18011 ! APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION. PERMIT NUMBER
BUUILDI$5 APPLICATION & PERMIT 1 p O g1
G BUILDING - ELECTRICAL-PLUMBING-MECHANICAL &'' 10 I I
OWNER'S �+ - PLAN CHECK VALIDATION
��yy NAME �'•�� PVA✓�`PA, OTV. ELECTRIC PERMIT FEE
../In'L RSI A PHONE t
OMERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00
c.No, LIGHTING FIXTURES 10.00/1.00 .
N
ncsyTRAETQRS 1 PPLIANCES-RESIDENTIAL 4.00
i
AODRE55
v DI? P�y/� fit/ PANELS 10.00 DATE OF APPLICATION
AOR HITECt PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEEP
uc:NO. SIGNS TRANS. 3.00
ARCH,OR ENG. - PERMIT VALIDATION
ARCHESS R SPECIAL CIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00 / �t �L�►
Il
ADDRESS s MOTORS SEE FEE SCH.
AS v.
SERVICE CHANGE 20.00
oxi c
b,o o LICENSED CONTRACTORS DECLARATION ,
a mow I hereby affirm that 1 am licensed under provisions of Chapter 9 - • ISSUANCE GATE
.N G w (commencing with Section 7000)of Division 3 of the Business and - -BLDG. ELECT. PLG. MECH.
F H z Professions Cr_a ryy license is in full f ' I feet. ❑
z o L - License ClasED Lia S o _ - �.
o z r w Dal' - Contractor °'
sc Y 2 J
rc a OWNER-BUILDER DF A A'1 N BUILDING PERMIT
a o d V - INFORMATION
F
u y I hereby affrm that 1 um exempt from the Contractor's License MISC.- ; TO ORD
H w o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter,
rc ,4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. $LEC.
D , requires tine applicant for such permit to file a signed statement that TOTAL PERMIT TO
F
$m he Is licensed pursuant to the provisions at the Contractor's License
Hza Law(Chapter 9(commencing with Section 7000)of Division 3 el tie (^l l
i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 1 V • I
K F$ the basis for the alleged exemption.Any violation of Section 7031.$ STORIES TYPE CONSTR.
n ; � by any more Himf five
Imanitsubllms the$550).applicant toacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 V
of not more than foo be prop dollars(my em1:
❑ I,as owner at(he property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will(to the work,and the structure is not
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The COntR.Em's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 • O S0.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
memsarenotintended or offered for sale.If,however,the bmlding GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
of improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4(EA.1• 2.00
builder will have the burden of proving that he did not m -mild or intBUILDING USE
prove for purpose of sale.). INDUSTRIAL.WASTE INTER. 30.00 RES IND' CON PB Omer
-._<. ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ 0 El ❑
licensed contractors to construct the 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 contractolfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner - Date WATER SYSTEM . 5.00 ACC.DATE- ACC.FILE No.
•WOKKERS'COMPE:NSA'FION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy Nn. mean. -
Q `❑�/ CCrtifiec o is
isheJ. FIRE SPRINK ENERGY T-24
Z Z ]p� Cerlifi �. e(e ih nl r ty Ins coon Division.
O P./ jvirat MISC.- REFER TO ORD. Y E] N❑ V ❑ N�
~ �+ PERMIT ISSUANCE 10.00 V FLOOD ZONE A.L.U.C.
PIC EXIiMPf1uN FROM WORKERS' l.r V
W > COMP17NSATION INSURANCE PLG.CONTR. LIC.NO, PLG. I
a' � v� NQ
O (This section need net he conmleted if (lie per is lne in oTOTAL v� N
�'VU
D Z hundred dollars 1$100)or less,I
U O 1 certify that in me performance of the work for Which this per. OTV MECHANICAL PERMIT FEE FEE SUMMARY
m
LL F mit is issued,I shall not employ any person in any anner so as to
U become subject to the Workers Compensation Laws of California.
EQ.DDmc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} m NOTICE TO APPLICANT: If,after making this Certificate of 1;
? 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
V such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C F.M.) 4.00
CONSTRUCTION LENDING AGENCY. AIRHANDLING UNIT(OVER 10,000C.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(Seo. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender i Address ELECTRIC
I rotatio thus1have read this application and sure that the above VENTILATION FAN (SINGLE) 4.00 tr
information is correct. I agree to comply with all city and county PLUMBING
anlinhnc's and state lows relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the
abovomentioned property for inspection purposes. BOILER-COMP (0.,100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, in nify and keep I...oless the City of MISC.- REFER TO ORD.
Cupertin a inst liabi tie judgments, costs and expenses which CONST.TAX
may i way ' gainst said City in cBnsequence of the PERMIT ISSUANCE 10.00
gra this mil MECH.CONT. LIC.NO. MECH.
�- TOTAL TOTAL
ore cant/ ommctor Date
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF 'CU,PERTINO 18011
--- ---- ' INSPECTION DIVISION , '
~ JOB INSPECTION RECORY I r
PERMIT EXPIRATION
JOB ADDRESS_�.�6 3 S V / G
. c1� ��,T# lOT# PERMIT EXPIRES IF WORK
OWNER WD ONTR ACTOR �/ L w.P-„ ,IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS I I I I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /F''{ 'oVZ.o
PLUMBING
ELECTRICAL Issun"ce OnrE /(7
MECHANICAL City-of - dion BLOC E,-Leer,I PLG I MECH
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION 3/FT,
' .� � � � -
MECHANICAL
ELECTRICAL PERMI1To
To I`
FRAMING STORIES U T o corvsrR.
INSULATION - .,
H< piG OCL .g OCC.GROUP RE$ UNITS
`PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I G
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO IT FLOOR AREA TOTAL ACREAGE
'DIAPHRAGM ' , - THE CONSTRUCTION TAX IS PAID '
oLILDING USE
fl00F SHEATHING RES IND CON PB 00",
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE ANSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
' ROUGH: � � SAN.# '
PLUMBING - ELECT,ENERGY
TRACT NO. PARCEL NO
TUBS.&SHOWER PAN - PLUMBING ENERGY '
• MECHANICAL, - - MECH,ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
FRAMING - ELECT.FINAL TEST
INSULATION PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE STRINK ENERGY T-24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - - Y "d "[D
• EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC.
- INTERIOR SHEAR - FIRE DEPT.
N❑ I Y ❑ N
SHEETROCK. GRADE . FEESUMMARY
EXTERIOR LATH. , - BUILDING
INTERIOR LATH- TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED,UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, ' MICROFILM
I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLumewc' . „ 0 'D
��. 2f� PLEASE GIVE JOB ADDRESS WHEN PHQNING.
— SEE'PERMIT FOR EXPIRATION DATE ''= MECHANICAL
. ,IMPORTANT! CONST.rnX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFJCE COPY,