14707 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• 13UI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER '
BUILDING
AQPLICATION & PERMIT
ADDRESS
IOC61 R066 Fd, BUILdING-ELECTRICAL-PLUMBING-MECHANICAL 14707..q07
OWNER's �N PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
COMpu PRONE 3 377? ��2-
'
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 / \
M11a1[f/WN Lie.No. 12Z LIGHTING FIXTURES 10.00/1.00
TOR'5 1�, ^
GONTRAC
AODREss (QdS ' jq PPLIANCES-RESIDENTIAL 4.00
WO. , PHONE J J4 PANELS 1 10.00 DATE OF APPLICATION
OR RCHI ECT - 321 PANELS (OVER 200 AMP) ' 20.00 PLAN CHECK FEE P.C.NO.
O
EN NEER 1/14$
M 1l� uc.No�G- SIGNS TRANS. 3.00
ARCH.OR ENG. o PERMIT VALIDATION
ADDRESS l5// q SPECIAL CIRCUIT 5.00
5'i S i . ZIP J EMP.METER OR POLE INS. 20.00
APPLICANTS ra// ,Q - MOTORS - SEE FEE SCH. IX
ADDRESS 7 P�IR�r_ .D L _
22 SERVICE CHANGE 20.0001-el t.0
0 0 0 LICENSED CONTRACTORS DECLARATION 1` 0
I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(Commencing with Section 7000)of Division 3 of the Business and _ G. ELECT. PLG. ' MECH.
i - Professions Code am my license is in full force' f - ❑
z o y- License Clas�Y/} Lie.Number ❑' ❑ ❑ .
Q m =w Dalu_2L / Contractor PR g1.
¢.y 1 2 BUILDING PERMIT
¢ Ic w ¢ OWNhR-BUILDER DECLARATION INFORMATION
dod ° MISC.- REFER TO OR
X ; LL m I hereby affirm that I am•exempt from the Contractor's License Ap UATION $/FT.
la:
u o¢ Law for the following reason.(Seo.7031.5.Businessand Professions PERMIT ISSUANCE 10.0 - 1^r
1 Code:Any city orcounly whichrequiresa permit to construct,alter,
R ¢ ¢ 0 improve,demolish,Or repair any Strvclarm prior to its issuance,also ELEC.CONTE. LIC.NO. ELIC.
E, requires the applicant fur Such permit to file a signed statement that. TOTAL PERMIT TQ
F
o he is licensed pursuant to the provisions of the Contractor's'License /Ar(/�1J�-
i
Law(Chapter 9(commencing with Section 7000)oI'Division 3ofthe
( i i c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 1/���/U'Q 0/_
I ¢ H $ the basis for the alleged exemption.Any violation of Section 7031.5 I STORIES TYPE CONSTR.
by any applicant for a permit Subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($5000:
❑ I,as owner of the'property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 occ.GROUP RIs.UNITS
sole compensation,will do the work,and the structure is not
intended or offered for wle (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND.. 5.00
Code:The Contractor's License Law does not apply to an owner of
Properly who builds or improeS thoreon,and who docs 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-11 NC.4 OUTLETS 6.00
mems are not intended or offered for sale,dL however,the building
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 OIM1er
U prove for purpose of sale.). INDUSTRIAL WASTE INTEfl. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed Contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.Bo 6.00 > ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
no an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
ISI contracts forsuch projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACD,FILE NO,
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby all'irm that 1 have a certificate of consent to sell-insure,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG,SITE NO.
copy thereof(See.3800,Lab C), � r'-7i L.T �7U�
Policy No. Ca rpany
0 ❑ le opy is ft
FIRE BETHINK ENERGY T-24
Z Z Certifie 'o y itinspection division. MISC.- REFER TO ORD.
0 Applicant v❑ N❑ Y ❑ N❑
CC PERMIT ISSUANCE 10.00 _ FLOOD ZONE A.L.U.c.
- CERTIFICATE WORKERS'LIJCOMCE PLG.CONTE. LIC.NO.
PLG. Y❑ N❑ Y❑ N❑
fL D This Section need not he completed if the permn is for one TOTAL
D Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which(lis per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ly F mit is issued,1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O w Date Applicant FSEISMICFISE
} 0 NOTICE TO APPLICANT: If,after making this Certificate of lex- ALTER OR ADD TO MECH. 5.00
F Z ontption,you should become subject to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must,forthwith comply with suhprovisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO10=C.F.M.) 4.00
AIR HANDLING UNIT(OVER 10=C.RM.) 6.00CONSTRUCTION LENDING AGENCYI 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 3097,CIv.C.L
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address
1 certify that I have read this applicalion and stale that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorim representatives of this city kr enler'upon the BOILER-COMP(Over 700,000 BTU)SEE FEE SCH, MECHANICAL
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
• Cupertino ag 'nst 'abilities,judgments, costs and expenses which CONST.TAX
lr may in any ycrue against said City in consequence of the PERMIT ISSUANCE 10.00
ting oft 'L MECH.CONT. LIC.NO. MECH.
2 b TOTAL TOTAL 9o2v�6�
Sin tum of Ap lican/C r for Ua e
OFFICE'COPY
POST. THIS CARD NEAR FRONT OF BUILDING'
CITY OF CUPERTINO -� . ',�- PERMIT NUM6EFI
-- INSPECTION DIVISION �_7" 0?
JOB INSPECTION'RECORD .
1 10061 Bubb Road- PERMIT EXPIRATION
r JOB ADDRESS UNIT# LOT#
PERMIT-EXPIRES IF WORK 1
OWNER Bubb Road. ' CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .180 oAY� OF PERMIT ISSU-
FOUNDATION ANCE OR' 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. I
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE - - TO COMPLY WITH THE APPROVED PLANS AND CITY OF
PERMIT.vquoanuN
CUPERTINO STANDARDS.'
GARAGE SLABS ,)/ f8' -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED A e vD�.Xp7e .Pi -•v
r UNDERGROUND /SLAB.
PLUMBING ^L WVI
ELECTRICAL „-.! 4 "� pp1�- ISSUANCE DATE
MECHANICAL f O ( pc. ELEcr PLc, MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDSO UILDI NO PERMIT
WOOD-^'-^^R__ �•. lSCd�M-e Of INFORMATION
VALUATION s $/FT.
PLUMBING ,. `l .F-n.7.' J I� )�' ��.�' - . . -: ;• 1. 'L i.+
MECHANICAL _
PERMIT To
ELECTRICAL . Y
FRAMING - - J }
INSULATION �-7- sroRles TYPE coNsra.
Yta. ?XC
GROUP - RES UNITS
EPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Le^!`�1 a elft
i ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.Fr,11.00F AREA rornE ACREAGE
!DIAPHRAGM
THE CONSTRUCTION TAX IS PAID
-
BUILDING use
i � . •` ROOF SHEATHING HES" IND CON PS 09",
'
APPLY NO ROOFING UNTIL-ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El ASSESSORS
1:1 ' �'
' ASSESSORS PARCEL NO,
ROUGH SANA
PLUMBING -- "- ELECT.ENERGY
TRACT NO. PARCEL NO.
TUBS 8 SHOWER PAN - " PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC.DATE ACC,FILE NO
ELECTRICAL - - BUILDING ENERGY
" FRAMING ELECT.FINAL TEST - 20NINa END.SITE Na
INSULATION PLUMBING G...
GAS TEST - GAS '
FIRE SPRINK ENERGY T 24
MECHANICAL
- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING . .v ❑ •"❑ - ` ❑ • -NEI
FLOOD ZONE A U C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE . FEE SUMMARY
EXTERIOR. LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS -BUILDING
-SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE w I -
OCCUPANCYOFBUILDINGISNOTPERMITTED,UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
:1 Z_ I MECHANICAL.
I — SEE PERMIT FOR.EXPIRATION DATE —
IMPORTANT!• CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
'OFFICE COPY