16362 APPLICANT TO FILL IN INFORMATIONXITHIN RED LINES- USE BALLPOINT PEN ONLY',
BU I LDING PROJECT IDENTIFICATION .PERMIT NUMBER ' "
BUIL ILDING APPLICATION & PERMIT ,
,. ADn�=a =•��� � �i�'6� 1'6362'
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S ,,J� , PLAN CHECK VA�ATION
1 N4MEC �y`r"" OTV. , ELECTRIC PERMIT .,FEE
PHONE l
CONTRACTORS - OUTLETS-SWITCHES-RECEP 10.00/1A0
-.-
LIC.NO. LIGHTING FIXTURES 10:0011,00
CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00 -
ADORESs. - -
PHONE .PANELS10.00 "a ', DATE OF APPLICATION Y
ARCHITECT. PLAN CHECK FEE P.C.NO.
On "' PANELS (OVER 200 AMP) 20.00 p
ENGINEER _ -
" : LIC.NO. -' SIGNS TRANS, 3.00
ARCH OR ENG, .1 PERMIT VALIDATION
ADORESS SPECIALCIRCUIT 5.00" -
- EMP.METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS ,',�.p
SERVICE CHANGE 20.00
Lc o o -LICENSED CONTRACTORS DECLARATION V ZT
'a u w I hereby infirm that I:un licensed under provisions of Chupler')+ - : ISSUANCE DATE
y Q$ (commencing with Section 7000)of Division 3 of the Busiueu anA' LDG. ELECT. l PLG. I MECH.
H z Professions Code,and my license is in full force and effect. E] .❑
+o 0 er o License Class Lic.Number
-
0 .-Contractor 1
BUILDING PERMIT
¢ra i ,OWNER-BUILDER DECLARATION _ ORMATION
wg,� H I hereby affirm that I am exempt from tum Contractor's License MISC.- REFER TO ORD
u O¢ Law lot the following reason,(Sec.7031.5,Itusinessand Professions' PERMIT ISSUANCE ' -1A.6f) LUATION S/FT.
r yya Code:Any city or county which requiresa permit toconstntulalteq '
Qac Q 0 improve,dem Dllsh,or repair any structure,prior to Its issuance.also ELEC.CONTR. LIC.NO. ELEC. ���,
¢ requires Hie applicant for such permit to file a signet]d-Statement that TOTAL �•/ PERMIT TO
La m he is licensed pursuant to the provisions of the Contractor's License "
H i`Q
Law(Chapter 9(commencing with Sec(ion 7000)of Division 3 of the
.µ Business and Prrfes,wrei Code)or that he is exempt fi e,efrom and OTV-. PLUMBING PERMIT FEE
¢ r$ the hosts for the Peged exemption.Any violation of Sect tun 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 '
if not nwre t Iran five hundred dollars($500).):
❑ L as owner of the 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 safe (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,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 SO.FT.FLOOR AREA TOTAL ACREAGE
�, himself a of rote his own offered for
provided that such improve-
meats are through
rlmmnded orofferectforsale.If,edthathowever,suhemprong .GAS-EA.SYSTEM-11NC.40UTLETS'6.00
or Improvement is sold wlthln one year of complelion,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 CON PB OnM1er
_ P�ovq for purpose of sale.). IN DUSTRIAL',WASTE INTER. 30.00
�( I,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
- IiCen'sed contractors to Construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
1 and Professions Code: Fire 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 it contractons)licensed PurSaant In
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACTNO. PARCEL NO.
❑ tont ex tont under 1,c. ,It.&P.C1 for this WATER HEATER W/VENT 6.00
on1. J
lwncr Duw9/ - WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO.
WOR KI iRS'COMPI. ION DECLARATION WATER TREATING EQUIP. 5.00
- I.hemby nlfinn•thut 1 have a certificate of consent to set Finsure.
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
a r copy thaicol'(Sea.3800,Lab.CJ. '
I'blicy No. 1 Company _ -
Q '❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY L24
Z Z e - ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O APplicaut Y ❑ N❑ Y ❑ NE]~ _m - PERMIT ISSUANCE 10.00
ir CER'II1ICA'1'I7 OF F:XBMPrION FROM WORKERS' FLOOD ZONE A.L.U.C.
W,> COMPF-NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
EL (' I his section need not be completed if the permit is Cir one _ TOTAL - Y❑ N❑ Y❑ N❑
hundred dollars($100)or less.)
U O 1 certify that in the Performance of the work for which this Per- OTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL I. mit is issued,I shall not employ any person in any manner ur as to
U become subject lathe Workers'Compensalion laws o(Calilinnin.
ED Uric Applirmn - BUILDING / �®
}.Do NOTICE: TO APPLICANT: If.after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 V
2 _ eniption,your should hecame subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK Q.
provisions of the Labor Code, you must forthwith comply with FEE a
U such.provisions or this permit shall be decried revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONS'1'RUCRON LENDING AGENCY •^ AIR HANDLING UNIT(OVER.10,000 C.F.M.) 6.00 BE ISMIC FEE t,Sf7
I hereby affinn'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 HEATING UNIT(OVER 100,000 B.T.U.)Lender's Address ELECTRIC ST
I certify HIM l have read this apGEcation and state that the shove VENTILATION FAN'(SINGLE) 4.00 - -
information is correct. I agree to comply with all city and county - PLUMBING
bolimmersand state laws relating to building construction, and BOILER•CDMP(3 H.P.Of 100,000 B.T.U.) 6.00
hereby authorise representatives ec this Glp R ,mer upon the BOILER-COMP (Over 100,000BTUI SEE FEE SCH. MECHANICAL
habove ereby entioned property for inspection purfmses. -
I (We) agree to save,'indemnify and keep harmless the City of MISC.- - REFER TO ORD. -
- Cupertino against liabilities,judgments• costs unit expanses'which .. .CONST.TAX -
ay in any way aceme against saiA City Consequence of(he PERMIT ISSUANCE 10.0011
ranti f its Perini . '/ " MECH.CONT. LIC.NO.', MECH. - 'n
z} r TOTAL .TOTAL
S'�Jffature of Applicant/Co n or Uate
OFFICE COPY
F,POSTTHIS CARD',NEAR-FRONT OF.BUILDING' ° '
" Pf.RM1T NUMB ER
,p. CITY .OF CUPERTINO 16362 .
,.
' INSPECTION DIVISION
'JOB.INSPECTION RECORD
1. p /-10 p PERMIT EXPIATION
S
JOB ADDRESS- IP// TEV. n/-f •l/� -�L'✓AT UNIT# -_.LOT tk ,.PERMIT EXPIRES IF WORK '.
` 'OWNER- V4•C./ i?'1/ n/Cst CONTRACTOR' - IS NOT'STARTED WITHIN
INSPECTION DATE .INSPECTOR• INSPECTION RECORD 180 DAii OF PERMIT issu
FOUNDATION " ' - ANCE OR '180.DAVS FROM`
' '' NOTE: ` ' ` LAST CALLED INSPECTION..
UFER ALL GRADING AND DRAINAGEISHALL BE INSTALLED
PREGONITE - TO COMPLY WITH THE APPROVED PLANS AND'CITY OF PEHMTI VALIDATION
CUPERTINO STANDARDS.. '
,GARAGESLABS, - {' - r
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND'/SLAB
PLUMBING
ELECTRICAL _ "' P71t_0 ISSUANCE DATE
• MECHANICAL .� ¢ xLUr pl:ecr. -PLa MEcll.l
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED MIT
` WOODFLOOR UP 'AV FORMATION^
PLUMBING - VALUATION /FT
t
MECHANICAL :, ' -
.. .. ; PERINIIT TO
ELECTRICAL"
FRAMING Pt,. j�L?R/ �� Rd✓L;.
' STORIES •TY ECONSTR.
' INSULATION � ' ' - .� �.
OCC.GROUP HES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
( ROOF NOTE IN
NO FINALSP.SHALLBE MADE BEFORE sn,FT;rLooR a,eA .roTAuncl+ecce
DIAPHRAGM '+. THE CONSTRUCTION TAX IS PAID
`DI
I DING USE
' ROOF SHEATHINGIs RES" a IND CO
❑N O O❑
APPLY..NO ROOFING UNTIL ABOVE HAS BEEN SIGNED: .,FINALS .,..;,, , DATE, ;,INSP;,, . ASSESSORS PAHCEL NO,.
ROUGH SAN.p
'PLUMBING _ _ ELECT.ENERGY
TRACT NO. PARCEL NO.
TUBS&SHOWER PAN' - PLUMBING ENERGY , - -
MECHANICAL• - 6. p' MECH:ENERGYp%�•'�r`8" •ACC%QATE ACC FILE NO,
ELECTRICAL _j ,� `;BUILDING ENERGY - - '
FRAMING- ' -" "' ELECT.FINAL TEST '
ZONING ENG,SITE NO.
INSULATION - PLUMBING ..
GAS TEST . : GAS- '
• MECHANICAL _ • .. FIRE SPRINK` ENERGY L➢J' '. I
COVER NO O WORK'UNTIL ABOVE-HAS BEEN SIGNED ' HEATING 7Y "� Y ❑ _N❑
. EXTERIOR SHEAR ELECTRICAL RELEASE. 'p �'�• PLooDzorvE ALuc
INTERIOR SHEAR FIRE DEPT:• $O El N� v'Lti� N❑
SHEETROCK '. ' GRADE - FEESUMMARY
-
EXTERIOR LATH BUILDING .. QASD
INTERIOR LATH .TEMPORARY APPROVALS . eulLoINc ' �`..
SCRATCH COAT ELECTRIC' PLAN CHECK
GAS •FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 'SEISMIC FEE IV v+
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI LBUI LDINGFINAL IS SIGNED BY BUI LDING,INSPECTOR.
MICROFILM • ,
ELETRIC
ARRANGE FOR INSPECTION BY PHONING.252-4505; -
F� jC �.'ONE,WORKING DAY BEFORE REQUIRED INSPECTION PLUMBING'
(� PLEASE GIVE JOB ADDRESS WHEN PHONING
Z " 'MECHANICAL +
1 : SEE PERMIT,FOR EXPIRATION DATE
IMPORTANT! covsT;TAx
PLEASE READ REVERSE SIDE,BE FORE 01 1
CALLING FOR FINALYNSPECTION. .. TOTAL
OFFICE COPY