14132 rM
CANT TO-FILL IN INFORMATION WITHIN RED LINES -' USE B! LL POINT PEN ONLY ,NG PROJECT I DENT[FIC PERMIT NUMBER
_ APPLICATION & PE14132
A/1 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
w A) . &
PHONE
cAME TORS UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
C4- �^ C LIc.NO. 66 LIGHTING FIXTURES 10.00/1.00
-.Z_ CONTRACTORD 's PPLIANCES-RESIDENTIAL 4.00 -
u y (e�/C�w,HarvE (per PANELS - 10.00 PLAN DATE CHECKOFFEAPPLICATION
0.NO.
ARCHITECT - PANELS (OVER 200 AMP) 20.00
OR
ENGINEER
' LIC.No. ISIGNS TRANS. 3.00
ARCH.OR ENG. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
EMP. METER OR POLE INS. 20.00
ADDRESNra /s-//6.5-<�NNyvA (° MOTORS SEE FEE$CH.
s SERVICE CHANGE • 20.00 •' i I`
woo LICENSED CONTRACTORS DECLARATION 1 -
m is I hereby affirm that 1 um It under provisions ul'Chapter 9' nhnG
y p p .[ 1x.115SUANCE DATE
y < % (commencing with Section 7000)of Division 3 of the Business and - BLDG' ELECT. 'PLG. . MECH.
r w Professions Code d my license is in full for aprJ e e El 1-1O
oi y o License Clan Lic.Numb7 I -
2 w H W - Dute Contmeorer e'
Y Q 4 OWNER-BUILDER DECLARATION - _ BUILDING PERMIT
MISC.- REFER TO ORD INFORMATION
_ �
w3 n N - I hereby affirm that I am exempt from the Contractor's License - VALUATION $/FT.
Fuoa Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 (O/
Code:Any city or county which requires a permit to construct,alter2 aa ,
� '-
ac 4 Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. TELEC.
- O u requires the applicant for such permit to file a signed statement that OTAL PERMIT TO
w he is licensed pursuant to the provisions of the Contractor's License I r�s
Law(Chapter 9(commencingwitll Section 7000)of Division 3 of the J •�l
ii o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
in r$ the basis for the alleged exemption.Any violation ofSeCtion 7031.5 1 STORibar TYPE CONSTR.
.w; -. by any applicant for a permit subjects the applicant to acivil penalty ALTER-DRAIN -WATER IEA.) 5.00 +
of not more than five hundred dollars(5500).1:
❑ 1,as owner of the property,or my employee's with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC,GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale(Sec. 7044, Businesi; and.Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees;provided that such improve-
mentsare notintended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 .
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA) 2.00' BUILDING USE
builder will have the.burden of proving that he did not build or im RES IND CON PB - Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with _ ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec_ 7044,Business LAWN SPRINKLERS;1 INC 5 V.B. 6.00 ASSESSORS FARCE L NO:
and Professions Code:The Contractor's License Law docs not apply -
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to -
. .
the Contractor's License Law. SEWER-SANITARY-STORM EA200ft/1000 TRACT NO.� PARCEL N0.
❑ I am exempt under Sec. - ,.B&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
I ,
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
hereby affirm that I have a certificate of consent to self-insure -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG:SITE NO.
copy thereof(Sec.3800,Lab.C.L
•� Policy No. Company
Q ❑, tified copy is her by furnished FIRE$PRINK ENERGY T-24
z 2 Certifi y is Iled ith the ( tion division. -
O pplicant' 9fyP%V 511 AF3 L'�e'/- MISC.- REFER TO ORD. y ❑ N❑ Y ❑ N❑
y CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 It
-FLOOD ZONE A.LU.C.
LU > COMPENSATION INSURANCE ' PLG.CONTE. LIC.NO. PLG.
Il O (This section need not be complelcd if the permit is for one t� TOTAL Y❑ N❑ Y ❑_ N❑
:) Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- QTYMECHANICAL PERMIT FEE FEE SUMMARY
.
LL mit is issued,I shall not employ any person in any manner so as to
Q -
become subject tothe Workers'Compensation Laws of Culifomia.
y Date Applicant ALTER OR ADO TO MECH. -5.00 BUILDING
} t0 NOTICE TO APPLICANT: If,after making this Certificate of Ex. -
F Z emption,you should become subject to the Workers'Cotnpensat ion APPLIANCE- 5.00 , PLAN CHECK
provisions of the Labor Code, you must forthwith comply with 7 17_7
FEE
V such provisions or this permit shall be deemed revoked. . AIR HANDLING UNIT(TO 10,0DDQF.M.) 4.00 -
CON S'TRuc'IIONLENDING AGENCY AIR HANDLING UNIT(OVER 10900C.EM.) 6.00 SEISMIC FEE S}.
I•hereby affirm that there is a Construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 '
the performance of the work forwhich this permit is issued(Sec. MICROFILM -
3097,Civ.C.). I HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATING UNIT I OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
. 1 certify that I have read this application and state that nd cothe above VENTILATION FAN (SINGLE) ' 4.00
information is correct. I agree to comply with all city aunty PLUMBING
ordinances and stale laws relating to building construction, and BOILER-COMPI3 H.P.GF 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon (tic - BOILER-COMP (Over 100,000 BT61 SEE FEE SCM. MECHANICAL
above-mentioned property for inspection purposes.
(We) a lee to Sit indern and keep'han... as the City of MISC.- REFER TO ORD. ,
Cupertino ain I' I mics,ju ments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
ma in w ccr le agai said in consequence of the
gra g f 1' rml . I MECH.CONT. LIC.NO. MECH.
0 _ TOTALTOTAL `f_7
�7
$i ( o Ap ca t ontrac Uate ,
OFFICE COPY
POST THIS D NEAR FRONT,OF BUILDINGPrHMIT NAILER
f
'CIT . OF CUPERTINO
14132' ' .
'INSPECTION DIVISION
JOB INSPECTION RECORD
I PERMIT EXPIRATION.
7501 BARNAHRT'-
JOB ADDRESS - • "UNIT# LOT#'
JOHNSON', GREENHOSUES ECT . PERMIT EXPIRES IF WORK.
OWNER coNTRAcioR•-, ISNOTSTARTED WITHIN ,
•n' •180 DAYS OF PERMIT.ISSU- : `
' INSPECTION DATE INSPECTOR INSPECTION RECORD.
FOUNDATION ANCE OR 180 DAYS FROM
UFER I. , .
LASTCALLEDINSPECTION.
PREGUNITE PERMIT VALIDATION`
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED,
UNDERGROUND /SLAB - l%t � 7 �ISE '•
n t.
PLUMBING ' ppeeyy}}pp ' w
ELECTRICAL: - "' al Of NUp 01("SSUANCEDATE
' MECHANICAL' BLDG- ELECT- PLG. MECH.o . I,
❑ ` 'a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT11
WOOD FLOOR INFORMATION
VALUATION •S/FT.
PLUMBING - - �' r, -
MECHANICAL
G - ELECTRICAL :PEHMITTO
t- FRAMING - .. .. ,•`.:F
x
INSULATION "' • j STORIES - TYPE CONSTR.
- - OCC:GROUP RES.UNITS"
"e PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . -
HOOF ' SO.FT.FLOOR AREA• TOTALACREAGE
DIAPHRAGM '
' s BUILDING USE
.. - RES IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED_ ❑ E 0 0 ❑'
ROUGH ASSESSORS PARC ELNO.
' PLUMBING
GAS TEST - _ - TRACT NO. PARCEL NO
MECHANICAL i
ELECTRICAL ; - I FINALS DATE INSP. ACC.OATE ,• ACC.PILE NO:
FRAMING _ SAN'*
INSULATION PLUMBING ZONING ENG.SITE NO.
. _ GAS ..
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED i HEATING • Y „"�. ' - .v 140
. . .
- LATH-INTERIOR ELECTRICAL � � � ❑ N❑FLOOD ZONE AL '
LATH-EXTERIOR• - FIRE DEPT. v Yo
UC.N❑
SHEETROCK GRADE - .FEE SUMMARY
SHEAR INTERIOR - BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVAL - BUILDING "�--
FIREWALLS 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 IS SIGNED BY BUILDING INSPECTOR: MICROFILM
ARRANGE,FOR'INSPECTION BY PHONING 252-4505, ' ELECTRIC
w ONE:WORKING DAY BEFORE REQUIRED INSP
E l'I
0� C ON. ', PLUMBING-
0 , I
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL`
IMPORTANT! coNsr Tnx
PLEASE READ REVERSE SIDE BEFORE,
CALLING FOR FINAL INSPECTION: TOTAL /• »—
. ' I :OFFICECOPY _ - ,