PERMIT# 9309 t;,(f,,,„�. ;r.� �:•-•Iv.-.I,I r I v I-III-L nv Irvrvnlrlr%I Ivey uul Ir111V FitU LINES - USE BALL POINT PEN ONLY '
,7,BIJJ I.,DI NG PRQJECT I DENTI FICATION PERMIT NUMBER
s�r euILDINc APPLICATION & PERMIT
9309'�'• � -L� UILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S , r a.. ✓a ;; 1 CHECK VALIDATION
ti rvgME CITY. �,'.,, z, ELECTRIC.PERMIT r. l " ' FEE '
1 PHGNE 3222121 `I /0'7" �y
1•� / CONTRACTOR'S -
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 Q✓✓ 7
uD.No. LIGHTING FIXTURES 10.00/1.00 ✓ r 7
CONTRACTOR'S
goo�REss 4- O �j- ;`,� APPLIANCES ES-RESIDENTIAL 4.00
l �`�IPHOrvE 3� Z•IZ PANELS 10.00
ANCHITECI DATE OF APPLICATION
OR PANELS 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEEWj) j
�P/✓ sec.No.�j j SIGNS TRANS. 3.00
ARCH OR ENG.
ADDRESS SPECIALCIRCUIT 5,00 PERMIT VALIDATION
SCIZ - '`� nP EMP. METER OR POLE INS. 2000. PAI l
-ANT'S l/�-'w. ..-Lir-/
ADDRESS MOTORS SEE FEE SCH. �i ) �E
r�YO ` ( D!a -Z� SERVICE CHANGE 20.00 SE�'Z r CA7 L
Cirri LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 City r 'F/f�a f�
rt i W I hereby affirm that I am licensed under prnvisi als of Chapter 9 Y)ly 01 p/}I'MiTE
a (modmenemg with Section 70001 0l'Divisiml 3 ul'tbe Uoinca and BLDG. LECT. PLG. MECH.
H 2 ProfesOmm,Co; Any license is in lull for { t
i Z = O, Litcns• I.I..Nwllb- ')�
O m F 'Uale� ��-(.'a1llrarlar E�� ��-yC,.__
4 , FJ �. 1"� p `SLI
E e, IS a OWNER-BUILDER DECLARATION BUILDING PERMITT %ii'
A D w D - MISC.- REFER TO ORD >'INFORMATION,�''%q'
x 3 . I hereby ails,, that I am exempt Item Ili,Crnitruclor's Licemc11
r u O ¢ Law for the following reason.(Sec.]03 Ls,Business and Professions VALUATION SIFT.
,
m ae Code:An cit or count PERMIT ISSUANCE
Y Y y which re uiresa 10.00
I > i 4 Permit to conslmcl,altcq D
¢ Q O Improve,demolish,Or repair any slHmlure,prior lu its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ n'yuires Iht applicant for such permit to file a signed statement that TOTAL
A w m,,; he is licensed pursuant to ilio provlSians OI the COnlmclai 5 License PERMIT TO
rI> L'aw(Chapter 9(cmnmomingwith Scclion 7000)ol Division3uflhc ' -;;s
S 4 o Busines,and PmfLsvnns Cole)nr that he n uempt Therefrom and QTY. PLUMBING PE RM IT s f 1•j"e�,1 FEE 1 Eij,./ ot
¢I-m the basis for the alloyed exanptr0n Any vmlal ion 01 Secl tori]D3I $ '!""'. I STORIES TYPEC� ONS
; _ by any upplicam loraporno sublecls Dm uppl'wntmaaivil penalty ALTER-DRAIN & VENT-WATER IEA.) 5.00 VA,/
of not more Than five hundrtJ Dollars(5500).):
❑ I,as owner of Iht properly,or my employees with wages m BACK FLOW PROTECT.DEVICE
(heir wee rompenwtion.will du the work,unJ the structure is nal 4.00 OCC.GROUP RES.UNITS '
imtnded or offered for sale(Sec. 7014, Rosiness and Pno CSSL°as DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contra 4or's License Law do s not apply to an owner of
progeny who LuilJs or improves thereon,and who docssuch work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL.�
himself or Through his own employees,provided Ilial such improve-
mentsarenot intended 0,offered for sale.If,h....er,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or intProvement o sold within one year of completion,the owner. , O
�I✓ wilder will have the burden 01 proving that he did riot build or On- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDIN USE
rovefarrimp0sc of sole.). INDUSTRIAL WASTE INTER. 30,00 i�ES IND c O Other
❑ 1,as Owner of the properly,and exclusivnlY contracting will, �f
licensed Contracorm to mmilllvl the project(Sec.7044,Ilusinc,, LAWN SPRINKLERS- 1 INC 5 V.O. 6.00 ASS3 ARCEL NO.
wW Prafesiom COdc:'fhe Comractor's License Law does not apply
to an owner of PmPeny who builds or improves Dsc.L•on.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 �/ / r 'O//
contracts for Sold,projects with a oommctods)licensed pursuant to G
Ilio Contranor'S License Luw. SEWER-SANITARY-STORM V-STORM EA.200ft/10.00 TRACTNO PARCEL NO.
reason WATER wn rxrny,l under See-, liu Ibis WATER HEATER W/VENT 6.00 '
Owner Date WATER SYSTEM 5,00
WORK F:kS'COMPIiNSA'1'ION DECLARATION WATER TREATING EQUIP. 5.00 ACC.DATE ACC.FILE NO.
I hereby ;dtirm that I have a certificate of consent m scl6i...re,
or a Certificu le of Workers'COmptnsatiml Insurance,Or «rlil icd ZONING ENG.SITE NO.
Co fie
Copy thereo' -.38Lab.C.l:]
Pobc 7_ Co : �JL1lJL �l
Cert iii, C II r I'u 11
Z 2 ' Cerlilir s,I, ) PH On division. FIRE SPRINK ENERGY T-24
F„ O PNicarlt- MISC.- REFER TO ORD. v N 0 Y ❑ NE]
' X C' 'nFIGi'E OP EXeMPTIUN FROM W'ORKERs• PERMIT ISSUANCE 10,001PLooO ZONE A.L.u.e.
IL > COMPENSATION INSURANCIi PLG.WNTR. LIC.NO. PLG,
CL O This section need not he completed if the permit i5 fur Ona' TOTAL Y N� Y IN
Z hundred dollars(S 100)or less)
V O I certify that in the pertormence of the work for h'ch Ibis ,. v
1'c CITY. MECHANICAL'PERMIT. I, ,FEE SUMMARY,- !''+.r
LL U mit is issued,I shall not employ any person in any manner sn us lO 7-
0 'FEE '1$I'
become subject to the Workers Compensation Laws of Calilorniu. _
a Date Applinnt ALTER OR ADD TO MECH. 5.00 BUILDING
>_ to
NOTICE TO APPLICANI': If,afteru
nking This Certificate of Fx-
)- Z ensption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you food forthwith comply will,
(.1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M-) 4.00 FEE
CONSTRUCT ION LIENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE - -
I hereby affirm that there is a construction lending agency 1'ur EXHAUST HOOD (WITH DUCT) 5.00
s perm
thmu
e Perlornce of the work for which this is issued(See. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Name
Lender's Address HEATINGUNIT(OVER100,000B.T.U.19.50 ELECTRIC'
I certify that I leave read this application and stat,Thal Ibc above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building Construction, and
moi• eby authorize representatives of this city IO enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
entioned property for inspection purposes. MECHANICAL
e) ISic- m save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
ptEli als inst liabilities,judgments. costs and c genu• which CONST.TAX
may i ;r ly)wyy aellF'gains) said City in cans seen of Ibc PERMIT ISSUANCE 10.00
gra 1 Irl II i MECH.CONT. LIC.NO. MECH,
g pp / TOTAL Tt� I/Jpp<
�
Si nature ofA licam Conuamor t TOTAL �
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
INSPECTION DIVISION
93r �
JOB INSPECTION RECORD
11
JOB ADORES PERMITEXPI RATION
• S /�!J{'I��UNI LOT# PERMIT EXPIRES IF WORK
OWNER �j CONTRACTOR ItA a IS NOT STARTED;WITHIN
INSPECTION DATE ! IN SP CTOR I SECTIO RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION •-L ANCE OR 180 DAYS FROM
UFER Q��_ -,•� jo--,L-s'S' Q,-Vl- �f-Q1.� 0 �[-� LAST LED INSPECTION.
PREGUNITE 10-7-� tic Ce�:, vS/ N- X' �ER 1T VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 71- 9-ire
1°- I�ir
UNDERGROUND /SLAB l -7-SS lIW/�N•r.'Li 'Fyry G( n
PLUMBING 3-e r
ELECTRICAL ISSUANCE DATE
MECHANICAL B cELE T. L al MECR.
oT
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bu DIN ERMIT
)INFORMATION
WOOD FLOOR Lc:o SD o S(o f O Vq UATION $1FT.
PLUMBINGMECHANICAL
ELECTRICAL
ELECTRICAL
FRAMING /Cu 1I ''�
INSULATION ro IEs Tv PCco s
ITI
ocC.GAO-UP HES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -a�56,Ju7r t Le-s
ROOF - _ SO.I .(LOON AREA TOTAL ACREAGE
/-1/-Y6 -.�cc[
DIAPHRAGM '
h�
1T0 r6� .A�
HE NO O DOS
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
E5501 HCEL NO. "
ROUGH 3-/-y[ c. 1 a f✓
PLUMBING /C 9-Y46
GAS TEST TRACT NO PARCEL rv0.
MECHANICAL
ELECTRICAL FINALS I - DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN # �- --_ ZONING ENG.SiTEN
INSULATION PLUMBING -•y(_
GASt1 a"(<-
FIRE BPRINKENERGY T-]<
MECHANICAL - — v ❑ N❑ Y ❑ N❑
,. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR ELECTRICAL j�7 _ e FLOOD ZONE A.L.U,C,
C'
LATH—EXTERIORt U-CW �� FIRE DEPT. -'L !y v❑ N❑ v ❑ No
SHEETROCK a �_. GRADE FEESUMMARY .
SHEAR INTERIOR _ J, (`,,,, BUILDING BUILDING
SHEAR EXTERIOR - TEMPORARY APPROVALS
FIREWALLS ELECTRIC 3 �Af' p FEE CHECK -
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY / SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM „
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC.
ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
�T
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
,. IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY