9340 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
\' BUI LDING PROJECT IDENTIFICATION PERMIT NUMBER
Y
ADDRESS �c APPLICATION & PERMIT 8340
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
E 'S PLAN CHECK VALIDATION
NAME
_ QTY. ELECTRIC PERMIT FEE
�Z%PQoNE
NAME A OUTLETS-SWITCHES-RECEP 10.00/1.00
L.C.NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS PPLIANCES-RESIDENTIAL 4.00
PANELS 10.00 DATE OF APPLICATION
NRCHOq (Tec - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINE R
uC.NO. SIGNS TRANS. 3.00
nooeess SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
IP EMP.METER OR POLE INS. 20.00
A uc 's
Ess TORS] SEE FEE SCH. OV K r eg-u/"�`-'•`-'
ADDR
SERVICE CHANGE 20.00
O o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
a u u I hereby effirnl Ilial I an,Ilcensed under provisions of Chapter 9 ISSUANCE DATE
w a N (commencing with Section 7000)of Division 3 or the Business and BLDG. ELECT. PLC. MECH.
r y z Professions Code,and my license is in full force and effect.
z o m - License Class B Lic.Number
o r w
Date 7/z9
O Contractor
¢ y ¢ ¢ ,l_- /OWN iR-BUILDER DECLA j BUILDING PERMIT
W o ^ INFORMATION
K ;u m 1 hereby of lied that I am exempt from the Cont ctor s License MISC.- REFER TO ORD �.
HLLOas Law forthe following reason. 7031.5,Business and Professions pERM1T ISSUANCE VALUATION $/FT.
Code:Any city or county which requires a permit tomnsHmet,alter, 1,0.00 d-D
Qan ¢ O improve,demolish,m repair anY structure,Prior W its issuance,also ELEC.CONTE.. UC.NO. ELEC. i /7/
C requires the applicant for such permit to Die u signed statement that TOTAL PERMIT TO
a w m he is licensed pursuant to the provisions of the Contractor's License
H z
Law(Chapter 9(eornnencing with Section 7000)of Dlvi5ion3 ofthe
a S/NGG� JZQA�//[
z er Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE r a y
the.basis for the alleged exemption.Any'violation of Section 7031.5 5T ittE vP CONSTR.
a 3 _ by any applicant F e hundred
permit dollars the applicanuoacivil venally ' ALTER-DRAIN&VENT-WATER (EA.).5:00 ,/ l/
of not more than Ove hundred dollars(my employees
h a s /L�I
❑ 1,as owner of the property,or my employees with wages as ,-BACK FLOW PROTECT. DEVICE , 4.00Occ.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 1 /J - 9
Code:The Contractor's License Law does not apply 1.an owner of R. J
Property who builds or iteproves thereon,and who does such work FIXTURES-PER TRAP 5.00 �^ 50.FT.FLOOR AREA TOTALACREAGE
• himself or through his own employees.Provided that such improve-
meats are not intended or offered for sale.If,however,the buildin6 orGAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 /
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4(EA ) 200
builder will have rh . - . .
e burden of proven,that he did not build or im- BUILDING USE
prove for purpose of sale.). RES IND CON Pe Other
❑�;l as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ El 13 ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
,11 end Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or improve,thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 q fo/a ��G
contracts for such projects with u contrtN
le (s)licensed pursuant to. .J G
the Contractor's License Law. s�\ SEWER-SANITARY-STORM EA.200ft/10.00 -- TRACT NO. PA CEL NO.
❑ lam exempt under Scc. N.&P.C.for this WATER HEATER W/VENT C7.110
reason 111 /_6
Owner Ua(e WATER SYSTEM ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIPS, 5.00
1 hereby affirm that I have a certificate of consent to self-insure. - -
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). &^rS
Policy No. Con.PanY �Y /1{ � .
0 ❑ Ccrtiliad copy is humby fumislreJ. rT r FIRE SPRINK ENERGY T-94
Z Z ��]] CeniI copy 1 hied with rhe city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑
O A�jlicant V N V N
K PERMIT ISSUANCE �/�/,/�
OCy CIiRTIPICA'fIi OP I[XE.MPTIOM1'PROM WORKERS' JYJIr. `� FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG:CONTE. UC.NO. PLG.
CL 0 (This section need not be completed if the pem [:]
,it is for one TOTAL i Y N❑ ❑Y N E]
::� Z hundred dollars(51001 or Ico.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE 31 FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. �- 5.00 BUILDING
>_ ID NOTICE TO APPLICANT: If,after making this Ceril'icme of fix-
r Z emption,you should become subject to rhe Workeri Compensation APPLIANCE 5.00 PLAN CHECK
provisions of doe Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A000.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 - SEISMIC FEE
I hereby affirm (liar there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permii is issued(Sec. MICROFILM lva
3097,Cie C.). HEATING UNIT(TO 100,000 '8.00
Lender's Name - HEATING UNIT(OVER 100,000 B.T.U.)0.50�\
L'ender's Address ryp ELECTRIC
1 certify'IhaI I have readb thlsapp)?llion and sIa c 1 a(the move 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- H.P.or 100,000 B.T.U.) 6.00 Q
hereby authorize representatives for
of this city es corer upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. 'MECHANICAL
about-mentioned property for inspection Purposes. O Q10
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may in any way aeenle 'gainst said City in consequence of the PERMIT ISSUANCE 10.00 p�
grantin of this permit. �a
rEC�NT. LIC.NO. TOETAL
i u o 'un/Con r ate T 30 TOTAL
INSPECTOR COPY
Y POST THIS CARD NEAR FRONT'OF BUILDING
• PEOMIT NUMBER
'
L X CITY�F CUPERTINO''" "- �'
� } `
INSPECT. 9340iON DIVISION " '
" JOB INSPECTION RECORD
' PERMIT EXPIRATION,
-77��7 On' 'Plage: ,
JOB ADDRESS��// UUNIT# L'-LOT# ,pERM1T'EXPIRES'If WORK.
OWNER•VfOCT1 / fr- SIV(ilS l//rC�l'. CONTRACTOR ( ,, 51 AS Y. IS NOT.STARTED.WITHIN
INSPECTION DATE .INSPECTOR .INSPECTION RECORD p :18o-DAYS OF.PERMIT ISSU.
FOUNDATION ' NCE,OR.180_DAYS FROM' '
3D-$S •ell STCALLED INSPECTION.
UFER r
PREGUNITE. PERMITvnuonnoN
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB,.
PLUMBING -
1 Jy' J
ELECTRICAL . �' Lt uaNCE DATE.
MECHANICAL' BLDG. EL CT. PLG. M cR.
• 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR _ VALUATIONT S/FT. :�.
PLUMBING 1461
/ -
.. MECHANICAL /D LJ' .. •' ' r' �� •YOU, .
PERMIT TO
ELECTRICAL-
.. FRAMING 0. _ G J` 'L�VV • -�_ +' ; ..
INSULATION
-3'
- STORIES_ ;+aYPE,CONSTR.'�•
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
`, ROOF' f H L SO.,FT.FLOOR AREA TOTAL ACRE AGE
DIAPHRAGM euaolNcusE
;'' RES IND CON PB' Ome,
-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED J V ASSESSOR S PARCEL NO.
-ROUGH � o- . '
PLUMBING' . r. ' �a�t-� , '
GAS TEST y D TRACT NO ,PARCEL NO.
. MECHANICAL'. - i '. .Y' tc LV UP� OOIILW J 1 7'• '"�. • •'
ELECTRICAL ` I'y .-FINALS LS'a` ' r ACC:OATE, ',Acc FILE rro
DATE SP. `
FRAMING �) I _ SAN # '( j ,ZONING ENG.SITENO.
• INSULATION PLUMBING.
.. - GAS .
t '� — .t - F IRESP 1 v-'E ER
. - t MECHANI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNE HEATIN r r J N
LATH-INTERIOR. - ELECTRI ,^� r.Doo zoNe . . Oah
LATH-EXTERIOR- �„^2�yp��} FIRE DEPT. ` Y❑. N❑' Y ❑ N❑ '
SHEETROCK .: •/,i-• ,r ' RADE _ T' FEE SUMMARY
SHEAR INTERIOR .•e.
J „ �'BUILDING
SHEAR EXTERIOR, o-'off • PORARY.'APP,ROVALS,
FIREWALLS . . • ELECTRIC' - PLAN CHECK ' '
.. GAS - 'FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY ' : SEISMIC FEE'
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDINGINSPECTOR. ,
MICROFILM
ARRANGE FOR'INSPECTION BY P.HONING_252-4505, 'eLEcrRlc Al
F ONE'WORKING DAY. BEFORE REQUIRED INSPECTION PLUMBING ,f•y
�•� z PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE.—
CONST.TAX C ,.-••.
IMPORTANT!
PLEASE READ,REVERSE•SIDE BEFORE ` :r •
CALLING FOR FINAL INSPECTION. , •• TOTAL
OFFICE COPY '