15014 o• APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY
•� 1r r
BUILDING'PROJECT IDENTI FICATION PE EMIT NU MEER'APPLICATION & PERMIT
BUILDING
ADDRESS
15014
Vt BUILDING-ELECTRICAL-PLUMBING.-MECHANICAL .'
OWNER'S PLAN CHECK VALI TION
NAME OTV. - ELECTRIC PERMIT FEE
� _C�(�tdlPGc�
CONTRACTO s / / q`�, UTLETS-SWITCHES-RECEP, 10.00/1.00 S
NAME /
I uc.NO. 2 LIGHTING'FIXTURES ES 10.00/1.00 O+U
ro PPCIANCES-RESIDENTIAL 4.00
g Ess"
,.PHONE "PANELS 10,00 DATE OF.APPLICATION
amcHir l D
PLAN CHECK FEE P.C.ND.
PANELS'IOVER 200 AMP) .00
GRGINEER
ph
]SIGNS TRANS. 3.00-
ARCH.OR ENG. X1'1' SPECIAL CIRCUIT 5,00 PERMIT VALID ATIOl
ApORE 5 / `' /• AT 5�.1 'N
Znv EMP.METER OR
POLE INS. 20.00 /J
ADORE urs MOTORS SEE FEE SCH.
AooRE as
SERVICE CHANGE 20.00 _ SX / �
p ,
w o o 1 LICENSIi1)CONTRACTORS DECLARATION _
- ¢v v, I hereby.(limn that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
H G w (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w z Professions Code,and my license is in full lone and effect. ff'71 ❑
,z O _ Lice, c Class Lin.Number
O z r' )ate Contractor
< x BUILDING PERMIT
¢ ¢ w < OWNER-BUILDER DECLARATION
MISC.- REFER TO ORD ORMATION
w3 n h .I hereby affirm that I am exempt from til.C Contractor License -
o J Law for the following reason.(Sec 7031 5,Basmessand 1 r hl scions - PERMIT ISSUANCE - --$e.BB a LUATION $/FL
ve
. Cod AnY city or county hichr Imr 'apermit th n'tract,alley
¢ ¢ < 2p inlpr InhIh repairstructure,yprior lr1issuance,also ELEC.CONTR. LIC.NO. - ELEC.
O ¢ Initials th '1111eaut for Sall permit to 111 a s 6 t d tinter L l that ' TOTAL O en
PERMIT TO
A w�I`s lieis licensedp ...tent to Lie p ov' ians of the Contractor's Liccme - A��/�Ca�
Law Chapter 9(commencing with Section 7000)of Divtson 3 ofthe - 7T
a Business and Professions Code)or that he is exempt therefrom and DTV. 'PLUMBING PERMIT. FEE•
¢ =$ t Ic basis for tm alleged exemption.Any violation ol'Section 7031.$ STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to.civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 /
of not more than five hundred dollars($500).) -
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
then sole compensation,will do the work,and the structure is not OCC.GROUP 'RES.UNITS
on
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'I'he Contmctor'sLicense Law does not apply to an owner of
property who builds or improves thereon,and who does such work - FIXTURES-PER TRAP - 5.00 So,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that one h inhprove'
ments,are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-I INC.4'OUTLETS 6.00
s or improvement is sold within one year of completion,the owner- GAS-'EA.SYSTEM-OVER 4 (EA.) 2.00 BW LDING USE
• builder will have the burden of proving that he did not build or int- RES IND CON PR Other
\/ prove for purpose of.eele.). INDUSTRIAL WASTE INTER. .30.00 13 El ❑ ❑ 1:1C I,as owner of the property,am exclusively contracting will
--"-- - licensed contractors to construct the project(Sec.7044, business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 AGSE55oRS PARCEL No.
to nofccions Cr c:The Contractor improve,
Law doesnalapply
In in owner of per11 ,Co builds or improves w does.and w11O LAWN SPRINKLERS-OVER 6IEA.) '1.00
ontrmte fur 9u I projects will- ntrmtar(sl licensed pursuant m ,
cntrhe atsbtr,rs ic,msc SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I:unc 'm t -r 'cc ,It.61'.C.Ii,r this WATER HEATER W/VENT x6.00 -
son
Owacr Dat, . . WATER SYSTEM ' . 5'.00
ACC.DATE ACC.FILE NO.
OR SRS'C(. PIiNSATIONDECI,ARA'I'ION' WATER TREATING EQUIP. 5.00
I h eby al Inn that Dave a cetlifivm,of......cut to sell-insua,C ZONING ENG,SITE NO.
at a -ilificat of Workers'Compensation Insurance,ore certified
copy thereof Sec.3800,Lab.C.). ?
Policy No. Conine, -
O ❑ Cenili d copy is hereby furnished. FIRE SPRINK ENERGY L24
Z Z ❑•Ccrtil -d copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y❑ N❑, Y ❑ No
y CIiR 'IPICATIi OF P:XE4IPTION FROh1.WORR1iR5' PERMITASSUANCE 10.00 FLOOD ZONE A.L.U.C.'
LU
Q COb1P1iNSATION INSURANCE PLG.CONTR; LIC.NO. PLG. - V❑ N❑ V ❑ N❑
1'1'his see ion need nm be conhpleted it the permit is for one TOTAL
Z) Z hundred dollars(5100)or less,)
U O I cerlity'that inthe pertormance of the work lit which this per, OTV. MECHANICAL PERMIT FEE FEE SUMMARY '
LL F mit is issued, I shall not employ any pcaon in any manner so as to
O w hecome subject to the Workers Curn ueut ion Laws of California. -
O
0. Datil - Applicant ALTER OR ADD TO MECH. 5.00 BUILDING /(,'SLS
} 0 NO]ICE '1'0 APPLICAN'1':'11';after making this Certilicule I, fix- -
F ? ."'Phan,you should become suh)cct to the Workers Con,.vitu as APPLIANCE - 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
'U
SLI' ....vision,or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) '4.00
CONS'I'RUX7HON LENDING AGENCY AIR HANDLING UNIT(OVER lO,DODGEM.) 6.00 SEISMIC FEE
1 hereby affirm that there is'a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 .
the performance of me work for which this permit is issued(See. - HEATING UNIT(TO 100,000 B.T.U.) 8.00 r MICROFILM
3097,CN.CJ. G
_ Lender;s Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 - ELECTRIC
Lenders Address
1 certify that I have read this application and stale(hal the above VENTILATION FAN (SINGLE) '4.00 r
ordinances h n correct:1 s rel to comply with all city and county PLUMBING
ordinances unci stale laws relating c to building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.1 6.00
hereby authon,c representatives of this city to enter upon the BOILER-COMP totter 100,000 BTU)SEE FEE SCH. MECHANICAL
abovc-mentianed property for inspection purposes, '
OVOagree save, indemnify and keep hannlass the City of MISC.- REFER TO ORD. -
--r - upertino a• in. liabilities,judgments, costs anse
d Cxpens which CONST.TAX
may ill an iw -.accrue ugai City in consequence of the PERMIT ISSUANCE -18.00 -'
Can
•ref hie renni
• t. MECH.CONT. LIG NO. MECH. '
• TOTAL TOTAL 37 `4e
446:4(cant/-7 V _contractor Dam - -_
OFFICE COPY
_ POST THIS CARD NEAR FRONT OF BUILDING `
°i _. ♦. •. - r' PERM1IIT NUMBER �
CITY -OF CUPERTINO 15014
INSPECTION DLVISION'
JOB INSPECTION RECORD
1 }
• _ t A `PERMIT EXPIRATION
JOB ADDRESS ... "A O ✓`�- UNIT#T_LOT# ' PERMIT EXPIRES IF WORK
' OWNER /Q,B°�/Cd]J`' G/Q-•—V-,�/•�,`. CONTRACTOR �' - IS NOTSTARTED'WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .. 180 DAYS OF PERMIT ISSU
y ANCE OR 180 DAYS FROM
• FOUNDATION —9p NOTE: - LAST.CACLED INSPECTION.
UFER- ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF 'PERA1Il VALIDATION .. .j
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 8 95 0 F�0.vYAe ac e evAr
r
UNDERGROUND/SLAB - — —�j$' E>J(,�p G' ;•,f.,• . ,. °t C( .
PLUMBING V rt -
ELECTRICALIMA I ISSUANCE Dn TE
MECHANICAL- BLDG. ELECT. PLG. MECR.
Ki o
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ': � BUILDING PERMIT
WOOD FLOOR { INFORMATION ,
VALUATION SIFT.-
. PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
� __
FRAMING
INSULATION _I'J_y{/n, - STORIES IVPI,CONSTR. ,
w j.
AA
OCC.GNOUP RES.UNITS
" :P,LIACEA0 SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED / - '
50,IT,FLOOR AREA TOTAL ACREAGE ,
L• ,± - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE + '
_ DIAPHRAGM - THE CONSTRUCTION�TAX IS PAID
L , `, T , . . ' BUILDING USE
ROGF SHEATHING a j, - . " - RES IND CON PB Om,.
�-AP�LY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED113
INALS .. DATE INSP. ❑ • � 0 •� O
_
ASSESSORS PARCEL NO
ROUGH
PLUMBING NERGY
TUBS&SHOWER PAN . NG ENERGY '"nG;NO �'nRceL No.
MECHANICAL- g �gg - NERGY -
ELECTRICALf2'v-..COr9Cc I +T' 'g 025 $$ G ENER Y Acc UATE ncc,EiLE No,
FRAMING , �ir INALTINSULATION NG I — zorvlNG ENC.SITE NO.
GAS TEST. - ' FIHFi SPRINK ENERGY LIG'
ICAL �� ' ^COVER NO WORK UNTIL ABOVE'HAS BEEN SIGNED G `'-� NO N�
• EXTERIOR SHEAR ELECTRICAL R SE FLooD ZONE A,L.0 C.
INTERIOR SHEAR I FIRE DEPT. `"❑ ❑ NEl
SHEETROCK GRADE FEE SUMMARY
EXTERIOR'LATH7 BUILDING -'J., U BUILDING �(,J.De
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC , PLAN CHECK
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE'
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM "
ARRANGE FO'R INSPECTION BY PHONING 252-4505, ELECTRIC
LU
H ONE WORKING DAY BEFORE REQUIRED INSPECTION:' PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING. _ -�'
Z - d: MECHANICAL-
SEE
ECHANICAL
- SEE PERMIT'F,OR EXPIRATI N DATE -•
.�_ .-_ (... .._'_'.__ .: - •. .CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE' TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY