17278 m- AAPLECANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL. EN ONLY
B' BUILDING PROJECT I DENTIFICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT )
w 1 �J �J
` ADOREss �� BUILDING- ELECTRICAL-PLUMBING -MECHANICAL 112'1 8
DwIVER9 PLAN CHECK VALIDATION
NAME +A QTY. ELECTRIC PERMIT FEE
NDv` PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00
NA
L LIC.NO.Z:Z-CI-3 it LIGHTING FIXTURES 10.00/1.00
P-ONTRAGTDRs APPLIANCES-RESIDENTIAL 4.00
noDHESS -
7Z0- .15PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 26,00 PLAN CHECK FEE- C.NO.
OR
' ENGINEER
uc.NO. SIGNS TRANS. 3.00
ARC R.OR ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
nap TEMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS : SEE FEE SCH.
ADDRESS r ryryry,,,
SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION -
vro v 1 hereby afri...I ilim I an,lirensed under Pm,i,bTa,of Chaptc,9 - ISSUANCE DATE
m Q vai (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H z Professions Cat and my license o ut full(oTyvgnd.eKpl n v� ❑ ❑ ❑
z O'�,- License Class LC Number LC.-1 J 1 .
9 z r Date Contrsctar_ .CO-��_ - -
H ; - BUILDING PERMIT
B rt wa OWNER-BUILDER DECLARATION INFORMATION
wu I- I hereby allirm that I em uempl from the Canlracloi s Lime MI$C.- R VALUATION ^ 4/FT.
H LL o a Law for the following mason.(Sea 7031.5,Husinessand Professions PERMIT ISSUANCE 10.00 VTr
Co' Any city or county which requirsa perout to construct.alter, 25
S ¢¢Q impro demolish,or repair any structure,prior to its issuance.also ELEC.CONTR. LIC.NO.
ELEC.
- D ¢ req uircr t applicant far such perinil to Ne n signed slatcmcnl thin - TOTAL PEq MIT TO -
w$ he is license urxlanl m the pruWsions of the contractor's License LIr =YItLY O✓
d H Z Q Law(Chapter 'ummencing with Sectlnn7000)of D ivision3ofthe
Bosloess and PFo1L. 'ora Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE �I'L�a
f Z O STORIES TYPE CONSTR.
¢ H the basis for the alleg exemption.Any viololion of Section]031.5
n ;� by any applicant foray it wbjects the applicant toueivil penulhy ALTER-DRAIN -WATER IEA.) 5.00
of not more than five bun d dollars($500).):
❑ I,as owner of me pro Fly,atiny cmployecs with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will he work,and the stmclum is nm ,�S
intended cur a fend for sale IS
7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 1L[J ��
Code: The Contractor's License La oa net apply to an owner of
property who builds or improves then and who does such work FIXTURES-PER TRAP 6.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,p 'ided that such impmve-
Prentsarenotintendedorofferedforsale. , owever,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
1 or hnprovement is sold within one year of co lotion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he d of build or it.- RES IND CON PB Oahu
prove for Purpose
oI salc.L INDUSTRIAL WASTE INTER.' 30.00
❑ I,as owner of the property,am exclusively ton cling with ❑ ❑ ❑ ❑
licensed contract... t. construct the project(Sec 704 , usiness LAWN SPRINKLERS-1 INC 5 V.B. s 6.00 - ASSESSOR PARCELNO.
anJ Professions Code:The Contranor's License Law Jncs n pply -
to an owner of
is
who builds or improves thereon.an who LAWN SPRINKLERS-OVER 5 IEA.1 1.00
contracts for such projects with is controctorls)licensed p.".act to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft110.00 TRACT NO. PARCEL NO.
❑ lamexe Tfoo.der Sec. ,B.dIP,C.for this WATERHEATER WNENT 6.00
reason
Owner Palo WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION _ WATER TREATING EQUIP. 5.00
1 hereby infirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or c,lific,le of Workc,s Compensation Insurance,or a certified
copy cthemoh'(Sec.3800,Lab.C.).
Policy No. Company_ -
�❑ Ceniticd copy is hereby rural d. FIRE SPRINK ENERGY T 24
z Z ,pp,,,,��// Ccrti-e Cory is file will the city inspection division. MISC- REFER TO ORD.
O A(�plicunl_ _ Y ❑ N❑ Y ❑ N❑
CC y cER'I'll'ICATGOI'IiXF:MI ION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C.
W >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. V❑ , N❑ Y ❑ N❑
EL 0' 1'I'his section not be completed if the Permit in for ul TOTAL
Z hundred dollars 15100 s.l - e
U O 1 certify that in the pu,fur of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.1 shall not employ as son in any manner so as to
U- become subject to the Workers Cmnpensa ' Laws of Califomio
0 w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING sC�
} w NOTICE 'f0 APPLICANN: If,after making this Ccrtificale of lix-
r Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the labor Code, you most forthwith comply with 'FEE
U such provisions m this pcnnit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
CONS]RUCTIONLENDING AGENCY AIR HANDLINGUNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
L
I hereby affirm that t fire is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 '
the performance of hIt ark fur which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
3097,CI V.C.).
Lender's. - HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC
LcndcF's AJdrtss
I Certify that I have read this application and state that the Show VENTILATION FAN (SINGLE) 4.00
..formation is correct. 1 agree to comply with all city and county PLUMBING
ordinal,m and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hreby authorize representative Of this city to enter upon the BOILER-COMP ((her,100,000 BTU)SEE FEE SCH. MECHANICAL
lop above-mentioned property for inspection purpoxs.
(We)- a to save, indemnify and keep hamiless the City of MISC.- - REFER TO ORD.
Cupertino g inst liabilities,judgments, costs and expenses which CONST.TAX
1
may in a y ay accrue PERMIT ISSUANCE 10.00
against said City in rs>:yuen a of the
ling f t i3 permit, MECH.CONT. LIC.NO. MECH,
21 TOTAL TOTAL
Si et Applicant Contin Dote
OFFICE COPY
POST. THIS CARD NEAR FRONT OF BUILDING _ PERMIT NL
CITY OF CUPERTINO 1727:$
INSPECTION DIVISION
JOB INSPECTION RECORD .
PERMIT EXPIRATION
JOB ADDRESS /5UNIT# LOT
PERMIT EXPIRES IF WORK
rnvNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: .LAST CALLEDINSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE ' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS _ J
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 1
II. UNDERGROUND /SLAB.
PLUMBING -
ELECTRICAL ISSUANCE.DAIC
MECHANICAL RLoc ELECT PLG, MECH.
FEB 211SJ:i E] ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
City Of'Cupertino INFORMATION
WOOD FLOOR'
p VALUATION SIFT.
PLUMBING in� RU
MECHANICAL - ^560
_ PERMIT TO
ELECTRICAL A .ie
FRAMING rcD Mu-•p l,,:r IJS / .^J ,A
STORIES TYPE CONSTR.
INSULATION
CDC GROUP RES UNITS
I
PLACE.NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED T aooR AREA TOTAL ACREAGE
I
I _ ROOF NOTE NO FINAL INSP.SHALL BE MADE BEFORE sn
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - - Hcs IND CON PR
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. SE ,� ❑
' ASSCSSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
MAGI NO. PARCEL NO.
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICALg. -y'i MECH.ENERGY Jy
ACC.DATE ACC.FILE NO.
ELECTRICAL BUILDING ENERGY IIIII
FRAMING\� ELECT.FINAL TEST ZONING ENG,SITE N0.
INSULATION PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY i.]A
MECHANICAL ! N[
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A U.C.
I EXTERIOR SHEAR ELECTRICAL RELEAS
INTERIOR SHEAR FIRE DEPT. v rvQ' r ❑ N❑
SHEETROCK - GRADEFEE SUMMARY
EXTERIOR LATH BUILDING
/ BUILDINGINTERIOR LATH TEMPORARY APPROVALS -
1 SCRATCH COAT ELECTRIC PLAN CHECK
I GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILMUi .'
ARRANGE FOR INSPECTION'BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE'REQUIRED:INSPECTION. PLUMBING
O _� PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION-DATE — MECHANICAL
0, ' IMPORTANT! CONST.TAX
` PLEASE READ REVERSE SIDE BEFORE '
r
CALLING FOR FINAL INSPECTION. TOTAL /,_. �
OFFICE COPY