The URL can be used to link to this page

16653 �'PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION PERMIT NUMBER BUILDING 5 �� APPLICATION & PERMIT . 1 (�� AOOREss •. I l! AJ ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAME ' PLAN CHECK VALIDATION pC� QTY. ELECTRIC PERMIT FEE T eHorvE NgMERAcroRs UTLETS-SWITCHES-RECEP 10.00/1.00 ---llP IJV sec.No 12 yLIGHTING FIXTURES 10.00/1.00 nooness rolls APPLIANCES-RESIDENTIAL 4.00 y L ONE PANELS 10.06 . DATE OF APPLICATION A CHIT cT PLAN CHECK FEE OR PANELS (OVER 200 AMP) 20.00 ENGINEER ' - sec.No. SIGNS TRANS. -- 3.00 moo EOR SPECIAL'CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 1 APPLICANT'$ ADDRESS • MOTORS SEE FEE SCH. ' r ADDRESS � ' SERVICE CHANGE 20.00 wO o LICENSED CONTRACTORS DECLARATION /(1111,-p 119610"t- < O•G0 t-<i W I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUA CE GATE G w (commencing with Section 7000)of Division 3 of the Business and A ELECT. PLG. MECH. r- y z Professions Code nit mglicense is in full fort a d f ect ` ❑ ❑ 2 0,4- License la -iri Lit.Number f 0 Datc Contractor-C,(J x f ��C . UILDING PERMIT aw OWNER-BUILDER DECLARATION ` - , INFORMATION W'g LL WI hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u 0 Q Law for the following reason.(Sec.7031.5,Business and ProfessionsVALUATION $/FT. so , Code:Any cilyor county which requires a permit to construct,alter, I PERMIT ISSUANCE - 10.00 Z.00 2 � ELEC.CONTR. - LIGNO. c ¢ ' improve,demolish,or repair any structure,prior m its issuance,also TEL E c, requires the applicant for such permit to file a signed statement that PE2Ti aO e C .� 6,� TOTAL�.e 0 0 - PERMIT TO ' wee w he is licensed pursuant to the provisions of the Contractor's License H Z>- Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe STM 6[,e['_[`. i o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ' /' ¢F the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES' TYPE CONSTR. by any applicant for a permitsubjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER.(EA.) 5.00 Giant more titan five hundred dollars(5500))'. O 1,as owner of the property,or my employees with wagesas BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP REB.UNITS sole compensation,will do the work,and the structure is 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 tlnreon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- mentshimse are not through his Or offered employees, or pro ided that such he building GAS-EA.SYSTEM-1 INC.4OUTLETS 6.00 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 of proving that he did not build or im- - RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 0 ❑ 0 !E] O d as owner of the property,he exclusively contracting with and Pro contractors to construct the project(Law does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO, toll n owner ns Code:The Contractor's License s th docs not apply to an owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such cenjeeL with a contractor(s)licensed pursutnt to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL N0. O ]Am exempt under See.-,B.&P.C.for this WATER HEATER W/VENT 6.00 . reason Owner' _ Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.- WORKERS'COMPENSAT10N DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self4nsure, _ ZONING .ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy therepf#&3 00,Lab.C.).�s. Policy No. �f,ffompanys�SJ O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z X Certified copy is filed with Ilse city inspection division. MISC.- REFER TO ORD. 0 Applicant V ❑ N Y ❑• No it CERTIFICATIi OFEXEMPTIONFROMWORKFRS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.Luc. LU C041INSATION INSURANCE PLG.CONSH. LIC.NO. PLG. CL o (This section need not be completed if the permit is for one TOTAL - Y❑ N� Y❑ IN D Z hundred dollars IS 100)or less I U 0 1 certify that in the performance Of the work for which this per- QTY. MECHANICAL PERMIT FEE ' FEE SUMMARY LL F- mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California Date - Applicant ALTER OR ADD TO MECH. - 5.00 BUILDING } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- (.... ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 - PLAN CHECK provisions of the Labor Code, you must forthwith comply with, AIR HANDLING UNIT FEE - V a such provisions or this permit shall be deemed revoked. (TO 10MC.F.M.) 4.00 CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMICFEE 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,CN.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 I. Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I 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 PLUMBING ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 hereby amhoriee representatives of this city to enter upon the above.ntentloned property for inspection purposes. g01 LER-COMP(Over 100,000 BTU)SEE FEE SCN. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs a it expenses which' PERMIT ISSUANCE 10.00 CONST.TAX m' any way accrue against said in nsel uIm of the " anon Of this permll. MECH.CONT. LIC.NO.' MECH. ' ` 0 � TOTAL TOTAL eof Applicant/Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING _ PERMIT NUMBER : CITY OF CUPERTINO 16653' INSPECTION DIVISION JOB INSPECTION RECORD •' , PERMIT EXPIRATION JOB ADDRE//S��S -�O�e2.� N//.' GU6'1-Ftx 2O UNIT#" _LOT# PERMIT EXPIRES IF WORK j OWNER,, 'J-ITTC/ - CONTRACTOR 4.'b eao?_Ti-V T IS NOT STARTED WITHIN . INSPECTION DATE I INSPECTOR /INSPECTION RECORD 180 DAYS of PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: -I' LAST CALLED INSPECTION. 1 UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ CUPERTINO STANDARDS. ' GARAGE SLABS _ - TT POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 't " UNDERGROUND /SLAB PLUMBING • ELECTRICAL - _ .ISSUANCE DATE MECHANICAL - BLDG ELECT,I PLG. MECH,I ' ❑ jgj ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED UILDING PERMIT . WOOD FLOOR MOAN FORMATION I�ALUATION - $TFT. " PLUMBING MECHANICAL. - Uv "l�\\\� •'•~�µ1 �� P ELECTRICAL ERMIT TO�M FRAMING INSULATION STORIE TYPE C-OlSTR.. - , - OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.,PT 1100D.IA TOTAL ncRgACE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING RES IND'Cocoa USEPB00— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ,FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH SAN.# PLUMBING ELECT.ENERGY . TUBS 8 SHOWER PAN" � � PLUMBING ENERGY TRACT NOPARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY -ACC.DATE, 'AGC.PILE NO, FRAMING - ELECT.FINAL TEST ZONING ENG.SITE NO. I INSULATION � PLUMBING - GAS TEST GAS MECHANICAL .. .FIRE SPRINK ENERGY T.)4 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NY ❑ N❑ EXTERIOR SHEAR .ELECTRICAL RELEASE - - - FLDDuzONE A.LU,C. INTERIOR SHEAR FIRE DEPT. - _ v❑ N❑ Y ❑ NE) SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH - - BUILDING INTERIOR LATH TEMPORARY APPROVALS 'BUILDING SCRATCH COAT ELECTRIC' D' PLAN CHECK • GAS -FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUIL DING FINAL ISSIGNED BY BUILDING INSPECT OR- MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 9+� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATION DATE = 1'; MECHANICAL , IMPORTANT! 'CONST.rax PLEASE READ REVERSE SIDE BEFORE `a r TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY