The URL can be used to link to this page

12663 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES'- USE BALLPOINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER HUItDDR SS & APPLICATION PERMIT ADDRESS D �� 110470 Imperial A BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNERS PLAN CHECK VALIDATION CITY, ELECTRIC PERMIT FEE NE446-1913 NAIVEA a I Qy OUTLETS=SWITCHES-RECEP .10.00/1.00 - Debcor Corporation LIC.No. 385712 LIGHTING FIXTURES 10.00/1.00 `• ADDRESS rORs 21625 Ste VeI1S Creek Blvd PPLIANCES-RESIDENTIAL 4.00 - Culpertilrio, 95014 PHONE 446-1913 PANELS 10.00 DATE OF APPLICATION ARCHITECT -PLAN CHECK FEE OR ' Seals & Assoc C-15162 PANELS (OVER 200 AMP) 20.00 ENGINEER .n ClarkLIC.NO. O-6 $2 SIGNS TRANS. 3.00 - AARCH,OR OR ESS ENG.Se a1 S, Oakland, CA ISPECIAL CIRCUIT 5.00 PERMIT VALIDATION . Clark, Saratoga. IP TEMP.METER OR POLE INS. 20.00 APPLICANT'SMOTORS SEE FEE SCH. ADDRESS 21621; qtpvpn, Creek Blvd, CIMt SERVICE CHANGE _ _ 20.00 t ' r Woo LICENSED CONTRACTORS DECLARATION "a Ir�{I ' /f a i w I hereby affirm that I am licensed under provisions of Chapter 9 •_ -� �., ISSUA C DATE s�/ ¢ d (commencing with Section 7000)of Division 3 of[he Business and JULIAC RL90.'f O.L€Cf1. PLG. MECH. r.N i Professions Codes.�nd my license is in full foref4, t�.,(f��( O Z o w - LicenCys I.ic.Number 3 �/.LL - 4 T t w Date // Contracmr De C�Jr-Cb-P ¢ Y I city of Cupertino, BUILDING PERMIT Ic o•i a : OWNER-0UILDER DECLARATION INFORMATION X m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION "$/FT. F.e- Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 .� Fu, i.E Code:Any city or county which requiresa permit to construct,alter, li ¢ ¢ 0 improve,demolish,or repairuny structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, p ar O K requires the applicant for such permit to file a signed statement that TOTAL 0 'RMITTO w qm m he is licensed pursuant to the provisions of the Contractor's License :2_)VFZ > Law(Chapter 9(commencingwith Section 7000)of-Division 3 ofthe ¢ Business and Professions Code)or that he isexempi therefrom and DTV. PLUMBING PERMIT FEE ¢r $ the basis for the alleged exemption.Any violalion of Section 7031.$ . -STORIES TYPE CONSTR, n ; - by any applicant for a permit subjects the applicant to a civil penalty - gLTER-DRAIN.&VENT-WATER (EA.) 5.00 /�. P� of not more than five hundred dollars(S5001.): ' ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sok compensation,will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of I � y property who builds or improves thereon,and who does such work I FIXTURES-PER TRAP 5.00 - SO.FT.FLOOR AREA TOTALALREAGE n himself Or lhrough his own employees,provided than Such improve- GAS 6:00 o meals are not intended or offered for sale,It,however,the building orimprovenlent is sold within one year of completion, the owners GAS-EA.SYSTEM-OVER 4 (EA.) 2.00BUILDING USE builder will have the burden Of proving that he did not build or im. RES IND CON PB Other prove 1,asO nee of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner or the property,he exclusively .7044,Bu with ❑ ❑ ❑ ❑ ❑. licensed colons od In construct the project(Sec does Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to ancontracts owner of properly who builds tr improvesthereon.n,and who LAWN SPRINKLE S°-.rOVER 5(EA.) 1.00 'J,S-7_ I , tine Cont Contractor's such eenw L with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 �J l the Contrada!s CiccnsC Law, Q'� TRACT NO. PARCEL NIT rea❑sonl em exempt wider Sec.-, ABP.C.for this WATER HEATEFI W/V,ENTI'_�'/ 6.00 -- Owner - Date WATER SYSTEM 5.00 i ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREAV GFCOUIP°rtIIIO 5.00 ' 1 hereby afflrm'thut I have a certificate of consent to sell-insure, - - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereor(Sec.3800,LAC.). USE, & Ca Policy No. Company I-pl&a 13F O �❑ek Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z V Cerlific c y is Ole with the city inspection division. ' p Applicam €�S.S.Z_ 4 MISC.- I REFER TO OR Y❑ N❑ Y ❑ N❑ CC to 'CERTIFICATE 017 EXEMPTION I7ROM WORKERS' PERMIT ISSUANCE 10.00 f � FLOOD20NE A.L.U.C. W > COMPENSATION INSURANCE: PLG.CONTR. - LIC.NO. PLG. ' CL a This seclidn need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N[]hundred dull o s is 100)or less.) U O 1 certify that in the performance of the work for which this per. OTY. MECHANICAL PERMITFEE FEE SUMMARY U. F mit is issued,I shall not employ any person in any manner so as to - U become sulsicct to the Workcis'Compensation Laws of Culil'omia. a Date Applicant ' ALTER OR ADD TQ.M :H,, 5.00 - BUILDING / } to NOTICE '10 APPLICANT': If,after making this Certificate 11 Cx- - !O F ? eruption,you should become subject to the Workers'Compensation APPLIANCE ° 4 °` 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked - AIR HANDLING NIT(TO 10,000.GF!M.) 4.00 CONSTRUCTIONLENDINGAGENCY AIR HANDLING(AITIOVER'10=6.EM.) 6.00 ' SEISMICFEE 12 Thereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT.)_ 5.8.000 p 1 ,the performance of tire work for which this permit is issued(Sec. -n - O - MICROFILM 3097,Civ.C.).. a HEATING UNIN(T 1100,000 B.T: .) 0 U Lender's Name� 11aazz 4iLender's Address1. 1 AlMa on V�(�T. -95-11 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I Certify than I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 e information is correct. I agree to comply with all city and county BOILER-COMP I3 H.P.tis 100,000 B.T.U.) 6.00 PLUMBING - colmances and slate laws relating to building construction, and hereby authorize representatives of this city to,enter upon the BOILER-COMP (Over 100,000 STU)SEE FEE SCH. MECHANICAL 5- above-mentioned properly for inspection purposes. (We) agree to Save, indemnify and keep harmless the Cityof MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX _IgO may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 a ranting, f this pen n. MECH.CONT. - LIC.NO. MTT OTA,' TOTAL / 7 <] /87 �+ Signature of pp'cant/Contractor le - 30 -` •/ OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER . CITY OF CUPERTINO X2663 INSPECTION DIVISION " ! JOB INSPECTION RECORD c . I 2 PERMIT EXPIRATION —S. JOB ADDRESS Ib l 7V L`1/lG�,/I(�-J� /(I!L/ UNIT# - LOT# C r �I-- PERMIT EXPIRES IF WORK OWNER / COQ ' CONTRACTOR - IS NOT STARTED WITHIN INSPECTION bATE INSPECTOR INSPECTION RECORD 180DAYSOFPERMITISSU- -FOUNDATION 6-2 S—*7 AN,CE OR 180 DAYS FROM ; LAST CALLED INSPECTION.' 'UFER ,PREGUNITE -, • PERMIT VALIDATION - x z-.& y_ 4 POUR NO CONCRETE UNTIL ABOVE HAS BE SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL , I `\ •Iss a E ATE MECHANICAL-+.' e oGy : LECT.+ PLO, or ©.' o, DO NOT POUR FLOOR UNTIL ABOVE HAS-BEEN SIGNED - BUILDING PERMIT WOOD FLOOR Al INFORMATION VALUATION $/FT. PLUMBING , •y�,� MECHANICAL ELECTRICAL'E- 'C r PERMIT TO )C S}JW lr FRAMING, I" STORIES TYPE CONSTR. INS LATION �CCGROUP RES.UNITS /o`heill KRUNCE,No SUBFLOOR UNTIL ABO E,HAS BEEN SIGNED 9 ROOF SO FT.FLOOR AREA TOTAL ACREAGE I l _ 4 p DIAPHRAGM BUDDING USE. .HES IND CON FB OIAel ,APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ '❑ ❑ ROUGH•' - - - ASSESSORS PARCEL NO. PLUMBING G _ .I "a...}"'7 .._ '4I`- Cr'..'b GAS TEST TRACT NO. PARCEL N0. � � � ,, ii, - MECHANICAL" ACC.DATE ACC.FILE NO, ELECTRICAL FINALS DATE INSP.. " FRAMING ' 2 SAN # /a a gF ZONING INSULATION j PLUMBING _ _pe�?cesl.rec�P._W 7-2 GAS MECHANICAL FIRE SPRINK ENERGY T-24 I � ' a-y- COVER NO WORK UNTIL ABOVE HAS BEEN ONED }' HEATING ❑ "❑ ❑ "� , LATH-INTERIOR 7211'— P FLOOD ZONE A.L.U.0 — ELECTRICAL Z�y ii LATH-EXTERIOR FIRE DEPT: Y❑ "❑ Y ❑ "❑ • SHEETROCK - ' - - GRADE - - FEE SUMMARY SHEAR INTERIORBUILDIN t -- SHEAR EXTERIOR . TEMPOR Y APPROVALS, 'BUILDING &3 FIREWALLS - - ELECTRIC I PLAN CHECK l GAS r FEE NO TAPE OR PLAS R TIL ABOVE HAS BE SIGNEDI OCCUPANCY 'SEISMIC FEE' �r1 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. .MICROFILM ' ARRANGE'FORINSPECTION'BYPHONING252-4505, ELECTRIC co•� F ONE WORKING DAY BEFORE.REQUI RED INSPECTION: PLUMBING 1{ z PLEASE GIVE JOB-ADDRESS WHEN PHONING. I — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL' I PORTANTd i CONST,TAX , —J — PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. _ - , - OFFICE COPY