15621 A+P—PLLIy, iNT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
El DING PROJECT IDENTLFICATION• 'PERMIT NumRER
6UILDING APPLICATION•&'PERMIT 15621-
O�56 �. I IJ 1
V BUILDING-ELECTRICAL-PLUMBING-MECHANICAL a.
OWNER'S. G
AME r PLAN CHECK VALIDATION
�( G. V' r ELECTRIC PERMIT FEE , e
(3i t C E/'i9N//� ONE 703 TY.
15UNTRACTOR OUTLETS 'SWITCHES RECEP 10.00/1.00 1
NAME
b '
, uc.No. -LIGHTING FIXTURES 10.00/1.00 '•- ,
CONTRACTOR'S -APPLIANCES-RESIDENTIAL 4.00 '
ADDRESS
PHONE'-. PANELS 10.00 a DATE OF APPLICATION
ARCHITECT 1, PLAN CHECK FEE PC.NO.
OR , r PANELS (OVER 200 AMP) 20.00 -
ENGINEER y LIC.NO. SIGNS TRAN& 3.00
AARCH OR DDRESS ENG SPE61AL CIRCUIT 5,00 PERMIT VgLI0ATI0N
ZIP - EMP.METER OR POLE,INS. 20.00
APPLICANT SMOTORS SEE FEE SCH'.
r
ADDRESS ,UL/E
. SERVICE CHANGE: 20'00
'00
0 o LICENSED CONTRACTORS DECLARATION 1 ( _
Q U U I hereby affirm that lam licensed under provisions of Chapter 9 ISSUANCE DATE
(wnunencing with Section 7000)of Division 3 oC the Business and
7 i Professions Code,and my license is imfull force and effect. BLDG.- ELECT. PLG. MECH.
z o w - License Class Lic.Number - '❑ ❑
0 r D Date Contractor
y E . . P BUILDING PERMIT
¢ O a ° OWNER-BUILDER DECLARATION - FORMATION
w ; u F I hereby affirm that I am exempt from the Contractor's License MISC.—` REFER TO ORD
U, LL o te Law for the following reason.(Sec.7031,5,Business and Professions pERMIT ISSUANCE - 10.00 13 TION
Code:Any city or county which requires a permit to construct,alter,
Q ar Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 1 n
iD u requires the applicant for such permit to file a signed statement that - TOTgL - .PERMIT TO
F
m be is licensed pursuant to the provisions of the Contractor's License - VIM
-
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the -
G /N
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
1 S' $ the basis for the alleged exemption.Any violation of SecImn 7031.5 STORIES TYPE CONSTR.
by any uPideant to,apermitsubjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
7 of not more than five Imndred dollars($500).):
❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
i,itended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law does not apply to an owner of
"E 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- ,.
Is GAS;EA.SYSTEM-11NC.40UTLETS 6.00
ments are not intended or offered for sale.If,however,the building "-"
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200 -
}�.M...;,+• builder will have the burden of proving that h . . .
e did not build or im- BUILDING USE
pro for purpose ofsale.). INDUSTRIAL WASTE'INTER. 30.00 RES. 'INo Ceti PB omar
I,as owner of the property,am exclusively contracting with , ❑ -❑ ❑ ❑ ❑
lie ed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and P fessions Code:The Contractor's License Law does not apply
to an Owner of properly who builds or improves thereon:and who ' LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsueh projects with a contractor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT NO. PARCELNO. ,
❑ I nm exempt under Sec. B.&P.C:for this WATER,HEATER W/VENT 6.00
reason
Own le- WATER SYSTEM - 5.00
. PCC.DATE ACC.FILE NO.;
WORKERS'-COMPENSATION DECLARATION, WATER TREATING EQUIP, 5.00
1 hereby affirm that I have a certificate of consent tO self-insure, - ZONING. ENG:SITE NO.
or a certificate of Workers'Compensation Insurance,nr a certified "
copy thereof(Sec.3800,Lab C.).
Policy,No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division.
O Applicant MISC.- REFER TO ORD. r❑
F • 'N❑ v ❑ „N❑
� y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE- 10100 FLOODZONE, A.L.u.C.
LU > COMPENSATION INSURANCE, PLG.CONTR. LIC.NO. PLG: -
CL O, 1This section need not be completed if the permit Is for one TOTAL Y❑ IN Y ❑ N❑
Z) Z hundred dollars 1$100)or leas) -
U O I certify that in tele performance of the work for which this
per- OTY. MECHANICAL PERMIT FEE - FEE SUMMARY
U. H mil is issued,1 shall not employ any person in any manner so as to
O become subject to the Workers'Compensation'Laws of Calil'omia.
O w6 Date Applicant - sALTER OR ADD TO MECH. P 5.00 BUILDING
} N. NOTICE TO APPLICANT: If,after making this Certificate of Ex-
� Z emption,you should become subject to the Workers'Compensation APPLIANCE, - ' _ 5.00 ' PLAN CHECK (
provisions of the Labor Coda, you must I'orthwilh comply with. FEE
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10,OODCF.M.) 4.00
CONSTRUCTION LENDING AGENCY' AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 - SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 -
the performance of lire work for which this permigis issued(Sec. - MICROFILM
3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 -
LeadersName - HEATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
- I etrtily that I have read this application and state that the above VENTILATION FAN (SINGLE) 4:00
information n correct I agree to comply with all city and county ,BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING
ornances authond stole laws relating to building construction, and' +
herediby arize representatives ec this city es`enter upon the' BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
sdk"4� ' above-mentioned property for inspection purposes. -
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Optician against liabilities,judgments, costs and expenses which pERMIT ISSUANCE 10.00 CONST.TAX s
may ok any way ace u against Said City in consequence of the _
Rnling of this pe I MECH.CONT. - LIC.NO. MECH,
G TOTAL TOTAL ' '�2:f-
I nature of icon/Contractor
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15621
INSPECTION DIVISION
JOB INSPECTION RECORD
�j ( - PERMIT EXPIRATION
4R79N. JOB ADDRESS /b00/'cS1MA}T06-R'- .l V L€ Ti UNIT 4: ` _LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR s IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OFPERMI.TASSU- I
FOUNDATION NOTE: ANCE OR 180 DAYS FROM� LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIOATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL
IssuaNCE GATE '
MECHANICAL BLOC ELECT vLc- .MECH
❑ ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - J - INFORMATION
PLUMBING VALUATION $OT.
.
MECHANICAL
ELECTRICAL'
FRAMING - - /,u I.
INSULATION .STORIES TYPE'CONSTR
Occ.GROUP RES.UNITS
,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FL.FLOOR AREA TOTAL ACREAGE
ROOF
NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res IND cON PB OR...
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
A SESBORB PgHCEL NO
ROUGH SAN.# '
PLUMBING R - ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY dHAE0 PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC,FILE NO.
,
FRAMING ELECT.FINAL TEST -
INSULATION PLUMBING - ZONING ENG SITE NO.
GAS TEST GAS
MECHANICAL - FIRE SPHINK ENERGY T.74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ Y ❑ N❑.
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD?ONE A.L u.C.
INTERIOR SHEAR a. FIRE DEPT. Y❑ N❑ Y ❑ N❑'
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH ,. TEMPORARY APPROVALS .BUILDING
SCRATCH COAT ELECTRIC FEE
CHECK s—ZJ"'
GAS `-
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252=4505, ELECTRIC
I- ' ONE WOR-KING 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