17052 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - .fERMITNUMBER
BUILDING APPLICATION & PERMIT a 17052
ADDRESS �R�
.�l94,0�zta� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
PHONE • .�
CONTRACTORS 7 UTLETS-SWITCHES-RECEP 10.00/1.00 .q& j�JJ 7 ''t �t.{( \-
AME ��p 1�./ Ls l 9
'p uc.NO,'17�ILF � LIGHTING FIXTURES 10.00/1.00 f
ADRESS CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00'
ADDRESS -
�PHON PI PANELS 10.00 DATE OF APPLICATION
ARCHITE T PLAN CHECK FEE ' P.C.NO.
OR 838 x$620 PANELS (OVER 200 AMP) 20.00 •,7
ENGIREE
LIC.NO, SIGNS TRANS. 3,00 -
AooR ESE ENG, SPECIAL CIRCUIT 5,00 4m PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
A
APPLICANT'S C?kC L+
ADORE
55 MOTORSA 1E) SEE FEE SCH.
ZZaIO SERVICE CHANGE 20.00
IDB o o LICENSED CONTRACTOR ECLARATION4AN 171989
a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
N a P- (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. MECH.
r y i Professions Code nd my license is in full I�� nnnriin ❑
Z,o y- `C Lit.Jess Lit.Numb W�
Z F a Doti iR IR� Contractor
r _ - t . 1
m s - BUILDING PERMIT
¢ 0 w OWNER-BUILDER DECLARATION INFORMATION
E:
n y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD'
VALUATION $/FT.
F u O j Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 2,DO � � 041
w� Code:Any city or county which requires a permit to construct,alter, �U 0.
rt Q a0.6
demolish,or repair any structure,prior to its issuonce,also ELEC.CONTR. LIC.NO. ELEC. 2
aa
D LL requires the applicant for such permit to file a,signed statement that - TOTAL JI PERMIT T
w $ he is licensed pursuant to the provisions of the Contractor's License
r i'i Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe
a$ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT 'FEE
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 5.0.0
of not more than five hundred dollars($500).):
❑ Las owner of the property,or my employees with wages as BACKFLOW 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 docs not apply to an owner of
property who builds or improves thereon,and who does Such work F IXTUR ES-PER TRAP' 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself Or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
ments are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner-
builder .will have the burden of proving that he did not build or im-
prove for purpose of Sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON -PB 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 for such projects with a contract )licensed pursuant In
the Contractor's License Luw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ lam exempt under SeC�,BAI'.C.for this WATER HEATER W/VENT 6.00
reason-
.4 Owner
eason.4Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
4 WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm than I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of WorkersCompensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C�y Sys
O Policy No. ComPunY f__1 -
❑ Certified copy is hereby f nished. FIRE SPR INK ENERGY T-24
2 ❑ Cer' d c y is f � Ith the ry p on division.
O Applicamr/[{LLyAJA_sZ a_ L � MISC.- REFER TO ORD. Y ❑ N❑ Y❑ Is
CC to CERTIFICATE OF EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.-
LLI > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This.section need not he completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
=) Z hundred dollars($100)or less.)
U O 1 certify that in the performance d ork for which Ibis per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
UL I- mit is issued,I shall not employ'' person in any manner so as to
U become subject to the Work• ora pens It
Laws of California.
O w BUILDING
y Dalc A ant ALTER OR ADD TO MECH. X5.00 r
} N NOTICE TO APP NT: If,after making this Certificate of Ex- - -
F ? emptioa you old become subject m the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions d e Labor Code, you must forthwith comply with F IY
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10000C.F.M.) 4.00 A "1
CONSTRUCTIO�LEN?ING, Y AIR HANDLING UNIT(OVER 10,000 C.EM.16.0 S ISMIC FEE N-w
.. I hereby affirm that (here ding agency for EXHAUST HOOD(WITH DUCT) 5.0Authe performance of Ore work t is issued(Sec. QI'I] FILM
3097,Civ.C.). . HEATING UNIT TO 100,000 B.T.U.) 8.00 0
Lender's Name_ z HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
s
4 ,I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
ordinances and state lawsrelatingto building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby autlmri.c representatives of this city to enter upon the above-mentioned property for inspection purposes. .BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
nay in any way accrue against said City in consequence of the
gr&nljng of this peerrmsit MECH.CONT: LIQ NO. MECH.
/:". .dlJi I/CI�/ / TOTAL TOTAL �5Q6p
Signalur of Applicanticontractor '
OFFICE COPY
%y PO T THIS CARD NEAR FRONT OF BUILDING..
' PERMIT NUMBER
- TY OF CUPERTINO - 17052
INSPECTION DIVISION
JOB INSPECTION RECORD
,., PERMIT EXPIRATION
I
JOB ADDRESS, O .C�O G1 lyU� UNIT#' _LOT# � 3 � ' f
"(") PERMIT EXPIRES'IR WORK '
OWNER t D! i CONTRACTOR IS NOT STARTED WITHIN `
INSPECTION DATE INSPECTOR' INSPECTION RECORD 180 DAYS OF PERMIT ISSU. '
FOUNDATION NOTE: Pn49 ANCE OR 180 DAYS FROM
UFER
ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEDINSPECTION.
PREGUNITE TO COMPLY WITH THE QING PLANS AND CITY OF PERMIT VALIDATION
CUPERTIN
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Gi CuPer�+uo �(�llt.iJ"lhu.�G[—I
UNDERGROUND /SLAB
PLUMBING { ��-•- L�
ELECTRICAL. 1
ISSUANCE DATE''
MECHANICAL BV))i ELECT I PCG. MEC.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
_ WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
� - I
MECHANICAL
ELECTRICAL
.FRAMING FI,
INSULATION STORIES TYPE CONSTR.
OCC,GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO,FT FLOOR AREA TOTAL ACREAGE
ROOF
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING I Es IND CON PR Orrlvl
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
ROUGH SAN.q ASSESSORS PARCEL NO. ,
PLUMBING- ELECT.ENERGY '
`
'TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
:n
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC.OATE- ACC.FILE NO,
FRAMING ELECT.FINAL TEST
INSULATIONZONING ENG.SITE NO.
PLUMBING .
GAS TEST GAS
MECHANICAL FIRE,SPRINK ENERGY T:24 ,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ NQ
" .
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZONEA,L U.0
INTERIOR SHEAR FIRE DEPT: ° ❑ . N❑ Y'❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH' TEMPORARY APPROVALS BUILDING-, z'
SCRATCH COAT ELECTRIC PLAN CHECK '>
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE . to
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC , t'
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O~0
PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z . .
MECHANICAL' r
- SEE PERMIT FOR EXPIRATION DATE - _
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. �(C/fJ•
OFFICE COPY