICE COPY