Loading...
17621 PpPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER BWLOING APPLICATION & PERMIT 17621 ADDRESS - I 11�j BUILDING -ELECTRICAL-PLUMBING -MECHANICAL �.'' OAER'S T L NPLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE PHONE C eR"cTORs ' UTLETS-SWITCHES-RECEP 10.00/1.00 6 LIGHTING FIXTURES 0U • 10.00/1.00 CONTRACTORS Gv 'T1No PPLIANCES-RESIDENTIAL 4.00 a.IC2 ADDRESS PHONE 'J PANELS 10.00 DATE OF APPLICATION ~ AR HrtE PANELS (OVER 200 AMPI 20.00 PLAIN CHECK FEE P.C.N OR O. ENGINEER - uc.No. SIGNS TRANS. 3.00 goo ESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 AO RE55rs MOTORS Y SEE FEE SCH. SERVICE CHANGE 20.00 Hoo LICENSED CONTRACTORS DECLARATION a 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE hQ.lu (commencing with Section 7000)of Division 3 of the Business and y BLDG. ELECT. PLG. MECH. H N i Professions Code.and my license is in full force h elle 4. ❑ z C - License las C�( Lic.Number ) - q Date�I.S-$�Contractor ltw, �1 I_ a y s -a BUILDING PERMIT ac rt w a OWNERBUILDERDECLARATION INFORMATION woa " MISC: RE 0 ; U.y I hereby affirm that 1 am exempt from the Contractor's License VALUATION S/FT. H u. C j Law for the following reamer(Sec.7031.5,tluvnrss and Professions PERMIT ISSUANCE 10.00 D Code Any city or county which re9uiresu permit to cnmtruct,alter - ac a a 0 improve,demolish,or repair any slrceture,prior to its issuance,atm ELEC.CONTR. LIC.NO. ELEC. y'� O¢ nyuires the applicant(lir such Pcrnhil to lite a signed statement that TOTAL I DO PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's Licens<• HiQ Law(Chapter 9(romestremgwith Section 7000)of Division 3 ofthe i.0 Business and Professions,Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Or H the basis for the alleged excntplion.Any violutlon of Section 7031.5 - STORIES - TYPE CO STR. d ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollar f 5500).): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for ale (Sec. 7IN4, Busincs and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 ' Code:The Contracmr i License Law does not apply to an owner of ' pre,cuy who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5,011 60.FT,FLOOR AREA .TOTALACREAGE himself re through his own employees.Provided that such improve- alerts are not intended oroffered Employees.pr H,however,that such chudding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE Wilder wi l have the burden of proving that he did not build or ire- RES IND CON PB Other prove 1,as owner of sale.). INDUSTRIAL WASTE INTER. 30.00 0 El 11 El ❑ L as owner of the property,he exclusively contracting with licensed contractors m construct the project7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. La Lo and Professions Code:The Contractor's Licensew docs not apply to antr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 the Cont fctoor r', ecoie=ts Lwitnamntracmrin licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Conlractor'a License Law. TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. B.&P.C.I'or this WATER HEATER W/VENT 6.00 ' reason Cosner Dam ,WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSA'r1ON DECLARATION WATER TREATING EQUIP. 5.00 - 1 hereby affirm that 1 have a certificate of consent to Sclt imsum, ZONING ,ENG.SITE NO. or a certificate of Workeri Compensation Insurance,or a certified copy thereoj�l1$$e�c���&qryab C.l. ♦�L�� ����������' - Policy NoG3LY0Tf4II�pany S-�/ AYJCTLI Amis( uL . 0 O Certified copy' hereby famished. Z Z' B/Certili�e�o+yis.�tiled i the 1y has ruction division. - FIRE SPRINK ENERGYToa 0 Applicant_ `-¢ _0 11 1_(G1'FL,b Wl� MISC.- REFER TO ORD. Y 0 ry❑ Y [:D NQ f y CERTIFICATEOF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.o. LU > COMPENSATION INSURANCIi PLG.CONTR. LIC.NO. PLG. L y N Y ❑ NNC]a. Z (This section need not be completed if the permit " for one TOTA hundred dollars IS 100)or less.) L) 0 1 certify that in the Pcrtormunce of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued.I shall nut employ any person in any manner so as m wbeemoc subject to the Worker'Compensation Laws of California. o. Dale ApplicantBUILDING } 0NOTICE l'O APPLICANT: If, he,making this Certiticute of Ex- ALTER OR ADD TO MECH. 5.00 F. Z_ emptier,you should become subject In the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U Saab provisions or this pernit shall he deemed revoked. AIR HANDLING UNIT(TO 1Op000F.ML) 4.00 .CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE l 1 hereby affirm that there 0 a construction lending agency tar EXHAUST HOOD(WITH DUCT) 5.00 the Performance of the work for which this permit is hoped(Sec MICROFILM 3197,Civ.C.). � HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name1Ws��� GorvLPea}oI2S HEATING UNIT(OVER 100,000 B.T.U.19.50 Lender's Addmss_L"1(..LL-AJ.[o/sg lC.V.t`F_ ELECTRIC 1. 00 1 certify that I have read this application and state that me above VENTILATION FAN (SINGLE) 4.00 ordinances n cornet. I agrel to comply with all city and county PLUMBING ordinances and state lows relating to building construction, and BOILER-COfs'P(3 H.P.Cr 100,0008.T.U.) 6.00 hereby, authorize representatives of this city to enter upon the BOILER-COMP(O.er 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) spree to ave, indemnify ALJ keep harness the City of 'MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which May in any way accrue age'nst said City in conscyucncc of the PERMIT ISSUANCE 10.00 CONST.TAX rp lin of th' permit MECH.CONT. LIC.NO. MECH. ( TOTAL TOTAL a l 1 Applacae Date ' OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING Pf.HMIT NUMBER ' - CITY OF CUPERTINO 17621 INSPECTION DIVISION JOB INSPECTION RECORD .PERMIT EXPIRATION JOB ADDRESS—! � L Z " _�r-- UNIT# -LOT# ' PERMIT EXPIRES IF WORK OWNER CONTRACTOR �a�61u e'Cj IS NOT STARTED WITHIN IN PECTION DATE INSPECTOR INSPECTION EC RD 180 DAYS OF PERMIT ISSU FOUNDATION " ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. ' LIFER - ALL.GRADING AND.DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - G/ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /:SLAB APR 114"1yb� PLUMBING /l, ot�y�,��! ,,� j- 7e ELECTRICAL ftmw DATE MECHANICAL - BLDG. I ELECT I PLG.- MICH. ❑ ❑ ❑. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT_ PLUMBING MECHANICAL +. VErrnlll To ELECTRICAL ,./'/- �fAA Wd Qcc7— FRAMING �t L+•y C� ! INSULATION - STORIES TYPE co srR, OCC.GROUP- RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE su s* FLooa AREA TOTAL ACR FACE , DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - Hes IND CON PB Olnrvr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El- ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH - SAN.# PLUMBING ELECT,ENERGY - ' TUBS 8 SHOWER PAN PLUMBING ENERGY MAGI NO. PARCEL NO r' ' MECHANICAL ; MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No FRAMING S ELECT.FINAL TEST- INSULATION PLUMBING _ GAS TEST - GAS MECHANICAL FIRESPRINK ENERGY T"24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,v ❑ NE ` ❑ NEj FLOOD ZDrvf A.L U.C. EXTERIOR SHEAR - ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v ❑ "❑ v ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK , . GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC , 69 o o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. ' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL ;,Qp OFFICE COPY "