14187 APPLICANT TO FILL IN INF 'ATION WITHIN RED LINES - USE P - L POINT PEN ONLY
-• EILFILDING PROJECT IDENTIFICAWN, 1W PERMIT NUMBER
BUILDING APPLICATION & PERMIT 14187
ADDRESS
- I BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S . PLAN CHECK VALIDATION
ME `1,^l UIC4 L ZEQ QTY. ELECTRIC PERMIT FEE
a. W PHONE
TRACTOR OUTLETS-SWITCHES-RECEP 10.00/1.00
E
UC.ry LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
AOPRESS
v PHONr4ts PANELS 10.00 DATE OF APPLICATION
ARHITECTPANELS (OVER ZOO AMP) 20.00 PLAN CHECK FEE P.C.NO.
on
ENGINEER
I.E.NO. ISIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESrvr$ MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
< U v 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w "' (commencing with Section 7000)of Division 3 of the Business and
G ' BLDG. ELECT. PLG. MECH.
F y i Professions C d my license is in full fore-' sff R❑ O
i o u2 License la Lic.Number V
o w F Date otractor
a y BUILDING PERMIT
E ¢w u OWNER-BUILDER DECLARATION INFORMATION
E
3 LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
Hut J Law for the following reason.(Sec.]03L5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
w Code:Any city orcounty which requiresa permit to construct,alter,
rc ¢ o improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
o u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO gyp,!
E
$ he is licensed pursuant to the provisions of the Contractor's License
rii
L..(Chapter 9(commencing with Section 7000)of Division 3 ofthe
a Business and Professions Code)or that he Isexetnpt therefrom and QTY. PLUMBING PERMIT FEE �OQE QOvI/�
sio
¢ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s ';;� by any applicant for a permit subjects the applicant to a civil Penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(SSOOM
O 1,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 Jo the work,and the structure isnot
intended or offered for sale (Sc,. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00
meats are not intended or offered for sale.IL however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that h .e did not build or im- RES IND CON PB Other
prove for purpose of sa1c I INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the 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 for such projects with n contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contra tor's License Law.
❑ I amexempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DIiCLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent toself-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thercGI(Sec 3800,Lah.CJ.
Policy No. C'otn Dany
I )P
O ❑ led C y IS II' `hy famished. FIRE SPRINK ENERGY T 24
Z Z Cc 'f p is tl-d with We cit 'nspcction division. MISC.- REFER TO ORD.
O ApplicantY [DN❑ Y E] No
CCT CERTIFICATE OF EXEMPTION ' MWORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC.
LL > C04ENSATION INSURANCE PLO.CONTR. LIC.NO. PLO.
CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
7) Z hundred dollars IS 100)or Icss.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H not is issued,1 shall not employ any person in any manner so as to
O L) become subject to the Workeri Com enation Laws of California.
P
X Dalc Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �Df
} (0 NOTICE TO APPLICANT': If,after making this Certificate of IN
F_ ? eriptirm,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK `) l
provisions of the Labor Code, you must forthwith Comply with FEE LJ e( `�Z
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY r AIR HANDLING UNIT(OVER 10p00C.EM.) 6.00 SEISMIC FEE 70
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(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county BOILER-COUP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100.000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned roperty for inspection purposes.
(We) a ee to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
C enino gains liabilities,judgments, costs and expenses which CONST.TAX
I, y in wa ccruc against said City in consequence of the PERMIT ISSUANCE 10.00
gr ming this p r ,it, l /J �y� MECH.CONT. LIC.N0. MECH. TOTAL [_'1
CSi,/L' TOTAL /] V r�
/ 'ignatureof App' ant/Contractor Date (s/
OFFICE COPY
POST THIS C&D NEAR FRONT OF BUILDING •
CIT OF CUPERTINO PER MIT NUMBER
INSPECTION DIVISION 14187
. • JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 10123 N WOLFE ROAD UNIT# 2017 LOT# PERMIT EXPIRES IF WORK
OWNER NATURALIZER CONTRACTOR NEW LIFE CONSTRUC/ IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
UFER
PERM
PREGUNITE rt VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB \ t"
PLUMBING
ELECTRICAL ISSUANCE DATE
BLDG. ELECT. PLG. MECH.
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION S/FT.
PLUMBING >
MECHANICAL I"
ELECTRICAL
FRAMING
STORIES -TYPE CONSTR.
INSULATION
OCC,GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT.FLOON AREA TOTAL wLH[AGE
ROOF
DIAPHRAGM
aw LDI usE
RES IND CONON PB om,,,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED
ASSESSORS PARCEL NO.
ROUGH
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL `
ACC.DATE ACC FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # zorvwG. ENG.SITE NO.
INSULATION PLUMBING
GAS —
FIRESPRINK ENERGY T.}A
MECHANICAL Y ❑ N[:) v ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SI NED HEATING
FLOOD ZONE A.L.U.c.
LATH—INTERIOR ELECTRICAL
LATH—EXTERIOR FIRE DEPT. `"❑ N� N
v ❑ ❑
SHEETROCK GRADE FEE SUMMARY
SHEAR'INTERIOR UILDING III—
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS GELECTRIC PLAN CHECK
FEE
AS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I I SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
111ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL `
CALLING FOR FINAL INSPECTION.
OFFICE COPY