12038 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
2.BU1 LD+NG PROJECT IDENTIFICATION
PERMIT NUMBER
BUILOI APPLICATION & PERMIT
ADDRESS 12038
' '10553 Farallone Drive BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
SII • NAME _ OTY. ELECTRIC PERMIT FEE
George Younger PHONE 252-657�J 0
NAAMERnc*oas UTLETS-SWITCHES-RECEP 10.00/1.00
Atlas Heating LIC.No.$ 465266 ILIGHTING FIXTURES 10.00/1.00
r-ONTRACTOR's
Aoof Ess APPLIANCES-RESIDENTIAL 4.00
155 Commercial St. PHONE 739-0516 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FE .G NO.
OR 94o86 PANELS (OVER 200 AMP) 20.00 uYD_
ENGINEER - -�
c.no. SIGNS TRANS. 3.00
AR CH.OR ENG. PERMIT VALIq U A�TION
ADDRESS SPECIAL CIRCUIT 5.00 IaNK 10
zIP EMP.METER OR POLE INS. .20.00 v
ADDRESS MOTORS SEE FEE SCH. of.CugerUnO
ADDRESS plyss Y� Y"
SERVICE CHANGE 20.00 1+ L7
woo LICENSED CONTRACTORS DECLARATION
¢U. I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
z n (commencing with Section 70007 of Division 3 of the Business and
¢ BLDG. ELECT. PLG. M CH
F y i Professions CoJs�Tandraw li<cnsc is in full fore ❑ ❑ ❑
a O - Lice C ss LVV Lia Number
z m T w Dal:744/8 _, Contractor
a m s "� BUILDING PERMIT
c ¢ OWNER-BUILDER DECLARATION
o a r� INFORMATION
E
I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
u O¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT.
H - PERMIT ISSUANCE 10.00
Code:Any city or County which requires a permit to construct,alter, _
e, w ¢2O improve,demolish,or repair any structure,prior to it,issuance.also ELEC.CONTR. LIC.NO. ELEC.
O u rectum,the applicant for such permit to file a signed statement That TOTAL PERMIT TO
n
lie is is licensed Pursuant to the provisions of the Contm etor's License
F z a Law(Chapter 9(commencing with Section 7000) dDivision 3ofthe
3 4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ H � the basis for the alleged exemption.Any violation of Section 7031.5 SrTORI S TYPE COPTSTR.
n ; by my applicant for a Permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollun($500)J'.
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 400
their sole compensation,will do the work,and the str cture is not . DEC.GROUP RES.UNITS
tended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's License law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 as FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
Ile
or improvement is sold within one year of completion. the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that he did not build or ins- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ES INO CON PB Oreo
❑ 1,as owner of the property,am exclusively contracting with ❑ El El El d contractors to emostruct the project(Sec.7044,Business LAWN SPRINKLERS 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conractons)licensed pursuant to
the Comractor'sLicense Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00
ason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE N0.
,WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofec osent to self-insure, ZONING ENG.SITE or a certificate of Workers'Compensation Insurance.or a certiticd NO.
Copy thereof(Seu.3800,Lab.CJ. s
Policy No. n1�/ f((p.puny Allied Pao.
O ��]� Cerli ll`efebIn , mmby famished. FIRE SPRINK ENERGY T-24
Z Z J'$ Cen1f d copx i filed 'th the city inspection division. MISC.- REFER TO ORD.
O Applicant- t
F f aU ng' Y❑ N❑ Y ❑ N❑
CC y CERTIFICATE OF Ii%E:MPI'ION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.C.
LU > ICOMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL 0 (This xCti6G need not be completed if lire permit h for one TOTAL ly❑ N❑ Y ❑ N❑
::� Z hundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California. -
0. Date Applicant BUILDING
} to NOTICE TO APPLICANT: If,after making this Cenifcce of li x- ALTER OR ADD TO MECH. 5.00
Z em tion,you should become subject to the Workers'Com
F _ p ,,Iy ith APPLIANCE 5.00 PLAN CHECK
U
provisions
h p uv s anof e ar faishe bor petmit shin be deemed ou must forthwith comply with AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a constriction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the perfornanee of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.Y - HEATING UNIT(To 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50
Lender',Address ELECTRIC
I Certify that I have mad this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.orlDO,000B.T.U.) 6.00
t hereby authorize representatives of on city to enter upon the BOILER-COMP IOver 100,000 BTUI SEE FEE SCH. MECHANICAL
hereby cntlnned properly for inspection puT.it) t
(We) agree to save, indemnify and keep N.L. the City'of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way accrue Judgments,
said City in cotLsequence of the PERMIT ISSUANCE 10.00
grnnlin of this r.it. MECH.CONT. LIG NO, MECH.
46-Signature of Applicant/ ntmcto ate
L TOTAL O DO TOTAL
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
'f PFRM1II7 NUMBER
CITY OF CUPERTINO 12038
INSPECTION DIVISION
JOB INSPECTION RECORD.
PERMIT EXPIRATION
JOB ADDRESS 10553 Farallone Drive UNIT# LOT#
- PERMIT EXPIRES IF WORK
OWNER George Younjzer CONTRACTOR Atlas Heating - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD Iso Dgvs of PERMIT Issu-
FOUNDATION ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PERMIT VALIDATION,,'
P•REGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED "
UNDERGROUND /SLAB
PLUMBING
ELECTRICALISSUANCE DATE
MECHANICAL - - - •BLOc, ELECT. PLG. . FnECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT,
PLUMBING � '
MECHANICAL -
ELECTRICAL -PERMIT TO
FRAMING 1
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR'UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM '
y BUILDING USE
RES IND CON PR Do—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 1:10 ❑
A ESSORS PARCEL NO.
ROUGH
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ACG DATE ACO.FILE NO.
ELECTRICAL FINALS DATE INSP.
,FRAMING SAN *
INSULATION - PLUMBING ZONING - ENG.SITE NO.
GAS
MECHANICAL
FIRE SPRINK ENERGY T-24r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , HEATING Y E] NE E] NE]
LATH—INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH—EXTERIOR FIRE DEPT. Y❑ N Y ❑ . N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR,INTERIOR BUILDING - -
SHEAR EXTERIOR - TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY 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
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING. .
- SEE.PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!
CONST.TAX
' '
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. -
OFFICE COPY