8992 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
,BUILDING PROJECT lDENTIFICATION PERMIT NUMBER
4llIlUING APPLICATION& PERMIT 8992` BUILDING - ELECTRICAL-PLUMBING_MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME• QTY. ELECTRIC PERMIT FEECONTr9 ONE
NAME
UTLETS-SWITCHES-RECEP 10.00/1.00
tic.No. LIGHTING FIXTURES 10.00/1.00
AUG Hess TORS APPLIANCES-RESIDENTIAL 4.00
PHONE PANELS . 10.00 DATE OF APPLICATION
ogcHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No.
ENGINEER ,
NoISIGNS TRANS. - 3.00
ARCH,Ess ENG' SPECIAL CIRCUIT _ 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 FAMP
APPLICANT EE SCH.s
ADDROOR - MOTORS SEE F `
MAY
rv7
SERVICE CHANGE 20.00 ' MAY eJ 1 19ey'/
0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE - 30.00 f }s� { ffNO
< W I hereby affirm that I am licensed under provisions of Chapter 9. .City,O B UAQ�E DATE
ian
(commencing with Section 7000)of Division 3 of the Business and BMG. ELECT. PLG. MECH.
r H z Professions Code,and my license is in full force and effect. ❑ ❑ ❑
.o z a o License Class Lic.Number Im
Date Contractor
¢ y E J
¢ ¢ OWNER-BUILDER DECLARATION: BUILDING PERMIT
rc ¢
°a ° - MISC.- REFER TO ORD INFORMATION
X
; at I hereby affirm that I am exempt from the Contractor's License
L. Law for the following reason, 70JL5,Business Prolessions PERMIT ISSUANCE 10.00 VALUATION E/Fi.
i > Code:Any city or county which requires a permit to construct,alter,
w
rt u, ¢ p improve,demolish,or repair any structure,prior to its issuance,also EIEC.CONTR.
reLIQ NOf ELEC.
uLL quires the applicant for such permit to file a signed statement that PERM
w$ he is licensed pursuant to the provisions of the Contructor's License D
r 2 i Law(Chapter 9(commencing with Section 7000)of Division 3 of the
f 4 c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
a H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant forapermit suh). is the applicant ma civil penalty ALTER -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GR u - REB.UNITS
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 does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
. .:. menus 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 GAS'-EA.SYSTEM-'OVER 4 (Ed.l 2.00
buil cr will have the burden of proving that he did not build or im BUILDING USE
p s for purpose of saleJ. INDUSTRIAL WASTE.INTER. - 30.00 RES IND CON PB `Omer
L as owner of the property,am exclusively contracting with - ❑ ❑ � ❑
tic used contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
at I Professions Code:The Cont rector's License Law does not apply -
t uIt owner of property who builds or improves thereon;and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
c motets for such projects with a comorewri s)licensed pursuant to SEWER-SANITARY-STORMEA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
am exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00 .
asrn
f
Owner Date WATER.SYSTEM 5.00 ACC..DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate o(consent to self-insure,'
or a certificate of Workers'Compensation Insurance,Or a certified ZONING. ENG.SITE NO.
copy Ihercof(Sec.3800,Lab.C.). -
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
~ O Applicant Y N Y [:] N[]
Lo CERTIFICATE OF Ex EmpTION FROM WORKERS' PERMIT ISSUANCE• 10.00 FLOODZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONT R. LIC.NO. U.
CL0 (This section need not be completed if the permit is for one TOTAL V N� Y[3 NC]
U 0 hundred dollars(SI00)or less.)
I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- ntit is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers;Compensation Laws of California. -
a Date ApplicantBUILDING
>_ t0 NOTICE TO APPLICANT: If,after making this Certificate oFE ALTER OR ADD TO MECH. 5.00
F Z 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
lire 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ,ELECTRIC
I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction„und BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize ropertyforinsves inspection
this city es enter upon the BOILER-COMP (Over 100.000 STU)SEE FEE SCH. MECHANICAL
hereby
coauthored property forinsp ofth i 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 10.00 - CONST.TAX
may in any w -rue against said Cily in consequence of the granting oft - ' MECH.CONT.. " LIC.N0. MECH.
- ' TOTAL -TOTAL 0-
Signature fA plicant/Con actor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
4 I + -P FRMIT NUMB
-��: CITY-" OF CUPERTINO ER
X9:92 INSPECTION DIVISION «'
JOB INSPECTION RECORD ' t
PERMIT EXPIRATION ?'
4 .
JOB ADDRESS - UNIT# - LOT#z •PERMIT EXPIRES IF WORK
r
OWNER' _ CONTRACTOR ' •. IS NOTSTARTEDWITHIN' ,
- INSPECTION. DATE INSPECTOR - INSPECTION RECORD 180 DAYSOF PERMIT ISSu-
FOUNDATION - ANCE OR 180 DAYS FROM'
LIFERLAST INSPECTION:
- _ -
PREGUNITE - - + PERMIL,vAE'DATION.
MAY 5 - 1�86'
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 'City Of CUpQIfIDO ;
PLUMBING - '
ELECTRICAL' -
- ISSUANCE GATE !
MECHANICAL' ' . . ELECT.. , PLG. MECH•-
:�, ❑ ❑ :�.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '-BUILDING PERMIT IT
• ` INFORMATION
WOOD FLOOR VALUATION. SIFT.
PLUMBING: ./ s
'MECHANICAL - -
L"• ELECTRICALS' (I' ._ - ' - PER o
I pp//JJ'))
FRAMING A.
1/// -
T RIES
INSULATION -TYPE CONSTR.
- '�. ` � �'� ' � _ ,
'OCC:GROU RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED. 'j, '
.1 '• ROOF I 50.FT:FLOOR AREA TOTAL ACREAGE
DIAPHRAGM
- - - BUILDING USE :
••RES IND ' CON 'PB OMer '
APPLY NOROOFIN6 UNTIL ABOVE HAS BEEN SIGNED !� •' r❑: ❑ ❑ - 11- '
N ASSESSORS PARC EL NO.
ROUGH,
PLUMBING
TRACT NO. ' PARCEL NO,
cns resr
' MECHANICAL
,FINALS ACC.DATE ACC.FILE NO. '
ELECTRICAL DATE 'NSP. '
FRAMINGt F' - SAN'# +. . .r .G
PLUMBI F " ZONING- ENG.SITE NO.
INSULATION- + .
GAS u.' -
�+ MECH NCA FIRE SPRINK ENERGY.T24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATI I Y fl 'N❑ -° ❑r."��❑ -
ELECT FLOOD ZONE A.L.0 '
LATH—INTERIOR . � � CAL ' .
LATH—EXTERIOR _ FIRE D T. I,: Y❑ IN F] -Y ❑ ;N❑. '
SHEETROCK - GRADE FEE SUMMARY
SHEAR`INTERIOR BUILOIN —
TEM ARY APPROVALS BUILDING ^. "
SHEAR EXTERIOR -
FIREWALLS - ELECTRICPLAN CHECK
GAS:' FEE `��..y-'
NO TAPE OR PLASTER,UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIGFEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM �^
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
^ �. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMeINc + '
- Z "PLEASE GIVE J09 ADDRESS WHEN'
PHONING. - - '
• ' MECHANICAL
- - SEE PERMIT FOR.EXPI RATION DATE _ ' -
IMPORTANT!
CONST.TAX
PLEASE READREVERSE SIDE BEFORE
CALLING FOR•FINAL INSPECTION. . : TOTAL.
+ - - - OFFICE COPY ` ..