17294 -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 17294
ADDRESsa(a 7_7Y 1X,40.esTC mWA l!/ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL , 1 ] J
OWNER'S PLAN CHECK VALIDATION
NAME. OTY. ELECTRIC PERMIT FEE
,J / vHDNE Z,3' -1ur
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
�1� .�i�f�i uC.No. 570*/ LIGHTING FIXTURES 10.00/1.00
CONTRACTOR S �/ y PPLIANCES-RESIDENTIAL 4.00
?6-
'411 br,IwJ]po /f C
PHONG pG PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH.On ENG. - SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS G
ZIP TEMP. METER OR POLE INS. 20.00 1-1 7
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS �0�
SERVICE CHANGE 20.00 i
Pr
w o o LICENSED CONTRACTORS DECLARATION
U,� I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
N<h (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F N z Professions Code,and my licmmse is in full force and effect. ❑ ❑ I� ❑
a D,.t - License Class I,ic.Number LI
H w Dalc Comlm,tro
BUILDING PERMIT
Sc ¢w 4 OWNI!R-BUILDIiR DECLARATION
= oAU MISC.- REFER TO ORD INFORMATION
w rc yL m I hereby collo That I so exempt from the Contractor's P's License VALUATION S/FT.
H u o Q Law for the following reason.(Sec.7031.5,Ihtsincss and Prnfossions PERMIT ISSUANCE 10.00
Code:Any city or county which requires a penin(to construct,alter,
2 Q 20 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PJgRMIT TO
a wm he is licensed pursuant to the provisions of the Contractor's License �(.
Fzi w
Law
- a Business and Professions Code)or that ht is exempt therefrom and QTY. PLUMBING PERMIT FEE r,
r o IhC basis for the alleged escau,tion.Any violation of Scclion 7031.5 STORIES TYPE CONSTR.
a.5, by any applicant l'or a permit subjects lire applicant to-cavil Iclmlty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).1:
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP RES.UNITS
their sole compensation,will do the work,and tire structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND- 5.00
Code:The Contractor's License Law does not apply to on owner of
properly who builds or impruvcs thereon,and who does such work FIXTURES-PER TRAP 5.00 so,FT.FLOOD AREA TOTAL ACREAGE
himself of through his own employees,provided that such improve-
P� rents are not intended or offered fur sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of conmplelion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or am- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1:1 ❑ ❑
❑ I,as owner of the property,am CxCluslvCIY contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 commetous)licensed pursuant to
the Contractor's License Low. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ 1 en"fart under Sec.-,L&P.C.tie this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 PCC,-DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of consent lir self-insure. kSZ Cum '�[(Jjj ZONING ENG.SITE N0.
or n certificate of Workers'Compensotiun Insurance,or u certi0cd
copy there.](Sec.3800.Lab.C.).
Policy No. Company -
O ❑ Certified copy is hereby famished. FIRE SPRINK ENERGY T24
Z Z O Certified copy is filed with the city inspection division. TO ORD.MISC.- EFtER y ry y N
O Applicant ❑ [:] [:] ❑
CL N CERTIFICATE OF EXEMPTION FROM WORKIiR$' PERMIT ISSUANCE 10.00 itq, FLOOD ZONE A.L.U.C.
IL > COMPENSATION INSURANCE PLG.CONTR. p,{vLJ(j yq,ro�:^^ PLG. ' �L s� ❑ ❑ ❑ ❑
4. O (This section need not be conmpleted if the permit is for o Y 1t. Vl 118neft, Y TOTAL Y N Y N
Z) Z hundred dollars IS 100)orIcs,) one
U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,1 shall not employ ar,person in any Inanity so as to
OW become subject to the Workeri Compensation Laws of California. BUILDING
Dale Applicant ALTER OR ADD TO MECH. 5.00
>_ cry NOTICE TO APPLICANT: If.after making this Certificate of F.
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
morisions of lira Labor Cody, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION L3NDWG AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a'
construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work fur which this permit is issued MICROFILM
3097,Civ.C.).
HE UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
/ Lender's Andrea
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ILft
00
information carate(. I agree to b with all city and county BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stale laws relW ing to to building construction, and
hereby authorize representatives of this city to enter tmon the BOILER-COMP (Over 100,GOO BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for Inspection Furrows.
(We) agree to save, indemnify and keep harmless lire City of MISC.- REFER TO ORD.
Fllu"e,
tino against liabilities,judgments, costs and expenses which CONST.TAX
in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ing of this permit. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL Iq,W
Signature of A pplicant/Contractor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 17294
INSPECTION DIVISION
JOB INSPECTION RECORD
^ PERMIT EXPIRATION
JOB ADDRESS�y�/. L J�_Y\RQFS*tEE^ UTk'WYUN1T# LOT#
_ 11PERMIT EXPIRES IF WORK
OWNER 'sM \�C 1 CONTRACTOR Ctw} PUKIn 1 O�1 IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE RD 180 DAYS OF PERMIT ISSU-
FOUNDATION ' ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND.DRAINAGE SHALL BE INSTALLED
PREGUTO COMPLY WITH THE APPROVED PLANS AND CITY OF N RMIT VALIDATION
GARAGE ITE CUPERTINO STANDARDS.' 1 L Q
GARAGE SLABS ��'�'1'—V
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL
BLDG ELECT PLG. MECH
-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING
MECHANICAL
PERMIT TO
ELECTRICAL - "IF,.%\
^
FRAMING I"1wr W.' -
STORIES TYPE CONSTR,
INSULATION
. OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
50.1 T!LOON TINEA TOTAL nCIiEAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
.a ROOF SHEATHING Nes INO ,CON PB o11—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L
ASS[SSOHS PARCEL NO
ROUGH- SAN.#
PLUMBING ELECT.ENERGY
IHACi NO. PARCEL NO
TUBS&SHOWERP✓,N PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ACL FILE NO
ELECTRICAL BUILDING ENERGY
.ec•+B
FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO
INSULATION PLUMBING
GAS TEST GAS 4 I:,,.
FIRE SPRINK ENERGY TQ9 '
MECHANICAL v NL v ❑ NL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 0 U B ID
FLOOD ZONE A.
EXTERIOR SHEAR ELECTRICAL RELEASE --I
INTERIOR SHEAR- FIRE DEPT. Y[] NL YL N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR'LATH 113UILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
O.� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! covsr.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL '-II Po
CALLING FOR FINAL INSPECTION.
OFFICE COPY