5998CITY OF CUPERTINO,INSPEMON RECORD
(OFFI(± COMO
28PERMIT. n 5 neva oLOT � O.
i ��Lll�c �rytJ lN &-)
UMER
FINAL INSPECTIONS DATE I INSP.
Gas
ELECTRICAL DATE (INSP.
Power Pole
ELECTRICAL DATE I INSP.
Underfloor S.M.
ues
ace
APPLICANT TO.FI'LL'IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION r
APPLICATION & PERMIT
•.
BUILDING -ELECTRICAL- PLUMBING -,MECHANICAL
- PERMIT NUMBER
59V V
71RMNG
2
NAME: -_j ..
' :+>' . xt",:°�
L
�. �PHONE'
ELECTRIC PERMIT FEE,
PLAN CHECK VALIDATION
'
'
NAMrLRacTaR's , _
.OUTLETS - SWITCHES -RECEP 5.00/1.00
`-
NO. Lr-(� �,L4,C
t
LIGHTING FIXTURES 5.00/1.00 -
CONTRACMarasTORSdr
(30 di
RESIDENTIAL 4.0
PANELS
PANEL$ - 5.00
PH p� (/�1'�
DATE OF APPLICATION
ARCHITECT I
OR
-ENO E -
J uc. NO I ".
SIGNS 6.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
noodess ENG. '.
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
EMP. METER OR POLE INS, 15.00
- zId
)110
aPPucaurs
ao.REss
MOTORS � - � 1,S �. SCH. ..
- SERVICE;CHANGE 10.00
t ," •'" r
LICENSED CONTRACTORS DF LAR 10.
OCT 2
-thereby affirm'Ihat l'am licensed underpin sono f r
(b.ilnllanciI ith Sect run' 7000) oLDivixion or
,Profesdio - Co -
Lacca .'ss -LieNumbc
dti y license is in full Ib
-
ISSUANCE DATE
Cot p
BLDG.. ELECT.
'
'•�
PLG. MECH.
-
•❑
-
Dal Contract.
BUILDING PERMIT e
INFORMATION
•
OWNI'l :BUILDER DECLnRATION " � "
'^
I hereby affirm that I am exempt from the Contractor's License
'Law for the following reason. (Sec. 7031.5, Businessand Professions
Code: Any city or county which rcquireso permit loconslrucl;alter,
'improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he is licensed pursuant to the provisions of the Contractor's License
Law (Chapter 9(commencing with Section 7000)o f Division 3 ofthe
Business and Professions Code)m
me that he is exapt therefrom and
` �
- REFER TO ORD
MISC. - '- -
VALUATIONS/FT.
qq
e�
�•�
//
pERMITIS$UANCE 6.00 lO -�
'f"
ELEC: CONTR. - LIC. NO.
- _
ELEC '�
TOTAL
PERMIT TO
/
_
DTV. PLUMBING PERMIT FEE
STORIES
TYPE CONSTR.
the basis for the alleged exemption. Any violation of Section 7031.5
by any applicant for a permit subjects the applicant to a civil penalty
.f nt more tire.s„
'ofive hundred donors ( e pl h
❑ I, as owner..( the property, or my my employees with wages as
their sole compensation, will do the work, and the structure is nut
Clty'Ot Cu
f
(, 310
ALTER -DRAIN & VENT -WATER (EA.) 4.00
-
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
intended or offered for sale (Sec. 7044, Business and 1'mfus,twO
-
of
Code: T'tie Cnntramor's License Law docs jet'apply,to miowne'a
property. who builds or improves thereon, and who does such work'
himself or through his own employees, provided that such improve.
mems are not intended or offered for sale. If, however, the building
-
_
FIXTURES - PER TRAP 4.00 6
"SG. FT. FLOOR AREA
TOTAL ACREAGE
'
GAS - EA. SYSTEM -1 INC.4 OUTLETS 4.00
or improvement is said within one year of completion, the owner-
builder will have the burden of proving that he did not build or am.
prove for purpose ofsaleJ.
O 1, as owner. of the property, am exclusively contracting with
�licensedcontractors
GAS - EA. SYSTEM - -OVER 4 IEA.) .1.00
-
BUILDING USE
RES . IND CON PB Other
❑ ❑ ❑' ❑ ❑
INDUSTRIAL WASTE INTER. 20.00
to construct the project (Sec. 7044, Business
and Professions Code: The Contractor's License I.aw dues not apply
to an ovmer of properly who builds or improves thereon, and who
LAWN SPRINKLE S 1 INC 5 V.B. - 5.00
LAWN SPRINKLERS - OV ER 5 (EA.) 1.00
. ASSESSORS PARCEL NO. .
contracts for such projects with it contmclor(s) licensed pursuant to
lha Contractor's License Law. •
$EWER -$ANT V- R ]EA'. 200ft/6.00
TRACT NO.
PARCEL No.
0 1 am exempt under Sec. , BAP.C. for this
ieasan
•ITate_
WATER HEA W/V T 4.00
Owner,
• 4.00'
WATER SVST P' e"
ll
ACC.DATE
ACC.FILENO.-
WATER TREATING EO IP. 4.00
WORKERS'COMPI:NSATION DECI-ARATION
1 he eby.alfirm that l have a certifcale.fcarrVat to self -insure,
'r a scute of C piBooissmiln'n liuuhrinc-ee,, or u certified co
ZONING
ENG. SITE NO.
. .
..
p rT,If al[�C-STP
Ce-,iTt d copy is herehyfur ishe .
Certh i 'nspc con.
pelican +C�!/--��_s�
�
FIRE SPRINK
Y❑ N❑
ENERGY T-24
Y❑ IN 0,
MISC.- REFER TO ORD.
Cl: RT114CAT1: OF I7XI:M PTION PROM WORKERS'
/
PERMIT ISSUANCE _ 6.00 y '�
FLOOD ZONE '
AL.U.C.
PLG. CONTR. LIC. NO.., -
PLG..
TOTAL
COW;NSAI ION INSURANCE
1'I'his section need not be completed if the permit is for one
Y ❑ N❑
Y'❑ N
-
hundred dollars (S 100) or less.)
I certify that in the performance of the work for which this per.
mil is issued, I shall not employ any person in any manner so as In
CITY MECHANICAL PERMIT FEE
„
-FEE SUMMARY
BUILDING'.
become subject to the Workers Compensation Laws of California.'
Dale Applicant
ALTER OR ADD TO MECH. 4.00
NOTICE TO If,'after taking this Certificate of Ex-
'empllon, you should become subject to the Workers' Compensation
APPLIANCE '- 4.00
PLAN CHECK '
provisions of the labor Code; you must forthwith comply with
such provisions or this permit shall be dcemed revoked.
AIR HANDLING UNIT IT 10 GF.M) 3,00
'FEE
'
AIR HANDLING UN IT lO ER p00C.EM.15.00
SEISMIC FEE
CONS'T'RUCTION LENDING AG17NCY
I hereby zffann'thut there is a construction lending agency for
EXHAUST HOOD,(WITHjDVCT) O 2.00
the,performance of the work for which this permit is issued (Sec.
3097.CorC.). .. ..
MICROFILM,
'
HEATING UNIT,Rb 0,000 B.T.U.) 4.00 a,•
HEATING UNITI ER 100000 B.T.U.)7.50
a -a ..
ELECTRIC E
/�..
3; V
,Lender's Name
Lender's Address
I certify hist I have read this application and stale that the above
information is comet. 1 agree to comply with all city and countyBOILER-COMPI3
ordinances and stale laws relating to building construction, and
VENTILATION I Ni;`LE') ", a 3.00
PLUMBING ` `
W
H.P. of -100,000 B:T.U.)' 4.00
BOILER-COMP.10ver 100,000BTUISEE FEE SCH.
MECHANICAL
,7
hereby authorize fire, tatives of this city to. enter upon the
c
above-mcntion p f pcction Purposes
MISC. -' ' REFER TO ORD.
Y
CONST. TAX '
(We) .fir It av n fy and keep harmless the City 01
s's w ich
Cu Perlin ga Y 7u g nis, costs and exp?117.,
ma n ais id.Cityin conscy ncc'o the
'PERMIT ISSUANCE t'. 3.00.3
gr:anl g m.
MECH. CONT., ;LIC. NO.y MECH.
TOTAL
S - /
TOTAL
Q
as 3
S moire Of Appll an Orllructnr Dila
OFFICE COPY