18730 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
:J3UI LDI NG PROJECT I DENTI FICATI ON ,PERMIT NUMBER
BUILDING I(7It APPLICATION & PERMIT ` 18730
AppRESS
I/kLLC-p`Y75I.110 �1 � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 4..
OWNER'S QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION
rvn�m� �
71WEI-5a'D/MES1P'4DNE gV,7
corvTRACTORs � • �/� �-l{ UTLETS-SWITCHES-RECEP 10.00/1.00 10-S
J>?,SEtGwaY72�✓L- LIONO.�`��w/ LIGHTING FIXTURES 10.00/1.00 �U•s'
ADDRESS
OTOR 57 n, /'] APPLIANCES-RESIDENTIAL 4.00
-5rw1wL,+jtrg -47(.og1 PHONE�f�/ -GL PANELS 10.0 pATEOF APPLICATION
ARCHITECTPLAN CHECK FEE P.C.NO.
DR G�FOa lPANELS (OVER 200 AMP) 20.00
ENGINEER VE' I?IYfE R'aR'(Auc.NO. C3059 ISIGNS TRANS. 3.00
AR. ENE.G. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION /
ADDpDRESS Ss 1 �V•V'J'J C{G/w•Ql. 2_19f///////•1N,/'
v
ZIP 75 TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS 2�j��ii2�r/ �/✓ /�
j=t'Yt(T}!-L4pCE .r- o SERVICE CHANGE 20.00
02 LICENSED CONTRACTORS DECLARATION
a U G I hereby aloin that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
w G w (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH.
w• m z Professions Code.,yy1l my(icer is in full force and ffect. (gyp ❑ ❑ ❑ ❑
z 0 a,- License Class tl Lie.Number_ ['£ U 159L1
2 rw Date IC-- Ar-Contractor �I'. `7
a y s J BUILDING PERMIT
¢ ¢ ce a OWNER-BUILDER DECLARATION
MISC.- fRfiFfAtTD ORD INFORMATION
K
3 a y 1 hereby affirm that 1 am exempt from the Contractor's License 1 p , 11..1
u• ¢o j Law Or the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - 10.00 VALUATION $/FT.
� -0 Code:Any city or county which requifesa permit loconstruct.aller, - ����/�
¢ 2 Q Q improve,demolish,or repair any structure,prior to its issuance,akp ELEC.CONTE. LIC.NO. ELEC. Lel o
0 u requires the applicant for such permit to file a signed statement that TOTAL ♦� x/ PERMIT TO V
K
m he is licensed pursuant to the provisions of the Contractor's License 6WI I I h
F z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe nj�A uq�
a
Business and Professions Code)or flat w is exempt therefrom and DTV. PLUMBING PERMIT FEE 11-r"-Y1I I'1�M�
¢ F o the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
dam_ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($5000.):
❑ 1,as owner of it,,property,or my mnployees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole emopensation,will do 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 Iniptoves thereon,and who docs such work FIXTURES:PER TRAP 5.00 SO.ET.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that sech impr..ve-
.,at,meCut intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improve
builment is sold within one year of completion,the owner-
GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
der will have tire burden of proving that Ins did not build or ins- . . .
EES IND CON Pe other
prove for purpose ofelle.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the projrcl(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'I he Contractor's License Law docs 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 contmclorlsl licensed pursumn to
Zhu Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I an,exempt under S".-.B&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner [)ate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK[!RS'CO.MPIiNSATION DECLARATION' WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certilicate of consent to sell-in...v, ZONING ENG.SITE NO.
,r u certificate of Workers'Compensation Insurance,or a certitied
copy there I' •c.3800,LauC-).
fo�I No � mpany D Ute. ti
O MCeAo
Juf 'hed. FIRESPRINK ENERGY T 24
z Cew th _ c 't inspection division. MISC.- REFER TO ORD.
O APPIIcao1 - Y ❑ N❑ Y ❑ N❑
~ w . PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
CIhM VI'IONR(JM WORKIiRS'
LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG,
C o 1'fhis Section need not be completed if the PCnn it is for one TOTAL Y❑ N❑ Y ❑ N❑
:D 2 Is undfed dol lens IS 100)or less.)
U 0 1 certify that in ate performance of the work I'or whldl this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ any person in any manner ,,as to
U become subject to the Workers'Compensation Laws of California.
O w UTue Applicant ALTER OR ADD TO MECH. 5.00 FELECTRIC
} y NOTICE: 'EO APPLICANT: If,atter..,.king this Certificate of Ex-
F Z cmption,you should become subject to the Workeri Compensation' APPLIANCE 5.00
U
provisions of isi,ms or this pebor Ch shall he deou emed rest vokedwith. AIR with AIR HANDLING UNIT(TO 10,000QF.M.) 4.00 �
pr pun
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000QF.M.) 6.00 d
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work) hich this permit is issued(Sec.
3097,Civ.C.). W HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's
Address
is
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct.I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-00
H.P.or 100,000 B.T.U.) 6.00
v hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indmnnify and keep harmless the City of MISC.- REFER TO ORO.
'.pedis, against bit" judgments, casts and expenses which PERMIT ISSUANCE 10.00
Tay wa ac a .gains 'd City in cons luunce of the
`rant go t s er MECH.CONT. LIC.NO. MECH.
-2. S• _e TOTAL _ TOTAL / 02
a are of Applica Gmraclor Will
we, OFFICE COPY
I
r_; POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF . CUPERTINO
1830
' INSPECTION DIVISION
JOB INSPECTION RECORD
/ 01 y2 �ft /alPERMIT EXPIRATION
JOB ADD E55,,� (�, L J / ( (� UNIT#,,qyo PERMIT EXPIRES IF WORK
owrvER �IyJpe— �J2eRJ CONTRACTOR V--C l �VN'.QTT -PW�IN
INSPECTION DATE. INSPECTOR INSPECTION RECORD 0 DAYS Of PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE:
LAST CALLEDINSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF P r VALIDA r10
CUPERTINO STANDARDS. / I
GARAGE SLAGS f,(,/�
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING � � ��
ELECTRICAL, �a _ ISSUANCE DATE
MECHANICAL "•tiu BLDG ELECT PLG. El
rF cR n ❑ ❑ ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ��+� BUILDING PERMIT
INFORMATION
WOOD FLOOR i r t VALUATION STFT.
PLUMBING - "" 00 z ("
MECHANICAL ���`�� ~
PERMIT TO
ELECTRICAL ,.
FRAMING
INSULATION - STORIES TYPE corvsrR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
' ROOF NOTE:NO FINAL INSP.SHALL BE MAD BEFORE s¢vT FLOOR ARLA TOTAL ACREAGL
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res rvU CON Pb 0'�.�
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.p
PLUMBING ELECT.ENERGY
. rRncr No. PARCEL No
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL - MECK ENERGY
ACC DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG SITE NO.
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL
FIRE SPRINK ENERGY T 2d
' v C ❑ N[]COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A-1
INTERIOR SHEAR FIRE DEPT, v[:] NID Y ❑ rv�
SHEETROCK GRADE FEESUMMARY
EXTERIOR LATH I BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT - ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEEdj.._
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC N
ELI WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00� PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL ,S/�•.3
OFFICE COPY