18527 nt APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUamScAPPLICATION & PERMIT
,
1852.7
AGGRESS i!
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL v. 18 5 2.7
{4~`F OWNERS p - - PLAN CHECK VALIDATION
OTY. ELECTRIC PERMIT FEE
> L/ PHONE
'6N A
ALMS s CT R 7 -
C NAME�J� S dT UTLETS-SWITCHES-RECEP 10.00/1.00 ,
S♦ 0 ollfu4if NO ILIGHTING FIXTURES, 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS r �J
HONEv//_77/y /`�
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 -
ENGINEER
' sec.No. SIGNS TRANS. 3.00
ADDRESS END, SPECIALCIRCUIT 5.00 P M VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 _
APPLICANTS - MOTORS SEE FEE SCH.
AGGRESS ZA
SERVICE CHANGE 20.00o0 0LICENSIiU CONTRACTORS DECLARATIONw I hereby altirm that I am licensed under provisions ofChapter9
y 1 (commencing with Section 7000)of.Division 3 of the Business and BLDG. ELECT. PLG. MEC..
F 0 i Professions Code,and my license is in full farce and effect. ❑ ❑ 110 0 B G License Class Lic.Nuns be, ^
2 w r Ow Datc COn LCtoT !1 V
¢ x s J I� BUILDING PERMIT
LC m w u OWNER-BUILDER DECLARATION INFORMATION
w0
a. N I hereby affirm that 1 am exempt from the Contractor's License MISC.- TO ORD VALUATION $/FT.
-Fu 0¢ Law for the following reason.(See.7031.5,Businessand Professions PERMIT ISSUAIMIT 10.00 - . .
Code:Any city or county which requires permit to construct,alter,
aQ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
A w m he.is licensed Pursuant'o the provisions of the Contractor's License �-xl �
r i i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe PC..HS
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
X s 0
Ir w m the basis for the alleged exemption.Any violation of Section en LS STORIES TYPE CONSTR.
by any applicant fora permit subjects(S500japplicant ton civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00
of not more owner
flue hundred apop dollars Imy em):
❑• 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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
_ Code:The Contractors License Law does not apply to an owner of
' ki. property who builds or improves thereon,and who does such work a FIXTURES-PER TRAP 5.00 4.00 SO.IT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA:) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
ce"'
prove for purpose of e INDUSTRIAL RES' .IND CON Pe Other
thP IAL WASTE INTER. 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.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors 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 contractods)licensed pursuant to
the Contractor's License Low. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
- ❑ 1amexempt.underSec. ,BAP.C.forthis WATER HEATERW/VENT 6.00 ,O�
reason
Owner Date WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'.CONIPF-NSATION DECLARATION WATER TREATING EQUIP. - 5.00 '
I hereby affirm I'll I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insuran ora cern ied
copy thereof(Sec.3800,Lab.C.)./I GYt/a
Policy No. - Company
0 �y❑♦� Certified Copy ishefeby furnished. FIRE SPRINK ENERGY T-24
Z Z /. Certified copy is filed with the city inspection division.
MISC.- REFER TO ORD.
o . ApplicantrL�
N❑ Y ❑ N❑. '
~ - PERMIT ISSUANCE 10.(10 ] NNE A.L.U.C.
CERTIFICATE OF 17XEMPTION FROM WORKERS'
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
CL Z (This section need knot be completed if the permit is for one TOTAL N❑ Y❑ N❑
hundred dollars(5100)or less.)
U 2" 1 certify that in the performance of the work for which this per CITYMECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 site]].not employ any person in any manner so as to -
O become subject to the Workers'Compensation Laws of California.
Ed Date- Applicant ALTER OR ADD TO MECH. - 5,00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? empsion,you should become subject to the Worker Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE -
U 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 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
JMICROFILM
09 performance of,the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
s�C•''t1 +x I certify hat I havo orad this application and state then the above VENTILATION FAN'ISINGLE) 4,011 - �,rA
`\}, information is correct. I agree t0 comply with all city and county PLUMBING 4!/
ordinances and state laws relating to building construction, andpresenes os co enter upon tBOILER-COMPI3 H.P.Or 100,000 B,T.U.) 6.00
hereby authorize representatives this the
P,; .}'Sl BOILER-COMP IOsrer 100,000 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property 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 accrue.egai said City in cone Oence o the PERMIT ISSUANCE 10.00
granting his permit. / �30 MECH.CONT. LIG NO. MECH.
plfY/ TOTAL TOTAL
Si sere of Applice onractor Date L
OFFICE COPY
POST THI&CARD NEAR FRONT OF,BUILID ING PERMIT NUMBER
CITY OF CUPERTINO 18527
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
^r'y JOB'ADDRESS ` `� / - UNIT# - LOT
QPERMIT EXPIRES IF WORK
• OWNER SYKCONTRACTOR V L:e•• D s y�� .QO�LIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION. ,
LIFER' - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
• PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF MIT VVAALIDDAATI
CUPERTINOSTANDAROS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED f ,'
UNDERGROUND /SLAB -
PLUMBING Ivio *a— R-uqA lUm. (/
D
ELECTRICAL pipill lssuArvc llArE
MECHANICAL - R:oc ELecT v:r MecR.
�.a a a g 196 ❑ ❑ ❑ .
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDn,,s.linn BUILDING PERMIT
ol YYW""t INFORMATION
WOOD FLOOR-
PLUMBING, VALUATION SIFT.
.. . / ,L.�_�
MEC ANICAL b
PERMIT TO
ELECiiICAL r _
FRAM.-SVG
INSULATION . STORIES TYPE CONSTR.
OCC GROUP RES UNITS
k...
nACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
r - ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O cr.FLOOR AReA TOTAL ACREAGE
d DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res 'mo cory PR o'I", .
�- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.
ASSESSOR SPARGE:NO
ROUGH SAN.#
PLUMBING ELECT:ENERGY '
TRACT.NO. PARCEL NO. ,
TUBS&SHOWER PAN - PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
l ELECTRICAL BUILDING ENERGY Acc.nnrE .AcG LLE ND
r FRAMING ELECT,FINAL TEST zorvlNc ENG SITE No.
INSULATION PLUMBING
l
GAS TEST GAS
FIRESPRINK . ENERGY TT 24
MECHANICAL - Y E -.No Y ❑ :NQ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
•PL000)ONE A.L U C '
EXTERIOR-SHEAR - ELECTRICAL RELEASE
II INTERIOR SHEAR FIRE DEPT. v❑ -N❑ v L7 No
SHEETROCK GRADE - FEE SUMMARY
�. XTERIOR.LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS .. FEE
I' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE.
Ir OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
Er
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
�� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGlg
6-d
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICALS
— SEE PERMIT FOR EXPIRATION DATE =
IMPORTANT! coNST.rax
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY