13990 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE.BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATIONPERMIT NUMBER
.GYy a':ILryNG
ADDRESS
APPLICATION & PERMIT
,`,166T7 - .S U CLIS� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13990
OWNER'$ PLAN CHECK VALIDATION
NAME . DTV. ELECTRIC PERMIT FEE
S F_ �` tL PHONE
crOFs
NAM[i OUTLETS-SWITCHES-RECEP 10.00/1,00
„ NAME � �
(.l1(�.� a LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL •.4.00 �p
ADDRESS,
vHorvE PANELS 10.00 Qom-' DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CREEK FEE P.C.NO.
OR
ENGINEER ,
- uc.rv0. •I ' SIGNS TRANS. 3.00 '
ARCH.OR ENG. S.BO PERMIT VA LIGATION
ADDRESS - SPECIALCIRCUIT _T
ZIP ITEMP.METER OR POLE INS. 20.00
AvvucANrs-
AD , MOTORS � SEE FEE SCH. � .i• - (I
DRESS n
(y 7 S&Xt f( fZ OF, SERVICE CHANGE '` 20.06 a1
H o D LICENSED CON'T'RACTORS DECLARATION V `: ylf;lt1i1�
< u v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N a N (commencing with Section 70001 of Division 3 Of the Business and ) BLD ELECT. PLG. MECH.
H N z, Professions Code,' my license is in fall forceps ffe t . . .A to. iCl�u ry
0 o r - License Class - +'LimtGcI rA _ ](1,' - �, I,p�
D z ° Dale Contrudor (;j�Rp
a , E a - BUILDING PERMIT
¢ ¢ ,¢u a , OWNER-BUILDER DECLARATION INFORMATION
" MISC.- REFER TO ORD w 3.A I- I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
FNo¢ Law forthe following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 O ��
�- Code:Any city orcounly which requires a permit to construct,alter,
Qa
ac 2 Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. ELEC. -f OQQ f
DLL requires the applicant for such permit to file a signed statement That S �rjTOTAL / DOC PERMIT TO AA
n w $ he is licensed pursuant to the provisions of the Contractor's License i
¢ the basis for the alleged exemption.Any violation of Section k�/EteL1rL 9Ld/T
rzi Law(Chapter 9(commencisgwith Sectian7000)of Dlvision3ol'the !d
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ D STORIES TYPE CONSTR.
I-$ tire malty
by any more
andresdollars(5500plicanttoacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 ,f
of not marc than flue hundred dollars 15500).E
O I,as owner of the property,or my employees with s ' BACKFLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their sole compensation,will the work,and the structurere is s not
(S
intended or offered for sale(Sec. doe Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The hContractor's buildsor License Law does out apply loess owner wof
ork
- - _
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.O U 50.FT.FLOOR AREA TOTAL ACREAGE
4•- himself or through his own employees,provided that such improve-
{ ments are not in or offered-for sale.l f,however,the building GAS INC.4 OUTLETS 6.00
o .
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) . 200 BUILDING USE
builder will have the burden of.proving that Ice did not build of am- . . .
RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
O T,as owner of the property,am exclusively contracting with _ ❑ ❑ ❑ ❑ 1:1,
licensed contractors to construct the Project(Sec.7044,Business LAWN SPRINKLERS- 1 INC'5:V:B. 6.00 ASSESSORS PARCE L NO.
and Professions Code:The Contractor's License Law does not apply
L 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/70.00
the Contractors License Law. RTRACT NO. PARCEL NO.
❑ 1 am exempt under Sac.-,BAP.C.for this WATER HEATER W/VENT 6.00 + -'
reason
Owner - Ike, WATER SYSTEM i'II (.: 1+L75.00 ACC.OATE ACC.FILE NO.
,. WORKERS'COAIPENSATIONDI:CLARATIONtx WATER TREATING EQUIP. 5.00
hereby affirm that I hove a certificate of consent to self-insure, - ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or.'certified
• copy'thereof(Sec.3800,Lab.CJ.
Policy No. Company -
Q ❑_Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z ❑ Certified copy is'filed with the city inspection division.
O Applicant - . MISC.- REFER TO ORD. Y[:] N❑ Y E] NE)
CC y CERTIFICATE 017 F.XEMPPION FROM WORKERS' 'PERMIT ISSUANCE 10.00 Q FLOOD ZONE .A.L.U,O.
LLI > COMPENSATION INSURANCE PLG.CO_4e TOTAL Y❑ N
NTR. p LIC.N PLG.
a o (This section need not be completed if the permit is for one wrv ❑ Y ❑ N❑
Z hundred dollars(8100)or Icss.) I '
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so s to
U becoino e.hLect to r,Workers' nt • tatlon aws of a:
>_ w Datedh_l Q pplicam - BUILDING 7 "Z
C1. E TO F ALTER OR ADD TO MECH. 5.0
} to NOTIC s PLd become
If,after making this s' lompa so 1
Z enlptiim you should become subject to the Workers'CComply war APPLIANCE -.t` 5.00 s� PLAN CHECK
provisions of Ute Libor Code, you must forthwith mmPly with T FEE
U such provisions or This permit shall be deemed revoked ,000 AIR HANDLING UNIT(TO 10C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.EM.).6.00 SEISMIC FEE !r�'
I hereby affirm that There is a construction lending agency for' EXHAUST HOOD (WITH.DUCT) 5.00
the performance of,ther�work Cor which this permit is issued(Sec. -. MICROFILM
3077,Civ.CJ. r`f�:� Ls HEATING UNIT(TO 100,000 B,T.U.Iq�8i00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
+•.x�i j.� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
At information is correct.I agree to comply with all city and,county BOILER-COMP(3 H.P.Or 700,000 B.T.U.) 6.00
`;tPLUMBING
'i ordinances and state laws relating to building constructin, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL �"
i/. above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
6may
tino against liabilities,judgments, costs and expenses which CONST.TAX -
' n any way accrue against said Cit in consequence of the PERMIT ISSUANCE 10.00 Q
ng llus per t. MECH.CONT. ,• 'LIC.NO. MECH.
•/0�., TOTAL
c�S7 r}� ICU- TOTAL
Signature of Applicant/Conte etor Date CKA.j-41 76
OFFICE COPY, + '
1 ,
POST THIS CARD NEAR,F.RONT OF BUILDING '
PFRMIT NUMBER .
' CITY 0F .CUPERTINO. 13990
INSPECTION DIVISION
— JOB INSPECTION RECORD '
'�• r PERMIT EXPIRATION
JOB'ADDRES! ' 20697' SUNRISE DRIVE UNIT;* - •LOT It
- PERMIT EXPIRES IF WORK
owNEa" •'' ABE PERRY '" .courRAcroR -OWNER"r IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION'RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 7_2440 wkVIC" Ac y'T6 'a, ANCE OR 180 DAYS FROM
_ LAST•CALLED INSPECTION.
.... . : :. . ., • :.' ��LJTI A�'.115� .. '
_ 1 - PERMIT VALIDATION
PREGUNITE
A ..
POUR NO CONCRETE'UNTIL ABOVE HAS BEEN SIGNED - -
_
UNDERGROUND /SLAB I et6upleCtIDO.r t'j,
PLUMBING
ELECTRICAL . "' F
ISSUANCE DATE
BLDC. ELECT. PIG. MECH.
- ' MECHANICAL FIAT I=
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ - BUILDING PERMIT M
WOOD FLOOR INFORMATION
t VALUATION S/FT.
PLUMBINGi „ K �0�, C,A
MECHANICAL '1
PERMIT+TO
ELECTRICAL
FRAMING .
_ STORIES - :TYPE CONSTR.
INSULATION
OCC.GROUP RES.UNITS
-PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - •
50,FTFLOOR.AREA - TOTAL ACREAGE
ROOF
DIAPHRAGM VER a - BUI LDING USE
ARES IND CON PR O,h.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - }` ASSEESSORS❑PARCEL❑NU, ED
ROUGH
PLUMBING • r
GAS TEST TRACT NO. PARCEL NO.,
'• MECHANICAL -
' ACC.DATF. ACC.FILE NO.
ELECTRICAL FINALS DATE INSP. -
I. - FRAMING' ' SAN # ZONING ENG.SITE NO.
INSULATION - PLUMBING '
GAS
FIRE SPRINK ENERGY T 24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING ❑ N❑• ❑ N[:]
FLOODZONE A.L.U.C.
LATH—INTERIOR . ELECTRICAL
LATH—EXTERIOR FIRE DEPT. "• Y _,❑. N❑ - Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
.,' SHEAR INTERIOR BUILDING " ' 'f'-'
SHEAR EXTERIOR
TEMPORARY APPROVALS
BUILDING
-1" FIREWALLS ELECTRIC '" - - - PLAN CHECK t
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE,^ .;• r .I i
• OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE FOR-INSPECTION BYPHONING 252-4505, ELECTRIC /. .
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. - 1 ' PLUMBING -
O� PLEASE GIVE JOB ADDRESS WHEN PHONING
1 2 I :. . MECHANICAL
* vw" = SEE PERMIT FOR EXPIRATION.DATE
IMPORTANT! ' " CONST.TAx
PLEASE READ REVERSE SIDE BEFORE r se TOTAL '
CALLING FOR FINAL INSPECTION l
OFFICE COPY. - -