The URL can be used to link to this page

18687 -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •40b, - BUILDING PROJECT IDENTI FICA710N' PERMIT NUMBER BUILDING APPLICATION & PERMIT a� O[� Q ADDREss ^' I• CJY U e dg,•( UILDING - ELECTRICAL-PLUMBING-MECHANICAL �' 18 v C) OWNER'S PLAN CHECK VALIDATION NAME - OTV. ELECTRIC PERMIT FEE d1n(sT- ..NE �S'Zro7y CONTRACTOR �i N C_ O UTLETS-SWITCHES-RECEP 10.00/1.00 6 rJO'-5UCNO.4O�L LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESSDRESSAPPLIANCES-RESIDENTIAL 4.00 A ''fp82,780'j PANELS 10.00 DATE OF APPLICATION ARCHITECT i, I PANELS (OVER 200 AMP) 20.00 ---PLAN CHECK FEE P.c.No. OR ENGINEE Coo uc,Na. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 ^(/%/t EMP. METER OR POLE INS. 20.00 /v APPucnrvrs MOTORS SEE FEE SCH. ADDRESS ��'''111 SERVICE CHANGE 20.00 /// /� /)/ woo LICENSED CONTRACTORS DECLARATION v - (/�<A / t u U I hereby of Firm that I nm licensed under provisions of Clmpter 9 - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r i Professions CoJyLand Fri is in full top�6 eflgc I t 1 7 ❑ ❑ ❑ ❑ z o i2 - License Class rl Uc.Nmnber- 4 6 1c x v r .v a v, Date Contractor i-tt1-�$�-\ �c�=MzSSa� In Ic w a OWNER-BUILDF DECLARATION n BUILDING PERMIT V INFORMATION E: I- I hereby infirm that I am exempt m the Contractor's License MISC.- - RTO ORD 3 0¢ Law for the followingrcason.(Seo 7031, usmessand Professions PERMIT ISSUANCE 10.00 `vA,Lunn ON S/FT. Code:Any city or county which requires iLlo construct,alter, 1 U ce sa Q G improve,demolish,or repair any structure,pilot In its issi mince,also ELEC.CONTR. LIC.NO. ELEC. l 0 D in D IS requires the applicant for such permit to file a signed smtemcnl.pWn TOTAL PERMIT TO w w_" he is licensed pursuant In the provisions of the Contractors Licer w P rzi Law(Chapter 9(enimencingwith Section 7000)ofDivision 3of0m �� // a %oriels and ProlesSmus Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE & SE the basis for the a lleged cxemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. .w by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): j ❑ I,as owner of the property,or my employees with wage as BACK FLOW PROTECT. DEVICE 4.00 DEC.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 property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided shat such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 menu 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 BUILDING USE builder will have the burden of proving that he did not build or ins RES IND CON PB Other prove t'or purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the pimuct(See 7044,Business LAWN SPRINKLERS-1 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 commons for such projects with a contractor(s)licensed pursuant to SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contract for such h projects Law. ❑ I am exempt under Sec.-.B&P.C.lin this WATER HEATER W/VENT 6.00 reason Owner We WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS*COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent lei self-insure or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab C.). Policy No. Company Q ❑ Cctlifed copy is hereby famished. FIRESPRINK ENERGY T-24 Z Z D Certified copy is filed with the city inspection division. O Applicant MISC.- REFER TO ORD, v ❑ N❑ v ❑ No j y CFRTIFICATli 01'Iix Em PiION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AL.u.C. UJ >_ COM1IPENSA"PION INSURANCE PLG.CONTR. ❑c.NO. PLG. IL O 1'1'his section need non be completed it the Permit is for one TOTAL v❑ N❑ v ❑ N❑ ::) Z hundred dollars(S 100)or less.) U O 1 ecHify that in the perfurmuncc of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I sha11 not employ any person in any Flapper so as[o UU bccomm subject the WorkeWorkers' oc C.ou ration Lawsof Californio. w A BUILQa pp ALTER OR ADD TO MECH. 5.00 } rola Dane licam NOTICE*1'0 APPLICANT: It, DING',after making this Certificate of Ex- F. ? emption,you should become subject to the Worker'Compcnsatimt 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 10MCF.M,) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE 1 hereby 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(Sic. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender'sName HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address Icertify[],at l have read thisapplicmion..it state than 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 of this city to enter upon the BOILER-COMP(Over 100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property I'or inspection purposes. (We) agree no save, indemnify and keep hmmlcss the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ra!Z of 1 is permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of Applicant/Contractor OFFICE COPY M1�✓ POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMI3EF CITY OF CUPERTINO - 18687 ,. INSPECTION DIVISION JOB INSPECTION RECORD � 7� PERMIT. XPIRATIDN { JOB ADDRESS 2ztf� -1iy9,5" e6'�s UNIT# LOT# 1 (( PERMIT EXPIRES IF WORK OWNER k�/,0- CONTRACTOR m4!� 1—, 10l /IS IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL Be INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF 'e RMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS • POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .///GAJ-'�'hClGt`� UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DAT MECHANICAL BLDG e77 PLc, MECH ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED f I[ V7 SDR B`INFOIRMATIONT PERMI WOOD FLOORVALUATION IS/FT. PLUMBING AF ' �I QaQ,, MECHANICAL - / / PLHMIT TO ELECTRICALAj =�1A�`,. FRAMING A / NY sTOHIES Es IVPE coNsiH INSULATION ' 1It OCC GROUP HES UNITS L PLACE NO SUBFLOOR UNTIL ABOVEHAS BEEN SIGNED SO [1 FLOOR AREA TOTAL PCP[PGL ROOF NOTE:NO FINAL INSP.SHALL B MADE EFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING - HES IND CON PB Ow., El 0 El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.p PLUMBING ELECT.ENERGY iHACi NO. PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY 1 ACC DATE ACC FILE NO 1 ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE$PRINK ENERGY TQ9 MECHANICAL ❑ NE-1 v ❑ N1:1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD zorvE ALuc EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v❑ N� . ❑ IN SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING ,00 SCRATCH COAT ELECTRIC PLAN CHECK ter_ FEE GAS �j. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 9't$' OCCUPANCV.OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z' MECHANICAL - - SEE PERMIT FOR EXPIRATION DATE - r IMPORTANT! CONST.TAX PLEASE SIDE BEFORE CALLING FOR FINALE INSPECTION. TOTAL 1�53•Cf� OFFICE COPY