18821 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.43UI LDING PROJECT IDENTIFICATION PERMIT NUMBER
-.0-uGING APPLICATION & PERMIT 18821
A oR s5(9� BUILDING-ELECTRICAL-PLUMBING -MECHANICAL "wa.
OWNERS PLAN CHECK VALIDATION
NAME
--/-r ELECTRIC PERMIT FEE
HONE /
rvnMe T s UTLETS-SWITCHES-RECEP 10.00/1.00
NIT LIGHTING FIXTURES 10.00/1,00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
eMt�A A
ll� �, PHONE I PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR S L' I PANELS (OVER 200 AMP) 20.00 ,
el
ENG /^�-
T11 T-(.(S �uc.NG.C� SIGNS TRANS. 3.00
ARCH.OR ENG P MIT VALIDATION
ADDRESS
�L)9e� S' eE!'cy� SPECIAL CIRCUIT 5.00
U DF'a��//
2IP EMP.METER OR POLE INS.. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a u I hereby affirm that 1 am licensed under provisions of Chapter 9 � U A
(commencing with Section 7000)of Division 3 of the Business and RA I
BLDG. LECT. PLG. MECH.
N z Professions Code,and my license is in full farcyy ay�1 9111<;i
L ❑ ❑ ❑
Z Imo License Class Lia Number JJ r 89
o m F j Date Contractor _ I �r 0 I,Jdg
¢ ins BUILDING PERMIT
Ic ¢ w u OWNER-BUILDER DGCLARATIO INFORMATION
X
o°'y I hereby affirm that I am exempt from the Contractor's License MISC.- CItV of fall( iR ,fjER TO ORD
n VALUATIONS $/FT.
H _ oa Law for following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE - - 10.00
Code:A n y ci l y or coun ty wh ich req Tires a perm it to construct,alter,
- ��O
,Q,m Q �. improve,demolish,Or repair any Structure,prior to Its Issuance,8IS0 ELEC.CONTR. LIC.NO. ELEC. v
- DLL Requires the applicant for such permit 10 file a signed xtatement that TOTAL PERMIT TO
w$ he is h mused pursuant to the provisions of the Contractor's License
z a Law(Chapter 9(commencingwith Section 7000)of Division 3 ofihu Te )'r'
4 o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE 1-fV
¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
`\ e_ S by any applicant for a permit subjects the applicant tell civil penalty .� Y
V of not more than live hundred dollars(S5001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00 Y
❑ I,as owner of lite 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 does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTALACREAGE
himself re through irate his own employees,Provided that such imlrrovu-
men(sare )its oroffered employeesnle.Iided that suhebuilding GAS-EA.SVSTEM-I1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- ,GAS-EASYSTEM OVER 4 (EA) 200 BUILDING USE
builder will have the boohn of proving that be did not build or in, . - . .
RES IND CON PB Other
th
prove for purpose of e.2 INDUSTRIAL WASTE'INTER3000 El F-1 El ❑ 13❑ as owner of the property, exclusively contracting with . .
licensedd contractnn to construct the
project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 AS$ESSOR$PARCEL NO.
and Professions Code:The who
fluids o License Law Joos not apply
to tr owner of property who builds to improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such cane L with a mntrucmr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
TRACT NO. PARCEL NO.
the Contractor's License Law.
❑ Inn exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date - WATER SYSTEM 5.00
_ ACC.DATE ACG FILE N0.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby infirm that I have a certificate ofconsent to self-insure ZONING ENG.SITE NO.
or a certificate of Workers'CompensationInuoa or a certified _
copy then f( c 3800 La .C.1. [ 7�i
Policy N 0OJC./W
O ❑ Cctlifii cop cop u• FIRE SPR INK ENERGY T24
Z 2 �K Certified co y is fled with t e -it?4on division.O Applicant MISC.- REFER TO ORD. Y❑ N❑ y ❑ NEICC PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
CCCF:R'fIFICAI'E OP EXEMI'1'10 IrRORKIIRS'
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL Z (This section need not be completed it the permit is for one TOTAL V❑ N❑ Y ❑ NC]
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work fur which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
O w' Date Applicata BUILDING '3 J�
Q. ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex__
F. Z emption,you should become subject to the Workers'Compensation APPLIANCE 1 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby afl'inn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance ofAm work for which this permit is issued flue. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify chat I have read(ties 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 laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby antlmrae representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)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.
K
perfino against liabilities,judgments, costs and expenses which CONST.TAX
y in any way accrue mast d C'y in consequence of file ' PERMIT ISSUANCE 10.00
in ofthis '"lL E MECH.CONT. LIC.NO. MECH.
�1wa / ///n 30 S� TOTAL TOTAL �t .40
S Nre o "p6ean r t r Mum r
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING \ PERMIT'NUMBER
rU CITY OF CUPERTINO
18821
INSPECTIONINSPECTION DIVISION,
"' ^+ JOB INSPECTION RECORD
/1 '• ////n//n PERMIT EXPIRATION
� JOB ADDRE . UN Tv�OO (�. L T
PERMIT EXPIRES IF WORK
OWNER - CONTRACTORS - IS NOT STARTED WITHIN
• ,t
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _ ANCE OR 160 DAYS FROM
NOTE: LASTCALLED INSPECTION.
r 'LIFER ALL GRADING AND,DRAINAGE SHALL BE'INSTALLED
PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vnu oanoN
CUPERTINO STANDARDS.
GARAGE SLABS _
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED , � •'.'f'!""'"
UNDERGROUND /SLAB _„A
PLUMBING n 1 E� 1',4011 //!y/y
ELECTRICAL - - - Inn 1 ' Is5JnN ln,
MECHANICAL r,IS11i?T n„ ' 4LDG CT. PLG. mECH.
lYT`• ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUAIION - SIFT.
• - -
MECHANICAL. r7• ""'�rY,/ '
ELECTRICAL PERMIT TO
FRAMING
INSULATION ST YP Co �+T .
OC\GROUP RES. NITS'
NRL=ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED _
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT FLOOR AREA _ TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
' . Rw LDmG USE
its ROOF SHEATHING , . - xE5 IND cory Pa 0m•1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 'El ❑ ❑ ❑ ❑
ROUGH SAN.a ASSESSORS PARCEL NO.
•
PLUMBING ELECT.ENERGY -
THACTNO. PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MLCH.ENERGY -
ELECTRICAL - BUILDING ENERGY Acc.DATE ACG PILE No
FRAMING. ELECT.FINAL TEST -
ZONING L ENG.SITE NO.
INSULATION �- PLUMBING
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T-24
•
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - NE] .y ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODZDNE A,LUC.
❑
' INTERIOR.SHEAR . FIRE DEPT. F] N❑ 0 N
l-:
SHEETROCK - GRADE FEE SUMMARY
EXTERIOR LATH .BUILDING. - 121.7 �
INTERIOR LATH TEMPORARY APPROVALS BUILDING ,
SCRATCH COAT ELECTRIC PLAN CHECK
' GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OD
OCCUPANCY.OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'
<+ LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
kv z PLEASE GIVE JOB ADDRESS WHEN PHONING..
- SEE PERMIT FOR EXPIRATION DATE —, MECHANICAL
IMPORTANT!, con sr. rax
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL �S'd.
OFFICE COPY