The URL can be used to link to this page

14145 J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROD T 11Y C TIG PERMIT NUMBER BDILDING APPLICATION & PERMIT 1414 5 ADDRE55 / BUILDING -ELECTRICAL-PLUMBING -MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME .�1 OT ELECTRIC PERMIT FEE `t ✓ PHONE CONTRACTORS C,..IU OUTLETS-SWITCHES-RECEP 10.00/1.00 to NAME eL Ll IN , /� Q LIGHTING FIXTURES 10.00/1.0030 CO9111Acrons APPLIANCES-RESIDENTIAL 4.00 ADOREss ✓ t Q R S HONE -a PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CqEEW7 P.C.NO. OR ENGINEER LIc,No. SIGNS TRANS. 3.00 ARCH.OR ENG. �' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRE55 ZIP TEMP.METER OR POLE INS. 20,00 APPucANTs MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION mwI hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE N A a (commencing with Section 7000)of Division 3 of the Business and w I BLDG. ELECT. PLG. MECH. I- i Professions Code, en d Icse is in full force a r f Z O m Licensy,CJass- J__Lie.Numbe ❑ ❑ ❑ 2 Z Dme-L.� Contractor A_5.- lyn`^'-','l.'.i a x ' I ' BUILDMG PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION INFORMATION o a O MISC.- REFER TO ORD F LL H I hereby affirm that I am exempt from the Contractor's License VALUATION 5/FT. H u o a Law for the following reason.(Sec.]031.5.Business and Professions PERMIT IS 10.00 is Code:Any city or county which requires a permit reconstruct,alter, ¢¢¢0 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 t(/V PERMIT TO wm he is licensed pursuant to the provisions of the Contractor's License /--/ tzi Law(Chapter 9(commenemgwith Section 7000)oi'Division 3oftlie a: Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE / ¢r$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(S500L): ❑ I,as owner of the property,or my employers with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their 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 thereon,and who does such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE • .lotsfenotinghhis ownrmred forS, le.I f,however,the improve- GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 mems are not intended or offered for sale.If,ed that s Em building 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 Other prove for purpose Of soled. INDUSTRIALWASTE INTER. 30.00 ❑ El El ❑ 1:1❑ 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 License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 MA.) 1.00 contracts for such projects with a contructons)licensed pursuant to the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT No. PARCEL NO. P.❑ Iamexemplunder Sec. .B.&P.C.fortllls WATER HEATER W/VENT 6.00 anon Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 t I herebythat I have a certificate of consent ture o self-ins . "affirm Cc a certificate of Workers'Compensation Insurance,ori certified ZONING ENG.SITE NO. 4o Py thcreol'(Sec.3800,Lab.C.l. a!e E�HT��.T.� Policy No. Company4! Y-U O ❑ Certified copy is hereby furnished. Imo_ FIRESPRINK ENERGY T 24 Z Z ❑ Certifm copy is J wit he city i pection division. OApplicant MISC.- REFER TO ORD. Y ❑ N❑ V ❑ N❑ / lr rA CIiRTIFICAI'E OF Ii%IiMPTION PROM wORKFr :RS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. EL Cl (This Section need not be completed if the permit is for one TOTAL Y ElNEI Y❑ N❑ Z) Z hundred dollar,1$100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,I shall not employ any person m any manner so as to Ow became subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE:TO APPLICANT: ll',after making this Certificate of lix- H 2 emption,you should become subject 10 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 10=C.F.M) 4.00OO CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOC.F.M.) 6.00 SEISMIC FEE 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 ISeC. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address __7H EATI NG UN IT(OV E R 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 BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and x� hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property lot 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 any way accrue against said City in mis��-{m,ncr of the PERMIT ISSUANCE 10.00 grant g of tl'js,permiLN^ �Y./ MECH.CONT, LIQ NO. MECH. TOTAL 1/ \/ j TOTAL \ S urco I onlrac or a[e /k\ OFFICE COPY ;7 POST THIS CARD NEAR FRQNT OF BUILDING CITY OF CUPERTINO R1 411 NU INSPECTION DIVISION 145 JOB INSPECTION RECORD !- PERMIT EXPIRATION 11000 n wolfe road 43 LOWEI7� JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER HEWLETT PACKARD CONTRACTOR FARRIS ELECTRICAL IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. �+y ANCE OR 180 DAYS FROM / FOUNDATION 6-7-pp �BGL �� LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG: ELECT, PLG. MECH. ❑ 0 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED +BUILDING PERMIT ' INFORMATION WOOD FLOOR VALUATION $IFT, PLUM'61NG MECHANICAL PERMIT To ELECTRICAL `LL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP HES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT.FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE ' RES IND CON PB 00eI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO. EAR L NO. GAS TEST ' ',MECHANICAL ACC.DATE E NO. 'ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS ' FIRE SPRINK ENERGY T 24 MECHANICAL v EJ NE-] r F] N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD zorve A.L.u.c. LATH-INTERIOR ELECTRICAL LATH-EXTERIOR FIRE DEPT. v N� v N ❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRICPLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ! —* • F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX 1 PLEASE READ REVERSE,S/DE EEEFORE TOTAL CALLING FOR FINAL INSPECTION. = � OFFICE COPY ,