15547 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
kCONTRACTORS
.BU-J-DINGPROJECT,IDENTIFICATION :PERMIT NUMBER_ '
t NAPPLICATION & PERMIT' � [[ /� �J r UILDINGELECTRICAL-PLUMBING-MECHANICAL E JJ`FfPLAN CHECK VALIDATION
QTY. ELECTRIC PERMIT FEE
EE UTLETS-SWITCHES-RECEP 10.00/1.00
Quit-Cconr uc.NO LIGHTING FIXTURES 10.00/1.00
f-ONTRAC1OR5 APPLIANCES 4.00
AOOREss ' p '
PHONE#/4 3N� PANELS 10.00 V/ O DATE OF APPLICATION
OR
RCRIiEci PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .c:NO.
ENGINEER
LIC.NO. �O• - SIGNS TRANS. 3.00
ADDRESS Ervc. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
irp , EMP.METER OR POLE INS. 20.00
ADDRESSTs - MOTORS SEE FEE,SCH, a�rQ
SERVICE CHANGE 20.00 ?�6�7
//3oo LICENSED CONTRACTORS DECLARATION I/ C
Fi w I Lerch,mf... that 1 am licensed under 'Twi'mnsof Chapter0 ISSUANCE DATE
a A (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. 'MECH.
r m t Professions Cod},and ty icense is in full force' fifer,(. r,A ❑ ❑ ❑
Zo i m o License lass S.._ Lic.Number -
_ w r,w Date Contractor- 'l war
< Y BUILDING PERMIT
¢ ¢w OWNER-BUILDER DECLARATION •�0 INFORMATION
.w;LL H .Thereby Whom that I nm exempt from the Contractor's License MISC.- - REFER T D
✓� VALUATION
a. Law Lawfor the following reason(Sec.7031.5.BusinessandProfessions PERMIT ISSUANCE 70
Code:Any city or county which requires a permit to constmep alter, -
¢ Q Or p Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
O¢ requires the applicant for such permit to file a signed statement that TOTAL
ou /(/" PERMIT TO
u w m he is licensed 9(commencing
the provisions of the Contractor's License
H z i Caw(els and
9(rommenCode)or Station is exempt therefrom
3 and /
a flm
Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ =$ by bells for[lie alleged exemption.Any applicant
ofSectromcivil
en L$ , STORIES TYPE CONSTR.
p3 _ by any applicant fora permit subjects theapplicant toacivil penally ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars f$500)J'. '
❑ I,as owner of the property,or my-employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
_ their sole compensation,will do the work,and the structure is not
intended or offered for sale (Stc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00
Code:The 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 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
ments are not intended 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 chat he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB CO.,
❑. I,is owner or 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 coutmetor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors license Law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,BAP.C.hor this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
"WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that 1 have a certificate of consent to self-insure, - ZONING EN
or a certificate of Workers'Compensation Insuranem,or a cern'eJ G.SITE N0..
copy thereof(See.3800,LaIr Ch _
Policy No-
0
oCompany�.)
❑ Cetli(icd copy is hereby furnished. C q FIRE SPRINK '• ENERGYT-24
Z Z Certified y is filed w tlI tht�ci inspection div ion.
O Aplic:mt��,__. ��-� MISC.- REFERTOORD. v [D N� V � NE]
F to PERMIT ISSUANCE 10.00
LJ CERTIFICATE(MPENS ION INSUROM1IWORK ERS' FLOOD ZONE A.Lu.C.
W >_ COMI'IiNSA'I'ION INSURANCE PLG.CONTR. - LIC.NO. pLG,
a- Q (Ibis section need not be completed if the permit is for one TOTAL V❑ NEI V 13NEI
a4z In...& d dollars(S 100)or less,) -
U O I certify that in the performance of the work 1'or which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL t mit is issued,I Shall not employ any person in any munnrr so as to
O
Cpbecome subject to the Workere Compensation Laws of Cnlifornla.
OL Date -Applicant ALTER OR ADD TO MECH. 500 BUILDING
�. W NOTICE-TO APPLICANT: If,after making this Certificate of Ex-
.
F Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
(� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4,00
- CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER 10,000C.FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency 1'ot EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM-
3097,Co.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 !
Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 �b
Lender's Addr Names - ELECTRIC
I certify that I have read this application and state that the above I VENTILATION 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 BOILER-COMP lover 100,000 RTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless rhe City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
n -
ay in any way accrue against Said City in consequence of the
ran log of this perinr MECH.CONT. LIO.NO. MECH.
`� �! ��cl rr U� TOTAL TOTAL
S gnsluredf Applmant/Conlractor Date '
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING-
PERMIT NUMBER
." CITY OF CUPERTINO ' 15547
INSPECTION DIVISION
JOB INSPECTION'RECORD
PERMIT EXPIRATION
JOBADDRESS /,60 TO •-JUN.U' A-. UNIT# _LOT#' 1
PERMIT EXPIRES IF WORK ;
OWNER "/A/ O / - CONTRACTOH ` O a-• V-,1 IS NOT STARTED WITHIN'
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU
FOUNDATION � NOTE: ANCE OR 180.DAYS FROM
� •• " '
L UFER
ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAeIDAI ION ,
CUPERTINO STANDARDS. I
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 7- Yv.d1- �; ..
UNDERGROUND /SLAB -
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL w/ ELDr, ILIECT PER. MECH
PN ❑ !E ❑ E]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - J�° 19 UILDING PERMIT
1 N q INFORMATION
' WOOD FLOOR "`� A UAnoN $/FT. 1
IPLUMBING 9d�►►'�
MECHANICAL 0,t, Ot
'ELECTRICAL - PERMrt•ho -
F AMING. .
:INSULATION STORKS TYPE CONSTR.
•�-- - - RK ,
OCC.GROUP RES.UNITS
7 f�PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF- NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O rT:FLOOR AEg. IOTAL ACREACF
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDINGUSE
ROOF SHEATHING RES IND , CON PB OT",
APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ' DATE INSP. ❑ 1:1 El ' 1:1 cl
ASSESSORSPARCEL NO --
` ROUGH SAN.0
PLUMBING ELECT.ENERGY'
.
TUBS SHOWER PAN � PLUMBING ENERGY TRACT N0PARCEL NO
MECHANICAL MECH.ENERGY
. y
ELECTRICAL � � BUILDING ENERGY - ACC.DATE ACCFILE NO
- -
FRAMING - ELECT.FINAL TEST, '
• INSU LATION - PLUMBING " 4FLOOD
ZONING ENG,SITE NO.
GAS TEST - - GAS ;SPRINK ENERGY T-]G
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° N0 A.L U.C.EXTERIOR SHEARELECTRICAL RELEASE -� - nINTERIOR•SHEAR - FIRE DEPT. ` Lam- N❑SHEETROCK . GRADE MMARY
y EXTERIOR LATH • BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS '
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
IND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOT PERMITTED UN TIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, T ELECTRIC
- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING..
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION:
OFFICE COPY