15488 ..APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
1
' BUILWNG PROJECT IDENTIFICATION RERMITNUMBER )
BUILOING APPLICATION & PERMIT Q Q
ADDRESS J v 8
iZIC S BUILDING—ELECTRICAL—PLUMBING—MECHANICAL . 15488
[
OW ER' PLAN CHECK VALIDATION
NAME - OTY. ELECTRIC PERMIT FEE
PHONE
NAMEOUTLETSUTLETS-SWITCHES-RECEP 10.00/1.00
'LIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRacr R•s IPPLIANCES-RESIDENTIAL 4.00'
\/ ;ADDRESS
�JL PHONE r _' PANELS 10.00 DATE OF APPLICATIO N
ARCHITECT PANELS (OVER 200 AMP) .20.00 PLAN CHECK FEE P.C.INO.
OR
O
ENGINEER
LIC.NO. SIGNS TRANS. 3.00 '
ADDRESSCHE"O SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS �
' SERVICE CHANGE- 20.00
woo LICENSED CONTRACTORS DECLARATION
a v w 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
'BLDG. ELECT. PLG. MECH.
H H z Professions Code,a my license is in full fore!m ec ❑ ❑ ❑ ❑
Z i m o License ala r Lic.Nwnber��- —
H
Date Contractor_ �,.
a m s � BUILDING PERMIT
¢ ¢a OWNER-BUILDER DECLARATION
¢ w v INFORMATION
E
;' r 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD ,
H _0 w VALUATION $/FT.
J Law Code:Any citylorcountyng whicSec.703 iresit Business tocnstrct,afessions pERM1T ISSUANCE 110.00 L
m0 Code:Any demolish,
countywhichregolresa permitriotoeonsuance,alter,
QM <0
improve,den10I15h,or repair any aLrllCLnrC,prior IO 1I5155nanee,also ELEC.CONTR. -LIC NO. ELED., tt
o u requires the applicant for such permit to file a signed statement that TOTANi a hl I;.Id's. PERMIT TO
A'w Beds licensed pursuant to the provisions of the Contractor's License 1
H x i
Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe P�
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500f):
❑ 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 Contractor's License Law does not apply to an owner of
• property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided lout such improve- GAS-EA.SVSTEM-I 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is sold within oneyear of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that he did not build or int . . . RES IND CON PB OtM1ar
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30,00 RE El❑ 1,as owner of the property,an exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSPARCEL NO.
and Professions Code:The Contractor's License Law does nor apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
.calms for such projects with a contructonsl licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,BAP.C.I'or this . WATER HEATER W/VENT . .6.00
reason
Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILENO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _
I hereby affirm(hat I have a certificate ofconsent to self-insure. ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
-� copy thereof(Sec.3800,Lab.CJ.``j
Policy Na. Company�C '
0 ❑- Certified copy is hereby furnrshM - FIRE SPRINK ENERGY T-24
Z Z CenIGed py ' filed with the city inspection division. MISC.- REFER TO ORD.
= N CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE .t 10.00 FLOOD ZONE A.L.U.C. ;
W 'COMPENSATION INSURANCE. PLG.CONTH. - LIC.NO. , PLG.
CL Cl (This section need not be completed if the permit is for one TOTAL Y❑ NY ❑ NC]
0 Z hundred dollars(S 100)or less.)
U O I certify that in the performance of ilia work for which this per. QTY. MECHANICAL PER FEE FEE SUMMARY
LL V- mit is issued,I shall not employ any person in any manner so as(o
U beer..subject to the Workers'Compensation Laws of Calitbmia.
y Date Applicant ALTER OR ADD TO.MECH. 5.00 BUILDING
}-y NOTICE TO APPLICANT: If,after making this Certificate of Ex-
ZZ ensption,you should become subject to the Workers 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.1 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE lSa
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the 3097,,Cie.C.�nce of the work for which this permit is issued d(Bac. HEATING UNIT(TO 100,000 B.T.U.) 8:00
Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 'ELECTRIC
Lender's Address
I'certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 '
information is correct. 1 agave to comply with all city and county, PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 '
hereby authorize representatives of this city to enter upon foe BOILER-COMP(Over 100,000BTU)SEEFEESCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which 'CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ranting DUNpertniL MECH.CONT. LIC.NO. MECH.
�p >
.4Z TOTAL TOTAL
Signature of Applicant/ tactor L� Da
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
k CITY OF CUPERTINO .
154'88
INSPECTION DIVISION. .
JOB INSPECTION RECORD
ry . PERMIT,EXPIRATION
11121_ Clarksten
' . .,JOB ADDRESS UNIT# _LOT# PERMIT EXPIRES IF WORK•.
OWNER TOMMY Shwe CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD leo DAYS OF PERMIT ISSU
,FOUNDATIONANCE OR.180 DAYS FROM
NOTE: LAST CALLED INSPECTION.,.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE . TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS"
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ti ;
UNDERGROUND /SLAB �y r
PLUMBING _ ,C
ELECTRICAL' ISSUANCE DATE
MECHANICAL - BLDG ELECT . PLG. MECH.
I El 13
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION
PLUMBING
r
MECHANICAL '
ELECTRICAL
FRAMING
INSULATION - i✓ a gg - STORIES YTYP F aC4s*R.
OCC.GROUP RES UNITS
7'v/3 SNoT�em p,9A. owe
_ IP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FT FLooH AHEn rOTAL.ACHEAce
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID. - q
' BUILDING USE
ROOF,SHEATHING HES IND • CDN PB om
w. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 1:1 1:1 ED
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING . ELECT.ENERGY
THACi NO PARCEL NO.
TUBS 8"SHOWER PAN PLUMBING ENERGY
MECHANICAL 1 MECR ENERGY
ELECTRICAL BUILDING ENERGY , .. ACC.DATE ACC.FILE NO
. , FRAMING ELECT.FINAL TEST -
ZONING ENG.SITE NO.
Ih INSULATION PLUMBING
I GAS TEST GAS
, FIRE SPRINW ENERGY T•ZG
• - MECHANICAL Y ❑ N Y ❑'. N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR Z - ELECTRICAL RELEASE FLOOD ZONE 'A,L.UC
INTERIOR SHE_ AR. FIRE DEPT. Y❑ NQ Y ❑ . N❑
SHEETROCK GRADE FEE SUMMARY
- EXTERIOR LATH O u¢ BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BUILDING d' '. '
SCRATCH COAT ELECTRIC ' PLAN-CHECK
GAB - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM '
i
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'
LL' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE.GIVE JOB ADDRESS WHEN.PHONING.
CFJ — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION..
OFFICE COPY '