18801 APPLICANT TO FILL IN .INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ✓
BU I LDING PROJECT I DENT[FICATI ON PERMIT NUMBER
BUILDING APPLICATION & PERMIT 01
/DBRE55 Q �,,wI
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
X
NAME�\ �./ l' OTY. ELECTRIC PERMIT FEE
I •``'ALI1 N. �I01�V PHONE {-3 '
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
W/1t4l&V. C010t, LIC.No. 371000 LIGHTING FIXTURES 10.00/1.00
nooAess'oRs - APPLIANCES-RESIDENTIAL 4.00
2 N. :5N.),1.Movi :5N.), PHONE IIIa 41100 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR L4LS RSsoU/>•1t5 PANELS (OVER 200 AMP) 20.00
ENGINEE I 9
C.IL uc.No GI DD ISIGNS TRANS. 3.00
ADDRESS ervc. SPECIALCIRCUIT S.DD PERMIT VALIDATION
/OZ VI/h^J S�a '� v zu,"I EMP.METER OR POLE INS. 20.00 O!oa JOS
(?-
APPLICANT LZA/r ft,,4 b" *,if, ` � MOTORS FEE SCH.
ADDBE$5 SI..f .
'(J� SERVICE CHANGE 20.00
O R 2
'02 LICENSED CON'RACI'ORS DECLARATION - U L
¢v v I hereby affirm that I am licensed under provisions of Chapter 9' O
2 w ISSUANCE DATE/J
y¢ F. mencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w z Professions Code,and my license is io full form and effect I Q CUp
o t,m o Date cClass hie.Number
m H w Date ContractorYN
¢ " `•
tt Iz w ¢ OWNBR-BUILDIiR DECLARATION BUILDING PERMIT
o a " . INFORMATION
m g;u y 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD 100
a0 ¢ Law for the following rcason.t$ec.7031.$,Businessand Professions VALUATION $/FT.
-„ PERMIT ISSUANCE 10.00
Code:Any city orcountywhich requires apermites construct,tdaheq
re improve,¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELED.
E m LL requires the applicant for such permit to file a signed statement that TOTAI� .00
w h
e is licensed pursuant to the Provisions of the Contnator's License PERMIT TO
F z a
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
Business and Professions Code)or that he is exempt therefrom and CITU. PLUMBING PERMIT FEES
li o the basis for the alleged excmplion.Any violation of Section 7031.$ ST ES TYPE CONSTR.
aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S50W.1:
❑ I,as owner of the property,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 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 TRAP500 so.PT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improves .
meats are not intended or offered for sale.If.however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or no GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
Prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑
licensed contractors to construct the pmjccl(Sec. 7044, BusinessFS
KLERS-1 INC 5 V.B. 6.00 ASSESSORS PAq CEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and whoKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor[al licensed pursuant to -
theComrctor'sLicenseLaw. ARY-STORM EA.200ft/10.00 TRACTNO. PARCELNO❑ lam exempt under Sec. ,e.&P.C.for thisER W/VENT 6.00reasonOwner Date EM5.00ACC.DATE qCC.FILE N0.
WORK ERS'COMPINSATION DECLARATION TING EQUIP. 5.00
1 hereby alfirm that I have a citlifmam ofconsenl to set GirI
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.CJ.
Policy No.-Co ny
O ❑ Certifiedc, is hereby'f fished. FIRE SPRINK ENERGY T24
Z Z jQ Certifie c yis f ed Ith (I ay inspection division.
FO A liicCc � .- MISC.- REFER TO ORD. Y � N - YC] NEI
W CCRTI FICA if:oP Eh:MPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UF..
LL > COMPENSATION INSURANCE. PLG.CONTR. LIC.No. PLG.
CL ❑ 11'his section teed not be cOln Pleted if the permit is for one TOTAL Y❑ N C] Y E] N E]
Z hundred dollars(5100)or less.)
U O 1 certify that in the performance o1'the work for which this per- CITY MECHANICAL PERMIT FEE FEE SUMI
LL U mit is issued,I shall not employ any person in avy mammy so as to
Uw beemccubject to the Warker,'Compensation Laws of California.
Q. Dau. Applicant - ALTER OR ADD TO MECH. BUILDING
} N NOTICI? 'f0 APPLICANT: IL after making this Certificate of Lx- 5.00
Z mnptien,you should become subject to the Workers'Compensation APPLIANCE . y 5.00 PLAN CHECK
U
Provisions
provisons of for thi le npenint shalor Code l be deou emest fd revoked.orthwith comply with AIR HANDLING UNIT(TO 10p00 C.F.M.) 4.00 FEE
CONSTRUCTION uiNowC ncliNCY AIR HANDLING UNIT(OVER 10=1 .F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction landing agency lou 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
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that 1 have read Blis aPPlicat ion and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBINGonfinancas and state laws relating to building construction, and BOILER-COMM H.P,or 100,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon thebove-mentioned property formspecuon purposes. BOILER-COMP fOver 100,000 BTU)SEE FEE SCH. MECHANICAL(We) agree t0 save, indemnify and keep harmless the City ofMISC.- REFER TO ORD.npertino against liabilities,judgmentscosts and expenses which CONST.TAXay in anywy accruegainst said City in consequence of the PERMIT ISSUANCE 1000r:ntin tis eravn 1. MECH.CONT. LIC.NO. ECHW_ TOTAL TOTALSlgnaloreOlApphcant(C ontfaclor Dam
OFFICE COPY
v
POST THIS CARD NEAR FRONT OF BUILDING
FIFTY Ir NUMBER '
CITY OF CUPERTINO 18801-
INSPECTION DIVISION
JOB INSPECTION RECORD -
JOB ADDRESS 1 �o �Nf/J✓� PERMIT EXPIRATION
UN" LOT PERMIT EXPIRES IF WORK
OWNER 6 CONTRACTOR IS NOT STARTED.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCEOR 180 DAYS FROM
NOTE:- LASTCALLED INSPECTION.
LIFERALL GRADING AND DRAINAGE SHALL'BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITU OF PER TVA VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB ,
PLUMBING
ELECTRICAL OCT I .X � ISSUANCE UATV.
MECHANICAL T�Oy BLOG ELECT. - PLm ME R.
City OfI El . El
DO NOT-POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED .tlfq BUILDING PERMIT
'WOOD FLOOR _ INFORMATION
PLUMBING
VALUATION SIFT.
� - � � ,
MECHANICAL - .-
ELECTRICAL - PERMIT TO ..
FRAMING
.INSULATION STOkBES TYPE CONSTR.
• OCC GROUP , RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
'
ROI sa.IT FLoory WHEW TOTAL ACREAGE
O
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
_ ROOF SHEATHING I BUILDING USE
RLS .IND CON PB Umn
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED . FINALS DATE INSP. 11 ❑ [IEl F-1
ROUGHSAN.p ASSESSORS PARCEL NO
PLUMBING ELECT,ENERGY
TUBS B SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL.NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE Acc PILE No
FRAMING ELECT,FINAL TEST '
INSULATIOMABOVE
PLUMBING ZONING ENG.SITE NO,
GAS TESTGAS
MECHANICAL FIRE SPRiNK ENERGY T.24
COVER N SIGNED HEATING v ❑ N❑ v ❑ N❑EXTERIOREIECTRICAGRELEASE PLOOLZONe AL U.o.
INTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCGRADEEXTERIOR FEE SUMMARY
BUILDINGINTERIOR . TEMPORARY APPROVALS BUILDINGSCRATCH CELECTRIC _zr �. PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED I OCCUPANCYI SEISMIC FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
SEE- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE C�
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY