13915 APPLICANT TP,f lJ-. • IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT I DENTIF I CATION i PERMIT NUMBER
BUILDINq � APPLICATION & PERMIT
ADDRESSI �qq s/ �� 13915
OeJ IT� BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
�:r, OWNER'S
i> PLAN CHECK VALIDATION.�
"ANI
O1L�y,lEo kE�-rO q47QTY. ELECTRIC PERMIT FEE,
HONEG 4
CONTRACTOR'S
N E '�f� gyp= //� OUTLETS-SWITCHES-RECEP 10.00/1.00 (s - -
CCW
7 UCc No.,-/uU .LIGHTING FIXTURES 10.00/1.00 16
rCONTRACCTTTORS APPLIANCES-RIESIDENTIAL 4.00
V ✓-� w^Q�/ NPHONE 7{/[/�JL PANELS 10.00 GATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
on fff w ` PANELS ( ER 200 AMP) 20.00
.ENGINES .111+Ar/ J
uc.No. /l SIGNS TRANS, 3.00
ADDR.SS ENG. Ir1r� �/ SPECIALCIRCUIT 5.00
ADO Q �/VUi V� PERMIT VALIDATION
/ Ilr V
7 Lr �"'' zIP a EMP.METER OR POLE INS. 210.LO,
ADDRESS TSt q MOTORS SEE FEE SCH. lT// CJS
/ ��� ��� SERVICE CHANGE „20.00 a20
W 0 I
F O O LICENSED CONTRACTORS DECLARATION
ri W I hereby affirm that I am licensed under provisions of Chapter 9 �.sel�/(lr"in�
a (commencing wit ecti n 7000)of Division 3 of the Business a $1A�e� 'e ..- ISS ANC6 ATE�w
H 7 2
Professions Coded njF license is in full fo fllE I ,r ' BLDG. ELECT. PLG. MECH.
t0 0 H O License Sys (_Lic.Number_ l/ - (-ZI ® ❑
m r w Date/.� Contractor (_ G1 I�I(10
Q a ��/ O ER- UILUER DECLARATION I _,/ ifs 1`
a Q W u �� �' BUILDING PERMIT
X ;u H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
u O< Law for[be following reason.(Sec.7031.5,Business and Professions VALUATION $/FT.
t - m PERMIT ISSUANCE 10.00 7
N� Code:Any cityor county which reyuiresn permit to construct,alter,
w n G improve,demolish,or repair xny structure,prior to its issuance,also ELEC.CONTR. LIC.NO, ELEC.
w m LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TD
he is licensed pursuant to the provisions of the Contractor's License /^' •TT /
rz¢ Law(Chapter 9(coiamencing with Section 7000)of Division 3 of the PLUMBING PERMIT FEE
E q D Business and Professions Code)or that he is exempt therefrom mW OTV,
P- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n
by any applicant for u permit subjects the applicant toacivil penaltygLTER-GRAIN&VENT-WATER
Of not more than five hundred dollars(8500).1: (EA.) 5.00
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and rte structure is not OCC.GROUP RES.UNITS
+ <v intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors 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 sa Pr.FLOOR AREA TOTAL ACREAGE
y himself or through his own employees,provided that such improve-
mentsarenotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or,improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of proving That he did not build or im- BUILDING USE
Prove for Purpose ofsale.).
C1 1, WASTE INTER. 30.00 RES IND CON PB Omer
1,as owner of the property,a...exclusively contra cling with RE IN ❑ '
licensed contractors to construct the project ISec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractors License Law does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with u cortmenrtsl licensed Pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
O 1 um exempt Corder Sec ,B.&P.C.for this
reason WATER HEATER W/VENT 6.00
Owner�/�..�•�y.�r�/�_ q WATER SYSTEM 5.00
ORKE 'COMP
�TI / ALL.DATE ACC.FILE NO.
wURKE COMP; TIN . .ARAT WATER TREATING EQUIP.
I hereby all'ir at lhove acerlil'icme of consent In act-msum,
/ ora certificate o orkers'Comperoci ion Insurance,or a certified ZONING ENG.SITE NO.
�•'• copy thereof(Se 3 Cm ,toy ).nGT�A
Policy No. Company T[
❑ Cerlil •d copy is here by furnished. FIRE SPRINK ENERGY T2a
Z 0 CeryTlydr fled wit I I_(_,Met
division.
F APPlicandl_(J./ MISC.- REFER TO ORD. v � N� v0 N�
W CF.RT'IhICATIi UI°EXEMPTION FROM WORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE a.L.U.C.
LU COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. - PLG,
CL O 'ClIfla section need not he Completed if the,permit is for one TOTAL Y❑ N❑ Y 0 N�
Z) Z hundred dollars IS 100)or less)
U O 1 certify ilia,in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL f- mit is issued, I shall not employ any person in any manner so as to
O W becnnm subject to the Workers'Compensation Laws of Culilorm:i.
n Dat` npphcam ALTER OR ADD TO MECH. •��5.00 BUILDING eLSa
} N NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F Z emPtion,you should become subject to the Workers'CompensationAPPLIANCE _ 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.W. 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.1' 6.00 SEISMIC FEE S�
I hereby affirm that there is a construction lending agency forNVENTI
EXHAUST HOOD (WITH DUCT) t 5:00 f1{1l1
the performance of the work for which this Permit is issued(Sec I y+ ' MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) $Adm
Lender's Name
-C "+� Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
W I certify that I have read this application and state that the aboveLATION FAN (SINGLE) 4.00
information 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.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
abom
ve- entioned property for inspectir purposes. BOILER-COMP lover 100,000 BTUI SEE FEE SCH. MECHANICAL /
T agree to save, indemnify an an harmless the City of MISC.- REFER TO ORD.
C er Tao against liabilities,jt en osis and expenses which CONST.TAX
ay in way accrue•agai st said C' in Umsequence of the PERMIT ISSUANCE 10.00 0
gra p r t. CONT. LIC.NO. MECH.
p /J TOTAL S-_ TOTAL 130 0
afore of Appl cant Contra or Date (((
OFFICE COPY tt
POST THIS CARD NEAR FRONT OF BUDDING
CITY OF CUPERTINO PF
AMIr NUMBER
`
INSPECTION DIVISION 13915
w"0 JOB INSPECTION RECORD
10549 SAN FELIPE PERMIT EXPIRATION
JOB ADDRESS UNIT4' LOT
OWNER
MONTE KERSTON CONTRACTOR GARY JOCHINASPERMIT EXPIRES IF WORK
'
IS NOT STARTED WITHIN
Is INSPECTION I DATE__j INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION _gj / — . AN
CE OR 180 DAYS FROM
UFER �•7 - MwN Awrti. 7• LASTCALLEDINSPECTI ON.;
PREGUNITE - - (--IT . uQ_/te PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED a� D r Vy ��
UNDERGROUND /SLAB
PLUMBING
_ .. ,
ELECTRICAL ISSUANCE DATE
f}h
MECHANICAL _ RLOG. ELECT. PLG. MECH.
❑ El ❑ ❑v
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 9uILDING PERMIT
WOOD FLOOR ~ r +qP',+'INFORMATION
PLUMBING U`�' •.VALUATION $/FT.
MECHANICAL
ELECTRICAL - - PERMIr rD
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC.GROUP RES.UNITS
_wt Yr IP,LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
1�I I' ROOF SO FT,FLOOR AREA TOTnL ACREAGE
�IDIAPHRAGM — /-
/ �, BUILDING USE
RES IND - CON PB op",
RAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ E) El ❑
ROUGH nssessons PpncEL NO.
"NG
TRACT NO. PARCELNO.
M-FNS-P.S DATE - INSP. ACC.DATE ACC.FILENO.
- zoNlNc
ENc.SITE No.FIRE SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Y ❑ N❑ Y ❑ N❑
LATH—INTERIOR _ FLODozONE A.L.U.C.
LATH—EXTERIOR Y❑ N❑ r❑ N❑
SHEETROCK GRADE
SHEAR INTERIOR FEE SUMMARY
BUILDING„.
SHEAR EXTERIOR TEMPOR Y APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS -'FEE /
LNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE j
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
010E Lu. I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F.Jt. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
zl PLEASE GIVE JOB ADDRESSWHEN..PHONING.
-SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
JMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE . TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY