The URL can be used to link to this page

12092 (2)PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .�'131.1I LDI NG PROJECT IDENTI FICA APPLICATION PE BUILDING —ELECTRICAL— PLUMBING —MECHANICAL PERMIT NUMBER UMBER m Infir BUILDING ADDRESS '/c ow PLAN CHECK VALIDATION E QTY. ELECTRIC PERMIT FEE PHONE — I R13 DATE OF APPLICATION GONrnacrOR's NAME Corp.,UC. NO.� UTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS rq ADDRESS tI NE 41L–I I PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINE J Uc. NO.0 PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3,00 ARCH. OR ENG, ADDRESS Mao OaA_CIAJA LJ(Dle SPECIAL CIRCUIT 5.00 PERMILVALIDATION PAU MAR 5 -1987 Ci IfC r1pr�{...� TEMP. METER OR POLE INS. 2000. APPUGA rs ADDRESS G"� MO,TONS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 SSUANC�tl#Yt/RY (commencing its Section 7000) of Division 3 of the Business and Professions end my license is in full fi se BLD ELECT. PLG. MECH. License 1ss c. Number Date Contractor BU DIN ERM OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Professions Law forthefollowingreason(Sec.uires a;ermit to Code: Any city Dr county which structure permit ht construct alms, improve, demolish, or repair structure, prior its issuance, also requires e applicant for suchh permit to file a signed statement that he is licensed pursuant to the provisions of the)fDisisiContractor's License NFORMATIO MISC. — REFER TO ORD yq gTION S/FT. I JAt. QOn PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL - PERMIT TO I QTY. - PLUMBING PERMIT FEE of Division 3 of the Law (Chapter 9 (commencing wish Section is exempt Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section LS v STOg�IFs TYPE ONSTR. byany applicam for apermBmbjectsthe $500).applicant loacivil penaBy en : ' of no[ more than five hundred dollars (my ALTER-DRAIN-WATER(EA.15.D0 L ❑ I, as owner at the property, or my employees with rewagesas em not their sole compensation, will (S the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCc P RES. NITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's mLaw does not apply to an owner of property who builds or mproves thereon, and who does such work improves TT_FIXTURES-PER TRAP 5.00 _ so. Fr. FjocRLAREA TOT7 ACREAGE himself through his own employees, provided that such improve- s arere notintended or offered for sale. If, however, the buildingilding GAS - EA. SYSTEM -11NC.40UTLETS 6.00 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- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING uSE RES IND CON PB Other �� INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITAR V -STORM EA. 200ft110,00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec. .B.&P.C. far this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPF.NSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self houre, or a certificate of Workers' Compensa`It.r In once, ar a certified copy thereof (Sec. 3800, Lab.C.). I rJJII__ Policy No. Company V ZONING ENG. SITE NO. ❑ Certifier copy is hereby furnished. Certifie co is filed with the city inspection division. A ieCe PY FIRESPRINK v N ENERGY T-24 v N Q MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONEA. L. U.C. PLG.CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one v� Nq Y� rv❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less.) 1 certify that in the performance of the work for which this per. mit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING . OR ADD TO MECH. 500 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER t0,000C.F.M.) 6.00 SEISMIC FEE �� CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performanc fh work for LC this permit is issued (Sec. 3097, Civ.CJ. 1 s HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name IQZQ Lender's Add re I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 �, PLUMBING f BOILER- OOMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,0008TU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. TAX a (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses whichCONST. may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MOETq. TOTAL i B I granlin of This Signa of phi nl/Contractor Ua[e OFFICE COPY 4 POSTTHIS C I' D NEAR FRONTOF BUILDING �.^ � CIT. F CUPERTINO10M INSPECTION DIVISION JOB'INSPECTION RECORD r�l JOB ADDR ESS `�,GLI�L C� ` UNIT# LOT --.PERMIT OWNER CONTRACTOR PFRn+IT NUN +RER PERMIT EXPIRATION EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAvs OF PERMIT ISSU. •' ANCE OR 180 DAYS FROM LASTCALLIGD CTION. f INSPECTION DATE INSPECTOR I ECTION RECORD FOUNDATION - -7 UFER PREGUNITE PERMIT VALIOA N MAR 5 -1987 C4 of CoperHno ISSUANCE DATE s Ci b POUR NO CONCRETE UNTIL AEtOVE HAS BEEN SIGNED UNDERGROUND / SLAB PLUMBING' - ELECTRICAL - MECHANICAL B o EL c. E DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED • Bu DING ERM INFORMATIO WOOD FLOOR vALuarloN /. $/FT. PLUMBING 3_ _8-2. MECHANICALa-$I-g ELECTRICAL PERMIT TO,. FRAMING INSULATION _ 3 STORIES TYPE CONSTR. uva e elow—.. WFHAS OCC. GROUP RES. UNITS PLAC NO SUBFLOOR UNTIL N SIGNED ROOF SO. FT. FLOOR AREA TOTAL ACREAGE ' �/ DIAPHRAGM —2,z4/ ' BUILDING USE. RES $NO CON PB Ona.. 24 El ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO, PLUMBING 1$ 7 GAS TEST 0 , TRACT NO. PARCEL NO. - MECHANICAL ELECTRICAL -1 ,. Q FINALS DATE INSP. ACODATE ACC. PILE rvo. FRAMING — SAN # ✓ INSULATION PLUMBING ZONING ENO. $ITE NO: r. rAlstd4g'7WOOS GAS FIRE SPRINK v ❑ N❑ - ENERGY LZ< v ❑ N❑ MECHANICAL COVERAO WORK U TILIABOVE HAVBEI N,SIGNE r.4: HEATING LATH-INTERIORv ELECTRICAL - _�1 FLOOD ZONE v ❑ N❑' A.L.UC. , v ❑ NEI LATH -EXTERIOR 'FIRE DEPT.' FEE SUMMARY SHEETROCK 0- GRADE_ SHEAR INTERIOR 6 % - BUILDING BUILDING - SHEAR EXTERIOR- _y..g TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE ' GAS .. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, . � ONE WORKING DAY BEFORE REQUIRED INSPECTION. o . PLEASE GIVE JOB ADDRESS WHEN.PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING r� MECHANICAL p CONST. TAX r � - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY