15656 �.. "tPPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
.PERMIT NUMBER
BUILDING PROJECT 1 DENTI FIC 1 �- - '�
BUILDING APPLICATION & PERMIT q
BUILDIN I
• ! 5656
�Z{G� ;� UILDING-ELECTRICAL-PLUMBING-MECHANICAL ,
OwNER'e - PLAN CHECK VALIDATION
NAIOt moi]• -y� � QTY. ELECTRIC PERMIT FEE
44
CONTRACTOR'S
NAME UTLETS-SWITCHES-RECEP 10,00/1.00
r LIC.NO. LIGHTING FIXTURES '10.00/1.00 .
CONTRACTOR'S - APPLIANCES RESIDENTIAL' 4.00
ADDRESS
K PHONE - PANELS- - 10.00 - + -
DATEOFAPPLICATION
RcnrtecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE 'P.0_NO.
O
DR
ENGINEER - "
_ �ilc.NoSIGNS TRANS.. 3.00 '
AARCH OR
DDRESS ENG. - SPECIAL CIRCUIT' 5,00 PERMIT VALIDATION
ZIP TEMP.METER ORPOLE INS.. 20.00 "
APPLICANT'SMOTORS C: 'SEE FEE SCH. 7.
SERVICE CHANGE - 20.00 ''
0. _ 9/91d�
Foo LICENSED CONTRACTORS DECLARATION
a u v I hereby aflino that 1 am licensed under Provisions of Chapter 9a - - ,.✓ ISSUANCE DATE' m
y Iu (commencing with Section 7000)of Division 3 of the Business'and
¢y BLDG., ELECT. PLG. , MECH.
F m z Professions Code,and soy license is in full force and critic[.
o z m G License Clss ❑ El El
aLic.Number ,-
m F Date Contractor
a m BUILDING PERMIT
Be � ¢ OWNER-BUILDF,RDECLARATION
•
E:
LL F 1 hereby aflirn that I am exempt from the Contractor's License MISC. REFER TO ORD 1I111OFORMATION
D
F u o a Law for rhe following reason.(Sec.707 1.5,Business and Professions PERMIT ISSUANCE 10.00 V^LUartON - S/FT.
Code:Any city or county which requires a Permit to construct,alter,
Q Q Q D improve,delhhollsh,or repair any Structure,prior to Its Issuance,8150 ELEG.DONTR, LIC.NO. ELECT: � �, -
a
8 0 ¢ requires the applicant for such permit to file a signed statement Olaf _ - r " _ TOTAIi,' ,•PERMIT TO
v w he is licensed 9(co nt to the provisions of 00 Contractor's License
•'F z j Law(Chapterand
Po.commenC de).,Section is exem00) pt
tDivisionhof o and
¢ the
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE .
¢ o the basis for the alleged exemption,Any violation of it cion 703L5 STORIES TYPE CONSTR.
u ;m' by any ore than
rofora permit subjects the applicant to
civil penally
f n
-
of more than five hundmL dollars($50003: ' ALTER-DRAIN'8i-VENT-WATER (EA.) 5.00 •' - ,
- ❑ I,as owner of the property,or try employees with wages as BACK FLOW PROTECT. DEVICE 4.00 - -OCC.GROUP RES.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 -
prUpCltyWIlUhaildsorimprovestlereon,and who(Iles such work FIXTURES-PER'.TRAP 5.00 _ - So.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve- .,
menti are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 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 that he did not build or im. . . BUILDING USE
prove for Purpose of sale.).'. INDUSTRIAL WASTE IN TER:, 30.00 RES 'IND CON "PB Omer
_ "❑'"I,as owner of the properly,am exclusively contracting with .. , El � �
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5V.B. 6.00 AS6 SSORSPARCEL NO.
and Professions Code:The Contractor's License Law docs not apply -
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5.(EA.) 1.00
contracts for such.projects with a contraetor(s)licensed Pursuant to
the Contractor's License law. SEWER-SANITAR V;STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
• ❑, Ionic ulhpt undr• SeP/y._.,Il.&1'.C.fo the , WATER HEATER W/VENT' -6.00
Ig
[)are�� VWATER SYSTEM 5.00
(�1 'ACC.GATE ACC.FILE NO.
K. 'C NSATION DECLARATION WgTERrTREATING EQUIP.. 5.00
herby al firm that I have a certificate ofconsent to sel Ginsure, - .I
or a Certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE.NO,
copy thereof(Sec.3800,Lab.C.L _
Policy No.-Company-
0
o. CompanyO O Certified copy is hereby furnished. FIRE SPRINK• ENERGY T 24
Z Z Cl" Certifiedcopy, fled with the city ihrspectinn division.
0 Applicant is MISC.- '`( REFEflTOORD.
p •Y•Q ' N[] YQ No
r2 PERMIT ISSUANCE 10.00 _
Lu - CHR'I'IPICAT ipr. EAI IO TINS PROM WORKERS' _ FL000 ZONE a.L.U.C.
W � COMPCNSATION INSURANCE PLG.CONTR. LIC.NO. IPLG.
d 0 (This suction need not he completed if the permit is focooe TOTAL Y❑ NY O NQ
� Z hundred dollars(S IOD)or less.)
U O I certifyflhm in the performance of the work for which this per- OTY. MECHANICAL PERMIT, FEE FEE SUMMARY
IL F mit is issued.I shall not employ any person in any manner so as to
O W become suffject to the Workers'Compenvtion Laws of California.
Date ApplicantALTER OR ADD TO MECH. - 5.00 BUILDING
ail
} tNOTICE 1'O APPLICANT: II' m
,after aking this Cert it Cue of fix- ' ' '
2 emption,you should become subject to the Workers'Compensation. A'PPLIANCE! - •" 5.00 - PLAN CHECK
provisions of the Labor Code,You must forthwith Comply with a V
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000CF.M.) 4.00 FEE
CONSTRUCTION LENDING AGENCY A18HANDLING UNIT(OVER 10MC.F.M.) 6,00 SEISMIC FEE
I hereby affirm that there is a construction lending agency lin EXHAUST HOOD (WITH DUCT) • 5.00
the performance of the work lot which this permit is issued(Sec. -
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.)' 8.00 MICROFILM
L"ders Name HEATING UNIT(OVER 100,000 B.T.U:)9,50 ELECTRIC
-' Lender's Address
I i'enzify that l have read this application and state that the ahovo VENTI L"ATION,FAN (SINGLE) -, .4.00
information is correct I ague to comply with all.cily and county PLUMBING .
drdinandes and state laws relating to building construction, and BOILER- PI3N.P.Df1OD,DDDB.T.U.)'�6.OD -
hereby �ulhorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER•COMP(Over[00,000 B7U1 SEE FEE SCR. MECHANICAL
(We) 'agree to save, indemnify and keep harmless the City of MISC.- a ,) ''- REFER TO ORD.
--..- - uliertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way aceta ins[ said City in consequence of the PERMIT-ISSUANCE SSUANCE 10.00
,r f thh pe hit / CH.CONT. iLIC.NO. TOTAL
Y' TOTAL
'Ig urs1) Appli tact D to I
OFFICE COPY
T
POST THIS CARD NEAR FRONT OF.BOI LDING '
' PEOMIT NUMBER,
CITY OF CUPEATINO
15656
•
INSPECTION DIVISION '
JOB•INSPECTION RECORD
,(�L� PERMIT EXPIRATION
d��K C
JOB ADDRESS A' Z/ r UNIY# LOT# y
!I,' - PERMIT EXPIRES IF WORK ,
'OWNER CONTRACTOR a IS' NOT STARTED WITHIN
INSPECTION y DATE INSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION }• - ANCE OR-180 DAYS FROM
,. NOTE: ' - LAST CALLED INSPECTION.,
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY'WITH.THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
`., PR EGUNITE CUPERTINO STANDARDS. _
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB.
. PLUMBING
ELECTRICAL. IssuANce DAre
MECHANICAL - - ^ B..�V ELECT PLC. 'M
FCH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ` DING PERMIT
4�. ¢ INFORMATION
WOOD FLOOR S VALUATION , SIFT,
PLUMBING.
MECHANICAL
ELECTRICAL - - PERMIT To
FRAMING:1.
INSULATION, , - - - SIOHIES .LYPE r,ONSTR.
DEC,GROUP RES UNITS
-
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL REMADE BEFORE SO R.FLOOR AREA TOTAL ACREAGE
DIAPHRAGM F THE CONSTRUCTION TAX IS PAID .
- 7 a BUILOING USE
ROOFSHEATHING' Res IND CON PB. Otprr
c I,APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS. `" DATE ,ma." INSP.'. ❑ ❑, ' ❑ ❑ ❑
ASSESSORS PARCF:I.NO.
ROUGH SAN.N>
PLUMBING: • • - ELECT.ENERGY �.
TUBS 8 SHOWER PAN - PLUMBING ENERGY TRACT NO PARCEL NO.
- MECHANICAL ,MECH.ENERGY - -
ELECTRICAL: BUILDING.ENERGY ACC.DATE ACCFILE NO
'FRAMING - ELECT.'FINAL TEST
INSULATION PLUMBING - zoNlNc ENG.SITE No.
GAS TEST,' - GAS -
- MECHANICAL - FIRE SPRINK ENERGY TZA
•, COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ,. HEATING', 6y, .' Y ❑ LN❑ Y ❑ N❑'
EXTERIOR SHEAR • ELECTRICAL' �� PLOOOZONE A.L,UCPE ,
INTERIOR SHEAR FIRE DEPT: Y❑ N❑ 10 N
SHEETROCK. GRADE, FEE SUMMARY
EXTERIOR LATH BUILDING'
BUIL
.INTERIOR LATH • 'TEMPORARY APPROVALS
BUILD
SCRATCH COAT ELECTRICS - PLAN CHECK
- GAS' FEE //a-�• .
NO TAPE OR PLASTER UNTIL'ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC EEE G .�-DI
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINALISSIGNED BY.BUILDING'INSPECT OR, MICROFILM-.
ARRANGE FOR INSPECTION BY PHONING;252-4505, ..ELECTRIC.' "
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING '
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z , MECHANICAL'
f
t
- SEE PERMIT FOR EXPIRATION DATE -
{ _ IMPQRTANTI CO_NST.TAX'
' PLEASE-READ REVERSE SIDE'BEFORE r -
CALLING'FOR FINAL INSPECTION. TOTAL
OFFICE COPY
• - � ; - - = " _ _ -�' _fir