16969 •1 A$PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER euaouaG APPLICATION & PERMIT ' 16969
R RE55
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL i"
\ W IRS PLAN CHECK VALIDATION
AME /f CITY. ELECTRIC PERMIT FEE
ONE
CONTRACTORS
ME ,My UTLETS-SWITCHES-RECEP 10.00/1.00
brria+/t J� LIGHTING FIXTURES 10.00/1.00
CONTRACTORS a �O PPLIANCES-RESIDENTIAL '4.00 �
ADDRESS 4,q ✓CJ
IIHON PANELS 10.00 DATE OF APPLICATION'
AS IrecT PANELS (OVER 200 AMP) - 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
AARCH.OR DDRESS ENG, SPECIAL CIRCUIT 5.0D PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANTS W, 5 MOTORS SEE FEE SCH.
A Ofl E55
SERVICE CHANGE 20.00
00 LICENSED CONTRACTORS DECLARATION - -
Fi w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
a (commencing with Section 7000)of Division 3 afar lainess and BLD ELEO PLG. EC
°z Professions C a icemse is in full f
z O - Licen�Cl�ss _ Lic.Numb99
2 Contract. a /."60
BUI DI G ERMI
¢ ¢ a OWNER-BUILDER DECLARATION
X a o INFORMATION
w0 N I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
H u 0 a Law for the following reason.(Seo 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 - VALUATION $/FT.
m Cade:Any city or county which requires permit to construct alter,
Q Q ¢ 2 Improve,demolish,or repair any structure,prior to IIs Issuance,aIS. EC.CONTR. ^ LIC.N0. ELE
ar ii: O u requires the applicant for such permit to file a signet statement Ilia G TC. `
n w$m he is licensed pursuant to the provisions'of the Contractor's Licens PERMIT TO
ri > Law(Chapter 9(commenc(ngwilh Section 7000)of Division 3 oflhe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
te =$ the basis for the alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
a ; - by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
action mare than five hundred dollars(SSDO).): '
❑ I,as owner of the property,or my employers with wag"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 sal, (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
- Code:The Contractor's License Law does not apply to an owner of
i properly who builds or improves thereon,ant wha does such work FIXTURES-PER TRAP 5.011 SG,FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
meatsare not
intended
oroffeyed for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200 BUILDING USE
builder will have the burden of proving that h - . . .
It,did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 El 0 1:1 1:1 El
❑ 1,as owner of tire property,am exclusively contracting with . .
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 far such projects with a conlmctons)licensed pursuant to SEWER-SAN V•STORM EA.200ft/10.00
the Contractor's License.Law. 'TRACT NO. PARCEL NO.
❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK CRS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP, 5.00
I hereby affirm that 1 have a certificate ofconsent to self-insure. ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance•or a certified
copy thereof(Sec.3800,LAC.).
Policy Nor Company.
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z 2 'led copy isfiled with the city inspection division. - TO
F O V,1, at MISC. REFER OD. Y E] NE] I Y C] NE]
y
cc: CERTIFICATEOFETIOIII'IFROM W'ORKIiRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.O.C.
W COM PIiNSAT10N INSURANCE .CONTR. LIC.N
PLG
d O
(I tax section need not be completed if the permit is for mal! 6 OT v❑ N❑ Y ❑ ijN❑
Z hundred dollars IS 100)or less.)
U O I certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
IL F mil is issued,1 shall not employ any person in any IIIDmler so as to
O W become subject to lire Worknrs Compensation Laws of California. BUILDING
IS. Date Applicant ALTER OR ADD TO MECH. 5.00
} to NOTICE '10 APPLICANT: If,after making This Certificate of Ex-
Z 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
C.1 such provisions or this permit shull be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10,000C.RM.) 6.00 SEISMIC FEE
1 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(Sec. MICROFILM
3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC lost
I certify that I have read this application ant state that the above VENTILATION FAN (SINGLE) 4,00
information is correct. 1 agree to comply with all city and county PLUMBING
ordinances and state lows reaming to Building construction, and BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00
I
authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(Wo) agree to save, indemnify and keep hunnlss the City of MISC.- REFER TO ORD.
j upertino against liabilities,judgmen costs and expenses which pERMIT ISSUA CE 1D,00 CONST,TAX
may 'n any way ac rue against Sri City in coastal ence of t
to gol'Ih is per t MECH.CONT. EC .
�/��'�yrI ° TOTAL
igna ur o phcan r at R/g'GV / /
OFFICE COPY
POSTTHIS CARD NEAR FRONT-OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO ' 16969
INSPECTION DIVISION
, - "•':; . JOB INSPECTION RECORD .
I',ERIo11T EXPIRATION
�y JOB ADDR ESS 7)0 US L-C�(A�CWLC '/�. UNIT# ,LOT# �•�'
P.ERMIT,EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD -.180'DAYs OF PERMIT ISSU-
FOUNDATION 1 'ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERnur VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB 1
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL I ELECT PLc. M cR
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED auILDINc ERMI
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING � � -
MECHANICAL '
ELECTRICAL PERMIT TO
i
FRAMING I
INSULATION sroRles tura CorvsrR.
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
•{ SU.11 FLOOR AIIIiA TOTAL ACNf AGE
p ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
L DIAPHRAGM THE CONSTRUCTION TAX IS PAID !
' BUILDING use .
ROOF SHEATHING - Res IND CON Pa oll—
❑ ❑ 11 ❑ ❑
M
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO
ROUGH SAN.a
PLUMBING �,�— ELECT.ENERGY
INgCi NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL �3_ ;/ MECH.ENERGY
';AQC DATE ACC FILE NO
' ELECTRICAL BUILDING ENERGY ..
FRAMING ELECT.FINAL TEST /- - '
ZONING ENO SITE NO.
_ INSULATION - PLUMBING
GAS TEST - GAS `
MECHANICAL
FIRESPRINK ENERGY T 74
_ -/ -.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ N❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U C�'"'7
�'
INTERIOR SHEAR FIRE DEPT.
Y❑ NE] YLJ NO
SHEETROCK GRADE FEE SUMMARY
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 INSPECTORcom
SM IGROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F� ONE WORKING DAY BEFORE'REQUIRED INSPECTION. - PLUMBING, �� ••'
o PLEASE GIVE JOB ADDRESS-WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE MECHANICAL
-
IMPORTANT! J CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY