6934 AL
IL,
APPLICANT TO FILL IN INFORMATIONVITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDINGPROJECT IDENTIFICATION - PERMIT NUMBER
BDLLDING APPLICATION & PERMIT..-
'„r: RES. 6934
BUILDING-ELECTRICAL=PLUMBING'-MECHANICAL
NAMES ''3' f .}Ani PLAN CHECK VALIDATION
4:ELECTRIC�PERMIIT 'idt y,5,yq, FEE `v+
'�� l PHONE '1 •• 'R"4 rK-�r ✓� `.��' /.CJ/ /�l/`�
aM cTU s
NAME UTLETS-SWITCHES-RECEP 5.00/1.00 v "-
�
G uC.N09.116347-5 LIGHTING FIXTURES 5.00/1.00 '
CN
TRACTOR S - PPLIANCES-RESIDENTIAL 4.00 I
- _ ADDRESS
ONE PANELS - 5.00 DATE OF APPLICATION
ARCInTE i, , SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
.b TIC.NO. SIGNS TRANS. •• 3.00
ARCR.OR ENG. ,SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
AOORESS
ZIP TEMP.METER OR POLE INS.__ 15.00
APPLICANTS �' MOTORS 11-14 E FEE SCH. '
ADDRESS
SERVICE CHANGE ; 10.00 p
000 . LICENSED CONTRACTORS DECLARA'I'ION .PA;� •� 1) •1 ��/pS
v w I hereby aflinn that I am licensed under Provisions of Chapter 9 ) ,. rISSUANCE DATE
w 2 w (commencing with Section]000)of Division 3 ifthe Business unit City B( VUPG'`�•••• BLDG. 'ELECT!•' PLG. MECH,
D z Professions Code,ayh>I y license is in full fo¢rdy{�'
z,0. License class_!; Lia Numhe 7I,- „Ir">a_ - ❑. . ❑- ^n�, ❑
g .::.2 Dale Contractor r{/jJ(/JCL . - '
Q Y L J - .,'
Or c W a
OWNER-BUILDIiR DECLARATION i'""' STT�'B ILDING PERMIT
o A U MISC.- REFER TO ORD r;p4iN FORMATION
w3 LL y .I hereby affirm that 1 am exempt front the Commemr's license VALUATto
L .. of Inw for thefollowing reason.(Sec.7031:5.Businessand Professions PERMIT ISSUANCE - 6.00 L'- Bf IIIU 5/FT.
Code: city or manly which requires a permit to construct,alter,
QQ Q 0 improve,demolish,or repair any structure,prior to Ih Issuance,also ELEC.CONTE.{ LIC.NO, ELEC. qqLU
- O or requires the applicant for.such permit to file:I v'igned statement that - TOTAL O - PERMIT TO ,
u w m" he is licensed pursuant to the provisions of the Contractor's License ,. s
Hzi Law(chapter 9(mmmumingwith Section]OOOIof Division 3 of the /-
- a Business and Praressious Code)or that he is exempt therefrom and OT4Y. PLUMBING PERMIT: - ^ FEE
r o .the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m 'byany applicant for a permit subjects the applicant Ran civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 '
' ,of not more than live hundred dollars(5500}):
❑- 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00
OCC.GROUP REB.UNITS
their com
Side compensation,will do the work,and the structure is not
:mended oq Offered for sale (See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Convactor's License Law docs nol apply to an owner of
properly wbo.builds Or improves thereon.and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himsclLor thnntgh his own employees,provided that such improve- r
ts/me not intended or offered for sale.If,howevee the building GAS-EA.SVSTEM-1IINC.4.OUTLETS 4.00 -
r ii provemem is wIJ within one year of completion,the..act-
GAS-EA.SYSTEM-OVER 4 (EA.). 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im. ---
proveforpurposeofsalcl. INDUSTRIAL WASTEIINTER.I'JUJ RES IND CON PB Omer
20.00 ❑ -❑ . ❑ ❑ ❑
.- ❑ Las owner of the property,am exclusively contractBusine s
and Pcd,conirs Cod . I construct the project La 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B.._ 5.00 -ASSESSORS PARCEL NO.
and Prolcssibof Coda ly who
build,
m Lnipmv Law docs not apply E -
' man owner of pmperly who builds or.improves thereon.and who' LAWN'SPRIN KLERSV OVERI5%(E'A:1 1.00 -
cmnoucts for such projects with a contractons)licensed pursuant to
Dm Contractor,License Law. SEWER-SANITARY-STORM' EA.200ft/8.00 TRACTNO. PARCELNO.
❑ Iam'cxempt un der Scc. ,B.&P.C.for this WATER HEATER W/VENT - . 4.00 .
reason
Owner Dale WATER SYSTEM 4,00 ACC.DATE ACC.FILE NO.
WORK 17RS'COMPI:NSA'1'ION DECLARATION WATER TREATING.EOUIP. 4:00
- I hrreby'ullirm that I have a certificate ofconsent tO sell:...surf, ZONING ENG.SITE NO.
or a i'crtificale of Workers'Compensation Insurance.or a certified
copylhereof(See3g00,Lab. ) ���i�,�
^� Policy No. Compan
y_ •XL"�
OIj Certified copy is here by turnihd FIRESPRINK ENERGY T 20
z ❑ Certifi I copy Lar'lilell wit icy inspection division. MISC.- REFER TO ORD. Y ❑ N❑ Y❑ N❑
APPllcallt' �R(I/// _
F-' /`�+��,]�`/' PERMIT ISSUANCE . 6:00 _ FLooD zorvE A.L.u.c. „
Cr - (JiRTWICT'I'Ii 0171 XEMP'NON IBOM WORKERS'. . .
UJ > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
4. O1'I'his secti6m need net be complutcd if the Permit is'for one TOTAL Y❑ .N❑, Y ❑ NEI
Z) 2 hundreddollars(S100)orlessf
U O 1 certify that in the performance of the work for which this per. O•fiV: O: r +.MECHANICAL'.PERMIT ;y%; F,EE .:a ?EE SUMMARY
U_ F not is Issued,1 shall not employ any person In any manner so as to
- `t
m
become subject to the Workers Compensation Laws of Cal tom a.
O
Date Applicant ALTER OR ADD TO MECHY6' 4.00 ' BUILDING
} N NO'1'I CE'f0 AITIACA N'I': If,alter making(his Ccrt ificam of F;x-
F Z emption.you should become subject to the Worker:Compensation APPLIANCE 4.00 --PLAN CHECK
provisions of the Labor Code, you muss forthwith comply withFEE -
CJ Inch provisions or(his permit shall be deemed revoked. ' AIR HANDLING UNIT(TO 10,000 CiF.M)' 3.00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE �fZ1
La I hereby affoin that there is a construction lending agency for EXHAUST HOOD IW ITHCDUCT)'i`" 2.00
the performance of the work for which(his permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
s Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
Lender's Address
I "}lily that I have read this application and state that the above VENTILATION FAN'(SINGLE)' 3.00 4Z
oatgJltTmion is correct.I agree to comply with all city and county PLUMBING `-
ordinanc3`smJ smm laws relating to building Dun and BOILER-COMP(3 H.Rof100,000B.T.U.) 4.00 I
....np„Luthorire'reprexcid.ives of thn.ci(y..Io enter upon [lie BOILER-COMP-(Over 10g0006TU)SEE FEE SCH. MECHANICAL OYJ
' ubavcmenlioned properly for inspection purrysus. _
-. (We) agree to save, indemnify and ke• hannluss the City of , MISC.- •REFER TO ORD. -
Cupertino against liabilities,judintan t Is and expenses which CONST.TAX
may in any way a e against sa' .I(
in consequence of the PERMIT ISSUANCE 3:00
grafi of this Pc I. MECH.CONT. LIG NO. + MECH
TOTAL '�7= yKTOJT+AL
Signature Applicant/C In come Uale /
OFFICE COPY •'
CITY OF CUPERTINO INSPECTION 'RECORD
(OFFICE COPY)
OWNhK
PERMIT ISSUED DATE ELECTRICAL DATE INSP.
Tdin
ctrica
Plumbing Power Pole
mechanicalr un
e as ec u irin Q ,
Solar Walls
Fire Sprinkler Ceiling
Sign Fixtures Int/Ext
otors
Misc. Gunding
e ower
Uther
FINAL INSPECTIONS DATE INSP, Not .Approved
Gas
ectric
Plumbing _ PLUMBING DATE INSP.
anent�cicaT—
orra`aisri;n- - Backflow
n
oor
oor
Planning
-
Partial Rough
Fire pt. pu h complete
eat a t. oarRough
ui ui ater ' Insulation
Other Main Drain
o am
Gas _
t itT e�
BUILDING DATE INSP. Not Approved
Pad Certification
oun anon ELECTRICAL DATE INSP.
re- rte
Slab-Membrarle Underfloor S.M.
Bond Beam ctsnsu atioT n
Underfloor GirdersFire an ers
Floor tee it ace
ie owns urease jiuct 4 Hood
is rams 77e our Shatt
eismecracin Condensate Drain
a s- ane i
!�ulpment An ora ge
Frame ues r
Vo
r nt t. of rover
_.
�Uther
Not Approved