18376 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BnlLonucAPPLICATION & PERMIT
E AooREss
MCD&$ �p . BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 183 7 6
OWNER'55 N� Y/ / PLAN CHECK VALIDATION
Zr o�TS�=� DTV. ELECTRIC PERMIT FEE
PHONE
croRs
NA.E UTLETS-SWITCHES-RECEP 10.00/1.00 5.17
NAME
LIC.NO. LIGHTING FIXTURES 10.00/1.00 ,
ADTRARESS ons PPLIANCES-RESIDENTIAL 4.00 , 0
COND
PHONE PANELS 10.00 DATE OF APPLICATION
AOR HCHIrscT oaf. - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No.
(� DorwvS Il�1�Q'e'LJ
ENGINEERL LIC NO. SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION,
')395 �ed.
zIv (/ EMP.METER OR POLE INS. 20.00 7 Z7�,�
AvvucArvr'S MOTORS SEE FEE$CH.
AooREsS
SERVICE CHANGE
PAID 20.00
_02 LICENSED CONTRACTORS DECLARATION 14 1
¢.u 1 hereby affirm that 1 am licensed under provisions of Chapter 9JUL ISSUANCE DATE
wG e, Ieommerang with Sue louts 7000)of Division 3 ofthe Business unit BLDG. ELECT. PLG. -MECH.
H w z Professions Code,and ny license is in full force and effect. �r ❑
,Zo m - License Class Li,Num her
0
H OW Datf Contract. 11
y f BUILDING PERMIT
¢ ¢ w u OWNER-BUILDER D17CLARATION INFORMATION
K
3 u 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
.. oa Law for the following reason.(See.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 �a�V VALUATION S/RT.
E -
Code:Anycity or county which requires a permit to construct,alter,
2 ¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ��GDP
ELEC.
to
- a ¢ requires the applicant for such permit to file a signed statement that TOTAL,2_q-V PERMIT TO
a w m" he is licensed pursuant to the provisions of the Contrnctur's License n 1
Hzin Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /(� �r�I 1
- Q Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE /`L Y.e- 0.
¢F p the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
to ate - by_uny applicant l'orapermitsubjebts 0te applicanuoacivil penalty�ny ALTER-DRAIN -WATER MA.) 5.00 rD(�
st man,than five hundred doll...($5001.):
1�3 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS
t Relr sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Pul'essions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds nr Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 FOD 50.FT.FLOOR AREA TOTAL ACREAGE
moot,am through his own employees,provided that such insprove-
tsentsarenotimm�dcdonoffered eesalf.Iided that however,the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that lie did not build or on.
prove for purpose of soleal. INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe Other
1.as Owner Of the property,am exclusively contracting with ❑ ❑ ❑ ❑ 1:1
licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL 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 contractor(l)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL NO.
O I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
.sots
Owner _ Dat` 7. . WATER SYSTEM 5.00
ACC.DATE ACG FILE NO.
Pc WORKERS'CONIPEN ,TION DrCLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate(it consent to th-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy themol'(Sec 3800,Lah.C.). _
Policy No. Company
O ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY T 24
Z_ 2 ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
0 Applicant Y ❑ N❑ I Y ❑ N❑
CCCF:RTIPIC
♦- y> CO
PERMIT ISSUANCE 10.00 ,p FLOOD ZONE A.L.U.c.
' S
I11 MPEIiIiXEMPTINSAT'ION INSURANCE FROM WORKERS' PLG.CONTE. LIC.NO. PLG. '`�� q
d O IT section need not be completed if the permit is for one TOTAL .2P2.0 V Y❑ NE] Y❑ N❑
7) Z hundred dollars IS 100)or less.I
U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I sl all not mnploy any person in any manner so as to
U becom t Workers' mpcmey'.onLw 'Culitornl ' BUILDING
O Ho Darn - pplicant_'TO�t6ALTER OR ADD TO MECH. 5.00 B
Y to NOT'I IO A'PLICAN'I': II,,dlcr nlakmg this Cenil roof lix-
F. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK „
provisions of the Labor Code, 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
CONST RUC'I ION Ll LADING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE a
I hereby al inn that there is a constnmtion 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.). I HEATING UNIT(T0 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC - QO
Lender,Address
oomati'y that icI haveorrect read this application and state thatitc above
VENTILATION FAN (SINGLE) 4.00 /+
information n correct. I agree to comply with all city and county BOILER-�GMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING ,UV
ordinances .nit state laws re lading m huilJing construction, and
hereby authorize representatives of 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 hurmlaz the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
r go f this coni. MECH.CONT. LIC.NO. MECH. p
TOTAL TOTAL 2GY�l�
Sidnaturs,ot'Applicart/Crint for c
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING eRMIT/Idfq
CITY OF CUPERTINO 18376
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_�L- P2- ---��L UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER c� ,� CONTRACTOR �� IS NOT STARTED WITHIN
INSPECTION ATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSU.
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROI&W AND CITY OF PE WI VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS 7 '^� C/
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Z /
UNDERGROUND /SLAB
PLUMBING �. 1'F ;7v IA Jr`
ELECTRICAL - J
717-77
PLIS
d LUG f:L[Cl PLC:.A IL iMlp+
MECHANICAL tyl ,Ty
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION SiFT.
PLUMBING n
r
MECHANICAL V �'� II +
PERM1III i0
ELECTRICAL
FRAMING
w STORIES 711E CONS R
INSULATION -
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
so Fr FLoov al+ea *Ural ao+cace
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND CON Pd O,Ile,
13
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. '� ❑ ❑
ASSESSORS PAHCEL NO
ROUGH SAN.0
PLUMBING ELECT.ENERGY
LHACI NU PAHCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL p MECH.ENERGY Q -
ELECTRICAL BUILDING ENERGY O ACC DATE ACC FILE No
FRAMING ELECT.FINAL TEST /1.$� 6 ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE 51RINK ENERGY TQ<
MECHANICAL _�J `/
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ^� v NE]
EXTERIOR SHEAR i ELECTRICAL RELEASE FLOOD?ONE AL U
— i o 1E] No ❑ N
INTERIOR SHEAR FIRE DEPT.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING 0 BUILDING pD
INTERIOR LATH - TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE Q
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERMITTED UNTIL BLIILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ,
Q`Q
WELECTRIC. ARRANGE FOR INSPECTION BY PHONING 252-4505,
F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00� PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION.DATE - rCHANICAL
IMPORTANT! NST.TAx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY