18688 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION -PERMIT NUMBER
BUILDING APPLICATION & PERMIT IcO
A00e� o
p. N'Y!1 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ,
OWNER'S PLAN CHECK VALIDATION
NAM
O/Cp x-(�'A/� 6 DTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTOR'S
NI
;E OUTLETS-SWITCHES-RECEP 10.00/1.00
!7 Q� (a uc.No.30 y- LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
oRs
ADDRESS APPLIANCES-RESIDENTIAL 4.00
,770 (./'/ NV'r l0`• PHONE 7-79.672 PANELS 10.00 DATE OF APPLICATION
OR
ARCHITECT - PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
moo Ess ENG 5.00 SPECIAL CIRCUIT S.QQ PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 (}_
AMOTORS SEE FEE SCH.
ADDDRESSDRESS
SERVICE CHANGE \A V LL,
Woo LICENSED CONTRACTORS DECLARATION
Fi w 1 hereby affirm That I:am�licensed under provisions o1'Chapte9 Sip-FI 11� - ISSUANCE DATE
a n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
0 n z Professions Cola y license is in Cull fort .7� ❑ O ❑
2 O se - License Class ( r- Con Number_ lin of A-
9 w 1-w Dam Contractor
¢ x s N BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION '
o d v - INFORMATION
X 3 u I hereby affirm [hal I am exempt from the Contractor's License MISC.- REFER TO ORD
u O¢ Law for the following reason,(Sec.7031.5,Businessand Professions VALUATION $/FT.
r - w PERMIT ISSUANCE 10.00
� w� Code:Any mulish sou my whiny strrequcture,
riot to construct,,also
¢ ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. - ELEC.
n a 0 u requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
whe is licensed pursuant to the provisions of the Contractor's License
H i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
f i ao Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE a C'
¢ I-$ the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR.
n3 � by any applicant for a permit subjects BLL applicant toa civil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars f S500).):
' 0 I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended,or offeredfor sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License'Law does not apply to an owner of
properly who builds at improves thereon,and who does such work F IXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
I himself or through his own emp)oyees,provided That such Improve-
mentserenotintendedoroffered$or sale,If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
c or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden at proving that he did not build or int RES IND CON PB Other
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with 0 ❑ ❑ C1 11
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
' and Professions Code:The Contract.,',License Law docs not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 .
contracts for such projects with s coutmctor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
. ❑ [am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Dam WATER SYSTEM 5.00 Ace.DATE ACC.FILE NO,
WORKS RS'COMPHNSAT'ION DECLARA'MON WATER TREATING EQUIP. 5.00
-I hereby.]firm that 1 have u cerlfic.m of consent to self-inslve, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a certified
copy lhtfYp[fk)},O0,Lab.C,).
Policy ompuny
0 ❑ Cerllfied copy is hV.Clay furnished. FIRE SPRINK ENERGY T-24
Z ZO pplie.fief copydisflilgdLant ly� pity inspection division. MISC.- REFER TO ORD. ❑ N Y NE
Applicant_ _-�___ b Y
rn CERTIFICA'1'EOP FXFMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c.
W D COMPENSATION INSURANC17 PLG.CONTR. LOC.NO. PLG.
CL 0 (This section need not be completed if lite permit is for tine TOTAL Y E3 NE] Y❑ N❑
hundred dollars($100)or lv..)
U 0 1 certify that in the performance of the work for which this Per- OTY MECHANICAL PERMIT FEE ' FEE SUMMARY
LL F mil is issued,I shall not employ any person in any manner so as to
O W become subject to the Worker Compensation Laws of California.
CO. Dale Applicant BUILDING,
} 0 NOTICE TO APPLICANT: If,after making this Certificate of H x*
ALTER OR ADD TO MECH. 5.00
Z emption,you should become subject to lite 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. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AG17NCY AIR HANDLING UNIT(OVER I0,000C.EM.) 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 Issubd(Sec. MICROFILM
3097,Civ.C.). - �[, HEATING UNIT ITO 100,000 B.T.U. 6.00 • O
Lendar's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that 1 have read this application copyand slide that the above VENTILATION FAN (SINGLE) 4.00
information n correct. Iagree ID comply with all oily and county PLUMBING
ordinances and ,laic laws relating to building construction, and BOILER-CUMP(3 H.P.Or 100,0008.T.U.) 6.00
hereby aulhoed representatives of this city to enter upon the BOILER-COMP (Overim000BTU)SEE FEE SCH. MECHANICAL a,•-1,0D
here by
properly for inspection this
purposes.to.
(We) agree to save, indemnify and keep hurmless the City of MISC.- REFER TO ORD.
Cape gains, liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
m in a_ way ser al" is, said Ci ly in consequence of Inc (•�•�
moi
no
MECH.CONT. LIC.NO. MECH.
TOTA
Q'LZB ;2j . 00 TOTAL X1. 00
Signature of Applicant/Contractor Umc -
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY. OF CUPERTINO PERMITNDb7FER
8688
INSPECTION DIVISION
JOB INSPECTION RECORD"
PERMIT EXPIRATION
JOB ADDRESS_ « 'e 1�•+• / E'� CDUN,IT# LOT#
PERMIT EXPIRES IF WORK
OWNER O �,� IJ` • CONTRACTOR 2°� IS NOT STARTED WITHIN
INSPECTIONINSPECTION1 DATE INSPECTOR - INSPECTION RECORD 180 DAYS OF PERMIT•ISSU
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .,r PERMIT VALIDATION
CUPERTINO STANDARDS.
��® "
GARAGE SLABS '-�f. y. 7-
POUR
_POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED SEP 2 ? 989
UNDERGROUND /SLAB �'�
PLUMBING IE�B
ELECTRICAL' CI-• � � ISSUANCE DATE
MECHANICAL RLOG ELECT PLG. I MECO
.. ' ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
'WOOD FLOOR VALUAIION SIFT.
PLUMBING" -
MECHANICAL. '
ELECTRICAL PERM�ITT TO
FRAMING /vt Qom"\
INSULATION - STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• . 5O IT GLOOR AHED TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING / 'RES IND
❑ ❑N PB E) El"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE IN ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
RGASTEST ,
- PLUMBING ENERGY
- MECH.ENERGY
- � Acc.DATE ACL.ALE NO
I BUILDING ENERGY
ELECT.FINAL TEST
20NING ENG.SITE NO.
- - PLUMBING
FIRE SPRINK ENERGY T"2<
MECHANICAL Y ❑ N❑ v ❑ N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "
FLOOD ZONE A,L U,C.
EXTERIOR SHEAR � ELECTRICAL RELEASE
INTERIOR SHEAR- FIRE DEPT, Y'❑ N❑ Y ❑ N❑
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 IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
AARANGE FOR INSPECTION BY PHONING-252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE —
MECHANICAL .0
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL ' u�
OFFICE COPY