8889 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDI NG PROJECT I DENTI FICATI ON . PERMIT NUMBER
all Ddc APPLICATION & PERMIA
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AD ES `9'
BUILDING -ELECTRICAL-PLUMBING-VAN"AME ` w{//o� OTY. ELECTRIC PERMITPLA/NCQHE V/A/LID(\'/AITION
PRDNE3V ' 3®�--'r'\ 11//NAMERADTORs UTLETS-SWITCHES-RECEP 10.00x•.23 /duc.ND. LIGHTING FIXTURES 10.00ADDRESS Ana APPLIANCES-RESIDENTIAL .00
ADDRESS
PRONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECKFEE P.C.NO.
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS eros SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP ITEMP.METER OR POLE INS. 20.00 `
APPLICANT s
ADDDRESSDRESSMOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 pA` S� /
D O o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
v
< U I hereby Miro that I am licensed under provisions of Chapter 9 m ISSUANCE DATE
v, a N (commencing with Section 7000)of Division 3 of the Business and LO ELECT. PLG. MECH.
r w z Professions Code,and my license is in full force and effect. ❑ ❑
Z o m- License Class Lic.Number
2 r Date Contractor In
y f BUILDING PERMIT
a w ar OWNER-BUILDER DECLARATION INFORMATION
woA MISC.- REFER TO ORD
a y 1 hereby affirm that I so exempt from the Contractor's License VALUATION $/FT.
F .. o j Law loathe following reason(Sec. oiresa Businessand Professions PERM 1T ISSUANCE 10.00
Code:Any city or county which structure.
permit to construct, also
Q E 0 p requires,demolish,or fop alt h T rillto PHOT n statement that ELEG CONTR. LIC.NO. ELE0. V ✓ E
O p (ellnllL`a the applicant for such peflllit to Illi'8 signed St:ItomL'nl tI181 TOTAL PERMIT TO
A w m LL he is licensed pursuant to the provisions of the Contractor's LlceLse
H z i Law(Chapter 9(commencing with Section 7000)of Division 3 oftlhe 1N7 yZCMQ��G
4 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Se the basis for the alleged exemption.Any violation III Section 703 L$ 1 STORIES TYPE CONSTR.
n ; $ by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00
❑ 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 rs not
intended or offered for sale (See 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 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such inhprsve-
mmnts are not intended or offered for sale If,however,the building GAS-EA.SYSTEM-1 INCA OUTLETS 6.00
or improvement is sold within one year of completion,the owner-
I GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDI usE
builder will have the burden of proving that he did not build or int- RES IND PB Omer
prove for purpose ofe.2 INDUSTRIAL WASTE INTER. 30.00
❑ L as owner off the property,run exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESS s RCEL NO.
and Professions grope The Contractor's License Law does not apply
to tr owner of property who builds tr improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contrudods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO: PARCEL NO.
❑ Ism exenpt under S ,B.&P.C1 11 WATER HEATER W/VENT 6.00
re
Own Uate WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK F.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah.CJ.
Policy No. Company
Q ❑ Certified copy is hereby furnished FIRE SHRINK ENERGY T-24
Z Z ❑ Certified copy is Bled with the city inspection division.iZ MISC.- REFER TO ORD.
p ApplicantY ❑ N❑ Y ❑ N❑
XN CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.001 FLOOD ZONE A.L.0 C.
LUQ COMPENSATION INSURANCE PLG.CONTH. LIC.NO. PLG. y❑ N❑ YE] NE]
0 (This section need not be completed if the permit is for one TOTAL
D Z hundred dollars($100)or less.)
U O 1 certify that in the performance of Ibe work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
w Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
} N NOTICE 'f0 APPLICANT: 11,after making this Certificate of Ex-
F ? ernption,you should become subject to the Worker,'Compensut ion 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency I'sr EXHAUST HOOD(WITH DUCT) 5.00 f
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
Lender's Address HEATING UNIT OVER 100,000 B.T.U.)9.50 ELECTRIC
\ I 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
ordinances and state laws relating to building construction, and BOILER-COUP H.P.or 100,000 B.T.U.) 6.00
• hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-nhentioned property for inspection purposes,
agree to save, indemnify and keep harmless the City of MISC.-
(We) REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City in co eRue a of the
gr of this per nit. MECH.CONT. LIC.NO. MECH.
�� yid B TOTAL TOTAL I� IN
gnature o f Applicant/ Rmm,tor Ute
OFFICE COPY
ELECTRIC SERVICE NOTICE OFFICE COPY
BUILDING INSPECTORS NOTICE
CITY OFCUPERTINO
To
You are hereby authorized to Connect electricol service for
Owner or Tenant 7 � Z T-TE'l7 .4 //✓ E
At /o / -; 3 /V AotiFE SP. o 7Y
No.of Wires Size of Wires-Size of Switch
Motor Load Voltage Phase
Heating Load K.W. Voltage
No.of Meters / Light I10New Service Reconnect
Hear 120 Three Wire More Service
No.of Adci.Meters Power - Th ee Phase Move Meter
ELECTRICAL INSPECTOR
i ~ v
POST THIS CARD NEAR FRONT OF BUILDING
IR RMIT NUMBER
' CITY, OF CUPERTINO a88g
' INSPECTION DIVISION
JOB INSPECTION RECORD
i
PERMIT EXPIRATION
JOB ADDR ESS UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSP C 10 DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION - LASTCALLED INSPECTION.
UFER
PR EGUNITE PERMIT vnu DATION
Y
f
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .�
UNDERGROUND /SLAB / ��j(r//J
PLUMBING CC
ELECTRICAL - IssuANCE UATe
MECHANICAL LOG ELECT. PLG. MECIF.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BuILDIND PERMIT
WOOD FLOOR INFORMATION
PLUMBING - ) VALUATION SIFT,
MECHANICAL 1
PER IT o
ELECTRICAL /
FRAMING
INSULATION STORIES TYPE CONSTR.
\ OCC.GROUP NES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF $O.FT.FLOOR AREA TOTAL ACREAGE'
DIAPHRAGM
-. BUILDING USE
HES INDC N PB Olnu,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED F-1 61 0
ROUGH ASSES7S enRCEL No.
PLUMBING
TRACT NO: PARCEL NO.
GAS TEST
MECHANICAL
ELECTRICAL' FINALS DATE INSP. Acc.DATE ACC FILE NO,
FRAMING SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
_ FIRE SPRINK ENERGY T 24
MECHANICAL r ❑ I,C—) Y ❑ N� '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C.
LATH—INTERIOR ELECTRICAL ,
LATH—EXTERIOR FIRE DEPT. v Nr(] N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING '
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
® O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
\ J� — SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.- t % /
OFFICE COPY -
I � 1
— — — L