Loading...
09753 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •BUI LDI NG PROJECT 1 DENTI FICATI ON - PERMIT NUMBER BUIL 7 . - .. IwL APPLICATION & PERMIT 09753 goORESS /07-1: 0 I•a�l . Q BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTV. ELECTRIC'LLPyyERMIT FEE PHONE* i. i'kF CONTRACTORS E NAUTLETS-SWITCHES-RECEP ,10.00/1.00 M S Lie.No. LIGHTING FIXTURES 110.00/1.00 CONTRACTOR - APP LIANCES-RESIDENTIAL 4.00 ADDness Z, PHOrvE ZAYM 3 PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER O LIC.Na. SIGNS TRANS. 3.00 AARC DDIT OR RESS ENG SPECIAL CIRCUIT S.00 PERMIT VALIDATION ZIP EMP:METER OR POLE INS. 20.00 _12-AID APPLICANTS MOTORS SEE FEE SCH. ADDRESS 1- SERVICE CHANGE 20.00 0 0 o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 I .{ I U v' I hereby affirm that 1 am licensed under provisions of Chapter 9 Be CE DATE v¢i (commencing with Section]000)Of Division-3 of the Business and ELECT. PLG. MECH. F N z Professions Code,DlAry license is in full force and a kct. z O"A - License Class Lic.Number_ L OS, El Cw Date Contract., Contractor - Q y 2 j . BUILDING,PERMIT - ¢ W w ¢ OWNER-BUILDIiR DECLARATION . INFORMATION aaaD MISC.- REFER TO ORD - w ;,� H I hereby nelson that I am exempt from line Contractor's License n o a Law for the following reason.(Sea 7031.5.Businessi nd Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. - 0 Code:Any city orcounty which requires a permit tOconstruct.alteq ¢ ¢ improve,demolish,or repair any structure,prim to its issuance,also ELEC.CONTR. LIC.NO. ELEC.ar - ✓ - ¢ he Melee elle applicant t t the permit t0 file d signed acors statement that TOTAL �prERM�IT TO , ¢ w m" he is licensed pursuant en the provisions Of the .1 Division License , ✓ /n,V,,fI/�J r z r Law(Chapter 9 Professions Cod ) rhSection is exempt therefrom omtitle net 4 4 o Business and Professions script or that vi is exempt Therefrom and QTV. PLUMBING PERMIT FEE ¢ � the basis for the alleged exemption.Any violation ofSection 7031.5 1 STORIES TYPE CONSTR. n ; $ by any appin.rt for a permit subjects the applicant too civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of nor more than five hundred dollars(5500).)i _ ❑ I,as owner of the property.Or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the Structure is not OCC.GROUP RES.UNITS 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 t0 an owner of properly who builds or imptoves thereon,and who does such work FIXTURES-PER TRAP 5.00 Sp,fr„FEooR onto TOTAL ACREAGE himself or through his own employees,provided that such improve- O'O.✓4Y/�_!/-7 J. ments are not intended or offered for sale.If however,the building' GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 y 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 im- IND CON PB Other prove for purpose of Sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as..net of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors t0 construct.the project l Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. • and Professions Codea'he 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 commetngs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. eon Co ❑ I am exempt under Sec. It.&P.C.fou His WATER HEATER W/VENT •6.00 �CS reinstall Owner Data WATER SYSTEM 5.00 ACC. ATE ACC.FILE NO. WORKERS'COMPEN$ATION DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affmn that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. m a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). - 1 Policy No. CompanYbVM..�I<isG1S�__ KCertified copy'is hereby furnished. FIRESPRINK ENERGY T-24 z Z ❑ Cetil'ied copy is Filed with the city inspection division. M C.- REFER TO ORD. 0 Applicant Y❑ N❑ Y ❑ N❑ N CE III'I FICA TI;OF Ii X tial PFION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O. LU _> COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 0 (This section need not be completed it the penmil is for one TOTAL YE] N❑ Y❑ N❑ Z) Z hundred dollars IS 100)or less.) - U 0 1 certify thm Ill.[ in the performance of the work for whlcb this per- TY.OMECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I Shall not employ any person in any manner so as to - U become subject to the Workers'Compensation Laws ofCalifornia' BUILDING n Date.Applicant ALTER OR ADD TO MECH. } to NOTICE 1'O APPLICANT: If after making this Certificate of Ex- H Z Lot,liun,you should become Subleet In the Workers'Compensation APPLIANCE 5.00 PLAN CHECK U such provisionrovisiolls of,fie or this peeor n t shot[be deemou musted revoked.comply with AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONS'rRI_CrION LENDING AGENCY AIR HANDLING UNIT(OVER IOJWOC.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 permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 , Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have reed this application and state that he shove VENTILATION FAN (SINGLE) 4.00 r information is correct I agree to Comply_wnt ith all city and couy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws retailing to building consul¢lion, and hereby aullionLe representatives of this city to enter upon the BD ER IOver 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. '(We) agree to save, indemnify and keep hil'odess the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, casts and expenses which CONST.TAX may in any way accrue against suit] City in consequence of the PERMIT ISSUANCE 10.00 granting of this permit. MECH.CONT. . LIC.NO. MECH. TOTAL TOTAL Signa Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF'BUILDING. PFIIMIT NUMBER 1 "CIT,Y 'OF CUPERTINO X97,53 q :INSPECTION DIVISION -, JOB INSPECTION RECORD .f S. _ A . PERMIT-EXPI RATION _'" __ - 'i•- - - PERMIT '-EXPIRES IF WORK OWNER CONTRACTOR ,r ' IS NOT STARTED WITHIN, INSPECTION DATE INSPECTOR :. INSPECTION RECORD - 780 DAYS OF PERMIT ISSU- FOUNDATION �'}j- _ ANCEO 80 DAYS FROM LIFER" JC DINSPECTION. a / PERW ALIUATIONl POUR NO CONCRE hNTIL ABOVE HAS AM SIGNED UNDERGROUND /SLAB, PLUMBING ELECTRICAL Z. ISSUANCE DATE •. MECHANICAL RLOG: ELECT, PLG. pi m R. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR n.. ,,, INFORMATION .VAWATION SIFT. -PLUMBING MECHANICAL - ELECTRICAL � .. FRAMING' $TORI[ TYPE CONSTR. INSULATION , OCdC,.GROUP RES.UNITS •gRLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN IGNED i.ff�•.` .S ROOF ' - • • . .' SO,FT FLOOR AI 'A 1m AL ACREAGE �( 'DIAPHRAGM l w f :i, • .� RES' INUUIIOC'I USEPR 00-.. -"- —4- ED—yAPP.LY NO ROOFING UNTIL ABOVE HAS BEEN SI NED - • "--0 " E3 ,I[�-'ASSESSORS PARCEL NO. 1. . ROUGH - PLUMBING - - _ ' GAS TEST. rRACT No.: - PARCEL No , MECHANICAL -yr, ( -7 ` .ELECTRICAL T�yi- FINALS ATE INSP. ACC DATE, Acc.FILENo. -.: FRAMING _ SAN #: x' " ZONING ,ENG.SITE No. INSULATION . _ PLUMBING �" '�� I GAS' FIRE$PRINK,. 'ENERGY i 24 . �Q MECHANICAL '/ '' FI ❑ - N❑, v 2 Q COVER N RK UNTIL ABOVE HAS BEEN SIGNED HEATING - FLOOD ZONE iA.L,U.C. LATH-INTERIOR - ELECTRICAL,- LATH-EXTERIOR LECTRICAL;LATH-EXTERIOR - FIRE,DEPT; - v N� „ :v;�. riJ❑ SHEETROCK -..��-ff' GRADE - FEE SUMMARY SHEAR INTERIOR _( _ 6 UILDINCkO" " BUILDING SHEAR EXTERIOR , _ -h(" V' TEMPO. ARY•APPROVALS ' FIREWALLS . ELECTRIC '. - PLAN CHECK • 'it. . FEE GAS- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE' ' f � OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. 'MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505; 7 ELECTRIC " LU ONE WORKING DAY BEFORE'REQUIRED INSPECTION I PLUMBING. .. C) PLEASE GIVE JOB ADDRESS,WHEN PHONING. . ' , . -SEE PERMIT FOR EXPIRATION DATE MECHANICAL c CONST.TAX'- IMPORTANT!, PLEASE READ'REVERSE.SIDE BEFORE •' TOTAL •t. CALLING FOR FINAL INSPECTION. .. -OFFICE COPY' • .' I I' ,?.