15258 (2) (
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_
BI PUIL GO' T NTIFI PERMIT NUMBER
BUILDINGAPPLICATION & P IT 15258
AOOREss ✓,¢LLC •/ov
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S �/' PLAN CHECK VALIDATIOp
"AME C/tGCd /T�/2 �'UG QTY. ELECTRIC PERMIT FEE y3 �J , 7f11/1
! PHONE p/ ^� 7
CONTRACTOR ClS� OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME /J //sl /xIli•
/CLIC.No. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S
ADDREss S'.(•O n% CJN%d1 tt``/' r1% APPLIANCES-RESIDENTIAL 4.00
�iOS(E/I Ctr a4 /f.yp R3dE'� 3 p/ PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR P&,1ic /Il/9V%, PANELS (OVER 200 AMP) 20.00
ENGINEER !{.•[( rV4
uc.No.0411 SIGNS TRANS. 3.00
nooness ENS led r.,e _4v dd SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
rM C zlv/S8 EMP. METER OR POLE INS. 20.00
av DIRESS s ./ p MOTORS SEE FEE SCH.
L r JX
/ G �f0 SERVICE CHANGE 20.00 ISSUANCE
w o o LICENSED CONTRACTORS DECLARATION
a v u I hereby affirm that 1 am licensed under provisions of Clmpter 9 ISSUANCE DATE
H z w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
Fy i I'rul'essions Code,and my license is in full farce and effect.
, Cy m- License Class Lie.Number El El 11
❑•
9 L -w D.tc Contractor
a y E -a BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDER DECLARATION
w? d H I hereby al flrin that run exempt Gam the Contract,,,',License
MISC.- REFER TO ORD INFORMATION
LLoa Law for the l'ollowingrcuson.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION SIFT.
� - Code:Any city orcounty which requires a permit to construct,alter, ��0
lio
¢ ¢ ¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC.
- O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
lieisis licensed Pursuant to the provisions of the Contractor's License
Hzvr
Law(Chapter 9(commencingwith Section 7000)ofDivision 3ofthe % tae /p./�2/2QyE,
a Furness and Professors Code)or that he is exempt therefrom and QTY- PLUMBING PERMIT FEE
¢r Oo the basis for the alleged exemption.Any violation of Section 7031.5 -STORIES TYPE CONSTR.
u ;`O by any applicant fora permit subjeclsthe applicant tea civil penalty gLTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(45001.):
❑ 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 s not
intended or offered for sale (Sec. 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 does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees.provided that such improve-
menu ore not intended or offered for sole.It,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 200 BUILDING USE
builder will have the burden of proving flm he did not build or fill- . . .
- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ C1 El 1:1 ❑
O 1,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 I.icenw Law Her not apply
to an owner of property who builds or improves thereon,and who LAWN SPR IN KLERS-OV ER 51EA.) 1.00
cmumets forwclt projects with a comractourn licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
the Contractors License Law.
❑ lain exempt under See.-,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner / Q _ Dan WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKS COMPENSATION D iCLARATION WATER TREATING EQUIP. 5.00
I hereby at firm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workeri Compensation Insurance,or a certified
copy thereof(See.3800,Loh.C.). '
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with tine city inspection division. MISC.- REFER TO ORD.
U Applicant Y❑ IN Y ❑ IN
T C 1 R'I'11:I CAT ti OF IiX CM PTION PROM WO RK Ii R SPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C.
UJ > COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
d Q hfhis section need not be completed it'the permit is for one TOTAL Y[:] N❑ Y ❑ N❑
Z hundred dollars 151000 or less.)
U O 1 Cerny that in the performmme of the work for which this per- QTY. MECHANICAL PERMIT FEEr�tt
ARY
LL H mil is issued, 1 shall not employ,any person in any manner so as to
U becofer sub'em Ie the Workers'Conr tion Laws of Calif....ia. &O
O wpL11aa L3%2 7
Hale-Applicant ALTER OR ADD TO MECH. 5.00
} m NOTICE TO APPLICAN"I': If,after....king this Certificate of Ex-
F. Z emption,you should become subject to the Workers'Con.pensation APPLIANCE ,a3. 5.00 provisions of the Labor Code, you mustforthwith comply with such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO IOJIDOC.F.M.) 4.00rCONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p000F.M.) 6.00 U
I hereby' affirm Ileal 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. HEATING UNIT(TO 100,000 B.T.U.) 8.003097.Civ.C.).Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50Lender's Address
Icertifythat(havered lhisapplication and state that thoabovc 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-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby aithoriec representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
may
in n way accn.e gainst said City in consequence of the PERMIT ISSUANCE 10.00
mnlitl nis tenni MECH.CONT. LIG NO. MECH.
r/� led" TOTAL
✓/ TOTAL 3 a�
S' pplmant/Coutrac UaT/
OFFICE COPY
POST THIS RD NEAR FRONT OF BUILDING • PERN11TNUMBER
CIio OF CUPERTINO 15258
INSPECTION DIVISION .p
JOB INSPECTION RECORD
/'' - PERMIT EXPIRATION
JOB ADDRESS f0k3 "� lWOL.-FE Ab UNIT# _LOT#
PERMIT EXPIRES IF WORK
OWNER -L.cp g CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMI7 VALmATION
PREGUNITE - CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB / •%�e_,�, ��
PLUMBING
ELECTRICAL ISSUANCE DATE
- BLOG ELECT PLO, MEGI
MECHANICAL ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
FORMATION
WOOD FLOOR io
IS. MLUATRIN SIFT.
PLUMBING _ �noJ
MECHANICAL
I'EHM1tR TU
ELECTRICAL d'o/Hyed V•E
FRAMING /
STORIES IVP[CUNSTR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$O.fi FLOOII Al1EL IOiPL ACFEAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE _
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
suuowc USE
ROOF SHEATHING RES IND CON PB 0m1 ,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. SP
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING - - ELECT.ENERGY '
THACi NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC DATE ALC,FILE NO
ELECTRI 46 BUILDING ENERGY
FRAMING ELECT.FINAL TEST ZONING ENG.SnE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T-24
MECHANICAL I [] IN Yo NF]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A L U C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v N� ' L7 N❑
SHEETROCK IGRADE FEE SUMMARY
EXTERIOR LATH - BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING a7 �--
SCRATCH COAT ELECTRIC i PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
00 PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL 3 r ,
CALLING FOR FINAL.INSPECTION.
OFFICE COPY