11055 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
J31JILDING PROJECT IDENTIFICATION PERMIT NUMBER
BWLD:NG APPLICATION & PERMIT -
RDP 5 5
r U i O BUILDING—ELECTRICAL—PLUMBING—MECHANICAL 1^V_1
WNEP'S
NAME PLAN LHECK VALIDATION
j CITY, ELECTRIC PERMIT FEE
i
ME ACTORS UTLETS-SWITCHES-RECEP 10.00/1,00 C)
uc. LIGHTING FIXTURES 10.00/1.00
foOTR CT R'S L.� APPLIANCES-RESIDENTIAL 4.00
OR ESS
(�� I P PANELS 10.00 DATE OF APPLICATION
OR PANELS
I E PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.NO. ISIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT 5.00
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANT
AMOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
wO o LICENSED CONTRACTORS DECLARATION ]RA /
rt.u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 C OST O D('
G a w (commencing with Section 7000)of Division of he Business and
H 2 Professions Co and my license is in full to c d e BLDG. ELECT. PLG. M£CH.
z o h - License Clnss _r_Lic.NumheAPR 16
m r ww Date ContractorInca
S IS w a OWNER-BUILDER DECLARATION BUILDING PERMIT
u MISC.— ER TO ORD INFORMATION
w; 0 I hereby affirm that I am exempt from the Contractor's License
Hwow Law for Any
or countywhichrequirclapeusinessond Professions _ VALUATION $/FT.
ang 703 PERMIT ISSUANCE 10.00 _
au Code:Any city or county which reyuiresaperiltoconstruc6alter, d a !
Se Q ¢D improve,demolish,or repair any structure,prior to its isumnce,also ELEC.CONTR. LIC.NO. ✓
ea a o u requires the applicant for such permit to file a signed statement That ELEC. Q,�
TOTAL PERMITTO
X � he is licensed pursuant to the provisions of the ContrxeNr's License �
Fz >
Law(Chapter 9(commencingwith Section 7000)o(Division 3 ofthe �/v7&fie 0, ;{65A/O
Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
6•!-:R thelasis for the alleged exemption.Any violation of Scction703I.5 STORIES TYPE CONSTR.
zzi, by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
:Moot mom than rive hundred dollars($500).):
<❑ Las owner the property,or my employees with wages as -
their sole compensation,will the work,and the Structurewag not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License law does not apply to an owner of -
�' property who builds or improves thereon,and who does such work FIXTURES-PER TRAP. 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
prove for purpose of sale.). INDUSTRIAL WAS TE INTER. . 30.00 REB IND CON PB Omer
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct OIe project(Sc, 7044, BusinessLAWN SPRINKLERS- 1 INC 5 V.B. 6,00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.I 1.00
contracts for such projects with a contractorts)licensed pursuant to
the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Dute WATER SYSTEM 5.00
ACC.OATE ACC.FILE NO.
' woRKr:Rs coMPENsn'rloN DECLARATIONWATER TREATING EQUIP. 5.00
�1 hereby affirm that 1 have a certificate of consent to selFirsam,
or a certificate of Worked Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Se3a,
Policy C,my
O O Cert'tied copy is hereby falai d. FIRE$PRINK ENERGY T-24
Z Z ❑ Cert tl 5 f ith he it lion Division. Y N ,Y ❑ NC]
Fp ApplicanL�s�_�a`4'�,�,�p�'� MISC.- REFER TO ORD.
CC m CERTIFICATE.OF EXEMPI[ON I7ROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE. PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the peril is for one TOTAL Y[:] NEI v N
� Z hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of CaliforniaDate .
W NOT Applicant ALTER OR ADD TO MECH. 5.00 Ste- BUILDING �5—
} to NOTICE To APPLICANT: If,after making this Certificate sa ion
F ? araphia,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this peri[shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OV .FM.) 6.00 SEISMIC FEE R eF s'
I hereby .frim. that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) _ ,f.5.00
the perlornrance nl'the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). � HEATING UNIT(TO 1 0 B`.7, ( ,00
Leader's Name.
Lender's Address_ HEATI NO UNIT(OV 100,000 B.T. ) 50 ELECTRIC �Q
t"^ q`1 certify that 1 have read this application and state that the above VENTILATION FAN ( o0 .00
.informatio "s correct. I agree to comply with all city and county - PLUMBING ordinances state laws relating to building Construction, and BOMP
ILER-CDI3H.P.6r ,000B.T.U.I 6.00
hereby enti ze representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL '3 S'=�
aboveemention save,PrOPindemnify
and
keeppoacs.
\ (We) agree s sive, indemnify and keep harmless the City of MISC.- REFER TO ORD.
gain t liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10.001X0 CONST.TAX
Y in accrue a aid City in consequence of the
gra ting his
It. MECH.CONT. LIC.NO. MECH. -1
TOTAL 3 S— TOTAL 9a
Sign t o Applicant/Contracm Date
OFFICECOPV
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 055
INSPECTION DIVISION
JOB INSPECTION RECORD
�}� PERMIT EXPIRATION
JOB ADDRESS �'�00 �V• 'De AN 29 &✓j UNIT# ' LOT 4t
r - PERMIT EXPIRES IF WORK
owrvER CorvrRAcroR IS NOT STARTED WITHIN
INSPECT DATE INSPECTOR ITISPE=ON RECORD180DAYSOFPERMIT ISSU-
LNCE OR 180 DAYS FROM
FOUNDATION �� a AST CALLED INSPECT]ON."I
LIFER
PREGUNITE Jam/ PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �G /
UNDERGROUND /SLAB
PLUMBING IIFIO�
ELECTRICAL y-o�� �K• ISSUANCE DATE
II MECHANICAL ,� � A-u-�''-�itl� c ELECT. PLO. MECR.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION s/FT. •
PLUMBING
MECHANICAL
ELECTRICAL PER TO
FRAMING
TORIES fVPE COKSTIT.
INSULATION
OCC GROUP RES.UNITS
'rt.XhCE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
-
ROOF SO.FT.FLOOR ARCA TOTAL ACREAGE
Iwo
DIAPHRAGM
/i . BUILD Gus
�l�INo PB omen
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0
/ ❑
ASSESSO S P CEL NO.
ROUGH
PLUMBING
GAS TEST - TRACT NO. PARCEL NO.
MECHANICAL y;
ACC.GATE ACG FILE N0.
ELECTRICAL FINALS DATE ]NSP.
FRAMING SAN # -
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS
MECHANICAL FIRE SPRINK ENERGY T.24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N Y ❑ NE]
LATH—INTERIOR ELECTRICALFLOOD ZONE AL.uc.
�' ❑
' LATH—EXTERIOR FIRE DEPT. YC] NE] YE N ..
SHEETROCK - GRADE FEE SUMMARY
. SHEAR INTERIOR - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS JELECTRIC PLAN CHECK
GAS FEE
INO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED r0lCCUPANCY " SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING Ej] ELECTRIC
"r �� ONE WORKING DAY BEFORE REQUIRED IPLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONI
impZ\ - SEE PERMIT FOR EXPIRATION DAMCDHANIDAL
IMPORTANT! covsT.Tnx
PLEASE READ REVERSE SIDE BEFORETOTAL
.CALLING FOR FINAL INSPECTION.
OFFICE COPY l