12106 �. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT.PEN ONLY
BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER
V
ADR G - APPLICATION & PERMIT 12106
A00Eaa
Lrw, BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME
b QTY. ELECTRIC PERMIT FEE '
Mv. 1a5 PHONE
tr`,.,.-y/ NAMERA oRs OUTLETS:SWITCHES-RECEP 10.00/1.00
IC.No. ,a1570 LIGHTING FIXTURES 10.00/1.00
CONTRACTi55ORS `
lONTRAC P ` 1� �Q� - APPLIANCES-RESIDENTIAL 4.00
l ' 1 PHONE 62-1 PANELS 10.00 DATE OF APPLICATION
AR
CHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No.
NCI
uc.No. SIGNS TRANS. 3.00ARC •
ADDRESS OA erva. SPECIAL CIRCUIT 5.00 ' PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
TS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
woo LICENSED,CONTRACTORS DECLARATION
a u
P. 1 hereby affirm that I am licensed under provisions of Chapter 9 '
2 w ISSUANCE DATE
G Q H (commencing with Section 7000) in Division 3 of the Business and BLDG, ELECT. PLG. MECH.
H 2 z Professions Code, d my license is in full farce -. e((ed.
O m - Li Is Class Lia NumberI�o � ' 1 •�y
4 N•t•w Date Conlmetor� L
Q y E J �C
S, rt w O NER-BUILDER DECLAR IAT I1N�k BUILDING PERMIT
K °' MISC.- - REFER TO ORD INFORMATION
3 u w 1 hereby affirm that I am exempt from the Contractor's License $/FT.
'n u O¢ Law for the following reason.(Sec.7031.5,Businessand Professions 10.00 VALUATION
- PERMIT ISSUANCE
m> Code:Any city sh county which structure permit toconsuanc ater
7 a (-,h\
Q O improve,demolish,or repair h p structure,prior n its issuance,also ELEC.CONTR. LIC.NO. ELEC.
y x c u requires the dp urmal'(ot such permit t0 file a signed actor's i that TOTAL PERMIT TO�
w m he is licensed pursuant to the provisions of the Contractor's License
ri> Law(Chapter 9(commencing with Section 7000)of Division 3 of the � P��rGM
a Business and Professions Code)'or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE `11
M 1 g the basis for the alleged exemption.Any violation of$ection 7031.5 j STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN 5.00
of not more than five hundred dollars($500).): -
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
their are compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7144, 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 F IXTUR ES-PER TRAP 5.06 SQ FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees.Provided that such improve-
/ or nts Improvement not
is sold or within ed one y ar o lcompleveq thebuildingowner,
GAS-EA.SYSTEM-1 INC.4OUTLETS 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.). RES IND CON PB Other
'❑ 1.as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 ❑ ❑
licensedd contractors to construct the project(Sec. 7044,Business LAWN SPR INKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law doesnot 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have.a certificate ofconsent to self-insure,
or a certificate of Workers'Compensation Insurance,ora certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). -
BRTI!FIC
Company
0copy is he by furnished:
Z Zy is le 't the city inspection division.
FIRE SPR INK ENERGYTZ4
O MISC.- - REFER TO ORD. Y E N� Y Q N�
~ rn PERMIT ISSUANCE 10.00
-0: - ATE OF EXEMPTION FRO WORKERS' FLOODZONE A.LLLC. I '
W COMPENSATION INSURAN E PLG.CONTR. LIC.NO. PLG, V N O V N
�' (This section need not be completed if the permit is for'one TOTAL
D Z hundred dollars IS 100)or less.)
U 0 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL-U mit is issued,I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws of California.
Date Applicant BUILDING �5�..�
Do ALTER OR ADD TO MECH. 5.00
} 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- -
2 emption.You should become subject to the Workers'Compensation APPLIANCE
I - 5.00 PLAN CHECK "
provisions of the Labor Code, you must,forthwith comply.with FEE
U such provisions or this permit strait be deemed revoked AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 'SEISMIC FEE,. /
• Thereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the 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 HEATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC - ..
0VA,
^ I certify that I 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, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ol' this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection 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 wa accrue against said City in consequence of the
grantin of this eimi MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
V 0
Signature 51, pplicant/Contractor Dale I
- FFICE COPY ',
POST THIS CARD NEAR FRONT•OF BUILDING. PERMIT NUMBER
. .CITY 'OF . CUPERTINO 12106 .
'INSPECTION DIVISION" I _ '
\\\ JOB INSPECTION RECORD
Sy � PERMIT EXPIRATION`
'`---, JOB ADDRESS - ��' (/ '•�• U T#• LOT `
PERMIT EXPIRES'IF WORK
OWNER CONTRACTOR ISS NOT STARTED WITHIN
INSP CION DATE . INSPECTOR INSPE I N EC '480 DAYS'OF PERMIT ISSU-
- - ANCE OR 180 DAYS FROM
FOUNDATION , .
LIFER - _ " LASTCALLED INSPECTION.*
PREGUNITE - ^ • PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
1, PLUMBING
ELECTRICAL - ISSUANCE DATE ,
` MECHANICAL ' - - BLDG. ELECT. PLG. - MECH.
' .1 ��, ❑ ❑ 'r ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED, BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION •.S/FT.
PLUMBINGs
' MECHANICAL
-
PEH_ TO
ELECTRICAL S O
FRAMING . . ..
R
' • 9T0 IES TYPE CONSTR.
INSULATION ' � r ^'� ,
u OCC.GROUP RES UNITS
PLACE NO SUB FLOOR UNTIL ABOVE HAS BEEN SIGNED
IROOF SO.IT.FLOOR ARE TOTAL FCflEAGE
/ DIAPHRAGM
-
I \•„ -_� ✓' RES IND CON F"�PB OMer
' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑' ❑' ❑ ❑ El
ROUGH
ASSESSORS PARCEL NO.
. .
PLUMBING Z //
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL' -
ELECTRICAL�X(AC Pf 'f_—Ab=xc - MHEATING
DATE INSP. A,cc.DATE. Acc FILE NO.
FRAMING cv..b.Q Z_INSULATION I' -„ �.. 6 1 ZONING ENG.SITENo.
,. FIRE SPRINK ENERGVT 2000VER NO WORK UNTIL ABOVE HAS BEEN SIGNED v OO NO "LATH—INTERIOR PL000 ZONE aE.u.c.
LATH—EXTERIOR FIRE DEPT. - v N] v l] IN E]
SHEETROCK
GRADE FEE SUMMARY I
SHEAR INTERIOR ' BUILDING e _ ,O-k7
- U
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS - ELECTRIC - PLANCHECK
% .. GAS FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYrSEISMIQFEE
OCCUPANCY OF,BUILDING ISNOT PERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR: •MICROFILM -
ARRANGE FOR'INSPECTION BY PHONING 252-4505, ELECTRIC
✓ `I FIN- ONE WORKING DAY BEFORE•REQUIRED, INSPECTION: PLUMBING
(�` O `PLEASE GIVE JOB ADDRESS WHEN PHONING.-
P", z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
"
IMPORTANT! TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL t
CALLING FOR FINAL:INSPECTION. /t
- OFFICECOPV -