17398 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
- - ,
•BU{LDI NG PROJECT 1 DENTI FICATION I PERMIT NUMBER17398
BDILD, G. APPLICATION & PERMIT
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'SPLAN CHECK VALIDATION
/AHI '1
NAME r
gg
MEbM�te�'Tiat Z3.-37170TV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
NAME llq�p rr OUTLETS-SWITCHES-RECEP 10.00/1.00 .D -
L $ Lt..No.�i7`r/.7� 2_ LIGHTING FIXTURES 10.00/1.00 TDO
CONTRACTOR'S
'I'�1� APPLIANCES-RESIDENTIAL 4.00
S Iy Lr(7�Ex PHONE e.7^JI -1 PANELS 10.00 DATEOF APPLICATION 1
ARCHITECT PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00 '-
ENGINEER �J
LIc.No SIGNS TRANS. 3.00_
ARCH.OR ENG. f PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP EMP.METER OR POLE INS.. .20.00
ADDRESSTs MOTORS SEE FEE SCH. J 1.
SERVICE CHANGE 20.00
_.02 LICENSED CONTRACTORS DECLARATION
¢ L,w 1 Imreby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing wdh ection 7000)of Division 3 of the Basin-stand and
¢y BLDG. ELECT. PLG. MECH.
r N i Professions Cod J my license is in full on ll ❑ ❑ ,
z o m - License Class Lic.Num
O w H w Date Coal, o
NA
a m s -06Y BUILDING PERMIT
E o i OWNfi R-BUILDIiR UECLARA" MISC.- RD INFORMATION
X 0 u v 1 hereby affirm that I am exempt from the Contractor's License
w VALUATION
� uoa Law for the following reason.(Sec.703 1.5,Businessand Professimu PERMIT ISSUANCE 10_.00 ��V'
Code:Anycity orcounly which requires a permit to construct,after, O
ELEC.CONTR. LIQ NO.
rt ¢ ¢ improve,demolish,or repair any struelure,prior to i[s issuance,also ELEC.
iL D¢ requires the applicant for such permit to file a signed statement that - TOTAL .-PO
n w m a he is licensed pursuant to the provisions of the Contractor's License PERMIT TO -
r > Law(Chapter 9(commemciagwith Section 7000)of Division 3 ofthe ! �/{7Q` `-_`
2 i o wl
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE .L �V A`td
It 1-o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES 'TYPE CONSTR.
by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 _ l
of not more than five hundred dollars(8500).):
❑ I,as owner of the property;or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and Ilse structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,GOND. 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.FL: AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. GAS-EA.SVSTEM'-11NC.40UTLETS 6.00
mends are not intended or offered for sale.If,however,the building
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 hit- - BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Orher
. .
❑ I,as owner of the property,am exclusively contracting with 1:1 ❑ ❑ 1:1 El
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 Low does not apply
to an owner of property who hands or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractos(s)licensed pursuant to SEWER-SAN EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ lam exempt under SEE.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
OwnerDate WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO.
WORKS RS'COMPENSATION DECLARATION p WATER TREATING EQUIP. 5.00 ,
I hereby affirm that 1 have a certificate of consent to wif-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified -
copy I hereof(Sec.3800,Lab.G).
Policy No. Company _
O ❑ Certified copy is hereby furnished FIRE BPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the. city inspection divi:iln. MISC.- REFER TO ORD.
0 Applicant v N� - v ❑ N�
F rn PERMIT ISSUANCE 10.00
0: LO CERTIFICATE OFEXEMPTION FROM WORKERS' FLOOD ZONE A.LU.C.
W >_ COMPENSATION INSURANCE PLG.CONTR. CIC.NO. PLG. '
1 ❑ ('this section need nut be completed if Ilia permit is for one - 'a TOTAL VF] N[] V❑ N❑
0 Z hundred dollars($100)or less,)
U O I certify that in the performance o the hacl per' OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall not emplo so in: y In r ys to
O W beeaa��ct•sylJ�cr�y the Wo n' ton ews ornia. -
o, Datu►�/_T=pLA Inant ALTER OR ADD TO MECH. 5.00 BUILDING �7 Q
} N NOTICE TO AfPLICAN'C ,e •r ma ' his ,rti care of lix-
h 2 empto n,you should become suM1 •d to a Werke mpensation APPLIANCE 5.00 PLAN CHECK R
provisions of the Labor Cade, you must forthwith comply with FEE- /v
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10pQOGflM.) 6.00 SEISMICFEE
z
I hereby affirm that there is a construction Icnding,agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. - MICROFILM
3097,CN.C.1. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I C Q -�
1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 _
information i .et. I agree to comply with all city and county PLUMBING
orlmances and :ate relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize •prese t 'ves' of this city to enter upon the 130 L'ER-COMP IOver t00p00 BTU)SEE FEE SCH. MECHANICAL
above-mentioned Pr fors pection purpous. -
(We) agree t ind it and keep harmless the City of MISC.- REFER TO ORD.
a ago' i'ti ,judge IS, and expenses which PERMIT ISSUANCE 10.00 ' CONST.TAX
ay n ay cc against 'i sty consequence of the
9 _ ""t. MECH.CONT. LIC.NO, w, MECH.
L
(ata TOTAL TOTAL J qiI
Sig pplicanl tract r Data � - '
OFFICE COPV
' POST THIS CARD NEAR FRONT OF BUIILDING - PERMIrNuMBER
`Y atJ CITY OF CUPERTINO 17396
INSPECTION DIVISION
JOB INSPECTION RECORD
` ,PERMIT EXPIRATION
JOB ADDRESS -
V��./ - a• '? UNIT# LOT# PERMIT EXPIRES IF WORK,
OWNER c�
CONTRACTOR CG,�'Z,� (� IS NOT STARTED WITHIN t
(INSPECTION AT INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER - NOTE: LAST CALLED INSPECTION. '
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERKIIT VALIDATION. .
GARAGE SLABS CUPERTINO STANDARDS. G
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 11 19VIj s f
UNDERGROUND /SLAB ' }C q �—[I ✓4
PLUMBING city of cFvj.Hww. I ' N I
ELECTRICAL V ,^'WVim+ ISSUANCE LATE
MECHANICAL PLUG ELECT I PLG. I %eECH
- - ❑ ❑ ❑ '❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR
PLUMBING VALUATION $/FT.
- A
to
.MECHANICAL' '
ELECTRICAL ' PERMIT To
FRAMING '`` ' 'J.'/
TUES TYPECONSTH,
.INSULATION` Ll )-(g It '
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED so.Fr FLooTynNEA rarALACNEACL
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ",m
"! bIAPHRAGM THE CONSTRUCTION TAX IS PAID'
11•••fy.Yay::::r:. - BU I LOING USE'
°�":�•' ROOF SHERES INUATHING CON PB'%jam"
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 1 ❑ ❑
. ASSESSORS PARCEL NO
ROUGH - SAN.q
PLUMBING ELECT.ENERGY
TNACi No "PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY '
ELECTRICAL - BUILDING ENERGY ACC.DATE ACC FILE NO
FRAMING - ELECT.FINALTEST
INSULATION ' '],6 PLUMBINGZONING ENG.SITE NO.
GAS TEST - GAS
MECHANICAL FIRE tSPRINK ENERGY T4<
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "Yi1"� "c] ` NE]
.fir FLOOD ZONE . A U.C.
EXTERIOR SHEAR W ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. Y C] N[3 Y ❑ No
SHEETROCK v — GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH "TEMPORARY OVAL$ r
rOi l]
SCRATCH COAT - ELECTRIC [
GAS. D. '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . �.
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.ARRANGE FOR INSPECTION BY PHONING 252-4505,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNST.TAx
PLEASE READ REVERSE SIDE BEFORE L TOTAL CALLING FOR FINAL INSPECTION. 1
OFFICE COPY