09777APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PI
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BUILDHVG PROJECT I DENTI TION gpp�L KATION& MIT
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12 02 LICENSED CONTRACTORS DECLARATION
F i w I hereby afrimr that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
H O1 Professions Code, a my license is in full fort n ffect
z o u°{ — License Class Lic. Number
2 m — Date 3 Contractor
rc ¢ w OWNER -BUILDER DECLARATION
w3: s- y I hereby affirm that I am exempt from the Contractor's License
F u m j Law for the following reason. (Sec. 7031.5, Business and Professions
m� Code: Any city or county which requires a permit construct, alter,
M ¢ o improve, demolish, or repair any structure, prior to its issuance, also
DLL - requires the applicant for such permit to file a signed statement that
e. w m w he Is licensed pursuant to the provisions of the Contractor's License
z¢ Law (Chapter 9(commencing with Section 7000) ofDivision 3 ofthe
I D Business and Professions Code) Or that Ire Is exempt therefrom and
¢ r m the basis for the alleged exemption. Any violation of Section 7031.5
i 3 — by any applicant for o permit subjects the applicant to a civil pondty,
of not more than five hundred dollars ($500x)
❑ I, as owner of the property; or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044; Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself or through his own employees, provided that such improve-
ments are not intended or offered for sale. If, however, the budding
or, improvement is sold within one year of completion, the owner.
'.l builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with
licensed contractors to ,mostonet,the project (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who
contracts Cot such projects with a contractors) licensed pursuant to
the Contractor's License Law. _
❑ I am exempt under Sec. - , B.&P.C. for this
reason
Owner Date
WORKERS'COMPF-NSATION DECLARATION
1 hereby from thm I have a certificate o fc.nlcnt it, yelf-insure,
or a certificate of Workers' Commensatifun Insurance, or a certified
copy thereo' te. j QIP i
Policy No. Into �LnR-
❑ fortified c y is hereby furnished.
Z z ❑Certified P1` Is Ole ith the 'city Inspection division.
P O Applicant .
= T CERTIFICATE A EXEMPTION VNI WORKERS'
W COMPENSATION INSURANCE
d 0 (This section need not be completed if the permit is for one
Z hundred dollars,S 100) or less.)
�.% 0 1 certify that in the performance of the work for which this per
U_ I— ant is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers' Compensation Laws of California.
CL Date Applicant
} m NOTICE TO APPLICANT: If, after making this Certificate of Ex,
F Z emption, you should become subject to the Workers' Compensation
provisions of Ore Labor Code, you must forthwith comply with
V such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm thut there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, CN.CJ.
Lender's Name
Lender's Address
I certify that I have read this application and state that the above
lnformatlon is mired. I agree to comply ,with all city aero'
county
m- nances and store laws relating to building roman. ion, and
hereby authorize representatives of this city to' enter upon the
.above-mentioned property for inspection purposes.
'(We), agree to save, indemnify and keep harmless the City of,
CQPratio.
against liabilities, judgments, costs and expenses which
may in any way accrue �8smst said City in consequence of the
\ granting a this permit. /
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BUILDING - ELECTRICAL- PLUMBING - MECHANICAL
ad'1"TT°pie#ivd43 >bTi
.
QP " ELECTRIC=PERMIT j, :p i r Y f' t s,FEE#,
7�:+t y-
I%UTLETS SWITCHES -RECEP 10.00/1.00 Q
LIGHTING FIXTURES 10.00/1.00
PPLIANCES-RESIDENTIAL. 4.00
ELS
ELS (OVER 200
N ONLY
PERMIT NUMBER
09777
PLAN CHECK VALIOATIOP
TEMP. METER.OR POLE INS. 20.00 ' d
MOTORS Sa FE tE4 Sr*
SERVICE
TEMP. POLE ' 20.00
I
'A ■M
MISC.- REFERTOORD
§. txPwTnvrvnmrs.wrvi ."g�4,
PERMIT ISSUANCE 10.000
`/VALUATION $/FT.
/�!,
-PERMIT TO
S/N FAH L
STORI TYPE CONSTR
J -V A
;ONTR. LIC. NO.
ELEC.
TOTAL /Y4
•-a'PLUMBING PERMITS FEES
ALTER -DRAIN &VENT -WATER (EA.) 5.00
BACK FLOW PROTECT. DEVICE 4.00
- OSP. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 5.00—�
FIXTURES -'PER TRAP 5.00
SD.FT.FLDORAREA
a0�
/!
TOTALACREAGI
GAS-EA.SYSTEM-11NC.40UTLETS,6.00
GAS - EA. SYSTEM - OVER 4IEA.) 2.00
BUILDING USE,
RES IND CON PB Oma
❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00 -
LA WN SPRIN KLER SV.B. 6.00
ASSESSORS FARCE L NO.
3af'a
LAW SPRIN KLER -O 51EA.) 1.00
SEWER-SANIT M Oft/ 10.00 /Q
TRACT NO.
60 YCp
PARCEL NO.
WATER HEA / 6.00
WATER SVSTE CUG S.00
a
ACC. GATE
ACC. FILE NO.
WATER TREA EQUIP. - 5.00
p
ZONING
ENG. SITE NO.
FIRE SPRINK
Y ❑ N ❑
ENERGY T 24
Y ❑ N❑
D.
PERMIT ISSUANCE r .10.00
ZONE
N❑
4YE
A.LU.C.
Y❑ N❑TOTAL
'LG. CONTR. a LIC. NO.
PLG.
�= ;+ MECHANIC/YL'aPERM1T #*%FEE.'+FEE�SUMMARVY
-
'y >'i.AS.
BUILDING
EArvf/�Gsl:
LTER OR ADD TO MECH. 5.00
APPLIANCE 1PA.11J 5.00
PLANCHECK
FEE
AIR HANDLING UNIT(T01O,OODC.F. 4.00
AIRHANDLINGUNIT 6.00
SEISMIC FEE
EXHAUST HOOD ( I H DUCT) 5.00 (�
MICROFILM
/ - HEATING UNIT (TO .00
HEATING UNiT(OVn fOO,000B.T.U.)9.50
ELECTRIC
04
VENTILATION FAN (SINGLE) 4,00
PLUMBING
p
BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.001
BOI LER-COMP (over 100,000 BTU) SEE FEE SCH.
MECHANICAL
/
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 10.00 00
ECH', CONT. LIC. NO. -" MECH,
TOTAL � q
!!
TOTAL',
-
o2
OFFICE COPY
CARD NEAR
HIS
POST. OF-BUILDINGNEAR FRONT OBUILDING
-
.
v
CUPERTINO,, • ��
i
7Cd
. r INSPECTION DIVISION 1'
_
JOB INSPECTIONORD
�'jJ�
E,S� � (.�6�1/W /w11/�,�'91AIT4f_"LOT-#'6�
JOB ADDR��"'�
'PERMIT EXPIRATION. "''
-
PERMIT'EXPIRES IF WORK..
OWNER ot&CONrRACTOR'.:
IS'.NOT,. STARTED WITHIN.
•180-DAYS OF PERMIT ISSU=
ANCE'OR _180 DAYS FROM`
.'LAST CALLED INSPECTION...
Ir -
INSPECTION DATE INSPECTOR
71
SPE TION RECO D
FOUNDATION - d,04 - i
(YYBG';`- -
�.di .�,
UFER- _
.PREGUNITE � ' 1, .�
PERMIT VALIDATION''
.
IssuANce onrE'�:.
•H.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED%UNDERGROUND/,SLABIT,
PLUMBING°
-
,'.' o 's'
ELECTRICAC',%, --. '... �. r' '.c
'MECHANICAL
B
ELECJ.
I . PCG.- M
'DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
- - ',
euI DING'P RMIT
INFORMATION
. WOOD FLOOR
PLUMBING
* -
VALUATON =„
yYy'•.�
s/FT.
'-MECHANICAL
1
_
"ELECTRICAL - ,.
- -
i'
PE
�.
TO
FRAMING
'.INSULATION -
. •
sr IE -
,TYPE CONSTR.
y
+-a •
OCC. GROUP
` RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
•,
7,=
•. ..,'n.
SO. FT FLOOR AREA
'.y
TOTAL ACREAGE
,t
+DIAPHRAGM ' ..
'
BUILDINGUSE
I.�
"' '
E INO, _1'CON PBS Other
El ❑ El 11
ASSESSORS PARCEL NO.
APPLY NO ROOFING UNTIL'ABOVE HAS.BEEN SIGNED _
- ROUGH
tz.
4
PLUMBING -
GAS TEST I� 2,8 ,
'�O , y//�
5
TRACT No
. v "PARCEL No
MECHANICAL -
06( ,_
6 Y„ U
i
Jo
ELECTRICAL 6_
FINALS DATE , . INSP.
ACC. DATE
''A Cc. FILE NO
FRAMING _ ?
SAN
-
.INSULATION.
.PLUMBING V
ZONING
`ENG. SITE NO.
-
GAS.
"MECHANICAL'
,,, -
FIRE SPRINK
Y, [ "❑
ENERGY T 24 '
Y ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING'
LATH—INTERIOR. - -
ELECTRICAL
Y❑ N❑,'❑N❑
LATH—EXTERIOR
FIRE DEPT.
SHEETROCK - -
GRADE -
FEESUMMARY
SHEAR INTERIOR
BUILDING-'�
BUILDING '�
r.A,
SHEAR EXTERIORy up„,prf� i.' _g -
,,, TEMPORARY AP ROV LS
FIREWALLS i, -
ELECTRIC ', Vt_'
PLAN CHECK
'FEE
.. 1.
GAS ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED [OCCUPANCY-,.'
SEISMIC FEE
OC CUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR..MICROFILM:,
' ARRANGE FO'R'INSPECTION BY PHONING,252-4505,,.. '
ELECTRIC
.
Lu
aLUMBIryc
ONE WORKING,DAY,BE'FORE REQUIRED'INSPECTION.
F�
�o PLEASE GIVE JOB ADDRESS WHEN PHONING..
iZ • „ I -
—SEE PERMIT FOR EXPIRATION DATE
;.MECHANICAL
v'-t'�•p
—
CONST. raz
IIVIRdRTANT!*`,
'TOTAL
' `PLEASE READ-.REVERSE SIDE BEFORE
.,,
CALLING FOR FINAL'INSPECTION. ,
-;
0
FFICE COPY-
— - - FINAL rRADE
ROUTE SLIP 5
File No.
d� 87� 1, Date
f J.I t
Location
Approved
Date Ins
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
I
❑ Backflow Device
i
❑ Sewer Connection
T Plumbing -Final
� Ov^ter orTenant
i At
17
Sf
Bldg, Dept,
Office Copy
Sanitary Permit No. �7
Plumbing Permit No.
Lot No. 38
Tract
j Date Connected I9_D to Final �a 9 R7
PLUMBING INSPECTOR
i
CITY OF CUPERTINO OFFICECOPY
GAS SERVICE NOTICE
i ,Toy .:
` You are hereby authorized to connect the GAS service for
1 t n
1 Ov,�orTenant ���-� � AY/PX//a"i
New Service
No. of Meters Reconnect
N_a. of Add. Meters Move Service
Move Meter
PLUMBING INSPECTOR {--•��i�---� OM
E
t
Tc
O
A
N
{M
�H
I
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N
C
ELECTRIC SERVICE NOTICE
OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OF CUPERTINO
,
C
19
You are hereby
authorized to Connect electrical service for
vneror Te nant
e
'10 -3e
c
vE�vi�/f
I . I� es <
Size of Wires Size of Switch
'.
Dtor' LoaH
Voltage Phase
acing Load
K. W. Voltage
t. of Meters
Light 110New Service
Reconnect
'Heat 120Three Wire
More Service
Add. Meters
Power ThreePhase
Move Meter
�of
J
"
ELECTRICAL -INSPECTOR
CERTIFICATE OF COMPLETION
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
DATE
�j
Z 1� BLDG. PERMIT NO. J
THE BLDG.
_ /7
LOCATED AT ( �� A -U e iA l LI (l
OWNED BY
`r, r
HAS BEEN
OMEETEDI OR USE AS
BUILDING INSPECTOR
`