12483 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
PERi25�8
BUILDING PROJECT IDENTIFIC ON APPLICATION & PEi not
BUILDING 3
ADDRESS
7Sv3 B : '
e,e BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER's I) .- ,. ,�:p. rt.• PLAN CHECK VALIDATION
NAME �r,�..>`i•i L� '. ):..�
GTN: '.•+•' v.�A ELECTRICPERMIT' FEE Ov A
PHGNE TS 3-��.Z
CONTRACTORs OUTLETS-SWITCHES-RECEP 10.00/1.00 a G 73
-�
NAME
i( as uc.N°. f7/SJ LIGHTING FIXTURES 10.00/1.00 - V
J CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
1 Zp� 7 J' PHONE SSz3 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 7777=
LAN CHECK FEE C.NO.
OR LIC.
.00
c.ND. SIGNS TRANS. ,:f\;i'
ADRENp. 500 PERMIT VALIDATION
ADDRESS
ss SPECIAL CIRCUIT
ZIP EMP.METER OR POLE INS: 20.00
ADDRESNrS MOTORS 'SEE FEE SCR. ( /I ( '• i11
SERVICE CHANGE ` `�
woo LICENSED CONTRACTORS DECLARATION 7 +•
a C,W 1 hereby affirm that I am licensed under provisions of Chapter 9 LECT, D�E
(commencing with Section 7000)of Division 3 of the Business and BLgG. ELECT. r ?LG.•i r,MECH j IO
D s� Professions Code,and y license is in full force and effect. yj��.�
. 82 License Class Lia Number-Yt TJ f-� ❑
f G Dale Conireclor JS4S,/•+:. �•-•har/d.:
rtw
OWNER-BUILDERDECLARATION BUILDIR PERMIT
MISC.- REFER TO ORD INFORMATION
wa.r I hereby affirm that I am exempt from the Contractor's rsf License VALUATION S/FT.
F u o"]J Law far the following reason.(Sec.7031.3,Ouslness and Profeuinns pERM1T ISSUANCE 10.00 Q
Code:Any city or county which requirvso permit Ioconxtrrel,aher,
Q , 40 improve,demolish,or repair any sn"a"ufe,prior 10 its issuance.aISO ELEG CONTR. LIC.NO. ELEC. O V
requires the applicant for such permit to file a signed statement Ilvt TOTAL ,?� PERMIT TO
w 2 he is licensed pursuant to the provisions of the Contractor's License
F x t Law.(Chapter 9(commencing with Section 7000)of Division'nf the - 4ddl Ta d
a' Business and Professions Code)or Ihat he is exempt Iherefroln and CITY. PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ton civil Penally gLTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollar,155001.1:
❑ 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 Jo Ilse work,and the structure is not
intended or Offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law dues nor apply to an owner of
properly who builds or improves thereon,end 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. GAS-EA.SYSTEM-i INC.4 OUTLETS 6.00
menus are not intended or offered for sale.If,however,the huilding
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILF)MG USE
builder will Leve the burden of proving that lie did not build or On.. RES NO CON P8 other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ 1:10 1,as owner of the properly,am exclusively contracting with
licensed contractors to construct the project ISec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSOR-PARCEL NO.
and Professions Code:The Contractors License Law does nut apply
to an owner Of property who builds or improves Ihercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conrnctoNs)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO.
❑ 1 am exempt under Sec.-,BARC.for this WATER HEATER W/VENT 6.00
reason
Danner Date WATER SYSTEM 5.00 ACC,DATE ACC.FILE NO,
WORKERS'COMPENSATION DECLARA HON WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell ileum, ZONING ENG.SITE N�.
or a certificate of Workers Compensation Insurance,or a cerlified
copy thereoflSec.3800,Lab.C.).
Policy No. Company
0 O Certified copy is hereby famished. - FIRE SPRINK - ENERGY 24
Z 2![ ❑ Certified copy is Filed with the city inspection division.
CII ant MISC.- REFER TO ORD. y [3q❑ y ❑ NC]- Applic
F ERMIT ISSUANCE 10.00
CERTIFICATE OI'EXEMPTION FROM WORKERS' PFLOOD ZONE
LU COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PAL Y❑ N
LG.
1 O (This section need nut be completed if the permil is for one TOTAL Y❑ N❑
:3 Z. hundred dollars/5100)or less.) -
U 21 I certify Ilett in the performance of the work fur which this per. FEE SUMMARY
IL 11 mil is issued.I shelf not employ any person in any manner sr,as to
DTV. MECHANICAL PERMIT FEE
F become snbje I to the Workers Co it to Lawyy�'fontia.
O W DatelYX/l7 Applicant_isQf O ^✓�t� BUILDING ; SG �a
NOTICE TO APPLICANT: If,after making this Certifiea(c of lix-
ALTER OR ADD TO MECH. 5.00
Z emplion,you Should become subject to the Workers'Cmupensal ion APPLIANCE 5.00 PLAN CHECK
I provisions of the Labor Code, you ..It forthwith Comply with FEE
U such provisions or this permit shell he deemed revoked. AIR HANDLING UNIT(TO 1O1000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER.10 C.F.M.) 6.00 SEISMIC FEE / 6
1 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.1' 6.00
Lender's Name HEATING UNIT(OVER 100,1100 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I hove read this application and stare that the above VENTILATION FAN (SINGLEIi+ I 4.00 information is correct. 1 agree to comply with all city and county PLUMBING
ordinances slid slate laws relating to building construction, and BOILER-COAT I3 H.P.Di 100,01111 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP 10var 100,000BTUISEE FEESCH. MECHANICAL
above-mentioned properly for 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 Scenic against said City in consequence of the PERMIT ISSUANCE 10.00 4 -�
granting of this permit. MECH.CONT. 71 N0. MECH.,
TOTAL TOTAL
�I Signatureof ApPlican/Contractor Dale
OFFICE COPY
POST THIF.% \RD NEAR FRONT OF BUILDING
CIl-f OF CUPERTINO 12483
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS 7543 Bolinger Road —UNIT 4__LOT#
PERMIT EXPIRES IF WORK
OWNER Mr. & Mrs. Rea CONTRACTOR Richard Hutson IS NOT STARTED WITHIN
INSPECTION:�.'J"'.xz' '::DATE, INSPECTOR .;?; NSPECTION,RECORD ;i,.. '.. ; 180 DAYS OF PERMIT ISSU.
FOUNDATION ANCE OR 180 DAYS FROM
LIFER LAST CALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE-HAS BEEN SIG ED:
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
ISSUAN,E DATE
MECHANICAL %IV IELECr PLG. H
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION ELFT_
MECHANICAL
ELECTRICAL .1SIT�v
FRAMING L /
INSULATION - STORIES tlPE CONSTR.
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE NAS BEEN SIGNED
ROOF SOFT.FLUORAREA TRTALACREAGE
• DIAPHRAGM
RUILOING USE
HES IND CON PR O,nr,
..,APPLYNO ROOFINO.UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORSPAHCEL NO
ROUGH �-2 1 S tpkt"
PLUMBING
GAS TEST TRACT NO. PARCEL NO
MECHANICALa
._7�(� o
ELECTRICAL Acc.DATE ACC.FILE NO.
—L :k �'dtu, INALS:et�ia`fig: a�„.tlAtE:�sA; k:INSP4i{='
FRAMING SAN #
INSULATION -Z PLUMBING ZONING ENO.SITE NO.
1Y s e q—L47 GAS
MECHANICAL FIRE SPRINK ENERGY T 2
-o COVE NO WORK UNTIL ABOVE HAS BEEN SIO ED HEATING y ❑ N❑ ° ❑ N❑
LATH—INTERIOR ELECTRICALFLDOD zoNE ALU.C.
LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ NEI
SHEETROCK — GRADE
SHEAR INTERIOR
SHEAR EXTERIOR TEMPORARY APPROVALS7 BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS
FEE
NO TAPE OR LASTER UNTIL
ABOVE HAS BEEN SIGNED 10ccuPANcv SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM - -
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
-' ICE COPY