15723APPLICANT TO FILL IN INFORMATION WITHIN RED LINES" -'USE BALL-POINT PEN ONLY
.,.BW
APPLICATION &PERMIT :'
BUILDING — ELECTRICAL— PLUMBING — MECHANICAL
PERMIT NUMBERLDINGPROJECTIDENTIEICATION u.,
0723
El- J
BUILDING
AOOREfiS /
OWNEH'S
NAME
N V PNONELSS• �zoJ
DTV. ELECTRIC PERMIT � FEE
1'
PLAN CHECK VALIDATION
.
-
-
DATE OF APPLICATION
CONTRACTOR'
NAMF /� I
/(�/. LIC.NO,' L
-
_ OUTLETS -SWITCHES - RECEP 10.00/1.00
LIGHTING FIXTURES 10.00/1.00
GONTRACTOW
DRESS ZZm
,__PHONE • O�
APPLIANCES - RESIDENTIAL 4.00
PANELS 10.00
ARCHITECT
OR
ENGINEER' •-
LIC, No.
PANELS (OVER 200 AMP) 20.00
PLAN CHECK FEE P.L. NO.
..
SIGNS TRANS. 3.00
AARCH. OR
DDRESS ENG: - Jt -
ZIP
. SPECIAL CIRCUIT 6.00
PERMIT VALIDATION
/
'
91t�n
y/���QQ
( U O ':
ISSUANCE GATE
BLDG. ELECT. PLG. MECH.
TEMP. METER OR. POLE INS. 20.00
APPLICANT S,• .. -
ADDRESS
- MOTORS "� - SEE FEE SCH.
- SERVICE'CHANGE 20.00
LICENSED CONTRACTORS DECLARATION
1 hereby affirm-thal 1 am licensed under provisions of Chapter 9
(commencing with Seclion'7000) of Division 3 of (lie Business and
Professions Cod%ef1) ense is in full for a _
License Cie Lit. Number
Dole-Conlmclor
OWNER -BUILDER DECLARATION
'MISC.
I hereby afl'imn that 1 am exempt from the Contractor's License
Law for the following ..son. (Sec. 7031.5, Business and Professions
Code: Any city or county which structurepermit prioo construct, iso
Improve, demolish, or repaii any structure, prior to Its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law(Chapter 9(commencing with Section 7000) of Division30flhe
liusiness and Professions Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
subjects Hit applicant [on civil penalty
by any ..to
lora hundred
Of not more than five Imndred dollars (f 5001.1: -
❑ 1, as owner of the property, or my employees with wages as,
their sole compensation; will do the work,'and the structure Is not
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
Property who huildsorimproves themon; mill who lines such work
himself or through his own employees, provided Thal such improve-
rnenn,menot intended orofferedfo,sale. if, however, the building
of improvement is sold within one year of complelion'the owner
builder will have the burden of Proving that he did not build or ire -
piove for purpose of sale.).-
❑ 1, as owner of the Properly, Sin exclusively contracting with
licensed contractors to construct the project (Sec. 7044; Business
and Professions Code: The Contractor's License Luw does not apply
to an owner of property who builds or improves thereon, and who
contracts for such projects with a contractodel licensed pursuant m
the Contractors License Law.
❑ Iain exempt under Sec. ,B.&P.C. lot this
tonson
-
- -
BUILDING PERMIT
INFORMATION
— REFER TO ORD'
PERMIT ISSUANCE 10.00
VALUATION
'
S/PT.
ELEC. CONTE. LIC.,NO. ELEC.
TOTAL
•
DTV. PLUMBING PERMIT
- -
PERMIT TO _
-
.�A.tx
_(
-q{ �SSTORIES
'J'J . '
TYPE CONSTR.
.. ALTER-OR-WATER(EA.) 5:00
BACK FLOW PROTECT, DEVICE q
OC��Cpp. GROUP
REE. UNITE
.
DRAINS -FLOOR; ROOF, AREA, COND. SIM1w
-
FIXTURES,- PER TRAP'' • 5.D
SO. FT. FLOOR AREA
TOTALACREAGE
- GAS-EA.SYSTEM-,11NC.40UTLETS 6.00
-
GAS EA: SYSTEM - OVER 4'(EA:) 2.00
BUILDING USE
RES IND CON PB 'Omer
❑ 0 El ❑
INDUSTRIAL WASTE INTER. 30;00
LAWN SPRINKLERS- 1 INC 5 V.B. .6.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
_
SEWER -SANITARY -STORM 200ft/10.00
TRACT NO.
PARCEL NO.
-
WATER HEATER W/VENT 6:00
Owner Date
WORK ERS'COM PIiNSATION DECLARATION
I hereby affirm that I have a certificate o1 -consent to rel Ginsure,
or a cenifcate of Workers' Compensation Insurance, or a cerlffied
copy It, of S, - 3800 Lab .C.l.
Policy Nn.SiyL�,n1q�1C��any - J.lDer3• JN]EM
�❑/ CcrlitieJe is lmrcby furnish ed.
Cerlifitd It iib IIIc city,
ity inspection t11ViSi0n.
Applicant �r
WATER SYSTEM' - 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP.. 5.00
.
ZONING
ENG, SITE NO.
'
-
-I
'FIRE SPRINK
y� 'ry
ENERGY 24
v0 IN E]
MISC. REFER TO ORD.
CERTIFICATE OF 17XFMPTION PROM WORKERS',
COMPENSATION INSURANCE.
(This•section need not be completed if the permit is for one
him dyed dollars ($100) nr less.)
I certify that in the perfomnune, of the work for which this per-
mit is issued, I shall not employ any person in any manner so as to
' become subject to the Workers' Compensation Laws of CalfforniB.
Danc Applicant
PERMITISSUANCE .• 10.00
FLOOD ZONE
Y) No
A.L.U.C.
Y E] N[]
PLG. CONTE. LIC. NO.
-
PLG.
TOTAL
CITY MECHANICAL PERMIT FEE
-
' ' -
-FEE SUMMARY.
BUILDING
_
'
•ALTER OR ADD TO MECH. 5.00
NOTICE TO APPLICANT: If, alter making this Certificate of lex-
enptioti, you should become subject to the Workeri Compens.lun;
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked
' CONSTRUCTION LENDING AGENCY
I hereby nffirm than there is a construction lending agency for
the purfonnance of the work for which this permit is issued (Sec.
3097, Civ.C.),
Lender's Name
'- APPLIANCE" ' 5.00
AIR HANDLING UNIT (TO 10MC.F.M.) 4.00
*PLAN CHECK
FEE ,
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
-' EXHAUST HOOD (WITH DUCT_) • - . 5.00
MICROFILM
'
HEATING UNIT (TO 100,000 B.T.U.) 6.00
H EATI NG UN IT.(OV E R 100,000 B.T.U.) 9.50
-
ELECTRIC
Lunde,'S Address
}I certify. that I have read this applicet ion and state that the above
information is correct. I agree In comply with all city and county
ordinances and State laws remtlngGO building construction, and
IIIauthorize representatives of this city to enter upon the
bo
ave -mentioned property for inspection purposes.
"i (We) agree to save, indemnify and keep hafmless the City of
Caper I ga est act',ilies, Gents, costs and expenses which
o m i say acen I said Cfty in cnnswluence'of the
ran' L stone ✓� �.n
- '�•t(C,iy�
K/
VENTILATION FAN (SINGLE) 4,00
PLUMBINGr'r
.
BOILER H.P. Df 100,000 B.T.U.1 PB!EO
BOILER -COMP (Oseer 100,000BTU) SEE FEE SCH.
MECHANICAL
,►.p
MISC. -` REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE ..J8-66
MECH.CONT. LIC. NO. MECH.
_ TOTAL a�09
-'
TOTAL-
'
'
Sig re of Applicant/Contractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NDMeeh
CITY OF. CUPERTINO
95723'
INSPECTION DIVISION
JOB -INSPECTION RECORD
I
PERMIT. EXPIRATION
.JOB ADDRESS h1 y6.Ci y -C...'/'1 (/C- UNIT.#, _LOT#
- - -
PERMITS
PERMITS EXPIRES IF WORK•
OWNER cONTRAcro-. .o'er -T ., '
IS NOT STARTEDWITHIN
. 180' DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM -
LASTCALLED INSPECTION. '
INSPECTION DATE INSPECTOR
- INSPECTION RECORD
FOUNDATION-
-
NOTE: " - '
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH -THE APPROVED PLANS AND CITY OF
LIFER- • - -
PREGUNIT.E - _
PE-ralr vauoarloN
,
CUPERTINO STANDARDS..
ISSUANCE DATE. '
GARAGE -SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED•-.-
('
UNDERGROUND/SLAB"
PLUMBING
-
ELECTRICAL_
MECHANICAL
-
.nLuc. ELEcr.
PLG. MECH.,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
y P�0
BUILDING PERMIT
INFORMATION
' 'WOOD FLOOR •;
PLUMBING - '.
I
� - 1e
VALUATION $/FT.
.. '1;
� �
MECHANICAL -
ELECTRICAL
Pe-nurro-.-
FRAMING
INSULATION
.'
STORIES,,.
rvPcomsTn.
E
OCC. GROUP
RES. UNITS
PLACE:NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
,ROOF -
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
SO. FI.FLOOH ANEA
10 AI. ACREAI.E
DIAPHRAGM -
ROOF SHEATHING.
'RES -IND iLDCOON USEPHLan-
❑ ❑ El , ❑
'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
FINALS I PATE INSP.
-
'.' ROUGH'
SAN.q
ASSESSORS PARCEL NO '
-
PLUMBING' -
ELECT, ENERGY'
TUBS&SHOWER PAN'
PLUMBING.ENERGY
TRACT NO,
PARCEL NO
MECHANICAL -, -
MECH. ENERGY
ELECTRICAL -BUILDING
ENERGY .
ACc.,DATE
-'
AC ..FILE NO.
FRAMING 'I•-
ELECT. FINACTEST
-
INSULATION•.
PLUMBING.
ZONING
ENG. SITE NO .
GAS TEST
GAS
MECHANICAL
-FIRE SPRINKr
•Y ❑ NE]
ENERGY T.aa
` ❑ �'.N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
- - -
EXTERIOR SHEAR
ELECTRICAL RELEASE
PLOoo mNE
v ❑N❑
a.L.u.c,
v'�❑ .N❑'
INTERIOR SHEAR
FIRE DEPT.
SHEETROCK --
GRADE
FEE SUMMARY
-
EXTERIOR LATH -
BUILDING
BUILDING'
'
.ILw
INTERIOR' LATH -TEMPORARY
APPROVALS
SCRATCH COAT - -
ELECTRIC
PLAN,CHECK
FEE '
,
- - -
GAS
NO TAPE OB PLASTER UNTIL ABOVE HAS BEEN SIGNED' OCCUPANCY
SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALIS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING -4505,
ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION,
O ' PLEASE GIVE JOB ADDRESS'WHEN PHONING.. •
PLUMBING
MECHANICAL-
- ✓ .'.
L .-SEEPERIVIMFOREXPIRATIONDATE
1
CONST. TAX
IMPORTANT!
PLEASE'READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. • .
" 'TOTAL
OFFICE COPY