09970 (2) APF; ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
LDI NG PROJECT I DENTI FICATION - - PERMIT NUMBER -
a°iAPPLICATION & PERMIT Q 7
.'o�, ADD On BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 099 O
f IJe
w ERS PLAN CHECK VALIDATION
l NAME
•-�H(/P QTY. ELECTRIC PERMIT FEE
R V PRONE
CONTRACTORS
NAME qqLJ��x ,f OUTLETS-SWITCHES-RECEP 10.00/1.00
�" "W UE.No. 2.642- LIGHTING FIXTURES 10.00/1.00
n'�o'''7OTREST°ns APPLIANCES
4.00
51 ( ft ONE '79072T PANELS 10.00 DATE OF APPLICATION
ORRcwrecr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER
ARCH.OR LIE.No, SIGNS TRANS. 3.00
ADDRESS ENG SPECIALCIRCUIT 55.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00 PAMp,
TS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 XT,
!3 01985
w O o LICENSED CONTRACTORS DECLARATION TEMP.POLE _ 30.00
a v u I hereby affirm that 1 am licensed under provisions of Chapter 9
I-a a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r o Professions Code, my license is in full fur a eft L L ❑ ❑ ❑ ❑
oz= License Class r r Lic.Number
2 x w Date Contractor
¢ a w a OWNER-BUILDER DECLARATION BUILDING PERMIT
- o A,° INFORMATION
X ; w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o a Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION S/FT,
- PERMIT ISSUANCE 10.00
m� Code:Anycitycountywhichany reqstructure,
prior tloconsuancalter, �.s_0
W ar 0 improve,demolish,or repair any structure,prior to its issuance,also ELEO CONTR. LIC.NO. ELEC. '�V V V
a a o u requires the applicant for such permit to file a signed statement that TOTAL
w m m he is licensed pursuant m PERMIT TO
the provisions of the Contractor's License ,
H Z Q Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe /}/n//NL UI8'4 L.
g i O Business and Professions Code)or.that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ I- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a E ,. by any applicant for a permit subjects the applicant to a civil Penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(85000.):
❑ 1,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
1J Code:The Contractor's License Law does not apply to an owner of
d property who builds or improves thereon,and'who docs such work FIXTURES,PER TRAP 5.00 SG.FT.FLOOR AREA TOTALACREAGE
himself re Through his own employees provided o that such improve-
orimprovemenotnmended or within
red one year ale.
(complever,tion the theo nee- ' GAS-EA.SVSTEM-11NC.40UTLETS 6A0 .
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER'4(EA.) 2.00 BUILDING USE
prove for purpose of sale.). RES IND CON PB. Other
'7 _0 1,as owner of the properly,am exclusively contracting with - INDUSTRIAL WASTE INTER. 30.00
iicensed contractors to construct the project(Sec. 7044,Business .
and Professions Code:The Contractor's LAWN SPRINKLERS- 1 INC 5 V.B. _6.00 ASSESSORS License Law does not apply - ,PARCEL NO,
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
the Contractor's License Law. - SEWER-SANITARY-STORM EAS,200ft/10.00 TRACT NO. PARCEL NO.•
❑ lam exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF,NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to set Ginsure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.). o^f
Policy No. Company
O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY TQ4 '
Z % Certific py rs,Eled w' the city inspection Division.
F - ppi am� ,��, r - MISC.• REFER TO ORD. Y E] N� Y❑ N[]
CC y CF.RTIFICA'FE OI'EXEMPTION FROM WORKERS' PERMIT ISSUANCE ,10.00 - FLOOD ZONE - A.L.U.C.
U COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. Y❑ N� V� N�
1 a (This section need not be completed if the permit pis for one TOTAL .
Z hundred dollars IS 100)or less.)
U O I certify that in the performance'of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY.
LL F mit is issued,I shall not employ any person in any manner so as to
U Ou become subject tothe Workerd Compensation Laws of California.
y BUILDING. `ro
Owe Applicant ALTER OR ADD TO MECH. 5.00 . SSP
} N NOTICE: TO APPLICANT: If,after making this Certificate of Ex
F Z 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 36 7 1
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOCRIA) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOOF.M.) 6.00 SEISMIC FEE
I hereby affirm that there is hlending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work forr whichwhich this
permit is issued(Sec. MICROFILM
30 .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
1 1 information
that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 •
i
information n correct,1 agree to comply with wi 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
hereby authorize rOPreaenforlinspection
ns Of this City m enter upon the BOILER-COMP(Over 100,000 BTU) FEE SCH; MECHANICAL
hereby
Amseimtionedrm preprese representatives
sp of this
purposes.
(We) agree to Save, indemnify and keep harmless the City of MISC.- 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 consequ nee of.the
11 this permit. against.said
CONT. LIC.NO. MECH.
i ��G�n 1025r/�S TOTAL TOTAL 737.2
Si afar of p ann ontractor ate
OFFICE COPY
L POST.THIS CARD NEAR•FRONT'.OF BUILDING
` � CITY "OF CUPERTINO PERMIT NUMBER
w
INSPECTION DIVISIONk• •''
' JOB INSPECTION RECORD
F , //•�q�� PERMIT EXPIRATION
JOB�ADDRESS _ IDI2� l.W}�//I(i{•�. tINVECTION
LOT#
-' - - PERMIT EXPIRES IF WORK
OWNER CONTRACTOR •IS NOT STAR TED'WITHIN,
'INSPECTION D TE INSPECTOR RECORD 190 DAYSOFPEHMIT ISSU:.
FOUNDATION e1p�3G ANCE OR 180 DAYS FROM f :LASTCALLED INSPECTION`v.
UFER PREGUNITEPERMIT vau D. _., '.v ;r
platni /.i.—t �'. J°'r c^ti ''c `"",44(', `•` PLAID
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED g .
UNDERGROUND /SLAB OCT; 3 0:1085
• PLUMBING - - -
ELECTRICAL - GbNof bmerrino 1• .,
.MECHANICAL i ELECT. I .PLG. I MEC.H .
El
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - - , , INFORMATION
PLUMBING'' VALUATION $/FT. - "
- . ,
'MECHANICAL -
ELECTRICAL - PERS IT To' . ,
FRAMING '
r
• INSULATION
STORIES TYPE C NSTR. '
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
'.ROOF � � � '.' 'f - SO.FT.FLOOR AREA TOTAL ACREAGEI
• DIAPHRAGM
BUILDING USE,
IND CON PB 00
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ .❑' ❑' ❑v
ASSESSORS PARCEL NO. .. '
• ROUGH ., ,
PLUMBING -
GAS TEST - ' TRACT NO, PARCFLNO..,,
MECHANICAL. - •
ACC.DATE - ACC:FILE NO.,' 1
• " ELECTRICAL - - •. FINALS DATE INSP.
FRAMING - SAN #
INSULATIONPLUMBING ZONING ENG.SITE No.. •'`%
GAS. -
FIRESPRINK ENERGY T.24 ;
,. MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ 'N❑ Y ❑` 'N❑
LATH—INTERIOR ELECTRICAL ..� ,. FLOOD ZONE .'A.L.U.C. •
LATH—EXTERIOR- FIRE' EPT. - Y❑ N❑ yl] N,❑ .
SHEETROCK. _ GRADE ' FEE SUMMARY,•
SHEAR INTERIOR \ BUILDING
SHEAR EXTERIOR - TEM PORARY'APPROVALS
FIREWALLS ' - ELECTRIC - PLAN.CHECK
•.r - GAS FEE -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY, SEISMIC FEE
OCCUPANCVOF BUILDING IS;NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM '
ARRANGE-FOR.INSPECTION BY PHONING 252-4505, ' ELECTRIC. r
LU ONE WORKING DAY BEFORE REQUIRED<INSPECTION. 1 PLUMBING.
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z
— SEE PERMIT FOR EXPIRATION;'.DATE = MECHANICAL
IMPORTANT! CON ST.TAX `
PLEASE READ REVERSE SIDE BEFORE T' 44i TOTAL /
CALLING FOR FINAL INSPECTION.
OFFICE COPY.