6448 APPLICANT TO FILL IN INFO TION WITHIN RED LINES - USE B&L POINT PEN ONLY
t - - PERMIT NUMBER
BUILDING PROJECT IDENTI FICA APPLICATION & PERMIT
RNILRING e7 �0 6448
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
'S9�✓ fua�/ o
.OWNER' * i' PLAN CH ECK�°L IDATION
QTY.;' ',5.. ELECTRIC"PE RMITy&I'`x8ax.rF,AEE}
c NTR/AcroRs Z ' OUTLETS-SWITCHES-RECEP 5.00/100
k < r LIc,��d7FZJ�A LIGHTING FIXTURES 5.00/1.00
CONTRACTONs Dn ESS APPLIANCES-RESIDENTIAL 4.00
p
- PROM[ �/ PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
�----- -
ENGINEER //
LIC.No. SIGNS TRANS. 3.00
'ADARCH ESS E"D' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 •�
AUNr'$ MOTORS SEE FEE SCH. �J,n
APPIL ESS Ess -
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
a is w I hereby affirm that 1 am licensed under provisionsof Chapler 9 ISSU CE DATE
I- 'e .(commencing w'h Scebon 7000)of Division 3 of the Business and
a y B 0 ELECT. P G Ms H
w z Professions Codc d my license is in full fore I a
2 o w - License CJy; Lic.Number_1
0 m ww Dute_•'j Conlructor_ -
a m s %BUILDING,PERMIT-'
¢ ¢ w ¢ _OWNER-BUILDER DECLARA'f10N
E
3 a-w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD `,k. INFDRMATIUN
H u 0 4 Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00 VALUATION S/RT.
Code:Any city or conety which requires a permit to construct,alter,
Q G 2 improve,demolish, i repair any str Llure,prior 10 Its Issuance,also ELEC.CONTH. LIC.NO. ELEC /
o u regwres the applicant fo such permit to file a signed statement that TOTAL
n, w m he:s licensed pursuant to the provisions of the Contmcmr's License - PERMIT TD-�
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the - -y' a`-:a'dy
¢o Business and Professions Code)or that he is exempt therefrom and OTY: _ PLUMBING PERMIT, t FEER
m the basis for the alleged exemption.Any violation of Section 7031.5' - '4 STORIES TYPE CONSTR.
u; - by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of nut more than five hundred dollars($5001.1: -
O I,as owner of the property,or my empluyees'with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
- their sole compensation,will do tire work,and the structure is riot
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON D. 4.00
Code:T'he Contractor's License Law does not apply to an owner of - '
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP ' 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve. �•
mems are not intended or offered for sale.If,however,the building J, IGAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00or improvdmeol is sold within one year of completion;the owner- GAS-EASYSTEM-OVER 4 (EA.) 1.00 BUILDING USE
builder will have the burden of proving that h . .
e did not build or im- R IND .CON PB Omer
prove for purpose(it the.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑
O I,as owner of the property,am exclusively Lromracling with
licensed contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractors License Law docs not apply
to an owner of property who builds or improves theram,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts Jot such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 4,00
reason
Owner Date WATER SYSTEM ` 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMVENSA I ION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have'a cerlificatc of consent tm self-insure' ZONING ENG.SITE NO.
or a cerilieate of Workers'Compensation Insurance,or a certified
copy thenrof(Sec-3800,Lvb.C.). VAI 0--77
Policy Nn. Cnntpany
O O Certified copy is hereby furnished. FIRE SPRINK ENERGY T-14
Z Z O Certified copy is filed with the city inspection division. 1MISC.- REFER TO ORD.
O _ Applicant Y❑ N❑ Y ❑ NE]CIiR'I'IFICA'I'Ii OP GXEMP'JI(IN FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 c,
W COMPE=NSATION INSURANCE PLG.CONTR. LIC.No. PLG.
CLZ (This section nmed not be completed if the permit is for one TOTAL / Y❑ N❑ Y❑ N
V O hundred dollars(8100)or less.) - -
I certdy that in the performance of the work for which this per QT.Y' MECHANICAL.PERMIT. x,'FEEu+ `" iFEELSUMMA`4RY
IL F mit:s issued,I shall not employ any person in any manner so as to y=' .':.' ' t i6�
U become subject to the Workers'Compensation Laws of Cut fornn. /
0 CL Date Applicant ALTER OR ADD TO MECH. •4.00 BUILDING (Q
} sic NOTICE,TO APPLICANT: If,after making this Certificate of Iix-
F 2 en:ption,you should become subject to the Workers'Cumpensulion APPLIANCE 4.00 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.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C F.IM 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
Ihe.performance of Ore work ITT which this permit is issued Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00 2
Lender's Name HEATING UN IT(OV ER 100,000 B.T.U.)7.50 M /
Lender's AAArcss ELECTRIC _
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00 �-
Inlormation is correct.1 agree to comply with all city and county PLUMBING
irdinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
-hereby authorize representatives of this city to enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-memitmed property for inspection purposes.
MW, c indemnify andkeep harmless the City of MISC. REFER TO ORD.
I styes, its• costsand expenses which pERM1T ISSUANCE 3.00CONST.TAX
r - City in consequence of[he MECH.CONT. LIC.NO. MECH.
TOTAL TOTALn tractor Date -
OFFICE COPY
* CITY OF CUPERTINO INSPECTION RECORD +
(OFFICE COPY)
X677 Lf UUIW,a. d.
LUI NO.
UWNER
PERMIT ISSUED XTEJ A ELECTRICAL DATE INSP.'
in
Frica
Plumbinja it Power Pole
anica �rgroun
Temp as ec Rou fiwiring
Solar a s
Fire Sprinkler ei in
Sign ures Int/Ext
Motors
Misc. L Grounding
e ower
Utner
FINAL INSPECTIONS DATE INSP, Not .Approved
Gas _ S
Electric
Pl
um��— - �� PLUMBING DATE INSP.
eco han'ica _yr
olar Backflow
0o r un
n
ram— r oor "
annin arta u o
� -P
Fire t. u CmMlete
V2
t t. Solar u
1 - ater '; ns ation Xvc.
Utnermain rain /
o am
Gas
.Other
BUILDING DATE INW, P. Not ApproVF=
Pad Certification r
Foundation ELECTRICAL DATE INSP.
RveltO�e o a -
a - em rane Underfloor S.M. _gyp
Bond emn Ducts & Insulation(_0
Undertloor Girders Fire Dampers
Floor Steel irelace
ie owns A brease ct & Hood
re r� a our t
e15meC racing Condensate rain
a s- ane s ui ment Anc ora e
rams Yw ec 2 ues 4 Uomb. r —'
Ada�.-h ter
4Wvallboards Irit/Ex-t. Not Approved
irewa s 5th �s
er 0mPu 0
7'
Net Approved0
a s • t•o CAA e i&k Q p G�;C, 3,T,-7—ST—