12559 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
- - 'ourLDl NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 12559
7 Aoo ESS
� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
O NE PLAN CHECK VALIDATION
\10 �' NAME / QTY. ELECTRIC PERMIT FEE
C TflACTI)o I
1l. NAME UTLETS-SWITCHES-RECEP 10.00/1.00 0 � +/
I .0LIGHTING FIXTURES 10.00/1.00
-' �, LIC.NO. ^ ^
VRS
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 A
ADDRESS
p Y �] PNDNE S PANELS 10.00 DATE OF APPLICATION
PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.0.NO.
CM
ENGINEER ('/
LIC.NO. 316 s SIGNS TRANS. 3.00
ARCH.ESS. ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
/9,� ZIP EMP.METER OR POLE INS. 20.00 /I -
APPLIESS MOTORS SEE FEE SCH. �;�-TV-�•/`l
ADDREu
SERVICE CHANGE 20.00 S//.x {day
0 0o LICENSED CONFRACTORS DECLARATION �/f [ 3
F=W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Professions Code, my license is in full fM&4
z o LicenuG ass Lic.Number ❑ ❑ ❑
4 z s- w Dote - Commcla y s ' LDING PERMIT
¢ ¢ 6 S OWNER-BUILDER D C FORMATION
wH 1 hereby affirm That 1 am exempt from the Contractor's License MISC.- REFER TO ORD pt. gq��IlpyN��
LL o a law r the following reason.(Sec 703 1.5,Business and Professions PERMIT ISSUANCE 10.00 ,VV D S/FT.
� - Code: try city or county which rcquiresa permit toconslmcL alon' �Z�1
Q Q o improve, areal ish,or repair any structure,prior o its issuance,also ELEC.CONTE. LIG NO, ELEC.
La ar O¢ require t applicant for such permit to file a signed smtcmcnt that TOTAL T�
a w he u littn pursuant to the provisions of the Contractor's License t, 01
x�
Law lChnpm in with Section 7000)of Division 3 ofthe y/.[II, 11-d
a Business and fessions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ = $ [he basis for the q said exemption.Any violation of Sect ion 7031.5 STORIES TYPE CONSTR.
a ; by vny applicant f<lcap ndmd dollars the($5000.)
toecivd penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than Nv undreJ dollars(55001J:
❑ 1,es owner of t property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their solo Compensation\will do the walk,and the structure is not
intended or offered for dale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -
Code:The Contractor's Llcame Law does not apply to an owner of ,
\� property who builds or imprllves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sa FT.FLOOR AREA TOTALACREAGE
himself or through his own empluyens,provided that such improve.
ments are not intended or offere �or sale,it,however,the building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner. GAS EASYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving that he did not build or ire - .- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
LI 1,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 '�'� O 3-0��-
3.
the Contractor's License
Law.
contracts for such projects with a cuntruCmlfsl'liccnud pursuant o SEWER-SAN ITARV-STORM EA.200ft/10.00
\ TRACT N0. PARCEL NO.
❑ 1 am exempt under Sec.-.B&P.0 for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certillcute of consent to self-insure. ZONING or a certificate of Wo Compensation In lance,or a certified ENG.SITE NO,
copy t file b.C.). ` yy
Parc �s' a G/7/J/i[1// %/_I[✓. .
Q Cetlifed copy is hereby furnished. FIRE SPR INK ENERGY T 24
z,Z ❑ Certified copy Is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. y ❑ N❑ Y❑ No
!r y CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
W 1 COMPENSA'I'ION INSURANCE PLG.CONTE. LIC.NO. PLG. y❑ N❑ V❑ N❑
O (Phis section need not be completed if the permit is for one TOTAL
2, hundred dollars IS 100)On less.)
U O 1 certify that in the performance of the..,it for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL h mit is issued, I shall not employ any person in any manner sir as to
OW become subject to the Workers'Compenvtion Laws of California. (�
y Date npNicant 00
ALTER OR ADD TO MECH. 5.00 BUILDING o
} to NOTICE '1'0 APPLICANT'. If,after making this Certificate of Fx-
F. 2 eruption,you should become subject to tie Workers'Comlacusalmn APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you must forthwith comply with FEE
U such provisionsor this permit shall be deemed revoked. I AIR HANDLING UNIT(TO 10MOC.F.NL) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 1o=c.F.M.) 6.00 SEISMIC FEE / Od
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performan cc of the work for which the omit is¢sued(Sec. MICROFILM
3097,Civ.C.).'�4/ �a HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's AUJrt ^ ELECTRIC
. 1 certify mthea at 1 have read this application and state that ve VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to camply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-OOfi H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter also the BOILER-COMP IOser 100,000 BTU)SEE FEE SCH. MECHANICAL
tabove-mentioned property for inspection purposes.
(We) agree to save, indemnify nd kharmless the City of MISC.- REFER TO ORD.
CupeNino afA,
liabilities, d n/CL"Plin
s and expenses which PERMIT ISSUANCE 10.00 CONST.TAX (�X3may ac e ,d consequence of the
-74
r i. - MECH.CONT. LIG NO. MECH.
TOTALTOTALSig arc of 'ph aN/ContruCtar Date
OFFICE COPY /
POST THIS CARD NEAR FRONT OF BUILDING
PFR\11T NUMBER
CITY OF CUPERTINO12559
INSPECTION DIVISION
JOB INSPECTION RECORD
- PERMIT EXPIRATION
/ JOBADDRESS 104-� ��v AVC
- UNIT# LOT#
,/ / / //�_ / PERMIT EXPIRES IF WORK
OWNER LTlieL LVTZ/-cR�'�/ CONTRACTOR C,`J� r V4rC /`/c= r IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD- 180 DAYS OF PERMIT ISSU-
ANCE
FOUNDATION _ _ ¢�� c.��`c- p�- gy pl�,�t-� LAST AL 180 DAYS FROM
-// LAS7CALLEDINSPECTION.
UFER 9�C L
PERMIT VALIDATION
PR EGUNITE ol
ti
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -a,p-
UNDERGROUND /SLAB
PLUMBING P _ _ ��. µilL.4w L,n�ir✓
ELECTRICAL It - t; ISSUANCE DATE
MECHANICAL BLDG. ELECT, PLG. MECH.
Y '�f L'rZ L l:2CT ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT
M NFORMATION
WOOD FLOOR VALUATION I $/PT.
PLUMBING / AL
MECHANICAL
PERMIT TO
ELECTRICAL vAl
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GHOUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
O.Fi,FLOORPREA iOTALACREAGE
ROOF
DIAPHR GM
BUILDING USE
F?r'aI-'V0 RES IND CON PB Oln,
APPLY NO ROOF 'UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH 42,X�
PLUMBING ✓
HACi NO. 'PARCEL NO.
GAS TEST
MECHANICAL
ACC.PATE ACD.FILE NO.
ELECTRICAL I FINALS DATE INSP.
FRAMING i SAN # ZONING ENG.SITE NO.
INSULATION PLUMBING -
�SS GAS
FIRESPRINK ENERGY T}9
MECHANICAL - v N❑ v NE]NO WORK UNTIL ABOVE HAS BE NED HEATING
LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.U.C.
LATH-EXTERIOR FIRE DEPT. Y ❑ N[:) Yo N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR yY BUILDING '- -
SHEAR EXTERIOR TEMPORARY APPRBUILDING
OVALS �el :S '
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE R PLASTER UNTIL A OVE HAS BEEA SIGNED OCCUPANCY SEISMIC FEE
UCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE.-
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY