16478 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
'-BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGn APPLICATION &PERMIT 1 y^�
• 1 RIj Q L[LI✓/1 An LJ r BUILDING—ELECTRICAL—PLUMBING—MECHANICAL f {J S
Ow ER'S rrITT YYYNNN ""l _ PLAN CHECK VALIDATION
E 0^'► QTY. ELECTRIC PERMIT FEE ,
• PHONE
NAMERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 r
LIC.No. LIGHTING FIXTURES 10.00/1.00 .S,a
CONTRACTORS PPLIANCES-RESIDENTIAL" 4.00 "
ADDRESS
PHONE' PANELS 10,00 DATE OF APPLICATION r
ARCHITECT• PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C�NO.
OR
ON
' LIc.No. SIGNS TRANS. 3.00
ARCH.OR ENGPERMIT VALIDATION
aooREss - SPECIAL CIRCUIT 5.00 �.
-
ZIP EMP.METER OR POLE INS. 20.00 �
�( APPLICANTS MOTORS SEE FEE SCH.
bA SERVICE CHANGE 20.00 /6/3 A�
00 LICENSED CONTRACTORS DECLARATION / —
¢ o u I hereby a(linn that I am licensed under Provisions of Chapter 9 ISSUANCE DATE
ya N (commencing with Section 70001 of Division 3 of the Business and G. ELECT. PLG. MECH.
F N z Professions Code,and any license is in full force and effect - ❑ ❑
z License Class m Lic.No be,
9 m r o Date - - Contractor , (��
¢ m s ' ®^-' BUILDING PERMIT
¢ ¢ w a )( OWNER-BUILDER DI C LARAr1ON RMATION
w 3 LL y I hereby aft v that um ex rapt from fheCn"Im tor's License MISC.— REFER TO ORD ION
US $/FT.
Law th following S 70315 Bunn s a dProfessions
u_o < ( PERMIT ISSUANCE
Cod Anycity n xtrya hr Dur sIf ennitt sisua t,alter. ./S
o Improv demolish, a repair any eltract ur rim t is issuance also ELEC.CONTR.
ELEC.
C p r qm[c shed Pursuant head t t then perau Ir Idea bn d std0.mcnl that - - -. TOTAL �� PERMIT TO
>< m he a liven sed connarfh f h I r vI a"-of the Contractor'.,Di t License
z a La (Chapter )( nm nc ng with S 11700(1 fDi i.i n3of the ('� +1y
i o Business and professions Code)or that lie is exempt therefrom andUMBING PERMIT FEE
¢ r o the basis for the alleged exemption. QTY. PL
Any violation of 7031-5 .STORIES TYPE CONSTR.
d3 �_o by any applicant fora permit subjects theapplicant too civil penalty. ALTER-DRAIN&VENT-WATER (EA.1• -.�
binot more than(ivc hundred dollars 155001.1`.
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered fur sale (See. 7044, Business and Professions DRAINS_FLOOR,ROOF,AREA,COND. -6.:00 --
Code:The Contractor 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 SQ IT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such ann rove-
mentsarenotintendedoroffeed for sale.If.however.the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
p
for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND PD Omer
Yl X1,as owner of thra
e property, n exclusively contracting with El ❑ El❑ El 11h n d c enactors m eonetrun the project)Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'fire 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 with a contracmdsl licensed pursuant to SEWER-SAN ITARY-STORM.EA.200ft/10.00 .TRACT NO. PARCEL NO.
the Conir2cl"yrs Liven�CLa
-'l am •keapumdtr e .BAP.C.for[his WATER HEATER W/VENT 6.00
0
\o 'Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE No.
WORKERS'COMPENSATTON DECLARATION WATER TREATING EQUIP. 5.00
II"ercry ufflnn that l have a cerlifcateof consent fosclf-insure, - ZONING ENG.SITE NO.
or a certificate Of Workers'Compensation Insurance,or a certified
copy thereof(Sas.3800,LAC.). '
Policy No. Company -
Q ❑ Certified copy is hereby furnished. - - FIRESPRINK ENERGY T-24
Z_ Z ❑ Certified copy is fled with the city inspection division. MISC. - 'REFER TO ORD.
O' Applicant Y ❑ N❑ Y ❑ N❑
~ m PERMIT ISSUANCE 49:68 — FLOOOZONE A.L.u.c.
� CIiRT119CA'Di OP EXEMPTION ION PROM WORKERS'
W � COMI'IiNSA'I'ION INSURANCE. PLG.CONTR. LIC.NO. PLG, �y
0 IT he, section.need not be wmpleted If the Permit is for u - - TOTAL V Y❑ N❑ v
C• ❑ N❑
Z) Z tr "d I dollar:IS 1001 rl :.) one `�
U O
W tf (fiat ttrrinae the which this r FEE FEE SUMMARY
F OTMECHANICAL PERMIT
M1 ' .red, I hall hot employ Iv cr,oun, nyucunc,,ea, .
to
U0bec>m -subject to the Worker.' C nop ":etion L w f California.
dQ Dat Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE '1'0 APPLICAN f. If,after making this Certificate of Ex- -
. . caption,you should become subject to the Workcr2 CUmPv.,aIloll APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith conhply with FEE
U such provisions cr,tlis permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONST RUCTION LENDING'AGI'-NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the Performance of the work Tor which this permit is issued(Sec. MICROFILM
3097,Civ C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Nim e
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC .
1/0
I certify that I have read a tens o counpl nand state that theaboveounty VENTILATION FAN (SINGLE) 4.00
'"for tion is correct. l agree to ora Ply he 'll city and county PLUMBING
Ninanees and tel laws rte Yny to building cont atom, and � ' BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 �—
hereby authonz representatives of this city to enter upon the BOILER-COMP (Over 100,o008TU)SEE FEE SCH. ' MECHANICAL
above-mentioned property for inspection purpows-
(Wc) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - •CONST.TAX
ay i , y way accnm 'inst said City in conugroem• Of the PERMIT ISSUANCE 10.00
a ng Permit. /6 ' MECH.CONT. LIC.NO. TOTAL
TOTAL
'n amreofA lice t/ o ae Date '
OFFICE COPY
POST THIS CARD NEAR FRONT OF-BUILDING vERp IT Nun1sER
CITY.. OF CUPERTINO
. .- + 16478
INSPECTION DIVISION
JOB,INSPECTION RECORD" ,
/^ ,/J •PERMIT EXPIRATION
' /Q6 �/ Z-11-K6 J9 J� UNIT# '_LOT#
JOB ADDRESS / PERMIT EXPIRES IF,WORK'
OWNER- tj_�2-T+N ' CONTRACTOR IS NOT STARTED. WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .180'DAYSOFPERMIT ISSU:
.- FOUNDATION ALLNOTE.
GRADING ANDDRAINAGE-SHALL BE INSTALLED- - . ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.'
' ALL G
PR EGUPJITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION -
CUPERTINO STANDARDS. . _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING A1� .ry �!L{`
ELECTRICAL Pr`,V ISSUANCE DATE
MECHANICAL - c, ELECT. Pu.. -.MECH. ;
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
eJ�X0 UILDING PEiiMIT
D`C INFO MATION
WOOD FLOOR ' - VALUATION SIFT.
PLUMBING - - - N
MECHANICAL
ELECTRICAL rel+,n(lJ{T—ro„
.. .FRAMING
INSULATIONS STORIES TvaE CON TR.
OCG GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
' - ROOFrornLnLee eE
. .NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so rT,LooR APIA -
DIAPHRAGM• THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RLs. SND' CON PE OIl
APPLY NO ROOFING UNTIL ABOVE,HAS BEEN.SIGNED • ,FINALS •DATE, INSP..a:, ❑ 1 ❑ ❑ ❑
ASSESSORS PAHCEL No
i ROUGH ' SAN.# ' - - _
PLUMBING ELECT.ENERGY '-
TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL MECH:ENERGY ' -
.._ ELECTRICAL O-y7!/. BUILDING ENERGY .ACC.DATE ACC:Fae NO.
FRAMING ELECT.FINAL TEST -.Z - zomwc, ENG,SITE No.
INSULATION - PLUMBING. •Y'
GAS TEST GAS
MECHANICAL P,RE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v 'N❑ ❑ N[:].
EXTERIORSHEAR - - ELECTRICAL RELEASE U. FLo0D zoNE A.Luc.
�. ��
INTERIOR SHEAR FIRE DEPT. ° N� w. ❑ N❑
SHEETROCK GRADE FEE SUMMARY '
EXTERIOR LATH, BUILDING 'p
BUILDING
INTERIOR LATH - TEMPORARY.APPROVALS
SCRATCH COAT - ELECTRIC PLAN CHECK '
GAS - FEE ..
_ NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' ' - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
II—_ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING'
O; PLEASE GIVE JOB,•'ADDRESS WHEN PHONING. d —
Z' = SEE PERMIT FOR •EXPIRATION DATE — s MECHANICAL
IMPORTANT! CONST.TAX `
+ PLEASE CALLING FOR FINAL INSPECTION.E TOTAL
OFFICE COPY