15458 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
•~BUILDING PROJECT IDENTIFICATION - - -PERMIT NUMBER
BUILDING Q APPLICATION & PERMIT 15458[Q
T � O O C_+1 BUILDING—ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S V PLAN CHECK VALIDATION
N We C / 4�fd^228
_ �ffQTY.
y� ELECTRIC PERMIT FEE' ,
>HONE <,J —222
1 CONTRACTORSUTLETS=SWITCHES-RECEP 10.00/1.00
NAME
' LIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S PPLIANCES
ADDRESS -RESIDENTIAL 4.00 -
• PHONE PANELS 10.00 DATE OF APPLICATION
-
ARCHITECT `PLAN CHECK FEE P.C.,NO.
OR PANELS (OVER 200 AMP) 20,00 y
ENGINEER
uc.uO:� SIGNS TRANS. 3.00 -
ARCH.ORENG, SPECIAL CIRCUIT 6,00 PERMIT VALIDATION
ADDRESS
Pan TEMP.METER OR POLE INS. 20.00 '
APPLICANTS MOTORS , SEE FEE SCH.
ADDRESS �L.�W ✓`^�--� '
SERVICE CHANGE, 20,00
woo LICENSED CONTRACTORS DECLARATION
be U 1 hereby aft urn that I am licensed under provisions of Chapter 9 _ ISSUANCE DATE
ma AA_ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
•.'-m z Professions Code,and my license is in full force and effect. ❑ ❑ El
o w - License Class Lic.Number
o z Date Contractor
¢ x sBUILDING PERMIT
¢ LiP, OWNER-BUILDER DECLARATION INFORMATION
w3 LL m I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD VALUATION $/FT.
F .. o¢ Luw for the following«ason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
¢ 2 Q improve,demolish,or repair any strmtmre,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
a
DLL requires life applicant for such permit to file a signed statement that TOTAL PERMIT TO
w As he is licensed pursuant to the provisions of the Contractor's License
zi
Law(Chapter9Commencing with Section 7000)ofDivision 3cflhe -
a Business ant]professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
the hasis for lhealle` l exemption.Anviolation of Section 7031.5 - STORIES TYPE CONSTR.
ger pion-c il
byany immoreican.fora permit euhjbra($50OH:com li�acivil penally ALTER-DRAIN -WATER (EA.) 5.00
. of not moa than five hundred dollars($500)x):
0 I,as owner of the properly,or my employees with wages w BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will JO the work,and the sl mclu«is mol DDD.GROUP - RES.UNITS
- intended or offered for sale(Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:Thr••Contractor's License Law does not apply to un owner of -
property who builds or improves thereon,and who does such work FIXTURES'-PER TRAP 5.00 SG.FT.FLOOR AREA TOTALACREAGE
himselfethrough his own employees,provided that such improve. GAS-EA.SYSTEM-1 INC.4 OUTLETS 6,00
Completion
minds are
not intended or offered for sale.If, the building
or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 EES IND CON PB Omer
❑ d as owner Of the property,he exclusively.contracting with ❑ ❑ ❑ ❑ ❑
and Pro contractors to construct the project(Sec.7044,of apply LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
- and Professions property
honb uctor's License Law Joel not apply -to tr owner of property who builds or improves Thereon,and t to LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for su License
ts Lwiotacontractor(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
LIIe COalmclofs License Law. T
RACTNO. PARCEL NO.
❑ I am exempt under Sec ,BAP.C.for this WATER HEATER W/VENT -.1 6.00
cousin /_..
Owner i.r. / d- WATER SYSTEM " '5,00
CC.DATE ACI(FILE N0,
WORKERS'COMPIiNSATI N DECLARATION WATER TREATING EQUIP,vh 1 '5.00 -
I hereby affirin that I have a certificate of consent to sell-insure, ZONING
or a cerlil icalc of Workers'Compensation Insurance,or a coil it -i I. ENG.SITE NO.
copy thereof(Sec.3800,Lab.C..
Policy No. Cnntpmny
O O Certified copy is hereby furnisher. " _SPRINK' ENERGY TR4
Z Z ❑ Cerlifed copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant '❑ N❑ Y ❑ N❑
� y CERTI 1:ICA'I E 01'Ii XEM PT ION FROM WO R K ER S' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > C04ENSATION INSURANCE PLG:CONTE. LIC.NO. PLG. El
N❑ v ❑ ❑
CL Z (Phis section need not be completed if tire v e permit is for one TOTAL O _ _
hundred dollars I S 100)or less. -
O 1 certify that in the performance of Life work for which this per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shat]not employ any person in any manner so as m
O W become subject to the Workers'Compensation Laws of California. BUILDING
n Date Applicant ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workeri Compensation APPLIANCE 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 UNIT(TO 1000C.F.M.) 4.00
CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER I0,000C.FM.) 6.00 SEISMIC FEE
- I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -the performance of the work dor whloh this permit is issued ISec. MICROFILM;
3097,Civ,C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER or100,000 B.T.U.)9.50ELECTRIC
Lend 's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
IRft rmutiol is correct. 1 agree to comply with all city and county BOILER-CX1MP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
- hereby authorise representatives of this city to enter upon the BOI
bove-mentioned property for inspection purposes. LER-COMP lose,100,000 BTU)SEE FEE BCH. MECHANICAL
a
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE -10.00 CONST.TAX'
may in any way a e Agar9W said City in co equeuce Of the
ranting of Ih{, mit. / MECH.CONT. LIC.NO. MECH.
L TOTAL ' TOTAL
can le
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING RMITNUMBER '
CITY: OF :CUPERTINO
I,NSPECT
LON DIVISION
JOB INSPECTION RECORD t
PERMIT EXPIRATION
• JOB ADDRESS 1508 AS tear"Coulrt' rr�UNIT#' _LOT# * '
PERMIT EXPIRES IF WORK
owNER - S&Ill 'Pan'g, , 'CONTRACTOR IS' NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
NOTE:.' ANCE.OR 160 DAYS FROM
- L-ASTCALLED INSPECTION.
UFER`- ALL GRADING AND DRAINAGE SHALL'B6 INSTALLED -
- "
PREGUNITE,. CUPERTINO STANDARDS.
TO COMPLY WITH THEAPPROVED PLANS AND CITY OF Penn+rt vauunnON
.. -a _ _
GARAGE SLABS - - .i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB." `+
PLUMBING
ELECTRICAL _ - 'ISSUANCE DATE
MECHANICAL•, - BLDG. ELECT, PI�L�GI MBCH.
q El El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR " INFORMATION
'VALUATION $/AT.
PLUMBING - • - • - .. ,
MECHANICAL
.ELECTRICAL
. f
FRAMING. ".�•s l,� v.� F:.,,:-(^ ,_
INSULATION - - - STORIES i TYPE CONSTR, -.;
n.pt OCC GRDUr• RES UNITS"
PLACE NOSUBFLOORUNTIL ABOVE•HAS BEEN SIGNEO
sl],FT F Loa...REH roTAL ACREAGE
- ROOF NOTE:NO'FINAL INSPi SHALL BE MADE BEFORE - -+
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID.
Y� •BUILDING USE
ROOF SHEATHING .: T+ •
S IND CON PR o,o,
APPLY NO ROOFING UNTILABOVE HAS BEEN SIGNED ,' - FINALS',:a ' 'DAT
ROUGH SAN.k - ASSESSORS PARCEL No.
PLUMBING. ,' - _ - ELECT.ENERGY. " " -
TRACINO, PARCELING
TUBS'&'SHOWER PAN•'- - PLUMBING ENERGY. _ 6.
MECHANICALMECH.ENERGY. .`
ELECTRICALBUILDING ENERGY'-' ACC.Dare ACC:FILE NO
FRAMING - - ;. I -; ELECT.FINAL TEST, ' ZONING .. ENG,SITE No.
INSULATION - PLUMBING,eo,0 �� IT
GAS TEST - GAS - •• - + .
`
MECHANICAL 'FIRE SPRINK , ENERGY 1 2
`� .. �� � I
COVER NO WORK-UNTIL ABOVE HAS BEEN SIGNED HEATING - 'Y E] "❑ ` ❑ N❑
A
EXTERIOR SHEAR � ELECTRICAL FLOOD ZONE L UC.RELEASE ` -- -
INTERIOR SHEAR' FIRE DEPT. Y E] N❑ v ❑ N❑
SHEETROCK _ GRADE FEE SUMMARY
EXTERIOR LATH BUILDING _
INTERIOR LATH - TEMPORARY APPROVALS BUILDwc
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 BUILDI NG INSPECTOR: MICROFILM
ARRANGE FOR INSPECTION BY PHONING252-4505, ELE.cTRIC
F�
ONE WORKING DAY BEFORE';REQUIRED INSPECTION. PLUMBING f.d -
o PLEASE GIVE,JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT.FOR EXPIRATION DATE — ,
IMPORTANTI CONST.TAX
PLEASE READ REVERSE''SIDE BEFORE TOTAL
CALLING'FOR FINAL INSPECTION.
:,.
. OFFICE COPY I