The URL can be used to link to this page

12298 _ PWPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Y J J-� ' 0 BU I LDING PROJECT I DENTI FICA PERMIT NUMBER BUILDINGRE APPLICATION & PE 12298 ADDBaSDO I _I�(/V V I�1 V 1 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'SPLAN CHECK VA LIDATION NAME0IUAL ONE QTY. ELECTRIC PERMIT FEE -7/ `/O/ _L coNTRAcaons NROto_aHtUTLETS-SWITCHES- 10.00/1.00 ,`� � �' 7 �� ALT/f 1 G/NIc.No. LIGHTING FIXTURES 10.00/1,00 6� o-T. COIsTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 - ADDRESS A�a1�-y�-- ))\ o PHONE PANELS 10.00 DATE OF APPLICATION ORDHITECT / PANELS (OVER 200 AMP( 20.00 PLAN CHECK FEE P.C.NO. OR GALT sec.rvo.Li�� SIGNS TRANS. 3.00 ARCH,OR ENG. 5.00 PERMIT VALIDATION ADDR ss r��r SPECIALCIRCUIT q G"C S0tJ '>T z,P 0) EMP.METER OR POLE INS. 20.00 nn�p Cl q I APPLICANMOTORS SEE FEE SCH. 1, Cs /av ` ADD Ess , ` J Ti.� RJr)6 El SERVICE CHANGE 20.00 C,h' OE aEl H Do LICENSED CONTRACTORS DECLARATION a La P I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE H G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H n Professions Code n y license is in full force ffee4 r 1:1 ❑ ❑ z o m Licenu C� ss Lic.Numbe 9 Date Com ractor a Nt: WA a OWNER-BUILDER DECLARATION BUILDING PERMIT A o A U MISC.- REFER TO ORD INFORMATION w3 u. 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. I- LL oa Law for the following rcasoa(Sec.703L5,Businessand Professions PERMIT ISSUANCE 10.00 / ,� ^/�ro Code:Anycityorcounly which requires a permit to construct,alter, ([' Io ELEC.CONTR. LIC.NO. w Q improve,demolish,or repair any Structure,prior to its issuance,also ELEC. D¢ requires the applleant lot such permit IU file a signed statement that TOTAL PERMIT TO A wm u he is licensed m000 d to the provisions of the Contractor's License z i Law(Chapter 9(commencing with Section 7000)of Division3 ofthe 1A171SK10K /L'�170t- Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE S STORIES TYPE CONSTR. H o the basis for the alleged exemption.Any violation of Seeder malty w. 7, by any applicant fora permit doll.rx($500plicant Lou civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(my em): ❑ 1,as owner of the properly,or my employees with re is not BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will(S the work,and the structure is not Code:The offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 merits are not intended or offered fur sale.If,however,the budding 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 am. RES IND CON PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ El El ❑ 1:1❑ 1,as owner of the property,am exclusively contracting with 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 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 contracts for such projects with a contraetmis)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ lam exempt under Sec. ,B.&BC.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00ACC.DATE ACG FILE NO. W'ORKERS'COAIPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sell'-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec.3800,Lab.CJ.. Policy No.' Company Q ❑ Certified copy is hereby Roushed. FIRE SPRINK ENERGY T24 Z Z �K'Certi6e.l� o1+y is fl¢d with the Ity inspection Division. REFER TO OR D. Applicant k�\�`�\�'H?-'`-Q1R.\� MISC.- Y❑ N❑ Y ❑ N❑ CCTPERMIT ISSUANCE 10.00 FLooO zoNE A.L.uc. � - CERTIFICATEOFEXEMPTION FROM WORKERS' ly > COMPENSATION INSURANCC PLC.CONTR. LIC.N0. PLG. v❑ N❑ Y ❑ N❑ CL O ('this section need not be completed if the permit is for one TOTAL =) Z hundred dollars(S 100)or less.) U O I certify that in lire performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY La is issued,1 shall not employ any person in any manner so as to /r Ow become subject to the Workers'Compensation Laws of California FFEE /J-.ITN Date Applicant ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT: If,alter making this Certificate of lix- ♦- ? Cmptian,you should become subject to the Workers'Compensation APPLIANCE 5.00 Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.NL) 4.00CONSTROCIAON LENDING AGENCY AIR HANDLING UNIT(OVER lo=CF.M.) 6.00 I hereby affirm tlml there is a construction lendingagency fr EXHAUST HOOD (WITH DUCT) 5.00the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.003097.Civ.Q).Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 imonancesl n estate . I agau ai comply with all oily and county BOILER-COMP(3 H.P,ar 100,000 B.T.U.) 6.00 PLUMBING ordinances and some laws relating to building construction, and \ hereby authorize representatives of this city to enter upon the BOILER-COMP (Ova,100,000BTU)SEE FEESCH. MECHANICAL above-nnentloned property for inspection purposes. (We) agree to save, indemnify and keep harniless the City of MISC.- REFER TO ORD. r Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue age' sl Said CIIY in consequence of the gtanI g of t,4 is permit, r MECH.CONT. LIC.NO. MECH. // TOTAL TOTAL S2 (003 ign re Appiic' Co ractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING • 0* , CITWF CUPERTINO PEHAllT NDM1101R INSPECTION DIVISION 12296 JOB �IINS1PECT{IIONRR\ECORD JOB ADDRESS ` F�� r """ T# LOT# PERMIT EXPIRATION PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNE - �- 7^ %M' C' V/ UNDERGROUND /SLAB o &)1/7 PLUMBING ANG /� 8`7 ELECTRICAL I. U NC D TE MECHANICAL fid, *� BL FILE T. P M 0 PSd� $3D DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED_ /� 1,j�� o* sul DING ERMIT WOOD FLOOR dK I FORMATION V VALUATION S/FT, PLUMBING MECHANICAL �o 70 PEHFIIT TO ELECTRICAL FRAMING INSULATION (S,-j�'7 Q,p Lys rlxc.(,C• (p 49/ (-a/ b sio IES TvvE coNSrR. (I I O l y' n Qu� OCC GROUP RES.UNITS iDdo,ntoaieiE PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED `�^�� q phi SQ FT.FLOOR AREn TOTAL PCR EPEE ROOF I L.ne MEcx om PEEr6 ALL CORR. Y-i-87 DIAPHRAGM 4 IB AREAS Y'2-87 BUILDING USE RES IND CON PB Omer E:l El EJ El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED `(—I.1--87 a 1n ElASSESSORS PARCEL NO ROUGH INA Lome- PLUMBING 'BLAIR - EXCEPT EMPT4 SINK HGDILI/PS GAS TEST9-7-82 R4N ROOF 8PT FJAL. -B' TRACT NO, PARCEL NO $LAIR AMDAL. MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL I FINALS DATE INSP. FRAMING ISAN # ZONING ENG,SITE NO. INSULATION r1 PLUMBING •& T-BR 9- y'2-S'l GAS y 7 87 MESPRINK ENERGY T-24 MECHANICAL . IS'Y'I Y ❑ N[:] Y C] NF] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICA _ _b-I] FLOODZONE aL.u.c. LATH—EXTERIOR FIRE DEPT. �' lyIv� ryv I] N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLSELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY i I SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Lu f- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 1.0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY