15610 A}�PLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATI ON 'PERMIT NUMBER I
�` E,nLD,Nc APPLICATION &'PERMIT 61 O
DaE s J
T{/LA 4A06A/IJIT A. BUILDING ELECTRICAL-PLUMBING-MECHANICAL 5
NERS PLAN CHECK VALIDATION '
AMru OTV. ELECTRIC PERMIT FEE
I
I� H+
CONTRACTOR'S
,� HAMEUTLETS-SWITCHES-RECEP 10.00/1.00 s
mweba1 DE��. X39�y i LIGHTING FIXTURES 10.00/1.00 -
LIC.N0.
IONT�R(ACTOR'S PPLIANCES-RESIDENTIAL '4.00 '
ADDRESS
I15c) I/
0. G^IiFLjjV PHONE 8(ab +94-1 , PANELS 10,00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP)., 20,00 PLAN CHECK FEE P.C.
DR
ENGINEER VINCEIJT KoN(n.
LIc.Ho. SIGNS TRANS. 3.00
ARCH.ORENG. Q - PERMIT VALIDATION .
ADDRESS - gyro ll .SPECIAL CIRCUIT 5.00
II?qE 4Y Ips sLLf Z P EMP.METER OR POLE INS. 20.00
APPLICAMOTORS SEE FEE SCH.
NT'S
ADDRESS(LCAg600F [y,(ITyJJ{y/.^�11�r1
15o E• c�P6E/r.� ao� �41e1 C!y++f�IL SERVICE CHANGE 20.00
0 0 LICENSED CONTRACTORS DECLARATION ppo
a v U I hereby affirm that I am licensed Ruder pruvisiuns of Chapter 9 1 Ol Woe
O�OISSUANCE DATE'
a w (commencing with Section 7000)of Division 3 of the Business and _ BLDG. ELECT. PLG. MECH.
H D z Professions Ca'le,,.a�m,nnm_y,license is in full force at d e�f�fe� ,
Z i w o icenac Class SaFM_p/19.1�Lic.Number 4 _q v
ale_��L1��.,- _Cnntracla_Airl�r/11AD_
`¢ x s T 3 p BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER UECLARA'I'[ON - INFORMATION
wO u .- REFER TO ORD
;u_ y I hereby affirm that I am exempt from the Contractor's Liarmse VALUATION $/FT.
F ,a Oa law for the following reason(Sec.7031.5.Businessand Professions PERMIT ISSUANCE lop B a
Code'.Any city or county whichrcquiresupermlt tocon,truct,ultcq �� d
¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR., LIC,N0. ELE
A.
D ¢ requires the applicant for such permit to file a signed statement that TC OOTAL a PERMIT TO
u w Or sc he is licensed purentur to the provisions of the Contractors License
rzr
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc S�Q WL.
f>iya Business and Professions Code)or thin he is exempt therefrom and OTV. - PLUMBING PERMIT FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a te. by anyore tthan tura permit subjects S500). ' ALTER-DRAIN VENT-WATER IEA.) 5.00
to
caacivil penalty SN
of not moren fivevc hundred dollars(he applicant
❑ 1,us owner of the property,or my employce�•w ith wages as BACKFLOW PROTECT. DEVICE 4.00 OCC.GROUP RES UNITS
their Sulu compensation,will do the work,and the structure is not
intended or offered for saleec
.(S . 7046, Businns and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 R -
Code The Contractors License Law doe or apply to an owner of
ho=ly who builds Or improves thereon,and who does such work FIXTURES-PER TRAP. 5.00 SO_FT.FLOOR AREA TOTAL ACREAGE
himxIf or through his own anployees,provided that such improve- r1 �/
Tents are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 dJ �
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 thus he did nor buildor ire RES IND CDN PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑
-❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSE RS PARCEL NO.
and Professions Code:The Contractor's License Ww docs not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.), 1.00 JS-�._13 --O 76
contracts forsuelm projects with a conauctorts)licensed pursuant to SEWER-SANITARY-STORM EA.2005[(10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
i ❑ [am exempt under Sce. ,K&P.C.list this I
Itasca WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPI NSATION DIiCIARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certifcale of can.¢nt to s11-irsuor. ZONING
or a eertifcate of Wbrken'Compensation Insurance,or a certilieJ ENG.SITE N0.
ropy the mof(Sec.3800,Lab.C.
Policy No. Compan 9Y_17 ._✓1'_S.L� _
O ❑ Certiliedcopyi'la"e is
Q FIRE SPRINK ENERGY T 24
Z Z ❑ -Certified copy is - wi ( u division.
O Applicant MISC:- REFER TO ORD. yo NE] Y ❑ NE]
~ y - PERMIT ISSUANCE r-1e-oo 7 FLOOD ZONE A.L.U.C.
LC CERTIFICATE OF li%IiMPTI PROM WORKIiRS' - '
LU COMPENSATION INSURANCIi PLG.CONTR. LIC.,NO. PLG. YEl N[:] V N�
0- 0 (This section need not be completed if the Permit is for one TOTAL J
hundred dollars IS 100)or less.)
U O 1 certify that in the perfomunce of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued,I shall not employ any person in any manner or as to
become subject to Workers'Compensation Laws of California.
0 Go Ric Date-ApplicantBUILDING
} rap NOTICE TO APPLICANT:
NT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
F ? emptlon,you should become subject to the Workers Compensation APPLIANCE - ' 5.00 PLAN CHECK
provisions of the Labor Code, you anal forthwith comply will, FEE
CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SMCFA&) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10DWC.F.M.) 6.00 SEISMIC FEE
I hereby uflimu that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for'which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 pp
Lender's Name
Gender's Address HEATING UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC OS�
I sertity that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 _y S-
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and slate laws relating to building construction, and BOILER-OOIrP 13 H.P.cr1DOXOB.T.U.) 6.00
hcieby ...theism representatives of this city to en tar upsm the gQILER-COMP IDV4r 100,000 BTU)BEE FEE SCH. MECHANICAL �-yS
above-mentioned property for inspection purpoxs.
I
(We) agree to save, Inde oily an keep ha ss the City of MISC.- REFER TO ORD. 7
Cupertino against ilium dgnme s, costs expenses which PERMIT ISSUANCE '1600 . CONST.TAX a A
may in any way true msD City nvqucncc of the '--'
ming of the air. MECH.CONT. UC.NO. MECH.
��� TOTAL D- S TOTAL / 7 7
Signature o Applic t/Con r Uatc IG/
OFFICE COPY
•i .POST THIS CARD NEAR FRONT OF•BUILDING PERMIT NUMBER
- CITY OF CUPERTINO,." 15610
INSPECTION DIVISION
JOB INSPECTION RECORD a
I - c,[, r Il y PERMIT-EXPIRATION
• JOBS ADDRESS /0 / d TLJL..g- 4: ,I UNIT#hLOT.# PERMIT EXPIRES IF WORK
OWNER u CONTE ACTOR •� a lA IS NOT STARTED WITHIN
INSPECTION- DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- -
FOUNDATION ))-g!{ ' ANCE OR 180 DAYS.F ROM
NOTE: LAST CALLED INSPECTION.
UFER' ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUPJITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. " -
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - `r ISSUANCE DATE
MECHANICAL - ELECT. PLG. MECH.
4
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Of zosimmrILDING
INFORMATION T
WOOD FLOOR'. vnwnnoN SIFT.
PLUMBING
MECHANICAL
PERMIT To .
ELECTRICAL
FRAMING - Lr, G'1 i
, 5, STORIES TYPE CONSTR.
INSULATION CI
OCC.GROUP RES UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED — 3-
.ROOF . NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.rT.FLOORAREA TOTAL ACREAGE
I�
DIAPHRAGM THE CONSTRUCTION TAX IS PAID eZ
nulLu use
ROOF SHEATHING -�1'-Qj9 /, � � Res IrvU CON Pa
14- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 'Ll 1-1Cl El
ASSESSORS PARCEL NO.
ROUGH SAN.J y
PLUMBING o- % ELECT.ENERGY "- J J76
TRACT NO. PARCEL NO
TUBS 8 SHOWER PAN - (}- PLUMBING ENERGY
MECHANICAL MECH.ENERGY - - h ACC DATE ACC FILE No.
ELECTRICAL' Q BUILDING ENERGY .
FRAMING . -73%OJb`S ELECT.FINAL TEST - ZONING ENG.SITE NO.
INSULATION PLUM13ING
GAS TEST GAS - -
1 MECHANICAL _ 7 FIRE sPRINK ENERGY r.za
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ' HEATING ❑ N0 v N�
EXTERIOR SHEAR �a- ELECTRICAL RELEASE FLUOU ZONE A.L.U.C. .
INTERIOR .SHEAR - Cy FIRE DEPT. . `' I] N❑
SHEETROCK _'y'J GRADE FEE SUMMARY
EXTERIOR LATH 1.5 BUILDING
INTERIOR LATH. 23-11 ,� TEMPORARY APPROVALSBUILDING �U�Sd
SCRATCH COAT ELECTRICPLAN CHECK
>yy... GAS FEE.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 63 .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILD ING FINAL•ISSIGNED BY BUILDING INSPECTOR, MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC f
.,ONE WORKING DAY BEFORE REQUIRED INSPECTION. - PLUMBING S 9
O� PLEASE GIVE'JOB'ADDRESS WHEN PHONING.
Z 'MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! . CONST.TAX 03
PLEASE READ REVERSE SIDE BEFORE TOTAL 7
CALLING FOR FINAL INSPECTION.
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
Date ...... 19............ Building Permit No. . ....
.........
The Building Located at --- ........................
..
Owned by ..... ------- ............ ..
... ............ ..
.. .
Has Been CgEEEet �or Use As: ......... -----------------------------
(Alte,ed)
.................................................................................................................................................
..... ................................................................................... .......................................................
..............................-....................... ........................0*-� ..... .......................................
--— -
-- --------k. ..�....1--l-n K
---- A ..............
PD-7 BUILDING INS ECIrOR