The URL can be used to link to this page

17075 m�nl nett Y APPLICANT TO FILL IN INF( FINAL GR IDE DUI LDI NG?ROJECT I DENTI FICI R°- RMIT NUMBER - 17075 I u.uolNc rADDRESS . l g File No. M 0 _ :HECK VALIDATION Ae N_ PHONE DateORS NAMELocation �� ( IC NO CDNTRACTOR'a Dfl EQ55 I/�/ � � 1 r/t t-fix--G JE HONE E OF APPLICATION ARCHITECT k ( I" ECK FEE P.C:N0. OR Su ect IC.N( AR.SS ENG. (�� RMIT VALIDATION DD APPLICANT'S ADDRESS _- I ' 1 ' ��✓l..�c'GLLIG.�� w00 LICENSED CONTRACTORS ECL Appro Q U u I hereby affirm that 1 am licensed under It - ISSUANCE DATE w G i (commencing with Section 7000)of Division ate ELECT. PLG. MEC . w i Professions Code,and my license is in full force add-efleet--- Inspector z o ,n- License Class Lie Number •-- <2 m w Date Contmctor ¢ m s I•„f„ p ,,,,� BUILDING PERMIT ¢ ¢w OWNER-BUILDER DECLARATION INFORMATION Z 0 n m I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD 3 u. VALUATION $/FT. r u 0¢ Law for the following reason.(Sec.703 t.5,Business and Professions PERMIT ISSUANCE 10.00 Code:Any city or county which requiresa permit m construct.alter, ,.S 1---/ U vo ¢ 2 Q G improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �!J b - DLL requires the applicant for such permit to file a signed statement that TOTAL to",43 PERMIT TO a w ne he is licensed pursuant to the provisions of the Contractor's License is ,...P FZQ Law(Chapter9(commencing with Section 700010 f Division 3 ofthe J`h F 4 D Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. d ; _ by any applicant for a permit subjects the applicant moa civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(55001.1: ❑ I,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 sale (Sec. 7014. Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 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 or through his own employees,provided that such improve- �• mens are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 32 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden al proving that he did not (lie or int- RE IND DON PB Other provr aspurpose owner of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ 13/ L as owner of the property,he eject(Sec. contracting with ' licensed contractors to construct the project ISec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORSP N 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 TJCJ_ Z X06 contras fo hprojects wi[ha corneums)licensed pursuant to [SEWER-SANITARY-STORM EA.200ft/10.00 TRACT VVNO. eJ PARCEL NO. the tr tor' License Las' a. ex rpt under5 '!__.B.&P.0 fqr this WATER HEATER W/VENT 6.00 reason L Owner Date WATER SYSTEM 5.00 ACC.DATE ACC FILE NO. N'ORKERS'COMPEN ATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ' E O ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800.Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. MISC- REFER TO ORD. O Applicant Y ❑ N❑ Y ❑ N❑ � N CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 ,,0K.) FLOODZONE A.L.UC. L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 3 CL O fThis section need not be completed if the permit is for one TOTALgJ,J Y❑ N❑ Y ❑ N❑ Z hun1reddol1ars(S100)orinss.) U O 1 certify that in the perfor uc of the w irk r which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is I u I shall not empl y any pi n I say manner s0 as to been u o the Worker �1's f California. O d Date Applicant BUILDING } N NOTICE APPLICANT: If,a ter making this C ti0catr of Ex- Ir x- ALTER OR ADD TO MECH. 5.00 �J 1 Z emption,you should become subject to the Worker Compensation APPLIANCE 5.00 PLAN CHECK provisions of the.Labor Code, you must forthwi h comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A00 CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE lE ( Z I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performs c cf Ile work for which t s permit is issued ISec. MICROFILM 3097,Civ.C.1. � - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's NamClUtA Lender's Address 4 rI /) �0�1•U HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC a' 1 certify that I hove read this applicid nn and nate that Rhe above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING din Orances and state laws relating 10 building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 • hereby atnhorio, representatives of this city to enter upon the BOILER-COMP 10 r 0 ,D I E FEE,$C,H, MECHANICAL above mentioned property for inspection purports. 'e agree to save. indemnify and keep harmless the City of MISC.kj EF TO ORD. L uper no against liabilities,judgments, casts and Expenses which 6^ t� CONST.TAX Art - may any way a against said City in con equence of the PERMIT ISSUANCE 10.00 ` `{ l m mg Of lh p it. MECH.CONT. LIC.NO. MECH. TOTAL Ct 3'.23 TOTAL na eo Applicant/ tractor t I IVs OFFICE COPY POST THIS CARD NEAR FRONT OF F BUILDING eRMIrNUMBER ;' . CITY 01 CUPERTINO 17075 / i T. INSPECTION DIVISION 2— JOB JOB INSPECTION RECORD n. -'? RM)T,E3P,4R f1ON Lam-'' JOB ADDRESS - �- �6 Al and Nm cl;_ CTUN 1T 1k _LOT# (•+ ((//�� PERMIT EXPIRES IF WORK •^OWNER JO lk(O. -CONTRACTOR •(_ �- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR FNSPIECTION RECORD 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM. FOUNDATION .NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STA DARDS. GARAGE SLABS u_$ �fE'� tkoLerz, dk / _,S POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED CLAF'++,�P= O ( � UNDERGROUND /SLAB PLUMBING ELECTRICAL ' "T''��"7'J� ISSUANCE DAJE MECHANICAL BLDG ELECT I PLG. �m lot DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION �t SIFT. PLUMBING MECHANICAL 5=1y-�+,i ..cti.• : PERMIT To �GF ELECTRICAL P(E} ��• FRAMING 9_!d S v " L- INSULATION STORIES rvaE CONSTR. I Oar T OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED $O FT FLOOR AREA TOTAL ACREAGE - ROOF NOTE:NO FINAL INSP.SHALL BEMADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RE IND CON ve amw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. E) 0 D 13 ' ASSESSORS PARC ROUG SAN.p I CCOp PLUMBING (g DZ'z @1 111S 0 ELECT.ENERGY � �JO TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC Dare ACC FILENo FRAMING ' ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. , GAS TEST GAS FIRE SPRINK ENERGY TZA MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN RIONED lHrATING V ❑ "� FLOOD ZONE A.L U C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v� N� vL No SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH 1 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 . 17" ,J` OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED I3Y BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC rl�n Iw� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z° PLEASE GIVE JOB ADDRESS-WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX �E�IFL PLEASE READ REVERSE SIDE BEFORE �f TOTAL' CALLING FOR FINAL INSPECTION. • - I L OFFICE COPY