15183 PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT.PEN ONLY
.BUI LDI NG PROJECT I DENTI FICATION - •• PERMIT NUMBER_ '
BUILDING APPLICATION'& PERMIT 15183
A RESS
_ .. oQ, �CA ck
I' BUILDING-ELECTRICAL-PLUMBING,-MECHANICAL 4'
' v
OWNER'S
NAME PLAN CHECK VALIDATION
T
PQI (-rl P MgD S-S�Dy CITY ELECTRIC PERMIT FEE -
PNON
' CONTRACTOR'S -
NAOUTLETS-'SWITCHES-RECEP '10.00/1.00
,
AN 'TrQm LIC.No.0 LIGHTING FIXTURES 10.00/1.00
f,ONTRACTO
•�: s , APPLIANCES-RESIDENTIAL 4.00
ADDaes
•'S(a(r4jsCL PHONE /'/S PANELS- 10.00 DATE OF APPLICATION'
�{ ARCHITECT
.p ' PLAN CHECK FEE P.C.NO.
OR 1' _ PANELS (OVER 200 AMPI,' 20.00 '
ENGINEER .
LIC NO ' SIGNS TRANS. , 3.00
AFCH.OR ENG. • - - PERMIT VALIDATION
ADDRESS ISPECIAL CIRCUIT 5,00
Zip TEMP.METER OR POLE INS. 20.00 - '
APPLICANT'S - MOTORS SEE FEE SCH. _
ADDRESS -
- SERVICE CHANGE 20.00 5/�1/f -
,02 LICENSED CONTRACTORS DECLARATION -
a is w 'I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE GATE
v~i< (commencing with Section 7000)of Division 3 D(the Rosiness and - BLDG. ELECT. PLG. MECH.
F m professimas C am icense is in full for ad oC ctj "
0 2C
e i .leans'Ca SS "Lic.Numb e 7f Q 0 0
w L Dale 2' Contractor C
a - E ..
¢ 0 i OWNER-BUILDER DECLARATION - IRMA ER T
X 3 LL y 1 herchy Infirm that I,am exempt from.the Contractors License MISC.- REFER TO ORD
`wLL'O ¢ Law for Ilse following•mason.(Sec.-7031.5,Businessund Professions VALUATION S/FT.
v= _ ,, s PERMIT ISSUANCEr 10.00 . _y;�E
Code Any my Or county which requires permit to mast nl I,:nteq spt8IlP'
f p ELEC.CONTR. LIC.NO. /(9T�yY_
¢ ¢ ¢O unpmy0.dClnobsh;or repair any structurt prior ID Its Issu'm c,also ELED. MIN
O ¢. reclaims the applicant for such permit to GI a signed sial nm tl that .TOTAL + V ,
he n licensed pa rsl ant to the provisions of the Conor actor 1 icense - PERMIT 0 •.
R z i, Law(Chapter 9(Commencing with Section 7000)DfDWalon 3 of the
E x o
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE /`
(E r$ the basis for the alleged exemption.Any violation.1 Section 7031.5 rally STORIES T PE CONSTR. .
by any applicant fora hundred
subjects theapplicanttaucivil penalty ALTER-DRAIN -WATER (EA.) 5.00
' - of not more than five hundred dollars(5500).): ,
❑ 1,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 Mructme is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00
Code:The Contractor's Licenser Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SEE FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improvc-
meats are nolintended or Offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 -
or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving thin he did not build Or itm BUILDING USE -
prove for Purpose ofsale.): INDUSTRIAL WASTE INTER3000 RES IND CON PB Darer
El . .
I,as owner of the'property,am exclusively contracting with El ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Co :.de 'The Contractor's License Law does not apply to an owner of properly who builds or improves Ihemon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ,
contraels forsuch,rojects'with a contractous)licemml prouant It, SEWER-SANITARY-STORM EA.200ft/10.00
the Conha,turs License Law. TRACT NO. PARCEL NO.
❑ 1 an,exempt under Sec. ,R.&P.C.for this - WATER.HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILENO. +
WORK ERS'COMPENSATION IMCLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a Certificate of Workers'Compensation Insuynee,or a certified - ZONING ENG.SITE NO.
clic lhcr•o" 0 .CJ. � /__ '
alley No_}2(a( CQh/any �rJ1'I
'0 ❑ Certaie, copy is hereby(urnkFrd
Z Z ❑ Ce ti co + i' file Ithtlhr ' .�•rt vision. FIRE SPR INK ENERGY T44
O Applicant Z`�- MISC.- REFER TO ORD. ' Y[] NE] Y ❑ N[
ti CERTIFICA ki EXEMPTION FROM WORKERS' PERMIT'ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU �_ COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG.
d O (Phis secti6m need not be completed if fire permit is for one TOTAL V 0 NE] Y❑ N
Z hundred dollars IS 100)or less.
- U O 1 certify that in the performance of the work for which Ods per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any mariner so as la - -
O W beconm xableci lu the Workers''Compensulion Laws of Ctlifornia. '
G. Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING
} to NOT'ICIi'I'O API'hICAN'I': If,alter making this Certil'iculc r7-17-
.. F.. Z emption,you should become subject to the Workers'Compensalion APPLIANCE" 5.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith comply with FEE
C7 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10.000C.F.M.) 6.00 SEISMIC FEE
v
1 hereby amino that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the ,Civ .). of the work for which this permit is issue)(Sca MICROFILM
3097,Civ,C.. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lunde,',Name HEATING UNIT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and stale final theabove VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING'
ordinances and state laws relining to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.),6.00
hereby, out'amee representatives ec This city 1.es enter upon the BOILER-COMP IOver,100,000 BTU)SEE FEE SCH. MECHANICAL
uhoby. autinned property forinspo inspection purposes.
'(We) agree to save, indemnify and keep harmless the City of MISC.- . REFERTO ORD.
upertino against,liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
mxy any way accrue against said Cify;in consequence of the
m tg Of this perm' MECH.CONT: LIC.NO, ,MECH. T
TOTAL TO1AL +.
S' afar fA earl/Contractor Uafe
` ' OFFICE COPY a».
POST THIS CARD NEAR,FRONT OFIBUI'L'DING
PERMIT NUMBER
CITY 'OF CUPERTINO g
-INSPECTION DIVISION , � �� " 3
JOB INSPECTION RECORD' -
1 ; Y /lI . '.
f SoZ��414, X 7-1 cd,
, / ' PERMIT EXPIRATION
JOB ADDRES
�- ' UNIT# _'LOT#
PERMIT EXPIRES IF WORK ;
OWNER y- gj OGG-S i CONTRACTOR 4,1776'LLe' T l/ IS NOT STARTED WITHIN
'INSPECTION DATE INSPECTOR I. INSPECTION.RECORD 180:DAYS OF PERMITISSU-
FOUNDATION" - - ANCE OR 180.DAYSIFROM
NOTE: - LAST CALLED INSPECTION.
LFER + ALL GRADING AND DRAINAGE SHALL-BE INSTALLED
TO COMPLY,WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATIONA
PR EGUNITE; CUPERTINO STANDARDS.
GARAGE SLABS - ' - .----^
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �v/ �.. '.
UNDERGROUND,/SLAB- 6z
4.
PLUMBING LY
Vpw {L
ELECTRICAL ` (LISSUANCEQ)A TE
MECHANICAL ''r - - BLoc. ELECT, I PLG.,. , MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' Bu¢owc PERMIT
x INFORMATION
WOOD FLOOR ' VALUATION , -SIFT:
PLUMBING -
MECHANICAL"
ELECTRICAL- ^ PERMIT,To.
FRAMING - • - J �_-
INSULATION,.:'•' . . STORIES TYPE CONSTR.
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO I T FLIIOH ARI.A TOTALACRF.AIIE
. ROOF•,, NOTE:NO`FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID,
ROOF SHEATHING REs IND ILOCONusEPE`•..y
APPLY. NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS OAT E INSP. 0 ❑ 1:1 :❑
-ROUGH SAN.k - F • nssessoas PARceLNo, ;
PLUMBING ELECT.ENERGY, .
PLUMBING ENERGY: IHACT No. PARCEL No
TUBS&SHOWER PAN -
MECHANICAL MECH.ENERGY
ACC,DATE ACC.PILE NO
ELECTRICAL - - BUILDING ENERGY - ,
FRAMING pLUMBINIGAL TEST'. - xoNlNc ..ENc,SITE NO.
INSULATION - -
GAS TEST ' GAS - I
• . . MECHANICAL;`•'1
eNERcv
FwesPivlNK
COVER NO WORK+UNTIL ABOVE HAS BEEN SIGNED , HEATING - ° ❑ NEI '° ❑ •".El
ELECTRICAL RELEASE -FLOOD ZONE A.L.D,C.,
EXTERIOR'_SHEAR '
INTERIOR SHEAR FIRE DEPT. - - Y NE Y 'NQ'
SHEETROCK '. ` - GRADE
�' i.r FEE SUMMARY
EXTERIOR:LATH BUILDING
MPORARY APPROVALS, BUILDING
INTERIOR LATH TEMPORA
' SCRATCH COAT ELECTRIC, «, PLAN CHECK !
GAS'
NOTA AS ER UNTIL ABOVE BEEN SIGNED occuPANcv'
OR - SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -
w' •ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC'
F- ONE WORKING'DAY BEFORE REQUIRED INSPECTION.
PLUMBING I
z° PLEASE GIVE JOB,ADDRESS WHEN PHONING.
= SEE PERMIT FOR EXPIRATION DATE,_ MECHANICAL
.IMPORTANT! CONST.TAX. *
PLEASE READ REVERSE SIDE BEFORE
E
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY --