15027 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,- USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION "' PERMIT NUMBER
BGILDING
-r ADORES
oda Ewt�ieE APL!GTIONPERMIT
��� � UILDING-ELECTRICAL-PLUMBING-MECHANICAL L15027
\`' OWNER'S PLAN CHECK VALIDATION
7.r NAME DTV. ELECTRIC PERMIT FEE
AI1�s . S(SK PHDNEzsS�4c4S % P �S�°
NAIIVERncTORs UTLETS-SWITCHES-RECEP 10.00/1.00
Q64 >('/Sk, uG,N -aj Ozq,SS LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
AOjoo*T SGEM(G APPLIANCES-RESIDENTIAL 4.00
Ct.4pla4zMlivo PHONE2SS. qs PANELS 10,00 DATE OF APPLICATION
ORCRIiECTpA�^G0�6 �S(6_� PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR 1 Y Y
ENGINEER
uc.No. SIGNS TRANS. 3.00
ARCH.OREN4AQS &-T-A L{JGV SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS T' I
L-05 C GAT0$ � i1QS 0S� EMP.METER OR POLE INS. 20.00
uT _
APPcAN5 C' MOTORS SEE FEE SCH.
ADDRESS r
DE z
SERVICE CHANGE 20.00
o /
Foo LICENSED CONTRACTORS DECLARATION
¢ u I hereby allino tint I and licensed under provisions of Chapter 9 ISSUANCE DATE
y Q,w (commencing with Section 7000)of Division 3 of the Business and -
r-w z I'rofexsions Cod' nd my license is in full f1a41nd e e s.
paw ELECT. PLG. MECH.
Z o m- License Class_ Lic.Num O Z. I ISI
4 Z H Date •�j• Contend FE-�
Q y E J
¢ wa
OWNER-BUIL DIiR f " RATION V DING PERMIT
A o A UJ)eor IN,F RMATION
w g LL H 1 hereby affirm That I am exempt from the Contractor's License MISC.- REFER TO ORD
F u o j Law far the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 78.00 / SIFT.
m� Code:Any city or county which requires a permit to construct.alter,
¢ ¢a improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. / y �t
E LEG
o LL requires the applicant for such permit to file a signed statement that TOTAL v J 3 vV V
n w m he is licensed pursuant to tile provisions of the Contractors License PERMIT TO
F Asa Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i o Business and Professions Code)or that he is exempt therefrom and
F
¢ m the basis for the alleged exemption.Any violation of Section 703 t. QTY. PLUMBING PERMIT FEE
5 STORIES TYPE CONSTR.
La ; _ by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCC.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,AR EA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
e:,p property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
f 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-I INC.4 OUTLETS 6.00 �' Q-,f'
/ or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2,00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PR other
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sea 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(EA.) 1.00 7J.2� '�,.-. � '
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
rWATER HEATER W/VENT 8.00
eas011
Owner Date WATER SYSTEM 5.00 PCC.DATE ACC.FILE NO.
WORK Ii RS'COM PENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a Er,Rficate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
L copy thereof(Sec.3800,Lab.C.l.
Y Policy No. Company�N f,/7
O Cetlilied copy a hereby l uritish'J.�^- / FIRE SPRINK ENERGY T24
z Z "•d opy is filed with the cly ins ection division.
p O- A nhc4 �� MISC.- REFER TO ORD, Y❑ IN Y N[]
= N IFICA 11i 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1D.00 at. FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d O (This section need not be completed if the pernit is for one TOTAL 63 �3 Y E] NEI Y[:] NEI
� Z hundred dollars IS 100)ar less.)
U O 1 certify that in the perfonnuncc of the work I., ehich thisper-RAIRHANDLINGUNI
HANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,1 shall not employ any person in any manner so as to
U became subject to the Workers'Compensation Laws of California.
i Date-Applicant p/a r0
} Go NOTICE TO APPLICANT': If,after making this Certificate of Ex- D TO MECH. 5.00 BUILDING J <O
F ? emption,you should become subject In the Workeri Compensation 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith emb,ly with FEE
U such provisions or this permit shall be deemed revoked. UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY UNIT(OVER10=C.RM.) 6.00 SEISMIC FEEI hereby affirm that there is a construction lending agency forOD (WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
_ Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
-.�
intellection n correct. I agree li comply with all city and county PLUMBING / 2
ordinances and slate laws relating to comply
will, co city
and,in.co and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 sw
hereby authorize represenb wes of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
4- above-mentioned property for inspection purposes. MECHANICAL 3 T�
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. �J
upertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue against sai City in consequence of the PERMIT ISSUANCE i �'
ante 1 this permit. MECH.CONT. LIC.NO. MECH.
�ar 5 3 g9 TOTAL �3 _ TOTAL 3153 !�
Si are of Applicant/Contraabr Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 1502
INSPECTION DIVISION
. JOB INSPECTION RECORD
PERMIT EXPIRATIONJOB ADDRESS ��' MD/R� UNIT# LOT#
' PERMIT EXPIRES IF WORK
OWNERlT .STS CONTRACTOR ,5 ,6'N IS NOT STARTED WITHIN
INSPE TION DATE�p INSPECTOR INSPECTIOECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION - �T7L) NOTE: ANCE OR 180 DAYS FROM
UFER ..',O- ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL-
ISSUANCE UAif: _
MECHANICAL BLDG ELECT,I PEG. MECH
❑ ❑ NH
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
ATION SBFT.
6.� 1u �dJ
MECHANICAL v
ELECTRICAL nn'' �•ERn11T To
FRAMING
INSULATII STORIES TYPEONSTR
/ Cit- {%M/J �� UCc GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4_3
_i
ROOF so.FT CwoR ARCA TOTALACREACC
I THOE CONOSTI UCTION TAX IISL BED ADE BEFORE Q
DIAPHRAGM
�--1 ROOF SHEATHING —'C�_� "Es JNDUILDCON USE PB O'l—
APPLY I ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGH SAN.N 5'�3 nssessoRS PARCEL No
PLUMBING ELECT.ENERGY - - ���''•' _ + f
TUBS 8 SHOWER PAN PLUMBING ENERGY 9 q� TRACT NO. PARCEL NO
MECHANICAL C�� MECN.,ENERGY
ELECTRICAL BUILDING ENERGY Acc.onre Acc PILE No
FRAMING ELECT.FINAL TEST
INSULATION PLUMBING3 ZONING ENG SITE NO,
L^
GAS TEST GAS
MECHAN[CALFIRE SPRINK ENERGY r]M
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ I Y ❑ n'❑ Y ❑ N
EXTERIOR(, k E LECTRI CAL,RELEASE FLooU costALUc.
INTERIOR', o-� FIRE DEPT. Y❑ No Y ❑ No
SHEETROCK Zp GRADE
FEE SUMMARY
EXTERIOR( I t - BUILDING ov �
INTE RIO i _ TEMPORARY APPROVALS BUILDING
SCRATCHCOAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 3
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
61
0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING 63
Z MECHANICAL
< . — SEE PERMIT FOR EXPIRATION DATE — 3443
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL / /
CALLING FOR FINAL INSPECTION.
OFFICE COPY