15484 APPLICANT TO FILL IN INFORMAI ION VVI FFIIN RED LINES -- USE GALL POINTPEN ONLY
BUILDING PROJECT I DENTIF[CATION
-PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1548 4
ADDRESS
. IN� C9� BUILDING-ELECTRICAL-PLUMBING-_MECHANICAL
O NER'S
�- -�� PLAN CHECK VALIDATION
' � "AME O iVg L-.tl yy) ., I QTY. ELECTRIC PERMIT FEE �
V/�..iry PRONE �I 7"
c NrRAcrOR's OUTLETS-SWITCHES-RECEP 10.00/1.00 (
NAME �,
v r1 r v5 LIC NO FL"[72 LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS /// �.y��
�i(!/ ✓ 4 Z5 PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE
OR
ENGINEER `^ LIC.ND. ~ SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
ZIP EMP.METER OR POLE INS. ASCH.
APPLICANT'S MOTORS SEE FEE ADDRESS
SERVICE CHANGE 2i
)-!a
�L IiNSIiD CON'I'ItACI'ORS DEC'LARA"[']ON
< I her 'nIhul I licensed uJProvisions f Chaplet)U u p( ISSUANCE DATE
N Q i (comnlencill, Section 70001 of Division 3 0l'I n,llusiness and pL LECT. PLG. MECH.
r N z I'rofeviass Cb • ale l is in toll I'ur' 41
t r
i ut Licens Sys .NulnabcFr_ `(�/��/y� f�y �I
--TJ ^1y /tcQ=>LZ LJ� U5.1..
a y ,Lh%YVI¢n'� P DING PERMIT
R w OWNER-BUILDER DECLARATION CVY''�1 NFORMATION
wOto MISC.- REFER TO ORD
g I hereby alfinn that I um exempt from the Con[mamr s License �1� VALUATION $/FT.
Fu04 Law for the l'ollowingreusmt(Sec.7031.5,Bminessand Professions PERMIT ISSUANCE 10.00
Code:Any Lily or eounly which requires a permit ro coustruct,alter, .ate-il
Q a, G improve,demolish,or repair,uly structure,prior lu its issualltt•,also ELEC.CONTR. LIC.ND. ELEC. p / //(/
n w m I requires the uppllcanl for such pennii lu file hiiNjjed sLllmnenl Out - TOTAL 3_k6_"D PERMIT TO
It.is licensed pursuant to the provisions of the Contractor's License
E• za Law(Chapter 9(commencing with Semion 7000)ul I)vkiou3 of file
x o BUSDICSS and Professions Code)or that he is exempt Ihcrefrom and CITY. PLUMBING PERMIT FEE
Ie r o the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
aim by unyupplicanl for a permit subjects the applicant nsz civil penally ALTER-DRAIN (EA) 5.00
of not more than five hundred dollars I SSo01J: - .
❑ I,as than
of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OC
their Sole compensation,will do the work,and the Structure is net C.GROUP RES.UNITS
Intended or offered for sale (Sec. 7044, Business.,,it Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:lite Contractor's License Law does not apply to un owner of
property who builds or improves[hereon,and who docs xlc))work F IXTUR ES-PER TRAP S.DD SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own cnpWyees,provided that such improve.
mems are not intended or offered for sale.ll;however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 L'
ter-, or improve rem is ,,It within one year of completion,Zhu owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden ol'poviug that he did nut build or till- BUILDING USE
prove for purpose of sale.,. RES IND CON PB Othnr
❑ 1,as owner of the Property,ten Cxclusivcly contracting with INDUSTRIAL WASTE INTER. 30.00 1:1 ❑ ❑ 1:1 ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects will,a cmuractor(S)licensed pursuant HI
the Contractor's License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO, PARCEL NO.
❑ I no exemptunder Sec. ,B,ml'.C.In,Rhos WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE N0.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I lave a cerliticate of consent loself-insure, ZONING ENG.SITE NO.
or a certificale of Workers'Compensation Insurance,or a cerlil'i'd
copy thereof(Sec.3800,Lab.C.)-
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
z Z ❑ Cerul'icJ filed wish 1 city pup, ion division. MISC.- REFER TO ORD.
g,1 Applicant -_ . _ Y N Y N❑
IY �'/ - cGR 1acAT:oFIsx.M oN FROM o1 S' PERMIT ISSUANCE 10:00 Z_ - FLOODZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. ✓L V NEI
Y NQI'fhis xclims need nut be conlpleled il' thePermit is fur one TOTAL
hundred dollars IS 100)or less.)
U O 1 evilly [hal in lite performance of the work lox which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any Ili a liner so as m
U become subject to the Workeri Compenwlion Laws of California. BUILDING .�_�
ED ate an
DApplict ALTER OR ADD TO MECH. 5.00 1j�
} W NOTICE TO APPLICANT: If, He,making this Ccrlificme of lix-
Z enprtiom,you should become subject to lite Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions o1the Labor Code, you must forlhwith comply with FEE
U Such provisions or this permit doll be devoted revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE 3 �
I hereby affirm that there is a comma ctiml lending agency for EXHAUST HOOD(WITH DUCT) 5.00
Be 3097eCDC.).ee of the work I'or which fill,permit is ivucJ ISce HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
,
Lenders Name•
Lender's Address H EATI NG U N IT(OV ER 100,000 B.T.U.)9.60 ELECTRIC ie')-
[ certify that have read this application till state that d above VENTILATION FAN (SINGLE) 4.00
information n carate[.Lagnc 10 comply with all city unit county PLUMBING p Ute.
ordinances and stale laws,fe)uting to building connructim,, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 /(9 O /
a
w ereove-mentioned property
authorize roperty perty,lalrves fur inspection purpows.of this city lu inter upon the
hbBOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL .]
a
(We) agree to save, indemnify slid keep hnrnJess the City of MISC.- REFER TO ORD.
u mal' If t Iisl{IM s, dgmenls, costs unit cxpumses which CONST.TAX
g PERMIT ISSUANCE A4.06
mal I oily w: . s[ said City in cuninluumu of Ibc
gran 141' Pe,I MECH.CONT. LIC.NO. MECH.
TOTALj_,,J.0 TOTAL t3 S
Sign tureSign of AfiT:Zi/Contructo/Corltructo Date d ..�
OFFICE COPY
_ POST.THIS CARD,NEAR.FRONT OF BUILDING
} -' - PERMIT NUMBER
CITY OF CUPERTINO 15484
INSPECTION DIVISION ,
JOBgINSPECTION RECORD
• - PERM I,T EXPIRATION
AOB ADDRESS o2�6�00�.�}::✓d'0W .G7 UNIT# LOT*f
f�, -PERMIT EXPIRES IF WORK
OWNER , l Ng-Cd IjX- `coNrRAcroR �aIJ/92i of oa [�- IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU-
FOUNDATION• NOTE: ANCE OR 180 DAYS FROM
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION.
PREGUNII T9 z
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
- .,.`.--• _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - �� podISSUANCE UA TE
M CHANICAL - - �D BLuc, ELec r. Pu.. MECR.
p a o a
v DO NOT POUR FLOOR UNTIL ROVE HAS BEEN SIGNED 2+ 5• BUILDING PERMIT
WOOD FLOOR MQy INFORMATION
PLUMBING
VALUATION $/FT.
- � � � - �
MECHANICAL CITY pf•CuDe <1D , 6
1 .1ELECTRICAL PERMIT TO
FRAMING - .:ft/ .-v ..�. y(7• .L.% �.
INSULATION - STORIES TYPE CONSTR
OCC.GROUP RES UNITS
l
IPL,, PLACE NO SUBFLOOR'UNTIL ABOVE HAS BEEN SIGNED
SO-PI 1 001 AREA .TOT AL ACREAGE.
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
M�,Q' DIAPHRAGM THE CONSTRUCTION TAXIS PAID
ROOF SHEATHING BUILDING USE
• RES IND CON PR UP-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 11 - 1:1 El 1:1
. ASSESSORS PARCEL NO
' ROUGH ' SAN.a
PLUMBING - ELECT.ENERGY
TUBS 8 SHOWER PAN
_ PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL � - MECR.ENERGY
ELECTRICAL
ACC.DATE ACC.FILE No,
BUILDING ENERGY
FRAMING ELECT.FINAL TEST —
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST - GAS ITZ
MECHANICAL FIRE SPR INK ENERGY RP<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - E "� � "L
EXTERIOR SHEAR
ELECTRICAL RELEASE 'F1.00Il ZONL' A,L.U,C,
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ `" L N❑
SHEETR06K GRADE - FEESUMMARY
EXTERIOR LATH BUILDING - I
INTERIOR LATH TEMPORARY APPROVALS BUILDING •'.,; U
SCRATCH COAT ELECTRIC PLAN CHECK .
GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE j 1
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY•PHONING 252-4505, ELECTRIC ,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION, cLumBlNc
CZt:
PLEASE GIVE JOB'ADDRESS WHEN PHONING.
— SEE PERMIT FOR,EXPIRATION DATE MECHANICAL
IMPORTANT! CONST.TAX .
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY