18090 AP,RLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY V
BU I LDINGPAOJECT I DENTIFICATI ON - ,PERMIT NUMBER
BUILDING APPLICATION & PERMIT 18090-7
ADDRESSC BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
J r 1
� MOWNER'S PLAN CHECK VALIDATION
NAMES QTY. ELECTRIC PERMIT FEE
. �akGNE 0) aoy , 1-43
NAMER"cross UTLETS-SWITCHES-RECEP 10.00/1.00
LC.NO, LIGHTING FIXTURES 10.00/1.00 '
ADDRESS
APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE• PANELS 10.00 DATE OF APPLICATION
ARCHITECT P.C.NO.
OR G- 9� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE
Ex
Ir_ P.IJ up SIGNS TRANS. 3.00
ARCH.OR ENG, - PE IT VALIDATION
ADDRESS ,{�' 1 SPECIALCIRCUIT - 5.00
z1f TEMP.METER OR POLE INS. 20.00 •`�,E��y
ASMOTORS SEE FEE SCH.
ADDREDDRESSS
SERVICE CHANGE '20.00
.02
oD LICENSED C6N'1'RACIORS DECLARATION 47 _
M<
u w .I hereby affirm that 1 am licensed under provisions of Chapter/ ISSUANCE OAT
G 5 (commencing with Section 7000)of Division 3 cf the Business and I- BLDG ELECT. PLG. MECH.
H n z Professions Code,and my license is In full force and effect. ❑ ❑ El i w C License Class Lie.Number
W H J Date Contractor
BUILDING PERMIT
¢w u t
OWNER-BUILDER DECLARATION INFORMATION
I'xu; I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFE T D
w Vq WATION $/FT.
FuOg Law l'or the following reason.(Sec.703L5,Businessand Profussione PERMIT ISSUANCE 10.00
�v+ Code:Any city or county which requires a permit to construcl,dw', 36, 090
RW¢Q Q improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
`x 9 he is licensed pursuant to the provisions of the Contractor's License J
Fzi Law(Chapter 9(commencing with Section 700()ofDivision 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE
E i o
¢ I-$ the basSay
the sora exemption.Objects
tsthAnyea plica tto action malty03 1.5 STORIES TYPE CONSTR.
by any applicant fivelumlmddojems lheapplicarn toacivil Penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars my em):
O Las owner at the property or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do she work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Protessions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractor's License Law does nor apply to an owner of
property who builds or improves thereon,and who dues Such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintendedoroffired for sale.If,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6,00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that he did not build or im- - . - . .
BUILDING USE
RES IND CON PB Other
prove 1,as. netose of sale.). INDUSTRIAL WASTE INTER. 30.00
V d as..net of the property,he exclusively counseling with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 6.00 - ASSESSORS PARCEL NO.
and Professions Code:I lie Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 �.,z- 12- 007 12_ 00 7
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SAN V-STORM EA.2001tI10.00 2
life Contractor's License Law. TRACT NO, PARCEL NO.
❑ l am exempt under Sac,.,B&P,C,I'or this WATER HEATER W/VENT 6.00
reason
Owner DaWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION 'WATER TREATING EQUIP. 5.00
I hereby affirm that I Iuve a certitcale cfconsent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy Unna.f(Sce.3800,Lb.C.).
Policy N.. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is fled with the city inspection division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
~LUT CtRTI FICAO fIFROM WORKERS'
PERMIT ISSUANCE 10.00 FLOOOZONE A.L.U.C.
W > COIMPHN1IN INSURANCE
PLC.CONTE. LIC.NO, PLG.
0. aZ (This section need not he crinlpleted if the permit is for one TOTAL Y E] N❑ Y [:] N❑
hundred dollars IS 100)or less.)
0 O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL U mit is issued,I shall not employ any person in any runner so as to
become subject to the Workers'Compensation Laws of California.
W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of Ex'
F Z emplion,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. AIRMANDLING UNIT(TO 10=C.F.M,) 4.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10A=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 permit is issued(Sec. MICROFILM
3097,Civ.C.). - HEATING.UNIT(TO100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
r information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-00MP(3H.P.or100,0008.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER (Over 100,000 BTU)SEE FEE SCH. .MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may In any way accrue against said City in consequence of the
grunting of this permit. MECH.CONT. LIC.NO. MECH.
� c, -r _ TOTAL TOTAL 6
Signature o ¢ant onAlruclar Date to , IOFFICE COPY
i
CITY OF CUPERTINO
INSPECTION DIVISION ,
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C�oy<y
y POST THIS CARD NEAR FRONT. OF BUILDING
UMBER
Jo-
CITY OF C&ERTINO ERMITN80
90
INSPECTION DIVISION 8
JOB INSPECTION RECORD'
.(� I�/J �� PERMIT EX4IRATION�
JOB ADDRESS � � �`��� + UNIT# _LOT#
�)� / A A PERMIT EXPIRES IF WORK
OWNER S�7iJK 1CQ.[ s} CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION. `
LIFER - _ ALL GRADING AND DRAINAGE SHALL BE INSTALLED _
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERT,I vA UDA [ON
CUPERTINO STAN%AkDARDS.
GARAGE SLABS - '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED figo P+IQ' T gv M /'�
UNDERGROUND /SLAB S 1
r
PLUMBING "J Fi
ELECTRICAL ISSUANCE AT
MECHANICAL OLOG ELECT. PLG. MECH
p ❑ ❑' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS B ENIIN! 'e d BUILDING PERMIT
ci uL rDY a igen INFORMATION
WOOD FLOOR VALUATION $IFT.
PLUMBING I ,L,a„ v�y
MECHANICAL DATE J j5 PEHMIr To
ELECTRICAL � ! /,'p�
FRAMING rj p "� ��
INSULATION �ciU � - sroR IES rvpE coNSTH
jj q
OCC GHOUL- RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,
ROOF NOTE:NO FINAL INSP.SHALL B A E BEFORE sa,FT ei oDH aura TOTAL ncHEaeF
DIAPHRAGM THE CONSTRUCTION TAX IS DAIIJ
BUILDING USE
ROOF SHEATHING -r I woHES IND CON Pe Ov",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS A INSP. El 0 El Q 1:1
ASSESSORS PARCEL-NO
ROUGH SANA 642- I r2
PLUMBING ELECT.E ERGY
TRACT NO PARCEL NO
TUBS 8 SHOWER PAN PLUMBI ENE)VY' '
MECHANICAL MECH.EN
ACC DATE ACC.FILE NO
ELECTRICAL � BUILDERGY
FRAMING ELECT. NALT .
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY LAG
MECHANICAL r N� r E] NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING '
FLOOD ZONE A.L U.C.
EXTERIOR SHEAR. - ELECTRICAL RELEASE
Y � Nc YL IN[]INTERIOR SHEAR FIRE DEPT.
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 .
OCCUPANCY OF BUILDING ISNOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
_ ELECTRIC
ARRANGE FOR INSPECTION BY PHONING 252-4505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION. '
PLUMBING
o PLEASE GIVE JOB ADDRESS Who PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ.REVERSE SIDE BEFORE TOTAL 4q„/
CALLING FOR FINAL INSPECTION..
OFFICE COPY
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