15990 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER'
UILDING APPLICATION & PERMIT 1 Cn(1)O
ADDRESS 3 I J J J
No. bdvl�e ,Nd BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OssInS PLAN CHECK VALIDATION
NAME . ` DTV. ELECTRIC PERMIT FEE
f8, PHONE �,S-vs b
CO RAC RS
AME n .{. OUTLETS-SWITCHES-RECEP 10.00/1.00
V /- L(, LIc.No. 3]. LIGHTING FIXTURES 10.00/1.00
r-orvTRACTOR'S APPLIANCES-RESIDENTIAL 4.00
DDRESS o ^r
O JJ PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECTPANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO.
OR .
ENGINEER
LIC.No. JSIGNS TRANS. 3.00
ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 ^
APPucnrrs MOTORS SEE FEE SCH.
ADDRESS --r _
SERVICECHANGE 20.00
w o o LICENSED CONTRACTORS DECLARATION
<m U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business anJ BLDG. ELECT. PLG. MECH.
rw`w Professions Cody ayd y license is in full for •o d if I� Lk
z o m License
Class-{.ab-Lie.Number_ -?2 ❑ ❑ 1:10 Z r O Date� l�.�(ja-Contractor
`a y s 00004W d, BUILDING PERMIT
¢ ¢ w ¢ OWNER-BUILDIiR DECLARATION
A o A U 10 MISC.- REFER TO ORD INFORMATION
, 2:¢ w I hereby affirm that I am cxeflmt from the Contractor License
ra uo¢ Law lot the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION
� - Code:Any city or county which requires a permit to construct,alter,
¢ r, Q improve,demolish,or repair any structure,Prior to ifs issuance,also ELEC.CONTR. LIC.NO. ELEC.
0,
requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
¢ w a he is licensed pursuant to the provisions of the Contractor's License
r,zi Law(Chapter 9(commencing with Section 7000)of Division 3 of ilia / g
¢ Business and Professions Code)or that he is exempt therefrom and QTsV. PLUMBING PERMIT FEE
gy�pp¢ f$ the basis for the alleged exemption.Any violation of Section 7031.5 h STORIES TYPE CONSTR.
by any applicantfor a permit subjects the applicant toa civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00
0 of not more than five hundred dollars(55001.):
❑ 1',as owner of the property,or my cnmloyees with wages as BACK FLOW PROTECT. DEVICE 4.00 occ.eaouP RES.UNITS
C. (heir sale compensation,will do the work,and the structure is not
intended or offered for safe (See. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
11-09 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 employces,provided that such impmvc
ments are not intended or offered for sale.
If.
however,
the buildir GAS-EA.SYSTEM-11NC.40UTLETS 6-.ft
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
e builder will have the burden of proving that he did not build or.in. RES IND WN PB ower
prove for purpose of safe.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as.,,,at of the property am exclusively conlracting 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'.'I'he Contractor's License Law docs not apply
to un owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.
Contracts for such projaci,with a contractors)licensed pursovnl to
ilia Cmnmctor's License Law. SEWER-SANITARY-STORM EA.200it/10. 0 RACT No. PARCEL NO.
❑ tum exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM C DATE ACC.FILE NO.
WORKS RS'CONIPENSATION DECLARATION WATER TREATING EQUIP. .00
I hereby affirm that I have a certificate of forsaw to self-imu«, ZONING ENG.SITE NO.
ora certificate of Workers'Compmisauon Insurance,or u certified
copy thereof(Sec.3800,Lab.C.
Policy No.-Company
j'(4'4'L'?- FV n"d
0 ❑ CcHitiedc is here by furnished FIRE SPRINK ENERGY T-24
Z z ❑ Caifidi•I-
y filed ith 1hC Pity inspection division. MISC.- REFER TO ORD.
PPlicun r _ Y ❑ N❑ Y ❑ N[-
0
~ PERMIT ISSUANCE ^78-00
(r - CBRTI PICATIiO'I? E. ION PROM WORKERS' c� FLOOD zorvE A.L.U.C.
LU >_ COMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLC. W
d O (Phis section need not be completed if the permit is for one TOTAL / '� Y❑ IN Y ❑ N❑
z hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not nmPIOy any person in any manner so as to
U become subject to tire Workers Conmensatinn Laws of California.
O w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} y NOTICE TO APPLICAN'r: 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 FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00
CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency fix EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,CN.C.l. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lenders Address
1 Certify that I have read this application and state the the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING U`
ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authori2 representatives of tints city to enter Inion the BOILER-COMP love,100,000BTU)SEE FEESCH. MECHANICAL
above-mentioned property for inspection purposes.
/ (We) agree to save, indemnify and keep harmless ilia City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE . 10.00 CONST.TAX
ay in a way acme against said City in consequence of the
rantin f lis \ MECH.CONT. LIC.NO. MECH.
2>- TOTAL TOTAL
S' flat reof Applicant/ , or Data
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 5990
INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS_/O 6PWOLI,,c;_s Rb UNIT# _LOT#
nn __ PERMIT EXPIRES IF WORK
OWNER l..(/ C/t?2 �/ l 'CONTRACTOR UM.B c7Z3`C-Ft= IS NOT STARTED WITHIN
INSPECTION DATE I INSPECTOR INSPECT IO RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM
LASTCALLEO INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRNIII VAI.IDAIION
.CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
L '
UNDERGROUND /SLAB .
PLUMBING
I
ELECTRICAL ISSUANCE DATE
BLDG ELECT FEELMEG+
MECHANICAL -
❑ El El ❑ :
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT
INFORMATION
WOOD FLOOR Vnwnnory $/FT.
PLUMBING
MECHANICAL -
' ELECTRICAL PtRMn Ta
FRAMING
STORIES TYPE CONSTR
' INSULATION fl
o V N
. !7 � OCC GROUP RES urvlrs
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
$0 FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILOI ON use
ROOF SHEATHING LES IND cow PB 011•1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED , FINALS DATE INSP. El 1-1 El [I ED
ASSESSORS I'AHCEL NO
ROUGH SAN.N
PLUMBING ELECT.ENERGY
TRACT NO PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH. ENERGY
ACC.DATE ACC FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST zorvmG ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPHINK ENERGY L94
MECHANICAL Y E] No I Q� NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FL000 zorvE ALuc.
EXTERIOR SHEAR ELECTRICAL'RELEASE
b� N[ L No
INTERIOR SHEAR � FIRE DEPT.
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR LATH BUILDING
BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT T ELECTRIC PLAN CHECK
F
GAS EE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
uj ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
- SEE PERMIT FOR EXPIRATION DATE -
MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY