12736 T
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
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BUILDING PROJECT IDENTIFICATION PERMIT NUMBER E ' ' APPLICATION & PERMIT� rT 1,W BUILDING -ELECTRICAL-PLUMBING-ME
MECHANICAL 12736
DINNER'5 PLAN CHECK VALIDATION
NAMEO�TY. ELECTRIC PERMIT FEE
?� /I-DI 22NC PHGNE
y�
CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00
,^ LIC.NO. '1 LIGHTING FIXTURES 10.00/1.00
rDDTRAAcroR's PPLIANCES-RESIDENTIAL _ 4.00
NTR J
HODEJ ��Q PANELS 1N.DD DATE OF APPLICATION
� ARCHITECT PLAN CHECK FEE P.C.NO.
/\ DENCINEER PANELS (OVER 200 AMP) 20.00
/j1�f1�RlLfF W/Fr2CNo. C�y�4� SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADDRESS _ SPECIAL CIRCUIT 5.00
'/O S S,44rl,9 CIL02 TEMP.METER OR POLE INS. 20.00 q
APPLICANTS
Nr'a aS C
AODR EMOTORS SEE FEE SCH. x�.Z
O
SERVICE CHANGE 20.00 �'`
0 0 2 LICENSED CONI ACTORS DECLARATION Jtk��14159 15II/7
toI hereby u(tirn that lam Ucrnwd under provisions of Chapter 9 ISSUANCE DATE
¢ (codmromng with Section 7000)of Division 3 f the Business and BLDG. T �p-y.G. MECH.
r h Professions Codr, my license is in full for d f la1L{BJQ �(lrJT
License Lie.Number
Q m J Entc Contract. '
a x s BUILDING PERMIT
¢ ¢ ¢ O ER-BUILDER DECLARAT'I
' ON
o a O INFORMATION
w ; ¢ m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
,. 0 < law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
~ moi Code:Any city or county which requimse permit to construct,alter,
9 O/
or ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEG CONTR. LIC.NO. ELEC.
u wO u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3.fthe
a Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
Z i o
le H g the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant to a civil penalty ) 5.00
RAIN&VENT-WATER (EA. ,Z
of not more than five hundred dollars($50X).): ALTER-D1..S-.ti�1K
❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 OCC GROUP RES.UNITS
their sok 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 -,j
Code:The Contractor's License law does not apply to an owner of
property who builds or improve,thereon,and who does such work FIXTURES-PER TRAP 5.0(1 SO.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
dents ere not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 /
or improvement is sold within one year of completion,the owner- �d'GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Other
❑ I,as owner of the properly,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 forsuch projrctiwilha contractions)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL O.
❑ l am exempt under Sec.-,P.&P.C.for this WATERHEATER W/VENT 6.00 `
reason , 7
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent to self-insure. -' ZONING ENG.SITE NO.
or s certificate of Workers'ComS7goIDtion Insurance a certified
copy thereo(ISec.3800,Ub.C.).
Policy NoIRICATET
Company
❑ Crrespy ishan furnished., r
FIRE SPRINK ENERGY T-24
Z / ❑ Certy is fl vith to ci impaction divisum. MISC.- REFER TO ORD.
APPllcant Y❑ N❑ Y ❑ N❑
~ �+ PERMIT ISSUANCE 10.00
I .MPTION 17RONI WORKERS' FLOOD ZONE A.L.11.c.
UJ ES COMPEN IONINSURANCE PLG.CONTR. LIC.NO. PLG, V❑ NE] V❑ NE]
_ (This section need not he completed if the permit is for one TOTAL
hundred dollars(S I00)or leas.)
U O I certify that in the perfomlance of the work for which this No OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any lwvncr set as to
O w become subject to the Workers'Compensation Laws of California.
Q. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 73��
>_ to NOTICE TO APPLICANT: If,after making this Certificate of Ex.
�-2 emption,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 thispermit shall be deemed revoked. AIR HANDLING UNIT(TO 1OX0C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE sX7
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(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 HEATING ON IT 100,000 B.T.U.)9.50 '
Lender's Address ELECTRIC
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply wilh all city and county PLUMBING
I ordinances and state laws relating to building construction. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 {\
hereby authorize roperty forves
inspection
this city to enter upon the BOILER-COMP (O.r 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection)city to
(We) agree to save, Indemnify and keep harmless the Chy of MISC.- REFER TO ORD. p
Cupepw against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX
may in ray way accrue inst said City in coA7_
the
gra ting f this milt. MECH.CONT. LIC.NO. MECH.
TOTAL - TOTAL 4e.Ift7
Si re ofApp ti ractor
OFFICE COPY
POST THIS CARD NEAR FRONT OFBUILDING
PERMIT NUMBER
CITY OF CUPERTINO 12736
INSPECTION DIVISION
JOB I:JSPE(}TION RECORD
I. 1 PERMIT EXPIRATION
I JOB ADDRESS/ 2/'��flYX Ii20001 Cr UNIT# LOT# /
�LV d-- /�.SSa G-, - ms-/ 'PERMIT EXPIRES IF WORK
OWNER
CONTRACTOR (/.21� COCQ /Llu � , IS NOT STA RTE D,WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD -180 DAYS OF PERMIT ISSU-
FOUNDATION6 I[(-[�C Ccv�Tt`-PL�F'( ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
LIFER
PREGUNITE - PERMIT VALIDATION
sSe Lr23
POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED
,UNDERGROUND /SLAB
PLUMBING
ELECTRICAL T ISSUANCE DATE
MECHANICAL BLDGYcEJL0T. PL❑O. M�.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED �NiJT q{1 G PERMIT
�`• VI �'%�fNFORMATION
WOOD FLOOR, 'VALUATION $/FT.
PLUMBING 40 -
MECHANICAL ' '
PERMIT ro
ELECTRICAL -
1 1�.
FRAMING
INSULATION STORIES - TYPE CONsrR.
J
OCC.GROUP RES.UNITS
t �
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sC FT FLCOR AREA TOTALACFFAGE
ROOF }
m
DIAPHRAGM �/� -
' - �( RES IND CON
USE PB' OOer'
APPLY R00 ING UNTIL ABOVE HAS BEE SIGNED ❑�- ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH .
PLUMBING
GAS TEST - TRACT No. PARCEL No.
MECHANICAL -rJ-
lao - / /J
ACC.DAiE ACC.FILE NO,
ELECTRICAL INALS DATE INSP.
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING _
T.Z..
GAS _
FIRE SPRI NK ENE RGYT
MECHANICAL
-/0- [:] NE] ❑ N
❑
COVER N WORK UNTIL AB VE HAS BEEN NED HEATING
L.U.C.
LATH-INTERIOR s' _3-,?17 ELECTRICAL - v-
FLOODZONE A.
LATH-EXTERIOR FIRE DEPT. Y❑ N❑ I Y I] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING
BUILDING 7- S
SHEAR EXTERIOR
TEMPORARY APPROVAL
FIREWALLS ELECTRIC / -jo-s-71 PLAN CHECK
L GASFEE .
NO TAPE OR PLASTEFFUNYIL ABOVE HAS BEbh SIGNED JOCCUPANCY SEISMIC FEE �S
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
Lu
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE .TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY