The URL can be used to link to this page

17355 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BIJI LDING PROJECT IDENTIFICATION 1. PERMIT NUMBER BU LOINS APPLICATION & PERMIT ADORESs BUILDING-ELECTRICAL-PLUMBING-MECHANICAL NICAL F(.O, 17355 IOSI �- ltr i ¢, owNERS PLAN CHECK VALIDATION , NAME ` CITY. ELECTRIC PERMIT FEE I `JC.GJ!�I PHON�SOr_O II CONTRACTORS U TS-SWITCHES-RECEP 10.00/1.00 +10.5 a+f uc.rvo. �/(o SdL LIGHTI FIXTURES 10.00/1.00 ADDDDRREE•SS/T�ORS (.L 3 % 9Aly aP PPLI ANC -RESIDENTIAL 4.00 ' ' /V3-ca 1aSt.JF PHONE PANELS 10.00 DATE OF APPLICATION,,' ARCHITECT PLAN CHECK FEE P.C.NO, OR PANELS (OVER 2 AMP) 20.00 ENER LIC.No. SIGNS TRANS. 3.00 AENG: .. PERMIT VALIDATION ' ADDRESS ooREss SPECIAL CIRCUIT 5.00 I ' ZIPEMP.METER OR POL ADDRESS Ars MOTORS SEE FEE SCH. Illi u\W-�1 ADDRESS SERVICE CHANGE �-�' 20.00 3IL,Oh woo LICENSED CONTRACTORS DECLARATION a u 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ' a,a N (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH, H L i Professions Co ,a� my license is in full toren eL ❑ ❑- o i y W License C -FiC� Con Number W 154 H w H Dulc ��v � Contractor�5-= rc a, Q a OWNER-BUILDER DECLARATION BUILDING PERMIT - a u - INFORMATION a'x ; LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL O ¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. M sr PERMIT ISSUANCE 10.00 Code:Any City Tpr county which requires a permit to construct,alter, ' IF a, I¢ 2 Improve,demolish,or repair any structure,prior In Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. ym LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w he is licensed pursuant to the provisions of the Contractor's License r z a Law(Chapter a(commencing with Section 7000)of Division 3 of the 4 O Business and Professions Code)or thathe is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r $ rhe basis for the alleged exemption.Any violation ol'Section 7031.5 - STORIES TYPE CONSTR. by any applicant for u permit subjects the applicant to a civil penalty qLT -DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500t): ❑ 1,as owner of the property,or my employees with wages as BACK OW,PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINNRTRAP AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of _ property who builds or improves thereon,and who docs such work FIXTURES, 5.00 M FT.FLOOR AREA TDTAL ACREAGE himself of through his own employees,'provided that such improve- mems are not intended or offered for sale.If,however,the building GAS-E .40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EER 4 (EA.)' 2.00builder will have the burden of proving that he did not build or im- BUILDING USE. -RES IND CON PB Other prove for purpose ol'sale.): INDUSTER', 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑.• ❑ ❑ ❑ ❑ licensed contractors to ronslruct the project(Sec. 7044,Business LAWN SPRINKLERS-.1 1 5 V-B. ^6.00 ASSESSORS PARCEL NO. " and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS•OVER (EA.). 1.00 contracts forinch License Law.h projects with a contracmrfsl licensed pursuant m the Contractor's SEWER-SANITARY-STORM EA. Oft/10.00 TRACT NO. PARCEL NO. - ❑ tum exempt under Sec.-,BARC.for this WATER HEATER W/VENT 6.00 reason Owner Duce WATER SYSTEM 5A0 ACC.DATE ACC.FILE NO. WORKtRS'COMPFNSATION DECLARATION WATER TREATING EQUIP, 5.00 ° I herebyefflnh that I Imve a certificate of consent to aclf-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof((S$e�c�.3�800,Lah.C.). e Policy No.SLCompa y ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z 111-Certified copey is riled with the city inspection division. MISC- REFER TO ORD. O Applicantttx� Y❑ N❑ Y ❑ Is ~ _N PERMIT ISSUANCE 10.00 FLOOD20NE A.L.U.C. � CF:RTI FICCO1 OF PAX I MINS FROM WORKERS' W � COMPIiNSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. CL Q (This section need not he completed if the Penn it is for one TOTAL Y❑ NO Y,❑ N❑ =) Z hundred dollars IS 1 00)or loss) U0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued, I shall not employ any person in any mnnnerso as to O U become subject to the Workers'Compensation Laws of California. , Uate Applicant BUILDING a ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,after making this Certificate of Ex. 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 CONSTRUCTION LENDING AGENCY AIR HANDLING 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 for which this permil is issued(Sec. MICROFILM 3097, Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) *00 9.va . Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC . ' I certify that I have read this application and stale thm the shove VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply wilh all city unJ county PLUMBING ordinances and stale laws relating to building construction, and BAILER-Q7MPI3 H.P.Of 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL 2 �� 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 }AsAQ �, CONST.TAX may h any way accrue Against said City in consequence uence of the OO rant! Iof this permil. MECH.CONT. LIC.NO. MECHL . 3 /s-� /�y TOTATOTAL e0 Signalu Applicant/Contractor Dam ` 1 1A5 ��O•��a(p /-00 21 1-` OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERM IT NUMBER CITY OF CUPERTINO, - 17355 INSPECTION DIVISION, • JOB INSPECTION RECORD / J• PERMITEXPIRATION JOB ADDRESS 0505 orz , UNIT# - _LOT4t T ��/4) G PERMIT EXPIRES IF WORK' OWNER ' 'CONTRACTOR - IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT,ISSU- FOUNDATION - ANCE OR 180 DAYS FROM - NOTE LASTCALLEDI NSPECTION. LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT-VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - E, I t. iy f• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -UNDERGROUND /SLAB PLUMBING1 v - ELECTRICAL - ,� T .1 ISSUANCE DATE MECHANICAL - �j / Oc ELECT. • PLO. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIED l BUILD,LLNG PERMIT N FQ'RMATI ON WOOD FLOOR VALUATION $/FT. • PLUMBING - � � - � - ' MECHANICAL ELECTRICAL - - PERMIT TO FRAMING sroRlEs , TYPE CONSTR INSULATION . OCC GROUP RES.UNITS �o" ale PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGftp ROOF LL BE MADE.BEFORE ' SO,FT FLOOR AREA TOTAL ACR.EAGL DIAPHRAGM - - - THE CONSTRUCTION TAX IS PAID ' ROOF SHEATHINGUILDING_ . ` � RES IND CON USE 00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED- FINALS. DATE INSP. ElQ Q El 1:1ROUGH - USAN.# nssessons PARCEI.No PLUMBING - ELECT.ENERGY TRACT NO PARCEL NO - TUBS&SHOWER PANPLUMBING ENERGY-- . MECHANICAL ' MECH.ENERGY- ACC DATE ACC.FILE NO ELECTRICAL, BUILDING ENERGY. - FRAMING , _ - ELECT.FINAL TEST, - ZONING ENG.SITE NO. ' INSULATION' - � PLUMBING GAS TEST - GAS ' MEGHANIGAL.'` FIRE SPRINK, ENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING. Y E]' N Y ❑ N� T EXTERIOR SHEAR 'r- ELECTRICAL RELEASE . FLOOD ZONE ALU C. INTERIOR SHEARFIRE'DEPT. NEI ' Y L N[D SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH . BUILDING _ INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIR�D.INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE'— MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ._ OFFICE COPY