Loading...
154974 r ,.,_APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT UILDING— ELECTRICAL— PLUMBING — MECHANICAL PERMIT NUMBER . 1 [ j� �7 .1''1' eBUILDINGI ADDRESS \ V� (��• w - NAME 'Nam^E TT '•x PC6 A W vl/1v • l \V ONE OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION! " NAreERACToas LIC. NO. ADDRESS TORS • PHONE t UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00' APPLIANCES -RESIDENTIAL 4.00 PANELS.10.00 ogcHITECT -' ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH a°ss ENG. ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION •�-� .�f `LNq ✓./,'fr-VI/}' ISSUANCE GATE BLDG. ELECT. PLG. MECH. TEMP. METER OR POLE INS. 20.00 APPLICANT'S ^ ADDRESS -// MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am'lice mcd under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie. Number. Date Contractor , ' t from the ION OWNER -BUILDER that I am exempt I hereby affirm ehat'I am exempt from the Contractor's License Law forthe following reason.(Sec. 7031.5, Businessand Professions Code', Any city or county which requiresPermit tO cons nc alter, improve, demolish, in repair any structure, prior to itsissuaua issuance, also requires the applicant for such ronnit ns oiler signed statement that he is licensed pursuant to the provisions oltire700 Contractor's License Law (Chapter ndPrcicomm, C ng ode)with Section is exempt thereto andtlic Business and Professions Coder or that he Is exempt ecrd'n70 and the basis for the alleged exemption. Any violation of Section malty for five permit subjects (500).he licanttoacivol penalty by any more of not more wenn Cove lie prop rty, o (my em): ❑ I, as owner at the will d property, or my employees with wages as inter sole compensation, will (S the work, and the structure is not intended or offered For sale (Sea 7044, notBusinesspply to Professions of Code: The whobuild or License Low dour not apply m an owner of Work himslf property Who buildsorrwne employees, thereon, providwho does such improve. himself re through his own employees, provided were such improve forsale,if, howeveq tire the o nee- or uts improvemenotnt is sold it within one year ofcompletionhedi, the owner - or improvement have is sold burden builder will have [ho burden ofproving that he did not the or im- prove of sole.). C) 1, 1, asas owner of the property, am exclusively contracting with licensed contractors dto construct the project (Sec. 7044, does not apply and Professions property Contractor's o License s th docs not apply to an owner of h projects who builds or improves thereon. P, ami who tiro contracts for such projects with a contrador(s) licensed pursuant to the Co rs License Law. I mexe pt under Sec. ,B.&P.0 f renis reas< �J BUILDING PERMIT INFORMATION MISC. — REFER TO ORD PERMIT ISSUANCE10.00 VALUATION " ELEC. CONTR. LIC. NO. ELEC. TOTAL PERM �$��' QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN -WATER IEA.)5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS ' DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS-EA.SVSTEM-I1NC.40UTLETS 6.00 ..�'— SQ FT, FLOOR AREA TOTALACREAGE GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other � .E] 0 0 ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS -1 INC5V.B. 6.00 ASSESSORS PARCEL NO. ' LAWN SPRINKLERS -OVER 5 (EA.) 11100 SEWER -SANITARY -STORM EA, 200fC[10.00 TRACT No. PARCEL No. ' WATER HEATER W/VENT 6.00 Own' Datc O WORK F-RS'COMPFNSATION DECLARATION I hereby affirm Ilial I love a certificate of e...ent t0 self-houre, or a certificate of Workers' Compensation Insurance, ora certified copy thereof'(Sce. 3800, Lab.C.). - - Policy No. Company WATER SYSTEM )ss. 5.00 ACG DATE ACC. FILE NO. WATER TREATING EQUIP. 15:00 _ ° • w ZONING ENG. SITE NO, •- MISC.- - REFER TO ORD. 11 Certified copy is hereby furnished copy is Bled. with the city inspection division. Applicant' - Applicant FIRE SPRINK YE] N� ENERGY T-24 Y❑ N[] CER' 1'I FICA' 117 OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section peed not be completed If the permit, is for one hundred dollars ($100) or less.) I certify that on the performance of the work for which this per. mit is issued, I shall not mnploy any person in any manner SO TIS to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become suhject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for to performance of the work for which [his permit is issued (Sec. 3097, Civ.C.). PERMIT ISSUANCE 10.00 /V — FLOOD ZONE Y N A.L.U.C. ' Y-[3 N O PLG. CONTR. LIC. NO. ,PLG. ''11 (fTJ TOTAL 0?d _ QTY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ' ALTER OR ADD TO MECH. 500 . APPLIANCE 5.00 PLAN -CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's AddressELECTRIC I certify that I have read this application and store that [Ie above information ccs n correct I agree to comply with all city and county ordinances and stale laws atives to building construction, and hereby authorize representatives this cozy to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of upertino against liabilities, judgments, costs and expenses which' ay in any way accrue agoaJl.� said City in m. •quence of the r' g his peel pg HEATING UNIT (OVER 100,000 B.T.U.) 9.50 VENTILATION FAN (SINGLE) 4.00 BOILER-COMP(3 H.P. Or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP lose, 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Signature of A pplican a/Contractor ate OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY 'OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD _ JOB'ADDR ESS .-20401. Stevens Creek Blvd. UNIT# -LOT# ' - OWNER WDV Properties CONTRACTOR - .PERMIT NUMBER - 15497 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT ;STARTED WITHIN - 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSP ECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD ' FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED. TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. UFER - PREGUNITE - PERMIT VALIDATION i ' -/,Ir,f ISSUANCE DATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED^ .UNDERGROUND/SLAB PLUMBING' ELECTRICAL . - MECHANICAL BLDG, ELECT I PLG. MF,CH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ 'BUILDING PERMIT INFORMATION WOOD FLOOR 'VALUATION $IFT. PLUMBING � - MECHANICAL ELECTRICAL - - PERMIT rO FRAMING INSULATION STORIES TYPE CONSTR. �POACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - - OCC.GRODP RES UNITS ' 1 � ROOF- NOTE:. NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID $O FT FLILII All TOTAI. ICIILAGI - ' DIAPHRAGM ROOF SHEATHING 'BUILDING USE RES IND CON PB 00 - ❑ ❑ ❑ CLD APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH • sAN.a NOPARCEL NO. PLUMBING - ELECT. ENERGY TUBS &SHOWER PAN - PLUMBING ENERGY TRACT • NO. PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL � - - BUILDING ENERGY ACCDATE . . ACCFILE NO FRAMING - ELECT: FINAL TEST ' INSULATION ^ PLUMBING ZONING ENG. SITE NO. GAS TEST .� GAS % MECHANICAL FIRE SPRINK Y ❑ N❑ ENERGY T 2 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE " FLOOD ZONE Y❑ N❑ A,L UC Y'L -N❑ INTERIOR. SHEAR - FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH - BUILDING - BUILDING INTERIOR CA7H- TEMPORARY APPROVALS SCRATCH COAT ELECTRIC I PLAN CHECK FEE • GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY VSEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL,BUILDING FINAL ISSIG NED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE — MICROFILM ELECTRIC ' PLUMBING MECHANICAL coNsr. rax IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING`FOR FINAL INSPECTION: TOTAL OFFICE COPY