C 8140 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
13UI L-DI NG PROJECT I DENTI FICATI ON ERMIT NUMBER
Re o,NG / APPLICATION & PERMIT O
ADDRESS �{ O //O
T BUILDING-ELECTRICAL-PLUMBING-MECHANICAL814
DWNER'S ^ PLAN CHECKV LIGATION
NAME (�,, GrT QTY• ELECTRIC PERMIT FEE
l l'�� 1 PRONE
CONTRACTOR ERACTOfl'S Q2St y9116 7_4 OUTLETS-SWITCHES-RECEP 10.00/1.00
/ NO. Z_LIGHTING FIXTURES 10.00/1.00 S
CONT ACTOR'S APPLIANCES
7-
4.00
/ AD-D�/sus(
7- HI CJ� LAaPNONE2^'l 1-"I^I,a
PANELS 10.00 DATE OF APPLICATION
ARCNITFCT T IEZt PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ofl 1
V ENGIN EEAJ (i(1/ (.K`
( LIC.No.- SIGNS TRANS. 3.00
ARCH.OR ENG. (,/1.'r' (G PERMIT VALIDATION
ADDRESS 711 S�, �I � SPECIAL CIRCUIT 5.00
1 l� zip (FU EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS f//
Z-1.5- aSY(a,I. SERVICE CHANGE „ 20.00
w a 0 A 41e.J YANCIE'DATE oo LICENSED CONTRACTORS DECLAR ION TEMP.POLE 30.00 U U I hereby affirm that I am licensed under provisions of Chapter 9 A ISS
H x w (commencing with Section 7000)of Division 3 of the Business and G �Uc��
w< % sa sl N BLDG. ELECT. PLG. MECH,
F v,i Professions Code,and my license is in full force ant of c
0 0�� License Class _ Lic.NumberZa{ �_IO- /�
Data Contractor CRY of Cupertino
a m s BtDIN6 PERMIT
a a W OWNER-BUILDER DECLARATION �pat4.J F`GRMATION
F
;e.m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o.Qi Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
F - PERMIT ISSUANCE 16rBB
Code:Any city or cuunly which requires a permit to construct,aUeq [[77
2 as ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Q Aa 4 1 J x
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E:
2 a- he is licensed pursuant to the provisions of the Contractor's License I T T O 20V�F
F I f Law(Chapter 9(commeneingwith Section 7000)of Division 3 ofthe 4(T �(Tt
4 c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE `I'Ve 11711
a F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4 4.00 OCC.GROUP RES.uNrrs
their sole compensation,will do the work.and the structure is not
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 docs such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTALACREAGE
-
himself re through his own employees,provided that such improve-
mmselfonotinlended hhisoroffereoyeesale.lf,ed that such
building GAS-EA.SVSTEM-i INC.4OUTLETS 6.00
or improvement is Sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA.) 200
builder will have the burden of proving that he did not build or im- • . .
BUILDING USE
prove for purpose of sale.). RES IND CON Pe Othar
El 1,as owner ol'the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ Cl ❑ ❑
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 IEA.) 1.00
contracts for such projects with a co iractos(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.I'or this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
11y,�cby affirm tlmt 1 have a cerlifjwte�Cy nsent to self-insure, ZONING ENG.SITE N0.
co a e`pF17. 3f YQorlv+sT�h> (ytlas I�Isrance,or a certified
copy emet( ec. 00,L C). [ e -
Policy No. Company tTd, r•�.✓s�K
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z VLCenifie opy I fited///W iih �th�eqcity/�'ns lion division.
O Applicant cVjIT s•45sit� MISC. REFER TO ORD. Y ❑ NO , Y ❑ NO
~
CERTIFI ATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.c.
4 -
LUQ_ COMPENSATION INSURANCEPLG.CONTR. LIC.No. I PLG, v❑ N❑ v ❑. N❑
(L 0 (This section need not be completed if the permit is for one TOTAL
0 Z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H not is issued,1 shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Datc ApplicantALTER OR ADD TO MECH. tAFI'?I 5.00 -o- 81ILlINI 1/6 �
>_ W NOTICE TO APPLICANT: If,after making this Certificate of Ex-
? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(To}1 A00C"N Qr4:00
CONSTRUCTION LENDING AGENCY AIR HANDLING LIN IT(OVER t0A0DC.F.MM,) 6.00 SEISMIC FEE /2
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WIT )n p 0
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 UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 30
I certify that I have read this application and state that the aboveVENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county PLUMBING
Ii ordinances and slate laws relating to building construction, unJ BOILER-COMP I3H.P.or100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILSR-COMp IOver1D0,000BTU15EEFEESCH. MECHANICAL 0�.d 0.0
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE gggpj CONST.TAX
may in any way accrue against said City in consequence of the
gmndffDf this permit. MECH.CONT. LIC.NO. MECH.
3 �2l- TOTAL.,2 g dO TOTAL /7Q 62
..-� ignatur (Applicant/Contractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PFRMII NUMBER '
' : r CITY OF CUPERTINO �j
INSPECTION DIVISION 8 � 4r1
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS O� Cd2�P5 ZZ UNIT# LOT 4t
PERMIT EXPIRES IF WORK
OWNERCONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIO RECORD leoonvsoFPERMIrISsu- '
FOUNDATION ANCE OR 180 DAYS FROM
UFER
LASTCALLED INSPECTION.
' - '
PREGUNITE . t PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I "' .•
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL - - ISSUANCE GAT4'
MECHANICAL BV. ELECT: PLG. MECH.
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT q
INFORMATION
WOOD FLOOR VALUATION
PLUMBING •, � �•
$/FT.
r
MECHANICAL
ELECTRICAL ' - - 7 PERMIT TO
FRAMING / "
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.IT,FLOORPREA TOTALACREAGE
DIAPHRAGM -`
BUILDING USE
' RES IND CON PB' O,h;,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑- ❑° ❑ ❑ ❑
ASSESSORS PARCEL NO, .
ROUGH
PLUMBING - - - -
GAS TEST TRACI NO, PARCEL NO.
MECHANICAL S^ �r
ACC.DATE ACC.FILE NO,
ELECTRICAu' FINALS DATE INSP.
FRAMING 7. SAN # ,
INSULATION, •j—
PLUMBING - 'ZONING` :ENG.SITE NO.
' GAS
MECHANICAL FIRE SPRINK ENERGY T-$0
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ,Y ❑ NO °❑ N
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 : TEMPORAR PP OVAL -. 1 BUILDING. .. _-/' -
FIREWALLS iELECTRIC 17Z PLAN CHECK
GAS FEE
I
` NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - - SEISMIC FEE
OCCUPANCY OF BU I LDI NG I S NOT PERMITTE D U NTI L SU I LDI N G F INA L I S SI GN E D BY BUI LD I NG I NSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC,
IU' ONE WORKING DAY BEFORE REQUIRED INSPECTION. . PLUMBING
1z PLEASE GIVE JOB ADDRESS WHEN PHONING. „
— SEE PERMIT FOR EXPIRATION DATE — . MECHANICAL
IMPORTANT! coysT.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
• OFFICE COPY -