18224 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT.PEN ONLY
6 I
- BUILDING PROJECT I DENTIFICATION !PERMITNUMBER
ADDRErvG '18224
ADOREss
a vl-,Olarlaiid 7)r. BUILDING -ELECTRICAL-PLUMBING-MECHANICAL .�.
OWNER'S - - , - 1 'PLANCHECK VALIDATION
NAME L ' CITY. ELECTRIC PERMIT. FEE
\ rh�F .)� C`=C=1d DrvE �/6-701 - - -
CONTRACTOR S � ,x ���•��'•t� �Jy�
NAME Z.'OAIS LTt oQOUTLETS-SWITCHES-RECEP 10.00/1.00 •�� M, A 1'�• ILJ
!J All • Qlt ' uc ND 4/� LIGHTING FIXTURES 10.00/1:00 .5�
r,DrvTRACTGR's tiL 'Trb �gVZ7 .� PPLIANCES-RESIDENTIAL 4.00 �[ \ �
' AODRESS .
I o'?,
� q .�J
Z A . /ICgK I�/LPRONEQPSS /O PANELS 10.00 DATE OF APPLICATION
1, ARCHITECTp PLAN CHECK FEE., P.C.NO.
OR o4° ���� y PANELS (OVER 200 AMP). `' 20.00
ENGINEER •Pausal Perp
,LIc.NG. SIGNS TRANS: 3.00
-- 'ARCH.OR ENG. TPERMI VALIDATION
ADOREss r SPECIAL CIRCUIT, - 5.00 .7, O
/6 6 Zlv9pol EMP. METER OR POLE'INS.-, 20.00 /
ADDRESS, - - MOTORS ,t, SEE FEE SCH. /�/
ADDRESS, ' �/
•Q SERVICE CHANGE � . 20.00
w 0 2 LICENSED CONTRACTORS DECLARATION
a u Lyi 1 hereby affirm that I am licensed under provisions of Chapter 9 _ DANCE ATE
w (commencing with Seclinn 7000)of Division 3 0(the Business Ilnd
a 'tY; - RLOG. ELECT PLG. ElJ
_ H N i Professions Cod• and my license is m full force and,eff��p1. � -
z 0 w - License Class 6� LIc Number�'h$.T
0 w F Dutc Contr.clot All 9 p - -
a m s TrV F BUILDING PERMIT
o u o nWNER-BUILDER DECLARATION INFORMATION
X g u_y I hereby al'flrm.tlmt 1 am exempt from the Contractor's License MISC:-
uOa Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE ,VALUATION $/FT.
Colle:Any city or county which requioxa lemon loconslRml,utter, - `�'� r/l/�nG�
2¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, -LIC.NO. ELEC. [� M� .1(3{. �� /-1
O II: requires the applicant for such permit to file a signed statement that - TOTAL /� " V PERMIT TO
n w m LL he is licensed pursuant to the provisions of the Comnlxror's Limnse
Q'• Law. Chapter 9(commencingwith Section 7000)of Division 3 of the
i 4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ H the basis for the alleged exemption.Any violation of Seel tm7031.5• - •- STORIES TYPE CONSTR,
by any applicant for a permit subjects the applicant to a civil penallyATT500
. -
of not more than five hundred dollars(S500L) / LTER-DRAIN&VENT-WATER (E
'0 Las Owl",of the property;(it my employees will,wagon as .�BACK FLOW PROTECT:DEV ICE 4.00 OCc:GROUP BEs.untTs
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions RAINS-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 jo.OC/ SO.FT.FLOOR AREA TOTAL ACREAGE
Himself or through his own employees,provided that such improve-
meals are not intended or offered for salell',hawevcr,the building GAS-EA.SYSTEM-1INC.4.OUTLETS 6:00 1Q,
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.)
+r builder will have the burden of proving that he did not build or bn- 2.00 BUILDING USE
RES IND CON. PB Ovner
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30:00 -
r 0 1,as owner.1 [lie property,an exclusively commcting with El 11 El ❑
licensed contractors to construct the project(S".-7044,Business AWN SPRINKLERS-11 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I'lie Contractors License Law does not apply
i to an ownerof properly who builds or improves thereon.and who LAWN SPR IN K LERS-OV ER 5(EA.) 1',007J
'Z/.. - II _O'�
contracts for such projects with x contrxehn(s)licensed pursuant to ✓`L��-
. - the Contractor's License Law. EWER-SANITARY-STORM EA.200tt/10.00 TRACT.NO. PARCEL NO.
` 0 Cop
am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reasra
Owner Date t WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKS RS'COMPENSAT1ON Di:CLARATION WATER TREATING EQUIP; 5.00
I hereby affirm that I have a certiflcale orconsenl to self-insure. ZONING
of a certificate of Workers'Compensation Insurance,or u certified ENG.SITE NO.
copy thereof(Site 3800,L.HCA
Policy No. • ' Company '
'0 ❑ Certified copy is hereby furnished.. . FIRE SHRINK ENERGY T-24
Z Z ❑ Cerlified Copy is bled with'Ihe city{ inspefit on division. MISC.- REFER TO ORD.
O Applicant v ❑ N❑ v ❑ N❑ •
~ m PERMIT ISSUANCE p -1$190A
FLOOD A.L.u.c.
lr •Cl:R'I'I FICATE OF EXEMPTION FROM WORKERS' I•T LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 2A/0 fl'his section need nor he comleted if te permit i,s foams TOTA 7 V❑ N❑' V❑ N❑ `
Z hundred dollars($ID0)or les,.)
U O I certily,that in the performance of the work for which this per- GTY ,MECHANICAL PERMIT. FEE FEE SUMMARY'
L F mit is Issued,I shall not employ any Person imyny manner so as to . t
(] w become subject to tie m
Workers'Compensation Laws of California.
y Dale Applicant / ALTER OR ADD TO MECH. 5.00 7. 07) BUILDINGQ�
NO'I'ICI','I'O APPLICANT: h,after nw king this Certificate of Ex-
F-. ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK -
provisions OL the Labor Code, you must forthwithcomply with FEE
U such provisions or this pinnir shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
'CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER IQOOOQEM.) 6.00 SEISMIC FEE - I'
1 hereby affirm that there'is'a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 '
the l erformmnce of the work for which this permit is issued(Sec. - MICROFILM
3097,Cie C.). - HEATING UNIT.(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT IOV ER 100,000 B.T.U.)9.50 1-
Lender's Address ELECTRIC .'� f;
I certify that l have read tbisapplicarion and state that thcabove VENTILATION FAN (SINGLE) -4.00 '
information n correct. I agree lingcomply with all city and county - 'PLUMBING _
I,
information
and state lows relating to building U city uction,and co my BOILER-COMP(3 H.P.or.100,0008.T.U.) 6,00
hereby, authorise representatives of this city IO enter upon the BOILER-COMP (Over 100,0006TU)SEE FEESCH. MECHANICAL
S
bove mentioned property for inspection purposes.
We; agree to save, indemnify and keep hunnlcss the City of MISC.- 'REFER TO ORD. -
upertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in'an w y accrue against 'IiI City in consequence of the PERMIT ISSUANCE Ia RI'.•00 �z•Q•]l
rantingg ..'�,ycolt/. G (J' MECH,CONT. LIC.NO. MECH. -
<<G� r•'G(il-�'I/Z. ' TOTAL TOTAL
Signature of Applicant/Commclor fDate - �L/ t /�•
OFFICE COPY
+ POSTTHIS NEAR FRONT OF BUILDING f '
' , CITY .OF CUPERTINO18224
D I N'
INSPECTION IVIS O , . .
JOB INSPECTION RECORD '
PERMIT.EkPIRATION
JOB ADDRESS , /UJIf Il��-�C�(W' r. ,NIT#
LOT#t �.. v ....+ _
L- n z PE_RMIT(E)P)R�F�S IFL�WON
NER - -LONTRACTO ISNOT STARTED WITHIN'
,- - INSPEC ON DATE' INSPECTOR - - .INSPECTION RECORD180 DAYS OF PERMIT ISSU-
FOUNDATION- 29-B G - .NOTE: ,F ��,t :ANCE OR 180 DAYS FROM
'UFER _ — —� . FALL GRADING AND.DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.'
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PER vn LlDnriON
IPREGUN ITE-. .. '� LUPE IND STA D DS
'GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Ilia. ( /
UNDERGROUND I SLAB .
PLUMBING
ELECTRICAL , I �Y
$SIIAN 'UA TE
MECHANICAL
Aue
r 'r -+
OD NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED < . . BUILDING PERMIT�{y ,INFORMATION
WOOD FLOOR --�•'�-
PLUMBING VALUAT;oN
If
�r
MECHANICAL - r. S
P'RM IT TO
ELECTRICAL —l/ '�f�.�wG {.I,A, �,• ' ,�
_ .FRAMING — _ Yr .:..• .
'INSULATION Si ORIES TYPCCONSTR..
_-_ „ v '�, " • OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-. ROOF - NOTE:NO FINAL) SP.SHALL BEM EF R
BEE so,-r'}T•F}Loon•AREA TOTAL ncReArL
'DIAPHRAGM - THE.CONSTRUCTION TAX IS PAID
' ` BUILDIG USE
ROOFSHEATHING .' Res IND CNON Pu Dm,l�
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE ,..INSP. ❑ ❑ "❑ ❑ 1:1 '
' S Fj.55F.SSORS P ARCEL NO.
! ROUGH SAN.q ,
.PLUMBING' - ELECT.ENERGY xJ� ''— X1 = 013 '
JN
TUBSBSHOWER PAN * 'PLUMBING ENER RAct NO, PARCEL No,
- - MECHANICAL MECH.ENERGY -'
ELECTRICAL' BUILDING ENERGY - CC.°ATE' Accvu.E No:
FRAMING ELECT.FINA 'TEST zO Nc emc.SITE No. .
INSULATION- PLUMBING -
GASTEST GAS,
- MECHANICAL' .FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS�BEEN IGNED HEATING. r - v ❑ N❑ v ❑ N❑
EXTERIOR SHEAR. ELECTRICAL RELEASE ' PLDou mNc q.L u,c.
.. V ElN❑ Y ❑ N❑
INTERIOR;SHEA R. �. FIRE DEPT. -
SHEETROCK GRADE _ FEESUMMARY
EXTERIOR.LATH' BUILDING.
INTERIOR LATH
TEMPORARY.APPROVALS, BUILDwG' �6 ,
SCRATCH COAT -' " ELECTRIC' VIE
CK
GAS - -
IF
'NO TAPE ORTLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY, EE �?II
OCCUPANCY•OF•BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY.BUILDING INSPECTOR. M
ARRANGE FOR INSPECTION BY PHONING•252-4505;: 3
yfO�.' ONEIWORKING'DAYBEFORE, REQUIRED:INSPECTION
Z
PLEASE'GIVE'JOB,ADDRESS'WHEN PHONING
1` pSEE.PERMIT FOR EXPIRATION DATE MECHANICAL '
:" IMPORTANT!` CONSTQAX
PLEASE READ REVERSE SIDE;BEFORETOTAL
CALLING FOR FINAL INSPECTION "
i
''` : OFFICE COPX' ' •