16707 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN'ONLY
BUI LDI NG PROJECT I DENTI FICATION fPERMIT,NUMBER,
Tu LD I NNG _ APPLICATION & PERMIT • ,$,,., O�.
ADDREs
;o' p BUILDING'—'ELECTRICAL—PLUMBING MECHANICAL
OWNER'S - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE -
_ � d2�L� S PHG�Eg71_� .
CONT.ACTOR .. ,.
NAME! UTLETS-SWITCHES-RECEP 10.00/1.00
LIE NZ3�'A(, LIGHTING FIXTURES 70.00/1.00 '
CONTRACTOR s APPLIANCES-RESIDENTIAL 4.00 -
ADDRESS �irp -ya ^^jj '•
yl lx�'^}1J. Y .HONE "J PANELS, 10.00 'GATE OF APPLICATION '
ORCHITET /\. - - PANELS (OVER 200 AMP) •20.00 '. PLAN CHECK FEE C.rvo. .
ENGINEER �( v`^ t • n
" Ir,\f\ LIC.NO, SIGNS TRANS. 3.00'
ARCH.OR ENG.- _ PERMIT VALIDATION
^ '
ADORE . - /f1' SPECIAL CIRCUIT 5,00 ,
�•1 pad �` • ' (Q� , A EMP..METER'OR POLE INS. - 20.00
APPLICANT'S -r ' MOTORS,ADDRESS SEE FEE SCH. l/tet.'+ QNt^'.v'•��'
SERVICE CHANGE .20.00
Foo LICENSED CON'T'RACTORS DECLARA'T'ION _ /// ((( _'•
G v v 1 hereby aifimt that 1 am licensedunder provisions of Chapter 9 _ ISSUANCE DATE
\ t
H G w (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT: PLG. MECH.
H z P olesslons Code,and cry licenseis in full force and effect. '
zo,"n- License Class LIc Number � ' � � � ❑
Q H r°Q Date ComractorPip
'
¢ a< a OWNER-BUILDER DECLARATION ,JBUILDING,PERMIT
X ;LL m hereby affirm That I amrexempt from the C'omractm Cicense� MISC.— REFER TO ORD FORMATION
u o j Law for the followin reason.(Sec.7031.5,Buslnessand Professions TION-• , $/FT.
H _ s PERMIT ISSUANCE ' 10.00
Code:Any Any my or county which requirnsa permit to construct.alter, O✓
¢ re ¢ FO improve,denmlish,or repair any structure,prim to its issuance,also ELEC.CONTR- LIC.NO. ELEG.
n
¢ Rtlulres the applicant for such permit to file a Signed statement that - TOTAL', B PERMIT TO
X
$" he Is licensed pursuant to the provisions of the Contractor's License -
r z a
Law(Chapter 9.(commencing with Section 7000)of Division 3 oftlie
z o Business unJ.Professions CoJe)or that he is exempt tlerefrnn and' OTV. -PLUMBING PERMIT FEE
the basis for the alleged exemption.Any violalionail'Smtion 7031.5 P STORIES .TYPE CONSTR.
d ; _ by any applicant for a pemtit subjects the applicant lou civil penalty
- of not more than five hundred dollars(5500).): _ ALTER-DRAIN&PENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees with wages as, - BACK FLOW PROT ECT.'DEVICE 4.00 oce.GROUP 'RES.UNITS.
(herr sole compensation,will do(le work,and lire structure R not ,
intended car offered for sale (Sec. 7044, Business and Professions - DRAINS-FLOOR,ROOF,AREA,COND. 5.00 • "a
Code:The Contractor's License Law does not apply to wi owner of•
property who huilds or improves thereon,and who Joe,such work FIXTURES-PER TRAP _5.00 50.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ments are out intended oroffered for sale.If,however,the budding GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 "
or
Improvement Is sold within on year of con id Iron tire" caner - GAS-EA.SYSTEM-'OVER 4'IEA.) 2.00
• bulld'r will have the burden of proving that lie(lit]not build or int 1 BUILDING USE
_ prove for purpose of sale.) INDUSTRIAL WASTE INTER. 30.00 RES AND CON PB 'oce.
d I,as owner of the property.airexclusively contracting with ,❑ ❑ ❑ _ ❑ ❑
I¢hlsed'contractors m construct the project(Sec, 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and I'rofesslons Cone'.'I'he Contract 's License Caw'dnos nal apply
to.an owner of pro erI who or s or improves thereon,and who LAWN SPRINKLERS-,OVER 5 (EA.), 1.00 t� _
ED
ntracts for s07
ac ornjects wit ronlractor(s)licensed pursuant to SEWER-SANITAR V-STORM EA.2001t 10.00 a
the CoN[uutor' ,ieense / '- TRACTNO. PARCEL NO.
❑ I ace pt u o. ` - •;B.&P.C.f. this WATER HEATER W/VENT � .6.00
• rl'aaall -
, Owner Date
WO RKIiRS' — WATER SYSTEM 5.00 Ace.DATE Ace.FILE No.
COh1PISNSATION DECLARATION' WATER TREATING EQUIP. 5.00
I hereby infirm that 1 have a certificate oon
fcsem Itself-insure. - -
or a certificale of Workers'Compcnsalioo Insumnce:or a certifiedt ZONING ENG.SITE NO.
copy thereof(Sce.3800,I.A.C.).
Policy No. Company
O ❑ Certifiedcopyisherebyfunlished. FIRE SPRINK ENERGYTY4
Z Z '❑ Certified copy is fled with the city inspection division. - ' e
O Applicant - MISC.- REFER TO ORD. ', ,q, v ❑ N❑ v ❑ N❑
PERMIT ISSUANCE 10.00 .
CERT'IFICATI:017 EXI MVTION FROM WORKERS' '1 FLOOD ZONE A.L.U.C.
LU COAIPF.NSWION INSURANCE PLG.CONTR. LIC.NO.. PLG.
11 O (This .section need not�be candoed if the permit is ter one - TOTAL y❑ •• IN❑ V ❑ N❑
0Z hundcd doll.lrs IS 100)or less), .. '^ - '. -
U O 1 certify that In the performance of the work for which this per QTYMECHANICAL PERMIT FEE:'. .FEE SUMMARY r -
IL F mit is Issued I shall not employ my perxon many manner so a s m . - :
U become subject to the Workers'Compensation Laws of California. t" -
O y Date ApplicantBUILDING
} NOTICE 'rO APPLICANT: If,aNcr.making this Certificate of Ex- 'ALTER OR ADD TO MECH.. Y5.00
rd.
Fz emption,you should become subject to the Workers Compensation` " 'APPLIANCE - _ 5.00 PLAN CHECK'
provisions of the Labor Code, you nwst forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) '4:00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER I0=C.F.M.)`6.00 ,. SEISMIC FEE ' S�
I hereby aDimr that there is a construction Icnding'agency for EXHAUST HOOD(WITH DUCT) x•5,00 .
the performance of the work For which this,permit ix"issued(Sea -MICROFILM
3097,CR.CJ., HEATING UNIT'(TO 100,000B.T.U.) 8.00
Lendor's Name - HEATINGUNIT(OV ER 100,000 BtT.U.)9.50
Lendci's Address ELECTRIC
! certify that l have read thisapplindimr and stale that theabove VENTILATION FAN (SINGLE) 4.00
r H tb,nation is correct.I agree to comply with all city and county PLUMBING'
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Of 100.000 B.T.U.)'-6.00
hererii authorize representatives this cily In enter upon in,ve-mentionedoperty forBOILER-COP (Over 100,000 RTUI,SEE FEE SCh. MECHANICAL
abo .i ection purposes.
(We) ogre• save.-; mify and keep harmless the City of F MISC.- ' REFER TO ORD. - -
------ —Cupertino nst li ,judgments,.coed. unJ ex pensc which -PERMIT ISSUANCE' - 410.00 CONST.TAX
may in w' c agui I said City in cons gawm of�e e - N
•mnti u ll' �YT70/ MECH.CONT. LIC.NO. MECH.,
- d / TOTAL_ TOTAL (0.3
Raweof and/Contractor Dale l:
OFFICE COPY ' �.
POSTTHIS CARD NEAR FRONT OF,'BUILDING ',. yEaMTN MIIR<
CITY OF ,CUPERTINO
INSPECTION'DIV,ISION. 1707 `
JOB INSPECTION-RECORD'
PERMIT EXPIRATION
JOB ADDRESS aaZ3 Ep0 UNIT#'
- — ..�_. __ .i, , - • _ t - PERMIT EXPIRES IF WORK..,
OWNER Q! - CcNTRACTOR� " �IS'NOT STARTED WITHIN ''
INSPECTION DATE INSPECTOR INSPECTION RECORD teo DAYS OF PERMIT.iSSU
ANCE OR 180•DAYS'FROM r:
FOUNDATION 'S NOTE:,
UFER ' .s. ALL"GRADING AND DRAINAGE SHALL BE INSTALLED .L AST CALLEDINS. .. ION:
-, PREGUNITE - TO COMPLY WITH THE APPROVED'PLANS AND CIN OF . PERmm VAIJDATION
CUPERTINO STANDARDS.-. I , �I
GARAGE SLABSit
_ .:.••"' " '
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- W0zt �,,, y ;,,' �.<.;",•�
r UNDERGROUND /,SLAB
PLUMBINGi
ELECTRICAL - t •-t • - -••ISSUANCE DATE..
i MECHANICAL �^ - "� L BLDG; ELECT. PLG..' mec Il
El El
F.
-00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 114BUILDING PERMIT
WOOD FLOOR" INFORMATION ,
PLUMBING sTPT.
c++v o
MECHANICAL
. ELECTRICAL , - PERnnT TO' ^a
FRAMING
INSULATION
..r. STORIES TYPE CONSTV. .4
' - - -
- - - OCC:GROUP 'RES.UNITS
PLACE NO-SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - -
ROOF - - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -SO�FT.v:.oP::AREA TOTAL AcnencE t
DIAPHRAGM THE CONSTRUCTION TAX IS PAID _{ e. I
-'• BUILDING USE -
ROOFSHEATHING - RES IND" CON PB. '�O,I:.,
^APPLY-NO ROOFING UNTIL ABOVE HAS'BEEN-SIGNED'.. FINAL'S '6-ATE' INSPri' ❑ El El El 'El-'
ASSESSORS PARCEL NO,
ROUGH, SAN.p:
PLUMBINGELECT.ENERGY. U`� ',.
TUBS.8SHOWER PAN - "i ' PLUMBING.ENERGY r/. 'TRACT No, nAaceL No. -A^
MECHANICAL I & b I MECH.ENERGY
ELECTRICAL - - BUILDING'ENERGY ACE DATE - ACC.FILE NO. •v
'•^'F . .FRAMING ELECT:F.I NAL TEST' ,
INSULATION , PLUMBING zoNiNc . BNc'.sITENo.
GAS TEST, - - i GAS - - "
FIRE SPRINK ENERGY L24
., . ; ... . ' � MECHANICAL '- '.r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 NE "�
D'T.
FLOOONE A,L U.L.
• EXTERIOR SHEAR' ELECTRICAL RELEA,$t
INTERIOR SHEAR FIRE.,DEPT. Y�❑ 'i�❑ ` ❑: N❑
SHEETROCK GRADE . FEE SUMMARY '
EXTERIOR LATH BUILDING
" INTERIOR LATH TEMPORARY APPROVALSA BUILDING
�3"
SCRATCH COAT. ELECTRIC- - PLAN CHECK
GAS FEE.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE - �•
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBV BUILDING`'INSPECTOR. MICROFILM
IT
I ' o� ARRANGE FOR,INSPECTION,BY PHONING 252-4505 ELECTRIC ONE WORKING DAY BEFORE-REQUIRED INSPECTION'. PLUMBING
2.
PLEASE GIVE.JOB ADDRESS WHENTHONING.,.
' - SEE'P ERMIT..FOR EXPIRATION DATE - MECHANICAL
IMPORTANT!' CONST:TAX
PLEASE READ REVERSE-SIDE BEFORE', :'*
CALLING FOR'FINAL INSPECTION- . TOTAL
" , : OFFICE COPY ,