The URL can be used to link to this page

9101 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY f e:f EIUtLDI NG PROJECT I DENTI FICATION PERMIT NUMBER no,LD,Nc APPLICATION & PERMIT AooREs IV-Ol Vo0_.IG591-ee BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 91 01 OWNERS PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE yv F P FF eI PHON[ .NONERACTORs UTLETS-SWITCHES-RECEP 10.00/1.00 ' LIG.No LIGHTING FIXTURES 10.00/1.00 roNTRAcrons PPLIANCES-RESIDENTIAL 4.00 AO RE55 IJ V/`/� � Few �� PHONE P�6-T PANELS 10.00 GATE OF APPLICATION ARRCHITECT PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C.NO, ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ADDRESS ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 ADDRESS MOTORS SEE FEE SCH. ADDRESS , SERVICE CHANGE 20.00 O o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 LS i 1985 a U w I hereby affirm that I am licensed under provisions of Chapter 9 {` Q ISSUANCE DATE 4 T (commencing with Section 7000)of Division 3 of she Business and BLDG. ISS yyyLppp ,,,rrf��FFB��Ck��s F N z Professions Cad aml license is In full for' e e t O Nt 0HU I Bill/' o0 n o License Cass L 1 Lic.Number u u L J Date-�j L X Contractor City of Cupertino sr¢a - OWNER-BUILDER DECLARATI N BUILDING PERMIT o IN w INFORMATION wal 3: H 1 hereby affirm thus I Em exempt front file Contractor's License MISC.- REFER TO ORD J Law for the following reason,(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00ti VALUATION �s SIFT. fw Code:Any city or county which requires a permit to construct,alter, �VO/ ! ELEC.CONED. LIC.NO. V V ¢ ¢ 40 improve, or repair any structure,prior to its issuance,also ELEC. ¢ wG u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO S w he is licensed pursuant to the provisions of the Contractor's License I HZ> Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ��'��T�Q� i o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢I-$ the basis for the alleged exemption.Any violation ofSection 703L5 STORIES TYPE CONSTR. u ; _ by any applicant fore permit subjects the applicant mucivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ I,as owner of the pruperty,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS sole compensation,will do toe 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 hoprobcs thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE ' himsN(f or through his own employees,provided that such improve- eQatintended ornffered for sale.If,however,the building GAS-EA.SYSTEM-11 6.00 vemenl is mIA within one year of completion ail owner. Guilder will have the burden of proving that lie did not build or iln- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE �- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES Irvo CON PB Omar ❑ I,as owner of the property,am exclusively contracting with ❑ El ❑ ❑ i] 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 huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contmctorls)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ tom exempt under Sec. ,B.&P,C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM Aec.DATE ACC.FILE NO. WORKF.RS'COMPENSA'fION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm That I have a certificate ofconsenl so sell'-insure, or a certificate of Workers'Compensation Insurance,or a certified f' ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Company �' ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. ❑ p Applicant v N v N ~ w � - CERTIFICATE OI EXEMPTION PPERMIT ISSUANCE 10,00 ROM WORKERS' FLOOD ZONE A.L.u.C. W C0� COMPENSATION INSURANCE PLG.CONTR. LIC.No. PLO, CL 0 (This section need not be completed if the permit is for one TOTAL bund,.]dollars 1$100)or ICas.) U O I certify that in the performance of Die work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ a person in�ny manner so o Q W Deco, a s� cl t e Workers'C (,weal' ow Culil'o Date A Iicant- BUILDING w Q. PP ALTER OR ADD TO MEC 5.00 sGrL , } E NOTICE pion,TO APPLICANT: If,utter making this Certificate Ex F. 2 empiion,you should become subject to the Workers'Ccomply with 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 ITO 10,000GF, 4.00 CONSTRUCTION LI iNDING AGENCY AIR HANDLING UNI ( ER.O .16.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of she work for which this permit is issued(Sec. MICROFILM 3097,Civ.C,). HEATING UNIT(T ,10. 0 8.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify Olaf 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 % 'nfomiati n is correct.1 agree to comply with all city and county - PLUMBING d`'tate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00 ry alfariae representatives Of this city to enter upon the BOILER-COMP (Over 100,000 B7UI SEE FEE SCH. MECHANICAL --Cy , ntioned property for inspection purpous. ' (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. -per line against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX play in y way ace a agai st sm City consequence of the grnntit f this Perrot. MECH.CONT. LIC.NO. MECH. _- r ! (�-745 TOTAL/ c� TOTAL Signature of Applic nt/Contractor Date OFFICE COPY ter- buIL.u1NG CITY: OF CUPERTINO PLR"IIT NUMBER INSPECTION DIVISION91 JOB INSPECTION RECORD 4«.+/a. '"�f //• [/ lre PERMIT EXPIRATION •• JOB AD DRESS' 1/ �7 �rksh I; UNIT# LOT# „1"a + I PERMIT EXPIRES IF WORK OWNER /IC r CONTRACTOR I" IS NOT STARTED WITHIN INSPECTION DATE `'; INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION . ANCE OR 180 DAYS FROM UFER - LAST CALLED INSPECTION. PREGUNITE q PERMIT VALIDATION POUR'NO CONCRETE UNTIL ABOVE HAS BEEN SIGN D UNDERGROUND /SLAB .. PLUMBING ELECTRICAL '• / /S ISSUANCE DATE MECHANICAL„ BLDG. ELECT. PLG. MECH. 119. ❑ ❑ ❑ ❑ DO NOT POUR'FLOOfl UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING it - VALUATION $/FT. MECHANICAL-aj^ ELECTRICAL Jl' PE m1 To FRAMING �QrL INSULATION !.fbTUHIR5 TYPE CONSTR. OCC GROUP RES.UNITS ' PLACE NO SUBFLOOR UNTHASIL ABOVE_ BEEN SIGNED ROOF t SO.FT,FLOOR.AREA TOTAL ACREAGE . _ ii AGM I BUILDING USE RES IND CON PB Ower APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORSPARCEL NO. PLUMBING „d GAS TEST ',�'( TRACT NO. PARCEL NO. MECHANICAL ,', ' ELECTRICAL FRAMING 'gip, _ FINALS DATE INSP. Aac FDATE FILE NO _ SAN # INSULATION PLUMBING _ zoNlNc eNc.SITE NO. GAS HANICAL MECFIRE$PRINK ENERGY T]9 t • ^ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEAnNG / Y ❑ N❑ ❑ N❑ LATH—INTERIOR ELECTRICAL _ FwoO zoNE A.L.u.c. LATH—EXTERIOR FIRE DEPT. 'r❑ N❑ v N❑ SHEETROCK SHEAR INTERIOR FEE SUMMARY BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS .BUILDING FIREWALLS - ELECTRIC PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE +a OCCUPANCY OFRBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM .:.Y -.uJ - ARRANGE FOR INSPECTION BY PHONING 252-4505, i'o ELECTRIC �a ,'j ONE WORKING DAY BEFORE REQUIRED INSPECTION. �, PLUMBING Y I;�w'..,�PftEASE GIVE JOB ADDRESS WHEN PHONING., L� tt�•;.i '�♦I, — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL Iw tS ;3 IMPORTANT! IIIa T CONST.TAX ' s: PLEASE READ REVERSE SIDE BEFORE S ;r� fy �f ;!j f "TOTAL CALLING FOR FINAL INSPECTION. ', C/u '•-! itl°{';ICE C61"!, _