The URL can be used to link to this page

12128 AF U_ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE ^LL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FIC N \ PERMIT NUMBER y BUILDING APPLICATION & PER IIT 12128 n^ ^ J-` ADDRESS I G I G _giJ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S V�7 PLAN CHECK VALJqJTION 1%7 NAME OTY. ELECTRIC PERMIT FEE �r ?v.D rwETNUZS PRONE NAME cToes OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME r, Li FET, MC LDO Lt..rvo.2z03ez LIGHTING FIXTURES 10.00/1.00 CONTRACTORS IC7 S,py �IVWN IU APPLIANCES-RESIDENTIAL 4.00 ADDRESS �{/� n VALO CM (24 PHONE739��/-E�I,.S1-71i PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN r, WAS6c AAP,1j r PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER ffYY VV G NK V`Y'�,V N Luc.No. LS SIGNS TRANS. 3.00 ARCH OR END. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 J ADDRESNrsr'1 I� � � pitmvo/j Ii t� MOTORS SEE FEE SCH. ADDRESS IR IPALt, kLTO C A 430 SERVICE CHANGE 20.00 / o /�/�/p/e F O LICENSED CON'T'RACTORS DECLARATION <U U I hereby affirm that I am licensed under provisions of Chapter-9 p� d C) ISSUANCE DATE m a w (commencing with Section 7000)of Division 3 of the Business andBLDG. ELECT. PLGI. MECH. H N Z Professions Cod n Ea license is in full fur a and eo ,Z Tl I�Y` M Licens lass Lic.Number X'll t _o m r. Date Contractor wL Z.O I` (�C7IX-S ¢ mIt¢ OWNER-BUILDER DECLARATION _ BUILDING PERMIT K o a u - INFORMATION % 3 u w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u o¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. rw0 Coda:Any city or county which requiresa permit loconstruct,alter, - IC) QQst0 Improve,demolish,or repair any Structure,prior to Its Issuance,also ELEC.CONTE. LIC. ELEC. (.rl�K �ooO ii:- 00 LL requires the applicant for such permit to file a signed statement that TOTAL t/T '� n pI he Is licensed pursuant to the provisions of the Contractor's License PERMIT TO Le i z Law(Chapter9(commencing with Section 7000)of Division 3 of the 2 m c Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE W r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. uby any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER (EA.) 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 their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 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 50.IT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered]or sale.If,however,the budding GAS-EA.SYSTEM-1INC.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 Ise did not build or im- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 . ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct due 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 contraetorlo licensed pursuant to SEWER-SAN EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 ' reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO. WORKF.RS'COMPF.NSAT ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsenl to self-insure, - - ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. eopy thereof(See.3BOQ,Laff`y 1P11'Z e'CMA-..I,S INJIN1b ),L Policy NCompany 0 El Cart ified copy is hereby furnish FIRE SIRE INK ENERGY T2s Z Z Certified copy is fithe led with the city inspection division. PMISC.- REFER TO ORD. Off. nn'cam v E] NE] v E) N❑ wry-/ CERTIFICATE 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10-00/6 FLOOD ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTE. LIC.NO. CL Z( This section.need not be completed if the pe..nit is I'or one TOTAL Y❑ IN E) Y ❑ IN C] hundred dollars IS 100)or Iess.) L) O 1 certify that in the performance of the work for which this per, DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shut[not employ any person in any mmmner so as to Obecome subject to the Workers'Compensation Laws of California. Co Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING A/O } N NOTICE TO APPLICANT: If,after making this Certificate of Ex- F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK provisions of The Labor Code, you must forthwith comply with FEE U such provisions Or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10{100C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=0C.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 the work for which this permit is issued(Sec. MICROFILM 3097,C.e.C.). 1 HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Address H EATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's AAddress _ ELECTRIC 1 certify that 1 have read this application and stale That the shove VENTILATION FAN (SINGLE) 4.00 information n correct.I agree to comply with all city and county BOILER H.P.or 100,000 B.T.U,) 6.00 PLUMBING �� ordinances and state laws relating to building construction, and 11 hereby authorize representatives of this city to Doter upon the above-mentioned properly for inspection purposes. BOI LER-COMP Carr 100,000 BTU)SEE FEE SCH. MECHANICAL r (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the /(3 grantingof This ermit. - MECH.CONT. LIC.NO. MECH. O SlS .� U -11 -S& TOTAL �f TOTAL satureof Applican/Contractor Date OFFICE COPY J ` . POST_ THIS ARD.NEAR FRONT OF BUILDING .T PERM IF NUMBER Cl OF CU-PERTINO '12128 INSPECTION DIVISION JOB INSPECTION RECORD / PERMIT EXPIRATION JOB ADDRESS ��00 ✓ "� c4e< UNIT# -LOT# PERMIT EXPIRES IF WORK OWNER 1�� % CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR thSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. LIFER PREGUNITE - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB1� PLUMBING - f ' 2 ELECTRICAL - ISSUnNCEDAT4 6b MECHANICAL elOc, ELECT. PLc. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL' ELECTRICAL - PERMIT TO FRAMING •`h '� INSULATION - STOR RS TYPE CONSTR. OCC GROUP RES.UNITS I;.PLACE NO SUBFl00R UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM RUIl0 USE ' REB IND CON PB 011ier APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El El 13 11 El ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL N0. MECHANICAL . , ACC. ELECTRICAL FINALS DATE INSP. ACCGATE FILE NO. FRAMING SAN # INSULATION- PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPHINK ENERGY T 24 ' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YO N[:] Y NE] LATH-INTERIORELECTRICAL - FLOOD ZONE A.L.u'.c. LATH-EXTERIOR FIRE DEPT. Y❑ NE] Yo No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING ' FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ✓�r OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1� F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. . r - Z'' ' MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — P IMPORTANT! CONST.rax PLEASE READ REVERSE SIDE BEFORE TOTAL �•'�` ` ~ CALLING FOR FINAL INSPECTION. OFFICECOPY,