11436 -APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
4• _ ft
BUILDING PROJECT IDENTIFICATION _ PERMIT NUMBER
LUILDING APPLICATION & PERMIT
/ - aDnRE=Bao � UILDING - ELECTRICAL-PLUMBING-MECHANICAL i 11 -436
-
Gg' PLAN CHEC VALIO ATION
c` 1`eY_in I OTY- ELECTRIC PERMIT FEE
coNrRACTlisi _
NAMUTLETS-SWITCHES-RECEP 10.00/1.00
E b(
Ua% -
stal 1+1ll-.LIC.NO LIGHTING FIXTURES 10.00/1.00
noonese OR �jlO TV, APPLIANCES 4.00 '
QO we IU• Y J--)-Z--y PANELS 10.00 DATE OF APPLICATION
ARCHITECT '- PANELS (OVER 200 AMP) 20,00 .PLAN CHECK FEE- P.C.NO.
OR
ENGINEER
� uc.NO. SIGNS TRANS. . 3.00
ARCH.OR ENG. SPECIAL CIRCUIT - 500. - PERMIT VALIDATION
ADDRESS .
! 'ZIP EMP.METER OR POLE INS. - 20.00
ADDRESS
I
Ars - MOTORS SEE FEE SCH. W/
DREss - �'
- SERVICE CHANGE 20.00 � �l
'02 LICENSED CON'I'RACI'ORS DECLARATION r t
c u� I hereby affirm that I mn);caused under provisions of Chapter 9 ' 1JL - ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business msd - BLD ELECT. PLG. MECH.
,�i Professions Code,and my license is in full force and effect. - { ❑ ❑ ❑
' 0 . - License Class Lic.Number - QI C11 e Q
D I-� Data Contractor- lz
Q y J L • • �� BUILDING PERMIT
EEQ.Ec �, 'OWNER-BUILDER DECLARATION •' INFORMATION
AOA 'MISO.- REFER TO ORD
is LL H I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
t. o¢ Law for the following reason(Sec.7031.5,'Buimessand Professions PERMIT ISSUANCE 10.00
- Cade:Any city or county which requires it permit to construct,are, /fT7/J
is R < FO improve,demolish;or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. - ELEC. VOD.
¢ requires the applicant for such permit to File a signed statement that TOTAL PERMIT TO
K
$ heis licensed Pursuant to the provisions or the Contractor's License
F z ¢ Law(Chapter 9(comnwncing with Section 7000)of Division 3o1 the K�
Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ r $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
d '; by any applicant for a permit suhiects ilia applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 .
- of not more than five hundred dollars($500).):
❑ 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 (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 1
property who builds or improves thereon,and who does such work FIXTURES--PER TRAP _ 5.00 SC FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsamnot intended oroffered for sale.If,howeve,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 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND N PB 'Omer
prove for purpose of sale.). ' INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ &Y ❑ ❑
licensed contractors to construct the project(Sec. 7044,.Business LAWN SPRINKLERS-1INC 5 V.B. 6.00 ASSESSOR 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 IEA.) 1.00
contracts for such projects with:t contractors)licensed pursuant to
the Contraetor's License Law. SEWER-SANITARY-STORM EA.200ft/10:00 TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,B.&I'.C.for this WATER HEATER W/VENT . 6.00 -
reason
Owner Dave WATER SYSTEM 5.00
ACC.GATE - ACC.FILE NO,
WORKERS•COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 '
.I I hereby affirm that I have a certificate of consent to salf.msure'
or a Certificate of Workers'Compensation Insurance,or a certified ZONING ENG:SITE NO. .
copy therelf(Sce.3800,Lab.C.).
Policy No. Cornpany
Q ❑ CerHf� is l¢rb untished. FIRESPRINK 1 ENERGY T-24
Z 2 ❑ Cerf red ap is Iled with Ne city inspection division. MISC.- REFER TO ORD.
AD PIicIryt�`f��/.Lt) Y❑ IN❑. V❑ No
OC - CENtIPL TL OP%IiMP N FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.-
L COMPENSATION INSURANCE. PLG.CONTR. ❑c.NO. PLG.
CL 0 (Phis section need not be completed if ilia permit is for one. TOTAL Y E] N❑ Y ❑ No
hundred dollars(SIO0)o1 less.) -
U Q I certify that in the performance of the work for which this Pei- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,l shall not employ any person in any manner so as to
U become subject to the Worker;Com nsation Laws of California.
w Date Applicant P' BUILDING'
a ALTER OR ADD TO MECH.- 5.00
} N NOTICE TO APPLICANT: If,after making i11;s Certificate to lix-
F Z pr visions
you should become subject must forthwitWorkersh
Ccomply wit! APPLIANCE, 5.00 PLAN CHECK ,
provisions io the Labor Code, you must drevoke comply with FEE
U. such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00
• CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE'
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
s the performance of ilia work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). _ HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT•(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC -
I certify that I have read this application and state that the above 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 momarizc representatives of this city to'enter upon the BAILER-COMP (Over 100,000 BTUI SEE FEE SCM: MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cu Strum agai I ;);ties,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
i y y ac me against said city in cone thence of the '
Fant' g er L I- MECH.CONT. LIC.NO. MECH.
�� TOTAL TOTAL
ignaNre of Applicant onlrnmor at - I
OFFICE COPY -
POST THIS CARD.NEAR FRONT OF;BULLDING,
- Z - + •• B - ,PTRMiT NUMBER
CITY 101" CUPERTINO . 11436
;., ..INSPECTION DIVISION"
JOB INSPECTION RECORD' f. a
PERMIT EXPIRATION.
,,����//yy yyyy,,�� p ,
1`. JOBADDRESS. IY�I�I�-•(LYIT# LOT#
PERMIT EXPIRES IF WORK,
owrveq / INrRACTOR - ` IS NOT.•STARTED WITHIN
` INSPECTION ' DATE INSP CTOR INSP CT ON RECORD
180 DAYS OF PERMIT'ISSU-
.
FOUNDATION - - - '•ANCE L DAYS FROM-'
.ry LIFER • .. ,. "
r< LASTCALLED INSPECTION.
s
PREGUNITE n r. •E' q• , ' PERMrt va uOATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /.SLAB.
`. PLUMBING -
ELECTRICAL + .. - I'SUCAELECTRICALMECHANICAL - .. B EL T.- E DATE I.c:r ' MECH.�-
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDt - BUILDING P RMIT
INFORMATION
WOOD FLOOR
vawanoN sl
r
,s FT
..
PLUMBING _ +'
MECHANICAL'.
�• ' ,
'ELECTRICAL PERMII'TO
_ a -�- :z - Y
FRAMING'
� r
' INSULATION - - - STORIES • Tv EC ,STR.
- OCC:GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO.FT FLOOR AREA TOTAL ACREAGE
r
ROOF'' " ,'• ?' .,r . : ..
"�•,',, DIAPHRAGM
BUIL pINc USE
RF.s "-.0 r C,O _ Po' Dino,'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
_ ASSESS7 ARCEL.NO.
ROUGH '
PLUMBING •-? z _ •,
_ TRACT No. •-PARCEL No
GAS TEST . .
MECHANICAL '%�'J- •r - ACC.DATE -'acc:+FILE No.
ELECTRICAL- _ . FINALS DATE INSP. ,
FRAMING .� SAN #. ,
INSULATION PLUMBING ZONING.
ENG.SITE No.
GAS
+ FIRE SPRINK - ENERGv.T'24
MECHANICAL
COVER No WORK UNTIL ABOVE HAS BEEN SIGNED . HEATING -� - .. OD zoN
El ' NEI:
FLOOD
'LATH-INTERIOR ELECTRICAL' E IN rvE_. A.L,u c.o N 11
. .
LATH-EXTERIOR FIRE DEPT. � -.�� _
SHEETROCK:. i • 'w GRADE ' FEE SLIMMARV
SHEAR INTERIOR! `j BUILDIN -
SHEAR,EXTeRIOR - " - -TEMPORARY APPROVALS'• - + BUILDING..
FIREWALLSELECTRIC s, PLAN CHECK -
GAS .FEE '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE, f+
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM, -
•'" ELECTRIC L
w + ARRANGE FOR INSPECTION;BY PHONING 252-4505,
I ONE WORKING DAY'BEFORE REQUI'RED'INSPECTION PLUMBING
z� P.LEASE•GIVE`JOB ADDRESS WHEN PHONING : ` ,
—:SEE'PERMIT FOR EXPIRATIONLDATE - MECHANICAL
-' • CONST.TAX,
.,
PLEASE"READ REVERSE SIDE BEFORE TOTAL
CALLING FOR;FINAL INSPECTION.
I 'OFFICE COPY '.. - - ...