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17207
O Z2 PO CC LU - EL 0 UO LL U Ow } N I- ? A s APf3'ttCANT[3TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER` 17207 - BUILDING 40nRESSs5, DR CLL' i OWNERS �l.-Tf1l_LI PHONE'`(J� ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S NAME pp uC.rvo.S ?,8 73 UTLETS'SWITCHES -RECEP 10.00/1.00 7P ILIGHTING FIXTURES 10.00/1.00 Ito D CON-TRACTGR-sPPLIANCES-RESIDENTIAL ADDRESS 4.00 175 GATE OF APPLICATION PANELS 10.00 ARCHREC oR Li1.iAi`I UA-L.E, C ENGINEER .� ale. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDDRESSS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 IIP ADDRESS r'a AoREss MOTORS SEE FEE SCH. r� ,{ ..�-.- s/ l_ l/ff_,V,` l (} uCC SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION OG• ( •- I hereby affirm that I am licensed under provisions of Chapler 9 (commencing widt Section 7000) of Division 3 or the Business and Professions Cod my license is in full force+�sL�f�q�-� 2 License Class Lic. Number-p7[Z'(_+L ISSUANCE DATE .1 ' BLDG. ELECT. PLG. MEC". L__4 � ❑ 1C Date_ _CnmructorC _.. _. OWNER -BUILDER DECLARATION I hereby cthat I am exempt from the Contractor's Licence Law for the following reason. ISec. 703LS. BIISInC55 and PlnfesslOnS Code: e,demyshconnly repair ny structurepermit locnnsuana,aheq improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file it signed statement that he is licensed pursuant to [lie provisions of the Contractor's License BUILDING PERMIT INFORMATION MISC.- REFER•TO ORD PERMIT ISSUANCE 10.00 121 VALUATION $/FT. ©(i CS.JC O EIEC. CONTR. LIQ ELEC. 1y1 (^ W TOTAL I 1 r J ` ly PERMIT TO Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the boats for the alleged exemption. Any violation of StG ion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars Ci ALTER -DRAIN -WATER IEA.) 5.00 BACK FLOW PROTECT. DEVICE. 4.00 ❑ I, as owner of the property, or my employees with wages its their sole compensation, will do the work, and the structure is not OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who onessuch work himself or through his own employees, provided that such improve- ments are not intended orofferedfor sale. Il', however, the building FIXTURES - PER TRAP 5.00 te(2 SO.FT.FLOORAREA TOTAL ACREAGE GAS - EA. SYSTEM -1 INC.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 int- prove for purpose ofsale.). Cl as owner ol'the property, am exclusively7044, contracting with GAS - ,EA. SYSTEM -OVER 4 (EA.) 200 . BUILDING USE RES IND CON PB Other INDUSTRIAL WASTE INTER. - 30.00 d lictnsro contractors to construct the project ISec. 7044, Business Professions Code: The Contractor's License Law does not apply to to owner of property who builds or improves thereon. umd who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts the Corr foor's L projects with a auriraetorfs) licensed pursuant In the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. '❑ I am exempt under Sec.., B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy lhereof(Sec. 3800, Lah.C.). Policy No. Company FIRE SPRINK V N ENERGY T-74 � E] I V N ❑ Cyrliifteedcco�py is hereby lurnlshed &/Cert ( d copy FI wI II de dy� m'J�` Applicant MISC. - REFER TO ORD. : IrICAI,�r_,q�_(.--tom C F:RTIPICA'TE OPE :MPTION FROM ORKIiRS' PERMIT ISSUANCE 10.00 tDQ FLOOD ZONE A.LU.C. - COMPENSATION INSURANCE (This section need not be completed it ' the permit is for one ❑, ❑ v N v N ❑ ❑ lfyyf) PLG. CONTR. '-W-6L23 KIT - PLG. DD TOTAL hulidred dollars Vi 100) or Icss.l I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any Donner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY become subject to the Workers' Compensation laws of (Cohi mia. Date Applicant NOTICE '10 APPLICANT: If, after making this Certificate of lix- BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers' Conmtmmt ion provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (OVER IOQODC.EM.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY Ihereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work lar which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM Lender's ,Addre Lender's Address HEATING ELECTRIC n / ISD I certify [)let 1 have read this application and stale that the above information is correct. 1 agree to comply with all city and county oidimnces and state laws relating to building eonstruCliOn, and VENTILATION FAN (SINGLE) 4.00 O PLUMBING I)G BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP IDver 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. •(We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against mid City in consequence of the ranting of this�pe MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 D ) MECH. CONT. LIC. NO. MECH. g a are of pp Icanl ntractor Date Kis' 3R84 �3 TOTAL 16 , TOTAL IV i OFFICE COPY a ` POST THIS CARD NEAR FRONT OF BUILDING " PERM IT NUMBEN CITY OF CUPERTINO 17207 INSPECTION DIVISION JOB INSPECTION RECORD �1K WeSf f"UNIT# PERMIT EXPIRATION I JOB ADDRESS —Ly LOT# I• q �J PERMIT EXPIRES IF WORK OWNER St; V` Q L CONTRALTO (-u, L IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU. ANCE OR 180 DAYS FROM INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION. NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION: UFER PREGUNITE PF.Hm Ir VALIOATION CUPERTINO STANDARDS. ti _ � GARAGE SLABS ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �,,,,.I ISSUANCE DATE UNDERGROUND /SLAB PLUMBING FEB 6 01'' of ELECTRICAL MECHANICAL - BLDG ILL-EEC�T PLG. VECH, ® ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR - VALUATION $IFT. PLUMBING + 0 07 V ?10 , MECHANICAL ELECTRICALPERM 7 TTO[�� I ,( - V e'�+"V FRAMING • C INSULATION STORIES TYPE CONSTR OCC GROUP RES 'UNITS RRACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Y-iasr ,p.�sr- /.yaw'• F"i+-�-� 4 ROOF ,�7I>!'M"NAi3iFORE53P. SHALL BE MADE E THE CONSTRUCTION TAX IS PAID' " sa Fr. rLooR AReA BUILDING -'USE TOTAL AcaeAGe 'DIAPHRAGM ROOF"SHEATHING . Res INo CON PB U0 - 11 El 11ASSESSORS APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.1:1 PAHULL NOi ROUGH SAN.M PLUMBING - ELECT. ENERGY TRACT NO. PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY 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 r ENERGY T 44 v ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE 61 iT FLOOD ZONE y ❑ N❑ P.C. U C. 1C) No INTERIOR SHEAR- .- FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH '" p- BUILDING ,�{/. BUILDING QST' p0 INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEENSIGNED OCCUPANCY I I SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. I ' MICROFILM --- W, I , ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC N sv U, ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. , U0 MECHANICAL = SEE PERMIT FOR EXPIRATION DATE - CONST. TAX IMPORTANT! TOTAL PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. e OFFICE COPY