8594 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .
PERMIT NUMBER
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
pull, G 8594
Ao1rREss ]SSS Barnhart � ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
0NEN'E - , PLAN CHECK VALIDATION
NAME City Of Cupertino OTY. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS
NANTHAc7oR's
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRAC70R'S - PPLIANCES-RESIDENTIAL 4.00
.ADDRESS
PHONE PANELS - 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE' P.C.NO.
OR
ENGINEER SIGNS TRANS, 3.00
LIC.NO. PERMIT VALIDATION
ARCH.OR ENG., SPECIAL CIRCUIT 5.00 -.
ADDRESS
ZIP EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH. 7
AODHEss
SERVICE CHANGE 20.00
eci /. TEMP.POLE 30.00
'.02 LICENSED CON'T'RACTORS DECLARATION
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DA E
H < w (commencing with Section 7000)of Division 3 of llle Business and V Ur' - BLDG. - ELECT. PLG. MECH.
r w z Professions Code,and my license is in.full force and effect. J El 1:1
❑
go-; License Clnei Lic.Number
El
Date Contractor_- BUILDING PERMIT
F
OWNER-BUILDER DECLARATION' - ' - INFORMATION
REFER TO ORD
w3 n y I hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION $/FT. -
u
Car Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
� Z, -i Code:Any city or county whictirequires a permit to construct.alter,
re rt< 2 improve,demolish,ar repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC.
i - 0.LL requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
wm he Is licensed pursuant mom provisions of the Contractor's License -
rii Law(Chapter 9(commencing with Section 7000)of Division 3 of the
- ¢ Business and Professions Code)or that he is exempt therefrom and QTY. . PLUMBING PERMIT FEE
¢ = g the basis for the alleged exemption.Any violation of Section 7031.5 STORIES YPE CONSTR.
i3 by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500L):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES,UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONE. 5.00 .
Code:The Contractor's License Law does not apply to an owner of
property who builds.or improve$thereon,and who docs such work FIXTURES-PER TRAP 5.00 50,FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such inlprove-
• ments are not intended or offered for sale.If,however,the building GA$-EA.SVSTEM-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 properly,are exclusively contacting with ❑ ❑ ❑ ❑ ❑. "
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:'The'Contractor's License Law does 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 SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sec,-,B.&P.C.tor this WATER HEATER
reasonOwnerW/VENT 6.00
_ per n.0
� Owner Dmc WATER SYSTEM 5.00 - Acc.OnrE ACC.FILE NO.
' - WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm.that I have a certificate ofconaent to set&insure• ZONING ENG.SITE N0.
I or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab C.). -
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. N
Q Applicant Y ❑ ❑N v ❑ C:]CIi RT]FICA IT OF IiXl%MPTI(1N FROM WORKERS'
~ w PERMIT ISSUANCE 10.00 FLOODIONE A.L.U.C.
� > -
UJ �COMPENSA'I'ION INSURANCE PLG.CONTE. LIC.NO. PLG. Y[:JN❑ Y C] N❑
LL O (This section need not be Completed if the permit is for one TOTAL
Z) Z hundred dollars IS 100)or cS,) - I '
U O 1'certify that in the performance of the work for which this per- TY. -MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.I shall not employ any person in any mannerso as to
-'
become subject to the Wkers'Componsatlon Laws of California.
- V or
w BUILDING
Date Applicant
a ALTER OR ADD TO MECH. 5.00
} m
NOVICE TO APPLICANT: If,ager making this Certificate Ex
Z eruption,you should become subject to the Workers'Compensation
tion APPLIANCE 5.00 PLAN CHECK
previsions of the Labor Cyou must forthwith Comply with FEE
(,1 such provisions or this permitit shall
shall be deemed revoked. AIR HANDLING UNIT(TO 10,0000 F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 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(Sec. MICROFILM
3097,Civ C.). HEATING UNIT(TO 100,000 B.T.U.) B.00 a
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN'(SINGLE) 4.00
information is correct.1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properlyfor inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- - REFER TO ORD.
. Cupertino against liabilities,judgments;costs and expenses which CONST.TAX
may in any way accrue against said City in Conse uence of the PERMIT ISSUANCE - 10;00
granting of[his ermit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
S%vieikri APPlic t/ mac[
OFFICE COPY -
POST THIS CARD NEAR FRONTOF BUILDING
PFRNIIT NUMBER
CITY.'OF CUPERTINO 89
INSPECTION DIVISION
JOB•INSPECTION RECORD
PERMIT,EXPIRATION
JOB ADDRESS UNIT# ' PERMIT EXPIRES IF WORK
OWNER CONTRACTOR } IS NOT STARTED WITHIN'-
IN
ITHIN"
. '.INSPECTION ' •DATE" INSPECTOR INSPECTION RECORD' leo DgvsoFee'annlnssu
FOUNDATION r s, - ' - ANCE OR'180 DAYS FROM.,.
'
LIFER wLAST:CALLED INSPECTION.
_ ,
PREGUNITE r' _ - PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB:4' - ' / •{
PLUMBING - , i • ' `'' 6 %. �.
r<
f.•'c
ELECTRICAL ISSUANCE DATE•'
MECHANICAL - BLOG, ELECT. PLG. MEC...t o El El
00 NOT POUR FLOOR UNTIL,ABOVEHAS�BEEN SIGNED BUILDING PERMIT, Y .
.`WOOD FLOOR - _ ! INFORMATION .
VALUATION' 'SIFT.
PLUMBING - `� �. � � ,
MECHANICAL -
,`v
ELECTRICALPERMIT,TO
FRAMING ~~^ YY
INSULATION „ '•STORIES 1 JVPE CONSTR.
OCC,GROUP ,RES.UNITS'
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF ' SO.FT FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
_ BUILDING USE
r. t
RES IND CON PB Oumr
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED .', '. El ❑ 0 ❑, Cl
ROUGH
ASSESSORS PARCEL NO.
r ,
w PLUMBING. ..r'
GAS TEST TRACT No. PARCEL NO.
MECHANICAL
ELECTRICAL . ,ACC.DATE ,ACC.F I IL.E NOr,;, 6'''
FINALS DATE: INSP. ;
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING. ,
GAS -
MECHANICAL` FIRESPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y "o Y ID No
LATH—INTERIOR ELECTRICAL - - FLOOD ZONE - .A!L.Uc.T7
LATH—EXTERIOR - + FIRE DEPT. +•.- Y❑ N❑ *' Y'o. N�'`
SHEETROCK - GRADE
FEE SUMMARY
SHEAR INTERIOR - BUILDING '' i - - -
SHEAR-EXTERIOR TEMPORARY.APPROVALS - BUILDING r .
' - FIREWALLS' ELECTRIC - PLAN CHECK' '
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - I: SEISMIC.FEE - -
OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBY_BUILDING INSPECTOR.
'MICROFILM
I r .
(ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F. ONE WORKING DAY BEFORE REQUIRED INSPECTION. "
"•PLUMBING
z� . PLEASE GIVE JOB ADDRESS:WHEN PHONING.
SEE PERMIT FOR EXPIRATION.DATE — MECHANICAL
- v • +CONST.TAX .
IMPORTANT. "
PLEASE READ REVERSE SIDE BEFORE TOTAL
- CALLING FOR FINAL INSPECTION.,
OFFICE COPY •- .. ;v' ,