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APPLICANT TO FILL IN INFORMATION'WITHIN RED -LINES -USE BALL POINT PEN ONLY
BUILDING PROJECT.I DENTIF I CATION
-
APPLICATION At PERMIT _
..-:1791.4
BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
PERMITNUMBER -'
- tk
INO;
BUILO. si7s'/fF'/Nf,S' &ESC
ADDRE BS
GAP �Q .0 - �^��t/
OWNER'S
NAME ///���.+�/�'''
' (✓�'/LVG /04;2 Z' PHONE,
-
DTV. ELECTRIC PERMIT • FEE
�PI,AN H C VALIDAJION��
j�II 33
2
CONTRACTORS
NA ME
OUTLETS -SWITCHES - RECEP' 10.00/1.00 `
LIGHTING FIXTURES 10.00/1.00
- LIC. NO. -
('rG�
IftiC.
TE0 APPLICATION
!
CONTRACTORS
AODRESSORE55 a
.PHONE
APPLIANCES 4.00
PANELS 10.00A'p
ARCHITECT
ENCINEEF RFZ uC. NO. G�
CP:c-
- �
PANELS (OVER 200 AMP) .'r. 20.00
C.
PLAN CHECK FEE PCNO.
- ..- r
i
SIGNS TRANS. 3.00
ARCH.ORENG.
AqDDqR�Ess r
orv(p fgjJ,j ZYI /<CUP� iI�'"Q/�
' SPECIAL CIRCUIT .5,00
PERMIT VALIDATION
��- 1r �` "-""
x
�,, EMP. METER OR POLE INS. . 20.00
APPLICANTS -
ADDRESS
�2
MOTORS SEE FEE SCH. •
SERVICE CHANGE '20.00
LICENSED CO 'TRACTORS DECLARATION -
d.
I hereby affirm (hut 1 am liceneed under prrwisions of Chapter 9
(commencing wit It Sell, n 7000) of Division 3,ofthe Business still
PfofeSsions Code, and my license is in fill] force and effect.
License Class Lie Number
ISSUANCE DAT
1
I. 1/� ,(� 1 /i 1663,
R`DG.
ELECT.
PLG., MECH.
Date - Contractor
_ BUILDING PERMIT
INFORMATION' .
,OwNli k-BuarniR DECLARATION
1 hereby affirm (h:0 I am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Cade: county which,equinese permit toconstruct,. lter,also
. an-
MISC.- - 'REF ER'T D
VALUATION
�"J`+yx 000
$/FT.
PERMIT ISSUANCE 10.00 Zri)
ELEC. CONTR. LIG N0.
', L
C. I p
TOTAL to t.4
'
e, demolish,
improve, de molish,.t repair any permit toff prior to its issuance, also
req aims [he applicant for such permit [n file a Fignelsmtement that
he is, licensed pursuant to the provisions of the Cmitractor's Licenw
Law (Chapter 9(ommenceig with Section 7000) of Division 3.f t he
Business and Professions Code) Or dust he is exempt therefrom andGTV.
4CiCJ/IiCJ
- PERMIT TO '• '
PLUMBING PERMIT FEE f
the basis for the alleged exemptioli. Any violation.f Segi.p 7031.5
by any applicant for a permit subjects the applicant toa civil penally
of not more than five hundred dollars ($500).):
.' °
STORIES �TYYPE CION/{TR,
V' -'A'/"
- C•
ALTER -DRAIN & VENT -WATER (EA.)' 5.00
-
I, as owner it the properly, or Fly employees with wages as
t sole compen4ul inn, will do tile work, and Iha Struehvc is not
BACK FLOW PROTECT. DEVICE 4.00 " {
- OCC. GROUP, RES. UNITS
DRAINS -FLOOR; ROOF, AREA, COND. 5.00
intended or offered for sale (See 7044, Business and -Profession,
Code: The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon, and who does such work
himself., through his own employees, provided that such improve-
mems are not intended or offered for sale. If, however, the building
or improvement is sold within tine year of conghlm ioo, the owner-
builder. will have the burden of proving that he did not build or im-
proveforpurpowofsale.).
❑ I, as owner of the property, in exclusively contracting will,
1
- I
FIXTURES - PER TRAP - 5.00
SO. FT, FLOOR AREA TOTAL ACREAGE
,Z
GAS-EA.SVSTEM-1 6.00
GAS - EA. SYSTEM -OVER 4' (EA.) 2.00'
But USE•
• IND CON PB orlon
y(J ❑ I ❑ o ❑
INDUSTRIAL WASTE INTER. ., 30.00
licensed contractors to Construct the project (Sec. 7044, Business
mol Pr. NSSions Code: The Contractor's License Law does not apply
Hill n owner of properly who builds or improves t ereortUanll who
LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 -
ASSESSORS PARCEL NO,
`7�I ,2� la' 03 /i
✓`'i'
LAWN SPRINKLERS - OVER 5 (EA.) 1.00.
colracls ctm-'s h projeaL with a cnntrador(sl limnsed pursuant to
(be Contradoi s License Law.
reason l amexeripl under Sec. i,B.&I'.C. lit Ibis
SEWER -SANITARY -STORM EA. 2001t/10.00
-' TRACT NO.
PARCEL NO.
at
WATER HEATER'W/VENT 6.00
Owner 217A F93A. A Date b-
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
' WORKERS'COMPENSA'I' IONDECLARATION
WATER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate of consent to self -insure.
or a certificate of Workers' Compensation Insurance, or a certified
ZONING
ENG. SITE N0.
- D_
copy Ihereof(See.'3800, Lab.C.1.
Policy No.` Company
•,
'FIRE SPRINK
Y❑, N❑
ENERGY T-24
Y❑ N❑
❑ Certified copy is hereby furnishelf
❑ Certified,copy k fled with the city, inspection division.
Applicant -
MISC.- REFERTOORD.-'s'
CERTIFICATE OF EXE NIPTION FROM WORKERS'
PERMIT ISSUANCE 10.00 2,U
FLOOD ZONE
A.L.U.C. - -
PLG.CONTR. + LIC. NO.
PLG.
TOTAL '���
COM1IPENSATIONINSURANCE
('f his section need not be completed' if Iha permit is I'or one
Y ❑ N ❑
Y ❑ N ❑
bundand dollars IS 100) or less)-
1 certify ]hat in the performance .f the work for which this Her.
mit is issued, 1 shall not employ any p' sun in on ma so as m
been yabje t{ythe Worker, CO all s o li Crnia
Date-Dii(( 'f9 Applicant _
NOTIC: AI'I .ICANT: If, after making (his Cs (,Nes71.
DTV. MECHANICAL PER FEE
FEE SUMMARY
`
ILDING
•� O
ALTER OR ADD'TOM ECH. 5.00
APPLIANCE' ° 5.00
_
'PLAN CHECK
emption; you should become subject In the Workers Compen.4(ion
provisions of the Labor Code, you nWSI forthwith comply with
such provisions or this'permit shall be deemed revoked.
FEE
AIR HANDLING UNIT (TO lo=c.F.M.) 4.00
AIR HANDLING UNIT (OVER 10=C.F.M.)6.00
SEISMIC FEE
00
CONSTRUCTION LENDING AGENCY
1 hereby affirm (hat there is a construction lending agency for
EXHAUST HOOD (WITH DUCT) 5,0
the performance of the work lit which this permit is issued (Sec.
3097, Civ.C.).
MICROFILM '
•�-•
HEATING UNIT (TO 100,000 B. 8.00
Lender's Name
HEATING UNIT 100,000 .T.U.)9.50 -
'ELECTRIC
!a-�p
LendersAddrcss _ -
' l certify; that l have read this application and State that the above
VENTILATIOWFAN (SINGLE)' 4.00
information is correct. I agree to comply with all city and County
ordinances and state laws oliling to building construction, and
PLUMBING
Z+
BOILER-COMM]-I.P.or 100,000B.T.U.) 6.00 -
'BOILER -COMP IOvar 100,000 eTU15EE FEE SCH.
MECHANICAL
��2�
herehy',authodic. representatives of this city -(o 'enter upon the
above-mentioned property for inspection purposes.
misc. - . - REFER TO ORD.
(We), agree to save, indemnify and keep harmless -the City of
uper-tino against liabilities, judgments; costs :md expenses which
may in -any way accrue ago}Qst said City in consequence of the
•mn of Penn / / ' -
- CONST. TAX
S ,
I�
, PERMIT ISSUANCE' '• 10.00 1
MECH. CONT , -LIC NO.
:
,, '
,
y]IIS
/
TOTAL
TOTAL /l 7 j
I�
1 AL
/L
1 -� IM
Signature of APpReant/Contranor
OFFICECOPY
" POST THIS CARD NEAR FRONT OF BUILDING ', ,.•
CITY OF CUPERTINO''
INSPECTION DIVISION
JOB INSPECTION RECORD
JOB ADDRESS _�"d L S ` ��!` CSE` lo&gN1T# - LOT#
�
OWNER, v,. t �I. P Q - ' '•CONTRaCTOR „
pFRM;T NUMBER
7,91
R r
PERyMI`T)EXP I RE$•O, WOR K-'
ISr NO,T 4 RT.E44__WI TH IN
780IDAVS�F �E}�RMIT ISSU.'
ANCE. OR,lWDAYS FROM
LAST CALL E D I NSPECTI ON.
,INSPECTION` DATE INSPECTOR
INSPECTIONRECORD -'
FOUNDATION -
.
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS pAjo,
LIFER 'Lq.'p
_PR EGUNITE :. '•
PERMIT VALIDATION
r''T .
/ 2 Y ��' �"•C�
I
ISSUANCE UATry
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN IGNEDDEG-0A'r
UNDERGROUND/ SLAB •
PLUMBING
cit,
nIr
p
ELECTRICAL
MECHANICAL-
F.L ,
PLG:r
DO NOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
-
BUILDING PERMIT
INFORMATION
WOOD FLOORY
VALUATION $/FT.
`c)N, rOA{,D
'%
PLUMBING - 2;D
.••
MECHANICAL
ELECTRICAL
PERMIT TO
.. �,.-- .:'i..
FRAMING-
,INSU LATION'•.STOHILS
OCC.GROUP
rYPE CDNSTI
RES. ITS
'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- : ROOF ' •-
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO. FT. FLOOR AREA
=^ -
_P�.`J �]
_ TOTAL ACREAGE
'�,•';.
DIAPHRAGM`S -
'-
-
ROOF SHEATHING
BUILDING USE.
IX IND CON PB Om",
APPLY NO, ROOFING UNTIL.ABOVE HAS BEEN SIGNED
FINALS,., DATE INSP.
ROUGH,
SAN.H
ASSESSORSPARCELNO
7.,•�.I; r
�-
PLUMBING . I I • •
ELECT. ENERGY- -
TUBS & SHOWER PAN ' _
PLUMBING ENERGY
TRACT NO.
-
PARCEL NO.
MECHANICAL
MECH. ENERGY
ELECTRICAL,' -
BUILDING ENERGY.
ACC DATE
ACC FILE NO
FRAMING
ELECT. FINAL: TEST.
INSULATION -•
PLUMBING
ZONING
ENG. SITE NO..
GAS TEST <,
GAS r
- -
MECHANICAL-
FIRE SPRINK
�" "E]
ENERGY T@A.
Y ED "�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
ELECTRICALRELEASE
FLOODZONE
Y ❑ NE)
A.L.0 C.
Y L No
INTERIOR SHEAR.'
FIRE DEPT.
SHEETROCK.
GRADE
FEE SUMMARY
EXTERIOR LATH 113UILDING
BUILDING
'
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC "
PLAN CHECK
FEE ,
•
GAS
NO TAPE OR PLASTER UNTIL ABOVE -HAS BEEN SIGNED JOCCUPANCY
I
SEISMIC FEE
q
1 . j(jlO
OCCUPANCY' OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUILDING -INSPECTOR.
MICROFILM
�""'^'•
ARRAIN
ARRANGE FO.R SPECTION BY PHONING'252-4505,
o�ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE';GIVE'JfJB.ADDRESS WHEN PHONING.
' SEE PERMIT' FOR EXPIRATION DATE -
ELECTRIC
PLUMBING
-,MECHANICAL
�.
TAX.
IMPORTANT!'CONST.
PLEASE 'READ REVERSE SIDE BEFORE
INSPECTION.
-.CALLING FOR FINAL INSP
, ,"'T AL .
OFFICE.COPY