15304 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION , 'PERMIT NUMBER N
BUILDING -- ;'`APPLICATION & PERMIT
ADDRESS
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
• rq"_ - NAME ,. .�-�w� �/{y-� Z� ' QTY. - ELECTRIC PERMIT, FEE _.
PHONE
CONTRACTo� - OUTLETS-SWITCHES-RECEP .10.00/1.00 .
A,4� y.• NAME- -
`BS;:A''''r.- _ 'LCa.. LIGHTING FIXTURES10.00/1,00
ADDRESS
APP.6ANCES-RESIDENTIAL 4.00
A ^�J� �yx'�.g ."J�J - - '
M1 11" I, PF-NE.c' r PANELS r 10.00 r DATE OF APPLICATION'• ' '
AR HITECT ],^ (`�� - PLANCHECK FEE P.C.NO.
OR Sf�Y\ SOA'✓ ' PANELS (OVER AMP) '20.00 .
ENGINEER _
uc.No. SIGNS TRANS: �., 3.00
ARCH.OR ENG. - -'
ADDRESS SPE IAL CIRCUIT 5.00 PERMIT,VALIDATION~,
_
ZIP TEMP.METER•OR POLE INS. 20.00 -
APPUDANrs
APPILI A - MOTORS SEE FEE'SCH.
•. - SERVICE CHANGE 20.00 '� �7
U u
woo LICENSED CONTRACTORS DECLARATION
¢v I hereby affirm that I am licensed ander provisions of Chapter 9 ISSUANCE DATE'
z w (commencing with Section 7000)of Division 3 of the Business and - - - BLDG. ELECT. PLG- -MECH.
wz Professions Code d 1
Z 0 m - License CI's ,e� Lic.Numbei. 'Z, O14
9 y r Dale Contractor
a Y E - .; BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION
S,
a o s INFORMATION
X 3 LL I hereby affirm that I amexemptfrom the Contractor's License MISC.- REFER TO ORD
f- 0 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT'ISSUANCE 10.00 VALUATION $/FT.
mm Code:Any city orcounty which requires a permit o construct,alter, - - -
¢ so G Improve,demolish,Or repair any structure,prior to Its Issuance,also ELEC.CONTR. „. LIC:NO. ELEC.
n w R requires the applicant for such permit to file a signed statement that TOTAL - MIT TO
he is licensed pursuant to the provisions of the Contractor's License PER
- r� R
H z a
Law(Chapter 9(commencing with Section 7000)Of Division 3 of Hie '•
4 0 Business and Professions Code)or that he is exempt therefrom and QTY. 'PLUMBING PERMIT FEE
in H $ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
a 3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-
DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and tire structure is not _
- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds Or improves thereon,and who does such work' FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- -
'��' meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00
Orlimprovement 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 im- - BUILDING USE,
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 - REs NO �•CON,. PS '-Other
- -❑ I,as owner of the property,um exclusively contracting with 1:1_ , ❑ O`.' ❑ ❑ "
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL ND:''.
and Professions Code:The Contractor's License Law does not apply - -to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA,) 1.00 t
r
contracts for such prolems with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ftI10.00
- tire Contractor's License Law. - TRACT NO. - PARCEL N0:
o .1 ma exemplander See.-,BAP.C.for this - WATER HEATER W/VENT,' 6.00 _
namon1
Owner Date - 'MATER SYSTEM r 5.00 ACC:DATE ACC.FILE NO.
WORKERS'COMPENSAt'ION DECLARATION WATER TREATING EQUIP. P ' 5.00 -
I hereby affirm that'I have o certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,ora certified ZONING 'ENG.SITE N0.
copytherefq(.S�fh�ily6rlr� •' -
colic Nre&. kft r� �• -�
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T-24
Z Z ertifi`d o is filed w h the It inspection division. -'------
0. Applicant V YPlt �'�,A�- �`y MISC.- .REFER TO ORD. Y.❑." N,❑ Y ❑ N❑ t
~ rn PERMIT ISSUANCE .00
CIiRTIPIC'ATF.OFEXEMPTION FROM WORKERS' .FLOODhaw : ., .', A.L.u.C.!.
ION
13- (This section need volt hcTcompletedlRf hcEpermil is for one
PLG-CONTR. - LIC.NO. `_ 0 AL Y❑ "N[ - Y ❑ ''IN[]
d'O
D Z hundred dollars($100)orless,) - - -
U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMI ` �f� ' FEE, 'FEE SUMMARY
Ibit is issued,I shalbaot employ any person in any manner so as to 4'
Q w become subject to the Workers'Compensation Lows of California. - - -
y Onte Applicant ALTER OR ADD TO MECH. BUILDING ti
} N NOTICE 1'O APPLICANTS. If,after making this Certificate Of lis- - - _
F Z emption,you should become subject to file Workers'Compensation APPLIANCE 5.00 PLAN CHECK•
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.)'' 4,00
CONST RUCTION LENDING AGENCY : AIR HANDLING UNIT(OVER 10=C.RM.1.6.00 SEISMIC'FEE `
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH'DUCT), 5,00 .•� - - _
RED-
the performance of the work for which this permit is issued(Sec. ' M ICROFICMr
3097,civ.c.). - .HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B:T.109.SO
Lender's Address ELECTRIC
I certify that I have read ti's applimition and stale,that the above VENTILATION FAN (SINGLE)' 4.00 - -
N information is correct, 1 agree to comply withall city and county gGILER-CGMP(3 H.P.Or-000 OOO B.T.U.) 6.00 •PLUMBING
yg; o'rdiriances and state laws relating to building construction, and - ,,LL��
"- hereby autlmri, represenmtves of this city to enter upon tire BOILER-COMP (Over 100,0_00 BTU)BEE FEE$DH. MECHANICAL' Ute'
above-mentioned property for Inspection purposes I, -
- (We) agree to save, indemnify and keep harmless the City of y MISC.- , REFER'TO ORD. - -
"-" apertoo against liabilities,judgments, costs and,expenses which .PERMIT ISSUANCE - 10.00 CONST.TAX
may l any way accrue against said City in consequent of the '
r n I f this "an, MECU.CONT. UC.NO. ME
"qa � � TOTAL '
S toe of Applicant/Contractor -
OFFICE COPY..
POST THIS CARD NEAR FRONT OF BUILDING
' .t' ' PERMIT NUMBER
CITY 01" CUPERTINO
1530
INSPECTION DIVISION
JOB,INSPECTION RECORD
tea. 'I PERMIT EXPIRATION
JOBADDRESS �0�7� 1/UC�dO ' � z UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER ' ,/I'1!L —r N �+-T CLrF'.� CONTRACTOR L' L� "T� IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPF4TION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION ' ANCE OR 180 DAYS FROM,
NOTE: LASTCALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PLRnvr VALIDATION
PREGUNITE CUP.ERTINO STANDARDS.
GARAGE SLABS
POUR NO.CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING -
ELECTRICAL • Issunrice unrr.
MECHANICAL - - RLDc ¢CECT., PLG. MEECCR
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR •INFORMA710N
'VALUATION - SIFT.
PLUMBING-� - - r , .
MECHANICAL
ELECTRICAL - - PERMIT o
FRAMING !%(
INSULATION - , - - STORIES TYPE CONSTR.
Tc. GRCUP RES UNITS
EP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R, 1
r .FLOOR AREA TOTPLACREAGE
t .�;,J ROOF NOTE:NO FINAL INSP.SHALL BE MA EFOR%
617APHRAGM - - THE CONSTRUCTION TAX IS PAID pf '
ROOF SHEATHING CN� Res iNpulLo`oN usEPe 'o
APPLY NO ROOFING UNTIL ABOVE HAS'BEEN SIGNED FINALS ' " DATE INSP: ❑ ,. ❑ ' ❑ ❑` ° ❑ `
ROUGH SAN.p nSSESSORS PARCEL NO
.
PLUMBING, ELECT,ENERGY•
TRACT NO 'PARCEL NO
TUBS 8 SHOWER PAN PLUMBINGTNERGY -
MECHANICAL _ MECR ENERGY
ELECTRICALACC,LATE ACC.FILE NO .r
BUILDING ENERGY
FRAMING ELECTFINALTEST
` INSULATIONPLUMBING` ZONING ENO.SITE NO.
GAS TEST GAS -
MECHANICAL -
FIRE SPRINK ENERGY T-24
• -
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •- Y NY ❑ N❑
EXTERIOR SHEAR - - ELECTRICAL RELEASE - FLooL zoNE A.L.ac
,
INTERIOR SHEAR FIRE DEPT. °'❑ N❑ Y ❑ NO.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING -
c
INTERIOR LATH' - TEMPORARY APPROVALS BUILDI a—^
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY O F BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR INSPECTION BY. PHONING 252-4505, ELECTRIC,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING '
z 1,
PLEASE GIVE JOB.ADDRESS WHEN PHONING.
SEE.PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! 1 'CONST,TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY