16047 PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY "
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER -
DILDING APPLICATION & PERMIT O n
ADDRES /� y� 4
.-� j�O�.,?I L7 U.98 RO,/F� � BUILDING -ELECTRICAL-PLUMBING-MECHANICAL {ie
/ OWNER'S - - PLAN CH�CPjLVALIDA N
NAME rZPtlt OTY. ELECTRIC PERMIT FEE �''� QQ�,_
F
IIIIIIIIIIIIIIIIF NAMERAcrORs UTLETS-SWITCHES-RECEP 10.00/1.00 i -
N uc.No, LIGHTING FIXTURES 10.00/1.00
CONTR ACTOR S APPLIANCES 4.00
ADDRESS �/ pr� '
_, VWIONE9cJr9(000 PANELS 10.00 DATE OF APPLICATION
AMEMITECT PLAN CHECK FEE P.C..NO.
OR /�,dv� PANELS (OVER 200 AMP) 20.00
ENcwEERs/QN `/'Q trC No C_(
13
, SIGNS TRANS. 3.00
C N0.
ARCH,OR ENG. PERMIT VALIDATION
ADDRES FSPECIALCIRCUIT 5,00
33 2J�16N EMP.METER OR POLE INS. 20.00
APPLICANT'$ - ( 6 /
ADDRESS MOTORS SEE FEE SCH.
_ SERVICE CHANGE 20.00 <
wo'o LICENSED CONTRACTORS I7ECLAR 1 N
Q Ea u I hereby.affirm that I am licensed under provlsl n of Chapter 9 ISSUANCE DATE
y z w (commencing with Section 7000)of Division 3 of he Business and
¢ DG. ELECT. PLG. MECH.
D'^ Professions Co P..1�nd ns license is in full t C�
z o License Class p y Lic.Numb r _ ISL ❑ ❑ ❑
4 y t w Uale_� �_Conlracto (��11DP.I�I11Q '
_w-_••^^- BUILDING PERMIT
rt ¢w
OWNER-BUILDI°R DEC ATIO - INFORMATION
a'x ;N N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
VALUATION S/FT.
F a.w J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10:00 0
Code:Any city or county which requiresa permit toconstrucL alter, p/� ODOr
Q rt S p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -51 f(�
mLL requires the applicant fur such permit to file a signed statement that TOTAL - PERMIT TO '
u w he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000)of Division 3 of the YV\�
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE e
¢H$ the basis for the alleged exemption.Any violation ol'Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant loa civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than Ove hundred dollars(5500)J:
❑ 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 do the work,and the structure is not
intended or.offered for sale(See. 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 docs such work FIXTURES,PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself ciar re through his own employees,provided that such improve.
himself a net through
or offered employees,
or provided that Such
emplore GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,lire owner- GAS EASYSTEM.OVER 4 IEA.) 2.00
builder will have the burden of proving that h - .e did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON PB Omer
❑ 1,as owner of the properly,am exclusively cont ng Wills INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ 11 ' ❑ ❑
licensed contractors to construct the project(See. 4,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License_JartSdoes not apply
to an owner of property who builds or imp es thereon,and who LAWN SPRINKLERS.-OVER 5(EA'.) 1.00
contracts for such projects with a contra IS)licensed pursuant to
the Contractor"License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Seo. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE N0.
WORKERS' OMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to sell'-insure,
or a certificate of Workers'Compensation
Insurance,or a certified ZONING ENG.SITE NO.
copy ther�La ny
Policy a puny ri!
O ❑ CerllfiC copy is hereby furnished. FIRE SPRINK ENERGY T24
Z
❑ Certl copy file h the city inspection division. MISC- REFER TO ORD.
O Appicant (j)- wd -I�A.t6 Y ❑ N❑ Y ❑ N❑
C_- N CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.•.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
'I CL Z( This section need not be completed if lire pe o or one TOTAL Y[3N❑ Y E] N[3
hundred dollars(S 100)or less.)
U O I certify that in lite performance of t ork for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not Employ a erson in any manner so as to
U become subject to the Wnrker' mpensu tion Laws of California.
l] y� Date APPh ALTER OR ADD TO MECH. 5.00 BUILDING
>_ to NOTICIi TO API' 1 'T: If,after nsa kiustng this Cc
rlil"cute of[x-
F 2 empurin,you become subject to the Workers Compensation - APPLIANCE 5.00 PLAN CHECK
U puovisio sinus or h is
it shall be deemelorth withd resetsed�omply with AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the pCrfmrmmci;,uJ Ole work for which tires permit is issued(Sec. MICROFILM �--�
3097;Civ C.). T
� - a�(�. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's NameHEATING UNIT(OVER 100,000 B.T.U.)9.50 - -
Wcr's nddre L �0 ELECTRICcertify that hove read thistion and state ilial lite above VENTILATION FAN (SINGLE) 4.00
n rmalion is rreol. I agree ply with all city and county BOILER-COW(3 H.P.Dr.100,000 B.T.U.) 6.00 PLUMBING
ur inances and state laws relating to building construction, and
se by author; mpresanlalives of this city to enter upon the 801 LER-COMP IOver too,000 eTU15EE FEE SCH. MECHANICAL
ve-mention property for inspection purposes. -
( ) agree t ve, indemnify and keep harmless the City of Misc.- REFER TO ORD.
p Ino again. liabilities,judgments, costs and expenses which CONST.TAX
any wa ccrue against said City.in consequence of the PERMIT ISSUANCE 1,0.00
1 goflhis nil MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL f� .
ignature of Applicant/Contractor Date '
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER,.
CITY OF 'CUPERTINO 16047'
INSPECTION DIVISION
JOB INSPECTION RECORD J f r
•, I r I �j Ip PERMIT EXPIRgyi N
JOB ADDRESS' ( �'` U p PIA UNIT# LOT#
LL_ � " p PERMIT EXPIRES IF WORK
OWNER L �r •
h er CONTRACTOR_F, y1/, IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD IOU DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM .
NOTE: LASTCALLEO INSPECTION. ,
LIFER • . '. ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEVMITVAuuATION..
GARAGE SLABS'
PREGUNITE� CUPERTINO STANDARDS. '
' *" � �
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1C,S lred2 (q1C-
UNDERGROUND /SLAB T 5.10—
PLUMBING ' `�E.Fiepta_ Q• kcz-1.'vA C-,- �$ -vvW'" VWi'-�C.
ELECTRICAL UE 'I of CD ertino ISSUANCE DATE
MECHANICAL ..F* _ ��� � DG ELECT v MECH.
Rja;fI
1`uT e- � `7 -
DO NOT POUR FLOOR UNTIL A.114VE f44S AEAffSIGNED )f (1,. p•IF., \'1jR9 . �, d,., BUILDING PERMIT
WO FL00 e 3 WFORMA710N
PLUMBING tj SA .firj VALUATION • .3 ,SIFT.
MECHANICAL' . l`\I �.^lR I'KF � L���2P�'ls h.+��I76� SVU Plot; _
PEHMIi T
ELECTRICAL ', .Y-.Jy •?
FRAMING
INSULATION �., STORIES TYPE CONSTRI
�
E L OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEF RE so�Er.FLuov ARLn TOTALACREAGE.
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
ROOF SHEATHING BUILDINGuse
HES IND CON H
PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 0 1:1 ❑
ROUGH SAN.k
ASSESSORS PARCEL NO
- � •
PLUMBING ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS&SHOWERRAN PLUMBING ENERGY -
MECHANICAL MECH.ENERGY
ELECTRICAL• BUILDING'ENERGY- - ACC DATE ACC FILE NO.
- �
FRAMING - - - ` ELECT.FINAL TEST
INSULATION __ ZONING ENG.SITE No.
PLUMBING
GAS TEST _ ' GAS
• _ FIRE SPRINK ENERGY T-]<
MECHANICAL
COVER NO WORK UNTIL ABOVE NAS BEENSIGNED HEATING Yo NE] Y O NE]
EXTERIOR SHEAR �` r, ELECTRICAL RELEASE FLOOD 20NE A.L U C.
NE] Y L NCD
INTERIOR'_SHEF.R j�.,� FIRE DEPT.
SHEETROCK - i'rf• GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING ;2
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC ' PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC'FEE
CCUPANCY OF BUILDING ISNOT PERMITT ED UNTIL BUILDING FINAL ISSIGNED By BUILDING INSPECTOR. MICROFILM •—!'
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
PLEASE GIVE JOB AbDRESS WHEN PHONING.
MECHANICAL -
SEE PERMIT-FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT!
PLEASE CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY