16606 APPLICANT TO,FILL IN INF2&MATION WITHIN RED LINES - USE LL POINT PEN ONLY
-� .BUIL DI NG PROJECT I DENTI FI N
.PERMIT NUMBER'
"-
aDILDING APPLICATION & PEW
IT - e
ADOREaa
rBUILDING-ELECTRICAL-PLUMBING-MECHANICAL " `l ,. &H6
OWNER'a ' „y^.� CHECK
V
NAME L(/riC.C-N�/iS/ PLAN CHECK VALIDATION
QTY• ELECTRIC PERMIT FEE n.
vHorvE
CONT gCTOR'S ✓.�
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
I'Y /✓ .�� /✓ LICN . Gf' ZZ- LIGHTING FIXTURES 10.00/1.00
~,b-APPLIANCES-RESIDENTIAL
,b PPLIANCES-RESIDENTIAL- 4.00 N
PHONE PANELS 10.00 D -
ARCHITECT ATE OF APPLICATION
OR PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG.
ADDRESS SPECIAL CIRCUIT 5.00 PERMIT VALIIfDATI'O1N�,.
ZIP EMP.METER OR POLE INS. 20.00
APPLICANT'S" /l
ADOREss /��z� nom'✓�JJ/!�//�sL' MOTORS - SEE FEE SCH.
waz Q��'-�J• - SERVICE CHANGE 2VC
If/I:I�'I �O.
FOO LICENSED CONTRACTORS DECLARATION R"
a u I hereby affirm that I am licensed Under provisions of Chapter 9
w a vAWi (commencing with Section 7000)of Uivision 3 of the Business and ISSUANCE DATE` '
F y 2 Professions Code,anJ my license is in full force and effect ELECT; PLG. MECH•
o i w D License Class Lic.Number O E]m F w Date.�p_=f Conlnctor
Q y� J w � •
M , w OWNIi K-B UILDF;R DECLARATION BUILDING PERMIT
F
3.LLy I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION
F u.O ¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION §/FT.rp
y '^ > J Code:Any city ar loam whichre uiresa PERMIT ISSUANCE Qb
� Y y pcnni[LoconslrucLelter,
Q 2 ¢ D improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. //�^J `1 Od P
D LL reyallL•a the appheanl fOr SOCA pelmlt t0 flle a a1gnL'd Slatem Cnl that TOTAL W N r I y'
e. w he is licensed pursuant[o the provisions of the Contr.¢tor's Lirense Vv/ PERMIT TO
F Z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
E i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ F the basis for the allegedexemption.Any violation of Section 7031.5
a- 3$ by any applicant fora permit subjects the applicant toa civil penally STORIES TYPE CONSTR.
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 `
❑ I,as owner of till property,or my employees with wages as BACK FLOW PROTECT
their sole compensation,will do the work,and the structure is not . DEVICE 4.00 OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, and
and Professions DR
Code: ROOF,AR EA,CON D. 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
himself or through his own employees,provided thus such improve- SO.FT.FLOOR AREA TOTAL ACREAGE
meets are not intended proffered forsale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
Prove for purpose of Sale), INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer
❑ [,as owner of the property;am exclusively contracting with 1:1 El El ❑ E]licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00
and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO.
to an owner of property who builds or improves thereon,and who -
LAWN SPRINKLERS•OVER 5 IEA) 100
contracts for such . .
projects with a comractons)licensed pursuant to -_
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/1400
❑ I am exempt under Sec. ,B.&P,C,for this TRACT NO. PARCEL NO.
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.�t
WORKRRS'COMPENSATION DECLARATION WATER TREATING EQUIP, 5.00 v 4
I hereby affirm flat I have a cerlificale of consent to sar-insure. •'
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑❑ Cc�sff�d copy is hereby furnished.
z Z lrtified py d wiflVI�f�y inspection division. FIRESPRINK ENERGY T-24
F O APDlicant-YC� Y�.'d MISC.- REFER TO ORD. - Y [:J
=E3N
Y❑ NCERTIFICATE OF EX17MPTION FROM WORKERS' PERMIT ISSUANCE 10.00
A.L.U.C.
W O COMPENSATION INSURANCE vIG.CONTR. Luc.NO. PLG= Z (This section need not be completed if the permit is for one TOTALY ry�
hundred dollars(S I OOI or Icss.l
U O 1 certify that in the performance of the work for which llper- OTY MECHANICAL PERMIT FEE
FEE SUMMARY
LL U mit is issued,I shall not employ any person in any manner so as to
O W become subject to the Workers Compensation Laws of California.
G Date Applicant ALTER OR ADD TO MECH. BUILDING {
} 2 NOTICE TO APPLICANT: If,after making this Certificate of ion 5.00
♦- _
emotion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
63
such
of the Labor Codc, you must forthwith comply with
V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4,00 FEE
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE XI
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(See. MICROFILM
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name (PI
r,/X
Lender's Address HEAT[NG U N IT(OV ER 100,000 B.T.U,)9,50 ELECTRIC (Poe'1W
1 certify tint I have read this application and slate That the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-O'OMP(3 H.P.or 100,000 B.T,U.) 6.00
hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD
upertino against Babilities,•judgments, costs and expenses which
ay in any w ecrue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
anon of lh' a nit. MECH.CONT. LIC.NO. MECH.
oi
, �o/ $ TOTAL TOTAL I �i
SlgnatureAp cant(C�anor Uate
- OFFICE COPY -
POST THI RD NEAR FRONT OF BUILDING
I • PERMIT NUMBER,. l
CIa OF CUPERTINO.
INSPECTION DIVISION 16606
• JOB INSPECTION RECORD
JOB ADDR ESS =O�1ICSL'�eM Q,\L�pa—UNIT# _LPERMIT EXPIRATION
,i
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU.
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
ALL GRADING AND DRAINAGE SHALL S INSTALLED• . .�).
I .
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITU OF PERMIT VALIDATION
GARAGE SLABS
CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAIp `
UNDERGROUND /SLAB
PLUMBING T
ELECTRICAL o� l
MECHANICAL L ELSEC*NCE Pi11 - MECR .
City ut DVB 6 ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILRING PERMIT
WOOD FLOOR - INFORMATION
PLUMBING VALUATION SIFT_
MECHANICAL �![jC• +"
ELECTRICAL P RMITr
K..
FRAMING
INSULATION STORIES TYPE CONSTR.
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE So P. FLOOR AREA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING BUILDING USE
RES IND CON PR OR";'
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ , ❑ ❑ ❑ ❑
ROUGH SAN.q ASSESSORS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY . TRACT NO., PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE. ACC.FILE NO.
FRAMING ELECT.FINAL TEST
INSULATION • PLUMBING ZONING ENG.SITE NO.
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY T.]E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ •.° ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLooD zorvE ALu.c.
INTERIOR SHEAR FIRE DEPT. v❑ N❑ v ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING ''' y
INTERIOR LATH TEM ORARY APPROVALS BUILDING ,
SCRATCH COATELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE -'tri c
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, `:' ELECTRIC (, ,GL`"
o�. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. ,~,
- SEE PERMIT FOR EXPIRATION DATE - ? ,, MECHANICAL '
IMPORTANT!
CONST.rnx
PLEASE READ REVERSE SIDE BEFOREIT
TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY