17476 APPLICANT TO'FILL''IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY JOB 1756
BUILDING PROJECT IDENTIFICATION - .PERMIT NUMBER
BpILDING - - - - - APPLICATION & PERMIT JOB #17 i6 • -
or ADDRESS ' ' . 17476
1 4]S BandlBUILDING -ELECTRICAL-PLUMBING-MECHANICAL
: OW R's .' ^' PLAN CHECK VALIDATION
NA C/ , CITY. ELECTRIC PERMIT FEE
110H
CONTRV
NAME G R - OUTLETS-SWITCHES-RECEP 10.00/1.00
Cal-Air, Inc. Llc'No,137195 LIGHTING FIXTURES 10.00/1.00
ADDRESS OR's _ APPLIANCES-RESIDENTIAL 4.00
ADDRESS - - � -
' ONE 947=0155 PANELS , 10.00 DATE OF APPLICATION
OA14R H E T PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.-NO.
ENGINEER
LIC,NO. SIGNS TRANS., 3.00
ADDREOSSS eNG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT Ss - MOTORS. SEE FEE SCH.
77S S. 1St. St. San'Jose SERVICE CHANGE_ _ 20.00
o O LICENSED CONTRACTORS DECLARATION'
.Q U U I hereby affirm that I am licensed under provisions of Chapter 9inaQ ISSUANCE DATE
N<w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. •PLG. MECH.
H z Professions Cod n y license is id full force e 1 ' - - _
o i w Licen�rr C,l+js�-�'f15s�� Lic.Number,�.,7{
.r Datc..i(- _v Contructor.� ;M- ,.1110. �1lLr1 Pkcr�'1' �I '"� El �
F N J
_E S,¢ ¢ OWNER-BUILDER DECLARATIONBUILDING PERMIT
- ¢e
A o A U INFORMATION
ce ; H I hereby affirm that I am exempt from the Contractor's License MISC.- 'REFER TO ORD
u.o Q Law for the following reason.(Sec.7031.5,Business and Professions L - VALUATION $/FT.
r - PERMIT ISSUANCE 10.00 -
w Code: e,y mulish county whiny reqstructure,prior
it tocunsuanLalter,
Q.¢0, improve,demolish,or repair any structure,prioi to its issuance,also ELEC.CONTR. LIC.NQ ELEC.
0
o re. requires the applicant for such permit to file a signed slatetnrat that - TOTAL
w m
c- he
is licensed pursuant m the provisions of the Contractor's License PERMIT TO
HiQLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe
4 D Business'and Professions Code)or fuel lie is exempt therefrom and GTY. PLUMBING PERMIT - FEE '
M r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
La
$ " byanyapplicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not mom than five hundred dollarS($500).):
❑ I,as owner of the properly,or my employees'with wogcS as
�. BACK FLOW PROTECT.DEVICE 4.00
[heir sole compensation,will do the work,and the s[rucmie is not OCC..GROUP RES.UNITS
Intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:Tim Contractors License Law does not apply to an owner of
property who bullas Or Improves demur,and who does such Work FIXTURES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE
himself m through his own employees,provided that such improve-
ments arenot inghhis oroffered oyee sale.lf,ed that
sthe building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build orJm. BUILDING USE
I\. prove for purpoan'of sale.). t INDUSTRIAL WASTE INTER. 30.00 - 'RES IND CON - PB Diner
❑ I,as owner of the property,am exclusively contracting with - - 11 El 0 El ED
licensed contractors to construct the project(Sec. 7044,Business
d .
LAWN SPRINKLERS- 1 INC 5 V.B. 600 - ASSESSORS PARCEL No.
anProfessions Code:The Contractor's License Law does not apply _
to an owner of property who builds or improves Hereon.,rod who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a-contructor(s)licensed pursuant to
the Contractor's License Law. - SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I dm exempt under Sec..,B.&P,C.for this
reason WATER HEATER W/VENT 6.00
(ixq Owner _ 'Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE N0.
/\ WORKERS'COMPHNSATION DECLARATION' WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, .
or certificate of Workers'Compensation Insurance,ora certifidd ZONING ENG.SITE NO.
copy thereofA$r .38
00,Lab.C.
.� Policy No. ( 4 Company T lbeert 1- h,1R1
O _ ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-Z4
. z Z ❑ Cerlifiey�� sQpy-is,tiled with the city inspection division. ,
P: 2Applicant-L:3L-�7W�yl,'.y:�,L...(�T�nQ��.�.q�-�s' MISC.- ' REFER TO ORD. O ❑
CC N CERTIFICATE OF IIXEMPI'ION 1 ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. N
LU > ,I COMPENSATION INSURANCE PLC.CONTR, LIC.NO.
PLG.
d aT his scdion need not he completed it the permit is for one - TOTAL Y❑ N[D Y ❑ N❑
D Z hundred dollun($100)or less.)
U O 1 certify that in the performance of the work for which[this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LJ_ 1- mit is issued, I shall not employ any person in any manner so as to
' OW become subject to the Workers'Compcnsation Laws of California.
a Date-- Applicant ALTER OR ADD TO MECH. 5.00 BUILDING -
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex=
F.. Z carnation,you should become subject to the Workers Compcnsation APPLIANCE 5.00 - PLAN CHECK
Provisions of the Labor Code, you must forthwith comply with U, FEE Such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10MC.F,M) 4,00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 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 for which this permit is issued(See. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address H EATINGUNIT IOVER 100,000 B.T.U.)9.50 ELECTRIC
1 certify that I have read this application and state that tie above VENTILATION FAN (SINGLE) 4.00
Inform' on is correct. I agree to comply with all city and county PLUMBING
ordinn and state laws relating to building construction, and BOILER-COMP(3 H.P.01100,000 B.T.U.) 6.00 -
hereby thorieC represe Ives of t11is city to-enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH.no MECHANICAL
above a tinned,propert for Spector purposes.
(W 'gree tosave, n I ify a I keep harmless the City of MISC.- - REFER TO ORD.
upr n against liahi ie or gmel s, costs and expenses ich CONST.TAX
n way ace e • i I sdi City i consequence o the PERMIT ISSUANCE 10.00
t is a "[. / CH.CONT: LIC.NO, M9q-SDSD . TOTALECH.
Signs of Applicant/Coptrador e Cal-Air Inc. 137195 C
OFFICE COPY "
POSTTHIS CARD NEA R',FRONT OF<BUILDING. ''JC6 1756
PERMIT NUMBER
CITY .OF CUPERTIN 6 1'7476
- INSP,ECTj,0N DIVISION
JOB INSPECTION RECORD
.. ..' .t
" /�• � PERMIT EXPIRATION
•'xL JOB ADDRESS D 7,r` oLVV I•I_�Y V - _ -
«{/ 1` UNIT# '- LOT# " E*� •
„ ,i' PERMIT EXPIRES IF.WORK
OWNER 'e ; u( CONTRACTOR.' — 1 ,I+' ��• �� 'IS' NOT ,STARTED WITHIN
- I S E TION DATE' INSPECTORINSPECTION RECORD 180DAYS OF PERMIT ISSU.
FOUNDATION - f- ; ANCE OR 180'DAYS FROM
NOTE:=. - ''- LAST,CALLEDINSPECTION.
UFER - - "- ALL,GRADING AND'DRAINAGE SHA2BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF `. PERMIT VALIDATION,
CUPERTINO STANDA DS
„ GARAGE,SLABS Q A s p: r.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED s - — _'�•�` f
UNDERGROUND SLAB,. ,( n y 1959
PLUMBING - - o- vA, ��;.d L
ELECTRICAL' clw O{{COQBltlpp
ISSUANCE DATE
1 BLDG. ELECT; .PLG. MECH.
MECHANICAL ( T _
rvv
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. BUILDING PERMIT
WOOD FLOOR. _ ` INFORMATION
PLUM GING. _ vALUAiION. $/FT.
MECHANICAL "
` ELECTRICA C" -« p..PERMIT TO
• .. FRAMING '; .. '.., ' ; - - .��-lei
+ INSULATION srDRIES TYPE CONSTR.
w
'OCC.GROUP •='RES UNITS
PLACE NO SUBFLOORUNTILABOVE HAS BEEN SIGNED -
SO FF.FLOOR AFEAL TOTAL ACREAGE
ROOF, NOTE:NO FINAL INSP:SHALCBE MADE BEFORE
DIAPHRAGM " •+ THE CONSTRUCTION TAX IS PAID
BUILDING USE -
ROOF SHEATHING + - •!RES 'IND 'CON PB Om& '
"APPLY NO"ROOFING,UNTIL""ABOVE HAS BEEN SIGNEO" xE 'FINALS DATE; a' "INSP.; t [11 Ej
•. - ASSESSORS PARCEL NO
ROUGH SAN.n
PLUMBING' r•" _ - .,ELECT.ENERGY
• TRACT NO. PgRCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY '
MECHANICAL - MECH.ENERGY.. '
" ELECTRICAL . ACC,.DATE, 'ACCFILE NO,
BUILDING=ENERGY
�."
FRAMING '.ELECT',EI NALTEST ZONING ENclslrE'No.
• INSULATION : - PLUMBING . •
,GAs:TEST GAS
NERGY T 2
MECHANICAL - FIRE SPRINK •E
- �_ e,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING'" 'Y "� " °, NO
' 'EXTERIOR SHEAR '- •E LECTRICALFLOOD ZONE ALL U.0;RELEASE '� " "� '
i' INTERIOR'SREAR " FIRE DEPT .. Y EJ ''"❑ 1
1 ° h N❑
SHEETROCK GRADE' r' - FEE SUMMARY' ,
1. EXTERIOR,LATH BUILDING':
INTERIOR LATH` TEMPORARY APPROVALSS :• BUILfJING .-
SCRATCH COAT. ELECTRIC••+.. --+ ' PLAN CHECK;
GAS .FEE
p,
NO TAPE'OR PLASTER UNTIL,ABOVE HAS BEEN SIGNED OCCUPANCY ;":
. SEISMIC;FEE ".
OCCUPANCYOF BUILDING ISNOTPERMIT,TED UNTIL.BUILDING;FINAL ISSIGNED BY BUILDING INSPECTOR:
MICROFILM
ARRANGE F0'R'INSPECTION'BY.PHONING"i 524505, ELECTRIC..
o� ONE WORKINO'DAY BEFORE REQ JI,RED INSPECTION P�unnalvGk;:'`
z PLEASE GIVE'JOB ADDRESS WHEN PHONING a
SEE,PERMIT FOR EXPIRATIONDATE MECI-ANICA�'
.E 'r.
IMPORTANTI ? p CONST.TA
':PL
EASEtREAD REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL IN! ECTION, �,.(.: ...
1 OFFICE'COPY
s