18904 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
II LDI NG PROJECT I DENTI FICATI ON PERMIT NOMBER
nDILD APPLICATION & PERMIT ^ 0
A�pRE55 -
•. .�QG�tJ ��K L�� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL `'�'.>
t� OWNER's - PLAN CHECK VALIDATION
( "AME n t� / OTY. ELECTRIC PERMIT iFEE
CONTRACTORS
rvgmE OUTLETS-SWITCHES-RECEP`)10.00%1.00 19,99
COAnf1L. U.Ils..4q37000 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR
AAPPLIANCES-RESIDENTIAL 07;4�t1 P
DORE1S
sN. _ PHONE9 �SIpOD PANELS 10.00 DATE OFPPLICATION -
ARCHITECT PLAN CHECK FEE P.C.NO,
OR - PANELS (OVER 200 AMP) 20.00 ._
ENGINEER ,r - JtEi{^'
/ uc.No, SIGNS TRANS. 3.00
ARCH,ORA
E"G yY SPECIAL CIRCUIT 5.47i; 00 DATION
,-/ IZ-P�
l 0 i7r*�QZ. Z,P 7 Z EMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
ADDRESS ra
ZZ /V A4-Aft W 4v'f' 15,), Q)'//p SERVICE CHANGE 20.00 JOUCC tr
w¢ i
Foo
LICENSED CONTRACTORS DECLARATION _
Fi W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a (commencing with Section 7000)of Division 3 of the�BSuLsiness and BLDG. ELECT. PLG. MECH.
o 0 4 m Professions Codyhs and m license is in full for .•�I(��QQe��f{ ❑ E ❑
= G License C+asS_p y Lie,Nun.her_019
F w� J Dale-�� 9 Contractor_VV4{,/ _8�py_
EC x 11 P,E"'xx 1 �p�//L BUILDING PERMIT
¢ ¢ ¢ OWNER-BUILDER DIiCLARAT'ION
o a u INFORMATION
E:
; 1 hereby affirm thus I an,exempt ironl the i,,a,s .d pr License
ons MISC.- REFER TO ORD
FLLOJ Law for the following reason,(Sec.7031.5,BusinessanJ professions PERMIT IS 10.00 - /- VALUATION $/FT.
Code:Any city or county which requires permit to construct.alter, 6040 QQ
¢ Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC, r0 x
- D ¢ requires D.e applicant for such permit to file a signed statement that TOTAL
a w m a- he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
Fzi Law(Chapter 9(commencing with Section 7000)pf Division 3 Of the
¢ Business and Professions Code)or llmt he is exempt therefrom and CITY. PLUMBING PERMIT FEE
Coro the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to o civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not nmre than five hundred dollars(5500).):
❑ 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 tile ru
e stcture 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:'Phe Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00SQ FT.FLDOR gREA TOTAL ACREAGE
himselfor through his own employees,provided that such improve.
mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
1 orildein.provcmmat is sold do enione year of con.pldtiothe owner. GAS.-EA.SYSTEM-OVER 4 IEA.) .2.00
bur will have the burden of proving that he Aid nobhuild or am. BUILDING USE
prove for purpose of sale.). RES No CON PB Other
❑ L as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project tSec. 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 forsad.projectswithacontrucrorlsl licwssed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor'slit uSec
nde . TRACT NO. PARCEL NO.
❑ tact uxcmpt under Sec. ,B.&P.C.li.r this WATER HEATER W/VENT 6.00
rCBSDII
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK 17RS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of mn5eat to wall-insum, '
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Copy the*So-,1A4,1 ,Lab.Cj
Policy Ntry 7`.1779�fompunY l�� 1,%OAWJVIT
O O Certified copy isl re yform,u•d. FIRE SPRINK ENERGY T.24
Z Z 7Q Cert If d oI�v d iy�the city inspection division.
O Adplicant _/ _(_/ MISC.- REFER TO ORD. Y❑ N❑ Y❑ N❑
J y CERTIFICATEOF EXEMPTION FROM WORKERS' . PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU COMI'ENSA-1'ION INSURANCE PLG'.CONTR. LIC.NO. PLG.
CL 0 11 his section need not be completed if the permit is for one _ TOTAL V❑ N❑ Y ❑ N❑
Z) 2 hundred dollars(S 100)or Tess.)
'U O I certify that in the performance of the work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mil is issued,I'sfill not en.ploy any person in any n.anner so as to
become subject to the Workers'Compensation Laws of California.
a Date Applicant BUILDING 4/0S
>_ w NOTICE TO APPLICANT: If,aftermaking this Certificate of Ex. ALTER OR ADD TO MECH. 5.00
H 2 eruption,you should become subject to the Wurkeri Con.pensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall he deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER IQOODC.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,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
- Lender's Name HEATI NO UN IT 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
I certifyinformation
Uis c r ecthave read res application and allstatec that d county VENTILATION FAN (SINGLE) 4.00
information n correct I agree to g to b with all city and county PLUMBING
ordinances and titule laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives for ins of this city es enter upon theabove- BOILER-COMP lover 100,000 BTU)SEE FEE SCH. -MECHANICAL
hereby authorize
property tar vespe l this
purposes.
(We) agree to save, indemnify and.keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE. 10.00 CONST.TAX
Try In any way ace, a against soid,Chy in consequence of the
ranynyof(h1f'plhmi a MECH.CONT. L.C.NO. MECH:
ASI/rte !//�•/ 1, TOTAL TOTAL '/6�
Si uture of Applicant/Cs ntractor Date -
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY. OF CUPERTINO NUMBER
INSPECTION DIVISION '` 18904
O
1
JOB INSPECTION RECRD ^
il/j�, r
T VxPIRATION
JOB(ADDR ESS P-wS 'UNI-T#' _LOT# �' 'w�Pr
PERMIT Er{P,IR,r F WORK
OWNER 4ek— - CONTRACTOR G IS NOT S RTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD •180 onus F PERMIT ISSU.
FOUNDATION I - - ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED 'LAST.CA LLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMn`nlr onnON
CUPERTINO STANDARDS. RNA
A�,
GARAGE SLABS RNAr/'
-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,
(tl'k32bz F�Rim\y,'c��s.l-9rt � Ap 1.c.
UNDERGROUND /SLAB _ _� 0• L ,:r " �7,.'jpb}j
PLUMBING4p' CGt22 ?iI 2—Z"4--tef
ELECTRICAL - - —p l UIF
A rl
�B,ANemnr*04n �9
MECHANICAL BLDG' I
ELECT I PLG. I MECR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR r INFORMATION
PLUMBING VALUATION,. S/F T.
SOU.
MECHANICAL'
ELECTRICAL
FRAMING -,�,,,,••
INSULATION - STORIES TYPE CONSTR,
OCL' GROUP RES UNITS
,-iP.LGACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Y - SO.FT PLOOR AREA TOIAL ACREAGE
ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
DIAPHRAGMTHE CONSTRUCTION TAX IS PAID
L BUILDING USE
ti. ROOF SHEATHING RES IND - CON Pe
"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE • INSP. 0 11 El El FD
ROUGH SAN.q
ASSESSORS PARCEL NO
'
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO,
TUBS 8 SHOWER PAN PLUMBING ENERGY.
MECHANICAL - MECH.ENERGY -
ACC DATE ACG FILE NO
. ELECTRICAL - BUILDING ENERGY
FRAMING ELECT:FINALTEST -
INSULATION - PLUMBINGZONING ENG.SITE NO,
GAS TEST GAS
MECHANICAL -
FIRESPRINK ENERGY T 24
v
COVER NO WORK UNTIL ABOVEv F] N[:] 0 NDHAS BEEN SIGNED HEATING „ '
EXTERIOR SHEAR
ELECTRICAL RELEASE FLOOD ZONE A L u.c.
INTERIOR SHEAR - FIRE DEPT. v ❑ NE] 1,L7 N❑
SHEETROCK ., Q.- GRADE FEE SUMMARY
EXTERIOR LATH - BUILDING. ,
INTERIOR LATH TEMPO RARYAPPROVALS BUILDING- f-09
SCRATCH COAT JELECTRIC PLAN CHECK -•r-
GAS , FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCY OF BUI LDING IS NOT PERM ITTED UNTI L,BU I LDING F INAL IS SIGN ED BY BUI LDING I INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMBING.
Z PLEASE GIVE JOB ADDRESS WHEN PHONING,
,.
— SEE PERMIT FOR EXPIRATIONDATE —• MECHANICAL
IMPORTANT! coNsr. rnx
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
1 . 'OFFICE COPY