17460 jAPP,LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER
BUILOINQ - - . - APPLICATION & PERMIT
Aoo RESs -
y �� � / D BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,. 17460
OWNERRS/ / n PLAN CHECK VALIDATION
NA/If� P: ZT I 'i/ O OTV. ELECTRIC PERMIT FEE
PR
�-•Pros, arve
1 1
OONTRACTOR'S
NgnME � UTLETS-SWITCHES-RECEP 10.00/1.00
/J/� ✓l"��1� LIC.No, LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
Tqa
ADDRESS
SzUR-L� PPLIANCES-RESIDENTIAL 4.00
C �]
PHONE 73 a PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO,
ENGINEER
LIC.NO. SIGNS TRANS. 3,00
AOOR ESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20,00 1 /`1DW�I
ADDRESS MOTORS SEE FEE SCH. p. eL• /t 1Y
ADDRESS
' SERVICE CHANGE 20.00
a¢z
F
00 LICENSED CONTRACTORS DECLARATION
Q -u I hereby affirm flat 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
,HA < w (commencing with Scelinn 7000)of Division 3 of the Business and IdwLOG. ELECT. PLG. MECH.
Professions Code,and nhy license is in full force and effect El E]z 0 m- License Class Lic.Number
9 a Datc Contractor
,f Cit)/ CU BUILDING PERMIT
, w a OWNER-BUILDER DECLARATION INFORMATION
X ;LL H I hereby aRlnn that 1 am exempt from the Contractor's Licenec
MISC.- REFER TO ORD
H LL 0 J Law for the following Person.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE , vnwnnDN SIFT.
Code Any city or county which requiresa permit to construct.alter, 10.00 -/n/ /�/+� /�y/
2 idli
�/
Q Q improve, emoshi
,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. /
ELEC. !i• /In,
a a, requires the applicant for such permit t0 file a signed statement that TOTAL
o. w $ he is licensed pursuant to the provisions of OhefDiCisLicense g ER T,xSI� 0
vh
H Z a
Law(Chapter 9(romehcing with Section 7000)of DivislioG on3 of the I�IgGI, I�J/J
2 a Business and Professions Code)or that he is exempt therefrom andDTV. PLUMBING PERMIT FEE
at I- $ the basis for the allaged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d3� by any more
fora permit dollar,the applicant ton civil penahy ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollars(5500)J:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compenmtion,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:'The Conlimic or's License Law does nod apply In all 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 re through his own employers.provided Om[such ins building
mems are through
rimended or offered employees,
or provided that s the building GAS-EA.SVSTEM-l1NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner-
builder will have Ole burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
- prove for
aso nee of sale.). INDUSTRIAL WASTE INTER., 30.00 RES INA CON PB Omar
❑ d ca owner rs tiro property,all exclusively contracting with 0 D 0 � El
nil Pro contractors to construct the paced(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions property
The Contactors License Law docs not apply to tr owner of progeny who builds or improves Ihrreon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such License
projects with a contractarls)IicensCA pursuant to
the Contractor's Licensee Lal SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ xc I I ulCr ' -A&- or this WATER HEATER W/VENT 6.00
reuxnl
owner .[ WATER SYSTEM ' 5.00 ACC.DATE ACG,FILE NO.
WORKFRS'COMPF- TION DEC RATI N WATER TREATING EQUIP. 5.00
1 hereby affirm that I have. certificate of Consent to self-insthre,
or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO. -
Copy thereof(Sec.3800,Lab.C.). -
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T@4
Z Z ❑ Certified copy is filed with the city inspection division.
_O Applicant MISC.
p: - REFER TO ORD. y [] NF] v [] No
jr !2 CERTIFICAI COP EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
LU > COMPFNSAT10N INSURANCE PLG.CONTE, LIC,NO, PLG.
CII'Ihis section need not be complool if the 'moll is for one _ TOTAL y❑ IN V IN
Z hundred dollars IS 100)orless.)
U O I certify that in the performrnce of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
ly„ l- mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
y Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING 64 DO
>_ W NOTICE TO APPLICANT: If,alter looking this Certificate Of Ex- _ r
F ? campfion,you should beconhr subject to the Workers'Conol in s.tloi APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you most I'onhwifh comply sell, FEE �.
U such.provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=11C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 _
'• the perfornance of Ihu work for which this perndt is issued(Sec. MICROFILM
3097,Co.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.0.50 ELECTRIC
I•certify That I have read[his application and state that the above VENTILATION FAN (SINGLE) 4.00
ordinances n corral I agree to colo b with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and star laws relating to building construction, Pott
hereby authorize representatives of this city to enter upon the BOILER-COMP IOver 100,000 BTU)SEE FEESCH. MECHANICAL
abovrmen[ioned property fo inspection purposes.
save, in
'n PC'and keep larmtes, the Cit'of MISC.- REFER TO ORD.
III a• t Hill ,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may i wa ecru against said City in co segue r of[he
g of[hi ani MECH.CONT. LIC.NO, MECH.
2� TOTAL TOTAL na
I ol'APp ant Cont r 1 fe U
OFFICE COPY
I
,POST THIS CARD NEAR FRONT OF BUILDING eRM,rNOMBE:R, '.
CITY. OF CUPERTINO,
17460
11NSPECTION DIVISION
'JOBAN`S,PECTION RECORD
ME
JOB ADDRESS / O Z 544/ 7 ��✓2-{J If PERMIT EXPIRATION
_LOT# '
-- - - - 'PERMIT EXPIRES IF WORK
OWNER ':.CONTRACTOR IS NOT.STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OVPERM1T ISSU-
FOUNDATIONNOTE: - - ANCE OR 180 DAYS'FROM
UFER - . .
"ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLEMINSPECTION.
PREGUNITE ' TO COMPLY WITH THE'APPROVEO PLANS AND CITY OF PERMIT YALIDATION
CUPERTINO STANDARDS,
GARAGE SLABS -
FOUR NO.CONCRETE UNTIL ABOVE-HAS.BEEN SIGNED. - d ,; + ,-. .`��,_•, r:,t.
UNDERGROUND /SLAB, ��.•,: i-
PLUMBING MAR 2
ELECTRICAL ISSUANCE DATE
MECHANICAL _ - .+. - Cly, •EEecr P,.r,. - MECR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
WOOD FLOOR FORMATION
PLUMBING vAC noN ,w S/FT.
w
MECHANICAL
ELECTRICAL - PERMn.TO
FRAMING
INSULATION ? _ - STORIES TYPE CONSTR t
.- - - - -
OCC GROUP , RES UNITS
-"- ' APLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROOF - NOTE:NO FINAL INSP.SHALL BE�MADE BEFORE S°,vT.P�oov AVER iornL AcecncE
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
ROOF SHEATHING - • - BUILDING USE
- - RES IND I D, PB OR",
°"APPLY NO ROOFING UNTIL ABOVE HAS BEEN°SIGNED +' Ll ❑ ❑ ❑ - ❑
- "•'•''FINALS 'DATE` INSP.:,
ASSESSORS PARCEL No.
ROUGH 11 - SAN.k'
PLUMBING _ _ ELECT.ENERGY -
TUBS&SHOWER PAN: - TRACT No PARCELED
^c PLUMBING ENERGY ,
MECHANICAL` MECH.ENERGY, -
ELECTRICAL ' - ACC DATE ACC.FILE No
.
BUILDING ENERGY
FRAMING, ELECT.FINAUTEST
INSULATIONPLUMBING 'ZONING ENG.SITE NO
GAS TEST GAS
FIRE SPRINK ENERGY T-24
MECHANICAL.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED " HEATING ❑ "❑ ❑ "❑ -.
1 EXTERIOR SHEAR ' + ELECTRICAL RELEASE - FLOOD zorve A.LD,C.
INTERIOR SHEAR ., FIRE DEPT. Y Y❑ N❑ Y ❑ 'N❑
SHEETROCK' 6 GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
'BUILDING '
INTERIOR LATH .. - TEMPORARY APP OVALS. ;
SCRATCH COAT ELECTRIC I PLAN CHECK
` GAS -- FEE
NO TAPE9 OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED•UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. I
MICROFILM
`ARRANGE"FOR INSPECTION BY PHONING 252-4505, 9 ELECTRIC
ONE WORKING ,DAY BEFORE REQUIRED INSPECTION. PLUMBING
. z PLEASE GIVE JOB ADDRESS WHEN PHONING.
tt - SEE PERMIT FOR.EXRIRATION DATE — MECHANICAL
F -
IMPORTANT!! CONST.TAX-
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION, TOTAL
OFFICE COPY