14239 ti APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
LI�;ING PROJECT I DENTI FICATION PERMITNUMBER
afr�,NGING �--� + APPLICATION & PERMIT
ApDREss
- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14239
OWNER'S • PLAN CHECK VALIDATION
"nmE
vNo"E 35W CITY. ELECTRIC PERMIT FEE
w �-7 y L
CONTRACTOR'S
N mEOUTLETS-SWITCHES-RECEP 10.00/1.00 7
uc.NO LIGHTING FIXTURES 10.00/1.00
CONTRACTOR's
ADDRESS
PPLIANCES-RESIDENTIAL 4.00
F�1" ^ A�&-,.oJ73Z"tqt9
PANELS 10.00 DATE OF APPLICATION
ARc"rtecT PANELS-(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR d
E 1c.6 No, ISIGNS TRANS. 3.00
ADDRESS E"G SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
TIP' TEMP.METER OR POLE INS. 20,00
ADDRESS . MOTORS SEE FEE SCH.
SERVICE CHANGE 20,00 ��/[
I Cj.JV l .Y 0 7
100 LICENSED CONTRACTORS DECLARATION p
"U I hereby arm that I am licensed under provisions of Chapter 9 s, n C,�95UANCE DATE
W affirm
N 4 u. (commencing with Section 7000)of Division 3 of the Business and IBLDC. ELECT. PLG. MECH.
r w i Professions Cod and my license is in full f a ct.
z o w - License Class_Lic.Number ❑
o m H Date Contracto
a m s - BUILDING PERMIT
¢ ¢a OWNEWBUILDER DECLARATION
¢ w v - INFORMATION
E o A MISC.- REFER TO ORD
X 3f¢H I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
F LL m j Law for the following reason.(Sec.7031,5,Business and Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a permit to construct,alter,
2 ¢<0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. TOELEC.
O u requires the applicant for such permit to file a signed statement that - TAL - PERMIT TO
I m he is licensed pursuant to the provisions of the Contractor's License �1
FZQ
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �^/^Tt�rX/dam
E D Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢I-.m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i' .R'- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(1500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.Group RES.UMTS
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,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 F IXTUR ES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
L himself or through his own employees,provided that such imlrrove-
mentsare not in tended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Other
❑ 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.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 forsuch projects with a contmctods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this - WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 ACG DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 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.
C
copy thereof(Sec.3800,Lab. "T'�-'
Policy No. - Compans(.-71 \fJk -
0 ❑ Cetlified copy is hby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified ep ,ys I d w th the City inspection division.
O Applicant co,ZL4'_ e93h MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
~ rn PERMIT ISSUANCE 10.00
T - CERTIFICATE OF EXEMPTION FROM WORKERS' YO❑ ZON❑ Y❑ C N❑
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed if the permit is for one TOTAL
hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL - mil is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. BUILDING
W Date Applicant ALTER OR ADD TO MECH. 5,00
r Na NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ?
conform,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.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) 5.00the '
3097,performance
MICROFILM
of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 .
Lender's Name HEATING UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
/. 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I 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
F hereby authorize representatives of this city to enter upon the BOILER-COM P(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
ti.Qfyr above-me ned property for inspection purposes.
(We) a ee o save, indemnify and keep harmless the City of MISC.- REFER TO ORD. '
Cupertino am liabilities,judgments, costs and expenses which CONST.TAX
any a accrue against said City in consequence of the PERMIT ISSUANCE 10.00
gr tin rm'4 MECH.CONT. LIC.NO. MECH. fq` TOTAL TOTAL b< T
rgnature PI and/Contracto Date - -
OFFICECOPY
s
POST,THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 14239
I INSPECTION DIVISION
Iri JOB INSPECTION RECORD
�. PE RMITEXPI RATION
W • 10101 ,BUBB ROAD I
JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK
APPLE COMPUTER HAREJE/CASHART
OWNER CONTRACTOR . IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION � ,�� ,�qr• ANCE OR 180 DAYS FROM
LIFER •
LASTCALLED INSPECTION.
PREGUNITE PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED w
UNDERGROUND /SLAB `, jr /y '7
PLUMBING
ELECTRICAL .ISSUANCE DATE s•
MECHANICAL - - BLDG. ELECT. PLG. MECH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION S/FT.
MECHANICAL
PERMIT To
ELECTRICAL _
FRAMING
INSULATION - - STORIES TYPE CONSTR.
.00C.GROUP RES.UNITS
®P.LIACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO,FT,FLOOR AREA TOTAL ACREAGE
DIAPHRAGM euaDINGusE
RES NO .CoryONPB Olnm
Cop
'APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED _I ❑ ❑ ❑ 0
_ ASSESSORS PARCEL NO,
ROUGH
PLUMBING
TRACT NO. PARCEL NO,
GAS TEST
MECHANICAL
ACC.OATE ACC,FILE NO.
ELECTRICAL 7FINALS„ DATE - INSP.
FRAMING ENG,SITE NO.INSULATION ING -
GAS
MECHANICAL - FIRE SPRINK ENERGY T.]4'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NO "�
LATH—INTERIOR ELECTRICAL FL000 ZONE A.L.u.C.
LATH—EXTERIOR FIRE DEPT. Y❑ NO , - Y.o N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR, I BUILDING
SHEAR EXTERIOR TEMPORARY APP"ROVALS” BUILDING '
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED,, OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
`` H+ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z'� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT,FOR EXPIRATION DATE - MECHANICAL
• 'IMPORTANT! CONST.TAX � �r -•
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY .