13388 (3) POST THIS D NEAR FRONT OF BUILDING
.-...J � r PERMIT NUMBER
-, CITTOF CUPERTINO
INSPECTION DIVISION 38
8
tk "' JOB INSPECTION RECORD '
^PERMIT
EXPIRATION
JOB ADOR ESS 862 BRENT DRIVE UNIT# Lor#
PERMIT EXPIRES IF WORK
OWNER ULYSSES PICHON CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION -
LASTCALLEDINSPECTION.
LIFER ,
PERMIT VALIDATION
PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB /7 � .
PLUMBING
ELECTRICAL ISSUANCE DATE
_ BLDG ELECT. PLO. MECIE.
. MECHANICAL -
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
DIN FORMATI ON
WOOD FLOOR VALUATION $/FT.
PLUMBING y L
MECHANICAL o PERMIT To
ELECTRICAL Jk /// i/r
FRAMING f- 4r'7f
STORIES T ECONSTR.
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.F�ARFATOTAL FLOOR
DIAPHRAGM
BUILDING USE
,.. ITR
ND CON PB � Oo'rr
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El I] 1] 11ROUGH W� d SESSORS PARCEL NO.
PLUMBING Out P+ C
ACT NCp, PARCEL NO.
GAS TEST
MECHANICAL
ACC.GATE ACO.FILE NO,
ELECTRICAL FINALS DATE INSP.
FRAMING izhIP1 SAN #
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS
' MECHANICAL FIRE SPRINK ENERGY T 24
Col
VERNTNO WORK UNTIL ABOVE HAS BEEN SI A.L.u.c.
NED HEATING "� v C] NE]
ELECTRICAL P�ooD ZDNE
LATH—EXTERIOR FIRE DEPT. v N� r I] "�
SHEETROCK GRADE - FEE SUMMARY
SHEAR INTERIOR DING 2Y ,BUILDING �•
SHEAR EXTERIOR TEMPORAR APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
i
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC Yt•
LU ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O0 PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
- CONST.
ONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL `
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APPLICANT TO FILL IN IN ATION WITHIN RED LINES - USE OL POINT PEN ONLY
r '-* U I LDING PROJECT I DENTI FICA N PERMIT NUMBER
X
BUILDING APPLICATION & PERMIT 13388
aoORE
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER's PLAN CHECK VALIDATION
NAME. / I OTY. ELECTRIC PERMIT FEE 8Z J1_l SSe c�oN PHGNE 3dOP 3a -s_
!„ NAMERACT S UTLETS-SWITCHES-RECEP 10.00/1.00 /
- 'LIC.No. LIGHTING FIXTURES 10.00/1.00
AC
ADDRESS R's ` APPLIANCES-RESIDENTIAL 4.00
CONTRAS
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
�x oR /f PANELS (OVER 200 AMP) 20.00
ENGINEER /�/ _I a C.NO, /- SIGNS TRANS. 3.00
AOAR
ORE 99 ENFG/pG(� SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
D cV 01) rrEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS AUG I SEd FEE SCH. P J
ADDRESS
SERVICE CHANGE20.00
woo LICENSED CONTRACTORS DECLARATION city.0 s rl7/(f
<I 1
u u I hereby affirm that I am licensed under provisions of Chapter 9 ISBUANCE DATE
(Commencing with Section 7000)of Division 3 of the Business and
G a A, ( S BLDG. ELECT. 'n G. MECH.
H 7 z Professions Code,and my license is in full force and effect e
a i W License Class Lic.Number Q
Date _ Contractor
a y BUILDING PERMIT
It as OWNER-BUILDER DECLARATION
s w v INFORMATION
w3 I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD
A VALUATION $/FT.
FLL00 J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q
i Code:Any cityorcommy which requires a permit m construct,alter, Au'
IF u a 0 improve,demolish,or repair an structure, per to its Issuance,also ELEC.CONTR. LIC.NO. r�� V
P P Y P ELEC.
y -y u requires the applicant for such permit to file a signed statement that TOTAL V PERMIT TO
w $e- he is licensed pursuant to the provisions of the Contractor's License
HZ - Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �' 1T`[ ��
S i o Business and Professions Code)or that he isexempt therefrom and QTY. CA(r PERMIT FEE �YVV
1-0 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.T 5.00
of not more than five hundred dollars(5500).):
❑ 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 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
A himself or through his own employees,provided that such improve-
f merits are net intended or offered for sale.IF,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or unprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
w builder will have the burden of proving that he did not build or im-
s, prove for purpose of sale.). RES IND CON PB Other
❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 11 0 ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. '
and Professions Cade:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with o conlractoAs)licensed pursuant to SEWER-SANITARY-STORM EA.2008/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I am exemptun der Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date- WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
Wo S'COMPENSATION DECLARATION ' WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
Q Applicant Y N Y [3 'NE]
toPERMIT ISSUANCE 10.00
� - CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.u.c.
LU COMPENSATION INSURANCE PLG.CONTR. LIC,NO. PLG
IL 0 (This section need not be completed if the permit is for one TOTAL Y IN[3 Y N❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY
UL ♦• mit is issued,I shall not employ any person in any manner so as fo
O become subject to the Workers'Compensation Laws of California.
0 w Date Applicant BUILDING �Sa
a ALTER OR ADD TO MECH. 5.00
} N NOTICE TO APPLICANT: If,after making this Certificate sa Ex-
1- ? emvision you should become subject to the Workers'Ccomply with APPLIANCE 5.00 PLAN CHECK
Provisions io the Labor Code, you most forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 70,000 C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 11000C.RM.) 6.00 SEISMIC FEE
1 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,Civ.C.). s HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC Q
Ids I certify that I have read this application and state that the above VENTILATION FAN (SINGLET 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-COMP 13 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 BTUI SEE FEE SCH. MECHANICAL
above-mentioned property for representatives
ofth i purposes.
r' (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 an way accrue a inst said City in consequence of the PERMIT ISSUANCE 10.00
granti g a It perm ` .MECH.CONT. LIC.NO. MECH.
/� - B7 TOTAL TOTAL
Si are f pplc nl ontmetor Date
OFFICECOPY