17143'APPLICANT TO FILL IN INFORMATION WITHIN .RED LINES - USE -BALL, POINT P.E'N ONLY
._BUIL'UING PROJECT IDENTIFICATION
^"-}
:,APPLICATION & PERMIT
BUILDING-ELECT.R ICA L—PLUMBING MECHANICAL
PERMIT NUMB ER. -.
17��14 3-
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BD LDIHG .
ADORE9a ^ .
G2 Z j
OWNER'S-
NAME// p.' //•//�A /r 'J �/
Ir
QTY.` ELECTRIC PERMIT' FEE'
PLAN CHECKVALIDATION. '
�� 11
11
-
- DATE OF APPLICATION ^
coNTRAciORs—s3
NPM f•�p,
Y%LYJG,$v :uc. n0..%.gam/7
- UTLETS - SWITCHES - RECEP "10.00/1 00 _
LIGHTING. FIXTURES - 10.00/100
CONTRACTOR �'S; ' @ �1/�
//Od• [i//Nle% .�'(J PHONEZ��I/JJ
APPLIANCES; RESIDENTIAL 400
PANELS • 1000 '•
ARCHITECTx- ^
OR
ENGINEER
' uc. NO.
PANELS (OVER ZOO AMPI. 20.00
PLAN CHECK FEE P.C.NO.
.,
'
SIGNS TRANS. ^- - 3.00
ARCH. OR ENG,
ADDRESS.'.
'.
., SPECIAL CIRCUIT ' _ 500 ''
-, PERMIT VALIDATION -
TEMP. METER OR POLE INS- ':- 20.00
Tip
-
APPLICANTS +
ADDRESS ✓
MOTORS; SEE FEE SCH.
- SERVICE CHANGE' .1"^^< .:r .20.00
'
EICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under ore inions of Chapter 9.
(commencing With Section 7000) of Drvrsmn 3 ofthe Business and
PCOfe961on5 C it and 11 It C See Is m toll fUIL/gB� fl""
LicenseClus � Lm Nomser %r /
ISSUANCE DATE
`BLDG.
-
-
ELECT.
PLG. MECH.
L_E1
Date- Contmeto
_Ill
OWNER -BUILDER DECLARATION- -
hereby affirm that 1 am exempt from the Contractor's License
Law,for the following reason. (Sec. 703 L5, Business and Professions
Code: Any city orcounty which requireso permit to construct, alter,
improve, demolish, or repair any structnte; prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he Is licensed pursuant t0 the provisions Of the Contractor's License
Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe
Bouness and Professions Code) or that he is exempt therefrom and
BUILDING PERMIT INFORMATION—'
,_
^'. .'
MISC. REFER TO ORD
VALUATION $JFT.
'7l 'Iwo
T
PERMIT ISSUANCE ," 10.00'
- -
CLEC. CONTH. - LIC. NO:
,
'-
'ELEC'
TOTAL'
PERMIT TO "
'^
r
'"
QTY. PLUMBING PERMIT 1 / FEE
STORIES
s TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
- V
byany applicant for a permit subjects the applicant On civil penalty
of not more than five hundred dollars ($5000.):'
„
e '
ALTER-DRAIN&VENT-WATER (EA.) 5.00', -
-❑ 1, as owner ofthe property, or my employees with wages as
[heir sole compensation, will do the work, and the structure is not
. BACK FLOW PROTECT. DEVICE' 4.00
- -
OCC. GROUP
RES. UNITS
'; DRAINS -FLOOR, ROOF, AREA; COND. 5.00
-
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 building"
"
-
FIXTURES - PER TRAP' 5;00
-
SG, FT. FLOOR AREA
43'
TOTAL ACREAGE -
,
-
GAS - EA. SYSTEM -1INC. 4'OUTLETS 6.00 -
or improvement is sold within one year of completion; the owner-
builder will have the burden of proving that he did not build or im-'
prove for purpose of sale.). - - '
'. ❑ I, as owner .1 the property, ani exclusively contracting with
GAS : EA..SYSTEM -OVER 4 (EA.) 2.00
' •
BUILDING USE
RES IND CON PB Ornar
El . 1:1 11- ❑' ❑
INDUSTRIAL WASTE INTER. . 30.00 '*�''.
licensed contractors to construct the project (Sea 7044, Business
and Professions Codc: The Contractor's License Law does not apply
to an owner of property. who builds or improves thereon, and who
-
- LAWN SPRINKLERS= 1 INC 5 V.B. _6.00
ASSESSORS PARCEL NO.
LAWN SPRINKLERS- OVER 5'(EA.) 1.00
contracts for such projects with, a'confactor(s) licensed pursuant to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/_10.00
TRACT NO.
PARCEL NO.
❑ I am exempt under Sec. ;B.11 for this
reason
-.
WATER HEATER W/VENT-' 6.00
Owner Dote
WATER SYSTEM' - - - 5.00 .
ACC.DATE
ACC. FILE NO.
RRCLB CQh1P ISATION DECLARATION
here yaf arm fill Yi#oaysn.•llaooccee''rtificate of consent to selfinsurC,
or ernOCeLL f Workers' ComP�gs�n�on Insurance� oJ ecert ad
copy roof (Se 3800 Lub.C)MI//O+t1�YL JNN/
Policy
'❑-Certified CCOPY is hereby furmshe
l c',ity', division.
'e y ed. coinspection
Applin
". WATER TREATING EQUIP ,t 500
'
ZONING -
ENG SITE NO.'
-
- ,
-
MISC. -" 'i 'REFER TO ORD. -
FESPRINK`-
IR
-
v ❑ ,N ❑.
_'ENERGY T-24p�fer
v E) NO
CERT FICA TE OF EXE PION FROM.WORKERS'
PERMIT ISSUANCE 10.00
'FLOOD ZONE.
A.L.U.C.;
COMPENSATION INSURANCE - ^"
(This LseatiOn need'no( be Completed if the permit Is for one
_
Y ❑I' N.❑.
Y.❑ N ❑.
-
PLG. CONTR. .. "LIC. NO.
-
PCG;
NOTAL -
hundred dollars ($100)or less)
I certify that the perfo ce of the work for which this per-
mit is Issued, Lshall nploy-any person in any manner so as to
- --
QTY" MECHANICAL' PERMIT ✓ FEE
-
-
-' FEE SUMMARY
-
BUILDING
/ -
1`tJO W
become subjec m Workers Compensation Laws of California,,
Date -=" Applicant-
' ALTER OR ADD TO MECH 5.00
NOTICE TO APPLICANT: If; after making this Certificate of Ex
empt ion, you should become subject 10 the Workers' Compensation
APPLIANCE' . - " 5.00
PLAN CHECK
provisions O1' the Labor Code, you must forthwith comply with
such provisions Or this permit shall be deemed revoked. -
FEE - -
-
AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 "
AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 (
'SEISMIC FEE ^'
'
. •"'�sCONSTRUCTION LENDING AGENCY.
I hereby affirm that there Is o construction leading agency for
EXHAUST HOOD (WITH DUCT) 5.00
the performance of the wor for which this permit isucd fSec
3097 CieC I , : % for,
MICROFILM
- -
HEATING UNIT (TO 100,000.B.T.U.) 8.00
Lender's bar Addr J /7
Lender's Address
HEATING UNIT(OVER 100,000B.T.U:)8.50
ELECTRIC
Iceitify tllabl have read thl's application''fd slate that the'above
VENTILATION FAN(SINGLE) -^ '4.0.0
-
Information is correct. I agree to comply with all city and county.
'ordinances and state' laws relating to building construction, and.
this city to enter upon the
hereby euahoed ropertyfor ins inspection
above-mentioned prepetly for inspof In purposes. '
PLUMBING
- -
' BOILER - COMP (3 H.P. or 100,000 B.T.U.), 6.00 .
BOILER=COMP (Over 100,000_ BTU) SEE FEE SCH.
MECHANICAL
(We) agree to sive, indemnity and keep harmless the City oP;
.. MISC. - •="' .REFER ;TO ORD.
Cupertino against liabilities, -judgments, Costsund'eapenws^which
may in any way.accrue against said City in Cuhs'equence of the
ranting of this permit's
7^S ^S
CONST. TAX
'.pERMIT ISSUANCE 10.00
MECH.CONT "f LIC NO. - MECH.I
roTAL
` ,%'
TOTAL
'
5 n' are of ,Applicant/Contr e r • Date
`
OFFICE COPY .
POST THIS CARD NEAR FRONT OF BUILDING
CITY.OF CUPERTINO'
INSPECTION DIVISION
JOB INSPECTION,RECORD. ,
r
tPEjR
JOB ADDRESS`-.�L`�� •`•'�`+�r UN IT _LOT,.#
y[1 <
OWNER" � (w�r. `.' � CONTRACTOR . t
PEeniTNumeER
::171.43 -
IT EXPIRATION
I2�� 1$,{r• i3
"PERMIT EXPIRES`IF WORK
IS NOT'STARTED WITHIN
180 DAYS OF PERMIT ISSU,
ANCE OR 180 DAYS FROM '
LASTCALLED INSPECTION.'
INSPECTION DATE INSPECTOR
INSPECTION RECORD,
FOUNDATION-
-
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THEAPPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
UFER
PREGUNITE - , -
-
PIJWIT VALIDATION,
d
'i, .77 -g M
PT
ISSUANCE On TE
GARAGE SLABS . " '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
'- UNDERGROUND/SLAB
PLUMBING
o✓, - dI
'_
ELECTRICAL.
MECHANICAL
• _ ,
BLDG.
I E.LLEECCT,
wPLC, . mec R.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
- WOOD FLOOR'
PLUMBING
VALUATION'
'l 7t��T�•.� �
$IFT.
•Q
MECHANICAL -
ELECTRICAL'
- -
- PEIvm IT TO
'
FRAMING-
INSULATION
STORIES
TrPECONSTR. -
'
OCC. GROUP
RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOFSq
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAXIS PAID
"-BUILDING
IT FL oafFREA
�.
TOTAL ACM I: AGc
'
DIAPHRAGM
ROOF SHEATHING
USE
+Cs IND GON PR on..',
❑ ❑ - ❑ ❑
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
'FINALS' " -DATE INSP.
'.ROUGH
SAN.#. ,
nbsh SSU.S PARCEL NO
PLUMBING -
ELECT. ENERGY
TUBS 8 SHOWER PAN -
PLUMBING ENERGY
TRACT No.
"
PARCEL No.
MECHANICAL '
MECH. ENERGY
ELECTRICAL"' ^Z
BUILDING LDING ENERGY -
Ac O, DATE,
ACC FILE NO
FRAMING -
ELECT. FINAL TE ST "
INSULATION .PLUMBING.
ZONING -
ENG. SITE No.
" GAS TEST - -
GAS
MECHANICAL
FIRE SPRINK
y ❑ ",0
ENERGY T.24
' , Y ❑ 'N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR - - -
ELECTRICAL RELEASE
FLOODZONE
`" ❑,. ".❑
A,L-U,c.
Y ❑ "❑
INTE RIQR SHEAR
FIRE DEPT.
SHEETROCK
GRADE .,
'. FEE SUMMARY
EXTERIOR LATH
BUILDING Vp`-' 1 1
'BUILDING
CPQ `.
,INTERIOR LATH - -
TEMPORARY.APPROVAL
SCRATCH COAT
ELECTRIC
I
PLAN CHECK'
FEE
-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY
SEISMIC FEE..
I
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING'INSPECTOR.
MICROFILM
ARRANGE F.OR,INSPECTION BY PHONING 252-4505, .:
7� - ONE WORKING DAY. BEFORE. REQUIRED INSPECTION.
PLEASE GIVE JOB ADDRESS WHEN PHONING.
-SEE PERMIT FOR EXPIRATION DATE -
ELECTRIC
'
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE -SIDE BEFORE -
CALLING FOR FINAL INSPECTION.
TOTAL
.�
.OFFICE COPY ...