13285 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION • PERMIT NUMBER
BWLDW(I Q APPLICATION & PERMIT
�'DRESS
-13285
F_ EvEHs �P BUILDING-ELECTRICAL-PLUMBING-MECHANICAL -
Eq'E PLAN CHECK VALIDATION
N"ME' `I - t OTY. ELECTRIC PERMIT FEE
:i
PH
ONE
CON Ar CTORS. OUTLETS-SWITCHES-RECEP 10.00/1.00
NA �kov '� ��J�`C Jg LIGHTING FIXTURES 10.00/1,00 `n .
CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
E
PHONE PANELS ' 10.00 .DATE OF APPLICATION
`RRCCT PANELS (OVER 200 AMP), 20.00 PLAN CHECK FEE P.C.NO.
on
EI
SIGNS TRANS., 3.00
ARCH,OR ENG: ' .. SPECIAL CIRCUIT 15:08 PERMIT VALIDATION
ADDRESS 1 _
ZIP EMP.METER OR POLE INS. 20,00 _.
APPLICANTS
MOTORS SEE FEE SCH.
ADDDRESSDRESS
SERVICE CHANGE 20.00
D
0 0
LICENSED CONTRACTORS DECLARATION I�V�
¢U U I hereby affna that I am licensed under provisions of Chapter 9 ( ISSUANCE DATE
ya w" (commencing with Section 7000)of Division 3 of the Business and B e n PLG. MECH.
o'6�' Professions Cod +ryy license is in full fa f ❑
s, 0. z ' License Clas �Z C/- Lic.Nmnbe � �_ ❑ ❑
C,
�,r Uate- Contract
'Q u s ,�, ' - • BUILDING PERMIT
¢ ac ¢ OWNER-BUILDER Df:CLARA N INFORMATION
a o - - - MISC.- REFER TOORD
F
3 n N 1 hereby u(6rm that I am exempt from the Contra of s License VALUATION $/FT.
r u. 0 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 t7 Y
,Aw Code:Any.city orcounty which requires a permit to construct,alter,
R ¢4 0 improve,demolish,or repair any'structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
n a D u requires the applicant for such permit t0 file a signed statement that
TOTAL PERMIT TO
X
$ he is licensed pursuant to the provisions of the Contractor's License _
r z i 4.w(Chapter 9(commencing with Section 7000)of Division 3 ofthe -
a Business and Professions Code)ortlat he is exempt therefrom and OTY. PLUMBING PERMIT -FEE
i D
¢r the basis for the alleged exemptiun.Any violation of Section 7031.5 STORIES TYPE CONSTR. -
c ;� by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars($500).):
❑ 1,as owner of Orn 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 ant] Professions 1 DRAINS-FLOOR,ROOF,AREA,GOND. 5.00
Cade: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 TOTALACREAGE
himself or through his own employees,provided that such improve. .
mems are not intended or offered for sale:If,however,the building GAS-EA.SYSTEM-I 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 CDN PB Dmer
prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00
` ❑ L as owner of the property,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑ -
licensed contractors to construct the project(Sec. 7044,'Business' LAWN SPRINKLERS-1 INC 6 V.B. ,6.00 ASSESSORS PARCEL NO.
and Professions Code:'1'he Contractor's License Law docs nut apply
Yvan owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 6(EA.) 1.00
commels for such projects will,a commelonsl licmucd pu roam to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Low. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ;B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Dam WATER SYSTEM 5.00
�� ACG.DATE ACG FILE N0.
PX OEC LA RATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that l have a cert Ucatet
self'¢are, .. ZONING ENG.SITE NO.
or a certificate of Workers'Compe u rtifieA -
copy thereof(Sec.3800,Lab.C.).
Policy No. Company - - -
❑ Certified - Pyiv'hereby furnished . FIRESPRINK - ENERGY T-24
Z Z ❑ Celtic ory ix filed w'th I division MISC.- - REFER TO ORD.
0 Applicant' - V,❑ N❑ Y1 N❑
0: w CERTIFICATE OF EXP-MPTION FROM WORKERS' PERMIT ISSUANCE 10.00
FLOOD ZONE A.L.U.C.
> COMPENSAT'ION INSURANCE 'aPLG.CONTR. LIC.NO. PLG.
-
CL Z [This ction need not he completed if tire TOTAL Y
e pennil'is for one ❑ N[_ V N❑ ❑
hundred dollars(S100)or less.)
U O 1 certify that in the performance of the'work for which this per- OTY. MECHANICAL PERMIT. FEE FEE SUMMARY
LL.I- Flit is issued,I shall not employ any person in any Danner so as to
0 become subject to the Workers'Compensation Laws of Calitornia.
y Dae Apl'lieamALTER OR ADD TO MECH. 5.00 ' BUILDING
} m NOTICE TO APPLICANT: 11',after making this Certificate of Ex.
F Z carbon,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK
provisions of the Labor'Coda, you must forthwith comply with AIR HANDLING UNIT(TO 10,000 C.F:M.) 4.00 FEE
C..1 such provisions or this permit strait be deemed revoked.;
CONSTRUCTION LANDING AGENCY AIR HANDLING UNIT(OVER 10MC:EM.) 6.00 SEISMIC FEE -
I hereby affnim that there is a construction[ending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of thew fon which this permit is issued(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name �/YF
Lender's Address / HEATING UNIT(OVER 100,000 B.T.U.)4.00 ELECTRIC r
I certify that l have read this application and state that the above VENTI LATION'FAN (SINGLE) 4.00 -
S- information is correct. 1 agree to comply with all city and countyPLUMBING
ordinances and state lawsrelating to building constriction, and BOILER-OOMP(3H.P:or100,000B.T.U.) '6.00
hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU[SEE FEE SCH. MECHANICAL
above-mentioned property for inspection Purposes.
(We) agree to save, indcnaify and keep harmless the City of misc.- - REFER TO ORD.
Cupertino ago i st lamVoa,"�"sg.'sai
' ent; costs and expenses which CONST.TAX
may i an a AceBy in consequence of the PERMIT ISSUANCE 10.00
grunting o er MECH.CONT. LIC.N0. MECH. ,
TOTAL TOTAL l hJ
Signature of Applica /Contra D to - Tib/
.OFFICE COPY' -
a ,.:7 . . I I -
z
POST THIS CARD NEAR FRONT OF BUILDING
'CITY OF CUPERTINO PERM1,T NDM1i9ER
INSPECTION.DIVISION 3205 t.
JOB INSPECTION RECORD
PERMIT'EXPIRATION
�oeAooREs6 20195 STEVENS CREEK" BLVD. UNIT •220 . ,_Lor#
'- PERMIT EXPIRES IF'WORK-
•• owNEa W D' T, CONTRACTOR REDWOOD CITY ELEC.. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTORrlN.,SPECTl,..ON RECORD 1BODAVSOFPERMIT-ISSU-
FOUNDATION'� oC — .ANCE'OR 180 DAYS FROM
LAST CALLED INSPECTION.
LIFER - 'PREGUNITE , PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDPAi D �'••6cvJ )0
UNDERGROUND./SLAB7PLUMBING M °` 19ELECTRICAL- - ; " ISSudNCE DATE
MECHANICAL _ I y O Ub R ELECT( .. PLG, MECH.DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR - vnwAnoN' SIFT.
PLUMBING
MECHANICAL,' r ' +
PERMIT TOp
ELECTRICAL
FRAMING - I i" �I"-•I°:—I
'INSULATION STORIES_ TYPE CONSTR..
'OCC.GROUP RES;UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN,SIGNED
,•• ROOF SD.FT FLOOR AREA .TOTAL ACREAGE
DIAPHRAGM -
BUILDING USE
' 'RES IND CON PH On :
El 0El
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED' ' ' '� ' ED
nss[ssDHs rAHe EL No.
ROUGH
PLUMBING '
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL. i"` .• `. ,
c
ELECTRICAL FINALS DATE INSP: ACC gnrE 'Acc FILE No
O' .
- FRAMING - - SAN
ZONING ENG.SITE NO.,
- INSULATION �, PLUMBING ,
GAS
FIHESPRINK ENE RGVT24..
MECHANICAL "k' O iv NQ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR - - - ELECTRICAL _ FLOOD ZONE dL.u.c.
,t LATH-EXTERIOR - FIRE DEPT. `'❑ NCj Y'o N❑
SHEETROCK . �. `3 'i' GRADE - FEE SUMMARY
' ,SHEARJNTERIOR - - BUILDING' , - • :BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC ` PLAN CHECK
- !• _� GAS . . FEE -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY ,' " SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMIT,TEO UNTILBUILDING FINALISSIGNED By BUILDING INSPECTOR. MICROFILM '.
ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC n•U �
F,� ONE'WORKING DAY BEFORE'REQUIREDlNSPECTION
Z " . PLEASE GIVE''JOBADbRESSWHEN.PHONINIS '.;r - RLOMBING
= SEE PERMIT FOR EXPIRATION DATE.— IIECH- -CAL-
` ,IMPORTANTI coNsr.rnx.
PLEASE READ REVERSE SIDE-BEFORE d TOTAL '
CALLING FOR FINAL INSPECTION. .
- ,OFFICE COPY
- _