13645 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES — USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION - - PERMIT,NUMBER
BUILDING APPLICATION•&PERMIT +
A00 ES
/us ' ,. BUILDING-ELECTRICAL—PLUMBING—MECHANICAL 13645
OWNER'S v�V PLAN CHECK VALIDATION
`1 �AI�J/�f� OTY- ELECTRIC PERMIT FEE
"aNIA
'
NAMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
h LIC.NO. • (p LIGHTING FIXTURES ,r 10.00/1.00 (�
CONTRACTOR'SPPLIANCES-RESIDENTIAL - 4.00 '
ADDRESS
PHONE' PANELS 10.00 'DATE OF APPLICATION
ARCHITECT a.r _ . 'w- - - PLAN CHECK FEE P.C.NO:
Dq {(/'/J ^dL/(asJ^y� Ji PANELS (OVER 200 AMP) 20.00 ••�D -
OR �s �-^ -
g' • uc.NO,l.�-. �� SIGNS TRANS. •3.00 3'
ARCH,OR ENG PERMIT VALIDATION
ODREES 20�J�f -SPECIAL CIRCUIT 5.00
y� 1 zm EMP.'METER OR POLE INS. M,20'.00, -
AaDRESSDDRESS MOTORS - SEE FEE SCHPIPLICAN .
• - +' SERVICECHANGE R(?7 •20:00, r•
0 -LICENSED CONTRACTORS DECLARATION
a v E I hereby affirm that 1 am licensed under provisions of Chapter 9 ra�r nF Mm[F+iM ISSUANCE OATS
H G ya (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT' Q P ll+ htEOH.
r 2 Professions Code,and my license is in full force and effect.,
License Class Lic.Number
o Date Contractor
- BUILDING PERMIT
¢ ¢ a OWNER-BUILDER DECLARATION+
a -
o a 0 - - INFORMATION
I hereby affirm that I am exempt from the Contractor's License - MISC.— ' REFER TO ORD VALUATION ,$/FT.
u0a Law(oche following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 -
F � 0 Code:Any city or.county which requiresa permit to construct,alter, /s
Q t
Q Q Q 20 Improve,demolish,Or repair any structure,prior to Its issuance.also ELEC:CONTR. LIC ND. „ - - ELEG 7
d W ant 0 Q 'requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ,
he is licensed pursuto the provisions of the Contractor's License
to z 1 Luw(Chapter 9(commencing with Section 7000)of Division 3 afthe,
i et Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ I-B the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR.
i ; _ by any applicant for a permit subjects the applicant toa civil penally ALTER-DRAIN&-VENT-WATER IEA.) 5.00
- - ofdot more than five hundred dollars($500).): � - -
+❑ I;as owner of properly,or my'emplo'yces with wages as BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES.UNITS
jtheir Sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner ol.
`� property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 `);p0 SO.FT.FLOOR AREA TOTAL ACREAGE
1, himself or through his own employees,provided that such improve-
ments arenot intended oroffered forsale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00
1+! or illlPrrvemmn is sold within one year of completion, the owner. GAS;EA.SYSTEM+OVER 4 (EA.) 2.00
ll builder will have the burden of proving that he did noLhuild c r Ira- BUILDING USE
prov for purpose of sale.). -' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orhe.'
I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
It,•died Contractors to Construct the project(Sec. 7044,Business LAWN-SPRINKLERS-1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO.
and Professions Code: the Carl mctor'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 contraclons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ 1 m pt under' W/VENT
WA
Sec. ,B.&P.C.bar Hits TER HEATER "p"x � 6.00
• naso✓tl - S.4'.....
Ow � ,�J WATER SYSTEM � _ 5.00 ACC.GATE ACF FILE NO.
14P
WORK ERS'C0ENSATIOV10' RATION ' WATER TREATING EQ_UIP-;1 - "'5.00 -
I hereby affirm that I have a certificate ofconsent to self-inaure, -
Or a canific:Do of Workers' mhpensation Insurance,or n certified Cup'..i:..n ZONING' ENG.SITE NO.
copy thereof(Sec.3800. . ..). - .�1�1 Of-iBUV `•" -
Policy No. C hp' '
0 ❑ Cetlif yfurnished. FIRE SPRINK ENERGY T 24
Z ❑ Ce' 1` ded spection division.
Applicun - MISC.'- . - REFER TO ORD. Y ❑ N❑ Y ❑ IN .
LU N CER'I'IFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 0 -� FLOOD ZONE A.h.U.C.
W — h COMPENSATIONINSURANC6 „ PLG.CONTR. LIC.NO. PLG.
CL ❑ (This section need not be completed if the permit is for-one TOTAL Y❑ N❑ Y❑ N[]
D 2 hundred dollars($100)or less.) -
U O 1 certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any Penna in any manner so as In . 5.00 /`� .Sa
0 Do beeone subject to the Workers'Compensation Laws of California.,
y BUILDING Datc Applicant ALTER OR ADD TO MECH. -
} so NOTICE TO APPLICANT: If,after making-this Certificate of Ex- -
F 2 emption,you should become subject to the Workers'Compensation Z APPLIANCE 'r.n T' 5,00 . PLAN CHECK
provisions of the Labor.Code, you musl'forthwilh comply with - . FEE.`
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO 10pODC.F.M.)� 4.00
CONSTRUCTION LENDING AGENCY c AIR HANDLINGUNIT,(OVER 10OW C.EM.) 6.00 SEISMIC FEE a 4�
I hereby affirm.that there is a construction lending agency for EXHAUST HOO D'(W ITH DUCT) _ 5.00
the performance of the work for which this permit is issued(Sec. - CT - .MICROFILM
3097,Civ.C.).,` HEATING UNIT_(T(?.100;000.9:T.0.) 8.00
- . .Lende'r's Name HEATING,UNIT(OVER 100,000 B.T.U:)9.50 dV
Lender's Address ELECTRIC 6 _
1'vP \ I certify that I have read this application and Slate that the above VENTILATION FAN (SINGLE) - 4.00 -
Infornasiom is correct. I agree to comply with all city and county, - PLUMBING N
'��4 ordinances and state laws relating to buildin6.construction, and BO
above-mentioned property for ILER-COMP(3 H.P.orr100,000B.T.U.)'6.00
- IIS ✓
j hereby-authorize representatives of this city to enter upon [be
t� inspection purposes.. BOILER-COMP Over 100,000 STU)SEE FEE SCH. MECHANICAL 3' -!
'1f, ..z'
_(We)!agree to savo,•Indemnify and keep hornless the City of '' MISC.- REFER TO ORD.
Cupertino against liabilities, menti, costs and expenses which - ' - CONST.TAX
'
Rtayaay a c e st said-City incosequen a of thePERMIT.ISSUANCE. � 1000pe MECH,CONT. - LIC.NO. MECH.
TOTAL36 ' TOTAL'.plic nt/Contractor. to IP
OFFICE COPY ' - '
POST THIS CARD NEAR FRONT OF BUILDING , }
., f RMIT NUMBER
' CITY: OF EUPERTINO 1364b
+ INSPECT•ION,DIV601\1-
JOB INSPECTION RECORD = `
� q, "" • .'` p� a PE RMITEX^Pr
I RATION
doBADDaEs19925STEVENSi.CREEK UNIT# LOT#�
,PERMIT EXPIRES IF WORK
OWNER MAROCCO„DEVELOPMENT coN1RACToa', _ }`:' "IS NOT STARTED WITHIN
INSPECTION DATE- INSPECTOR INSPECTION RECORD 780 DAYS OF PERMIT ISSU-'
FOUNDATION - - ^��” s
AUFER o. ,OI�AL:C2. L2: , ANCEOR 780 DAYS FROM
LAST�CALL•ED INSPECTION.
PREGUNITE , I��a[r/�7 , , _per PERMIT vALmanON .
POUR NO.CONCRETEUNTIL ABOVE HAS BEEN SIGNED: 74 r �v �a,f r
"UNDERGROUND [SLAB C1iJ,Cf gp2ttma:
PLUMBING�I ' -
ELECTRICAL - ISSUANCE DATE
MECHANICAL r BLDG. ELECT. PLG. MECH.
40
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED , t" .' BUILDING PERMIT,
` INFORMATION
,WOOD.FLOOR' vawnuory - 8/FT.
PLUMBING, r +
_ MECHANICAL ., _ - • 'e
ELECTRICAL PERMIT To ' .
FRAMING _ • D P ^ti -..y,.
INSULATION STORIES TYPE CONSTR.-
e
1 S, OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTICABOVE HAS BEEN SIGNED I "
ROOF SQ FT.FLDOH AREA TOTAL ACREAGE
DIAPHRAGM '
BUILDING USE
t f HES IND CON PB - OMP
APPLY,NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH
PLUMBING • PARCEL NO.
p �f L -
TRACT NO
�r .
GAS TEST.',., 'r </ �� -
MECHANICAL '
,,,,. ACC.OaTEer. ACG FILE NO.
ELECTRICAL FINALS DATE INSP.
.FRAMING'Qiv,d, �t I 16.*2147 " SAN # • - .
t
INSULATION PLUMBING - (77
1 ZONING ENG..SITE'NO.
. . GAS + i
MECHANICAL' FIRE SPRINK ENERGY T�24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑' "� Y'Or. "0
,.LATH—INTERIOR ...f;,; r.' 'E L'ECTRICAL',, _ FLgoD¢orve - ,a}�u,a
LATH-EXTERIOR, .': :r" .. -a?. FIRE DEPT. ^.; '; v.❑ NO v ❑ "N❑ ;,
SHEETROCK" • GRACE- 'FEE SUMMARY
SHEAR INTERIOR- - BUILDING " BUILDING
.. SHEAR EXTERIOR 'TEMPORARY APPROVALS
' FIREWALLS - ELECTRIC. - PLAN CHECK
GAS - FEE'
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ti SEISMIC FEE ;%f
OCCUPANCY OF BUILDI NG ISNOT PERMITTED UNTILBUILDIN GFINA L IS SIGN ED'BY BUILDING INSPECTOR.
,•.. f . „ MICROFILM
ARRANGE FOR INSPECTION BY PHONING 2524505, ELECTRIC
� ! F ONE WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING j
!�)) z� € PLEASE GIVE JOB_ADDRESS WHEN PHONING: k*
SEE PERMIT FOR EXPI'RATION'DATE —, MECHANICAL
IMPORTANT! CONST.-TA .
PLEASE READ REVERSE SIDE BEFORE - TOTAL
CALLING FOR FINAL INSPECTION.
OFFICECOPY•. '�-