17623 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
P
BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER -
g . 1J11_61G APPLICATION & PERMIT z. 762
1 3
ADDRESS I U ((��
BUILDING -ELECTRICAL-PLUMBING -MECHANICAL r.
e r '
OWNER' - PLAN CHECK VALIDATION
"AME _1 OTY. ELECTRIC PERMIT FEE
e�r.Y �� xPHONE
NA.0 crags UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
E, tllcarc.No. r LIGHTING FIXTURES 10.00/1.00
Ess
AoAcuoRmE o 's PPLIANCES-RESIDENTIAL 4.DO
DD G /e PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,c.N .
OR
ENGINEER
LIC.no. SIGNS TRANS. 3.00
Aooa@u ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPUCANTs MOTORS SEE FEE SCH. r 1
ADDRESS
SERVICE CHANGE 20.00 T w
09 LICENSED CONTRACTORS DECLARATION Y
v u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE -
wz u (commencing with Section 7000)of Division 3 of the Business and APR BLDG. ELECT. PLO. MECH.
H o i Professions Code,and my license iz in full fortt and effec ❑ ❑ ❑
2 o m -
a y Class LLOU
o ZHw Date Contractor
- BUILDING PERMIT
er s w u OWNER-BUILUE;R DECLARATION INFORMATION
s o A MISC.- REFER TO ORD
w u- LL h I hereby affirm that 1 am exempt from the imess Contractor's License VALUATION
H .. oa Law for the following rcason.IScc.703L5.Busineuand Pro(rssiuns PERMIT ISSUANCE 10.00 5/FT.
S V,�� Code:Any city or county which requiresapermit loconslruct.alter. ELEC.CONTR. LIC.NO.
R u, Q O improve,demolish,or repair any structure,prior to its iauancc,also ELEC. -
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
E
$ he is licerued pursuant to the provisions of the Contractor's License
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 o(tle
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE ✓`
the basis for the alleged exemption.Any violation of Section 7031.5 STORIES
g p Y TYPE CONSTR.
by any applicant for apune subjects the applicant me civil Penalty 'ALTER-DRAIN -WATER (EA.) 5.00
� of not more than five hundred dollars 155001.1:
❑ 1,as owner of the property,or my employees with at 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 ale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:The Contractor's License Law does not apply to eI owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 so.I.FLOOR AREA TOTAL ACREAGE
himselfts orthrough his own ffeedf r provided hJ that such improve
himelfo through
ot ornempl fees,pr.ILed that such
emprovg GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or hnprovement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have the burden of proving that hu did not build or ins- BUILDING USE
prove for purpow of sale.). INDUSTRIAL WASTE INTER. 30.00 RES, IND CON PB Other
❑ I,as owner of the Property,am exclusively Contracting with El- El ❑ D ❑
licensed contractors to construct the Proicct(Sec.7044.Business LAWN SPRINKLERS-1 INC.5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:9'he Ccmtraetur's License Lw docs not apply •
to an owner of property who builds or improves tben•on.and who LAWN SPRINKLERS-OVER 5dEA.) 1.00
contracts forsuch projects with a contractor(s)licensed pamuant to '
the Convumnr's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
I ❑ ImnexcmptmW,r Scc. .It.&P.C.for Ibis WATER HEAT ER W/VENT 6.00
masun
Owner Uafc WATER SYSTEM . 5.00 ACC.DATE Ace PILE No.
WORK ERS'COMPISNSA'IION UECLARAf ION WATER TREATING EQUIP. 5.00
• I Iaerehy attifm that I have a eurllacaie oaf cou,cot to sea=ill, _
or a certificate of Workers'Compunmtion Insurance,or a certified ZONING ENG.SITE NO.
copy t hereyy����S�ec 1800J Lh.C.)
Policy Nn/_&_64tplpany-�yl4a-T�/.w_ir ,
O ❑ Cctlilied coly is humby lumLUacd - FIRESPRINK ENERGYT-24
F- o ❑11Jertific p fled yy��tfY^��,q�,`�4 tion Division. MISC:- REFER TO ORD. YE] NE] Y [] IN
A I m � c
ir w+ PERMIT ISSUANCE 10.00
LU - CIiRTIIs COMPENSATION
IONER(1MWORKERS' FLOOD ZONE AL.U.C.
W iced hot he ON lewd if NCh PLG.CONTR. LIC.No. PLG. Y❑ N❑ Y
d O hundred
section S10 not he complmnl if lira ry:nuit is for one TOTAL N
� Z hundred dollun IS 100)or less)
U O' 1 certify that in the perloxmancc of the work for which this per. QTY MECHANICAL PERMIT FEE FEE SUMMARY
IL H our is issued,1 shall not employ any person in any manner so as to
Q L) mor
become object to lire Wkers'Compcnsatinn Laws cf Culifmrnia.
EL Doc Applicum BUILDING
} ALTER OR ADD TO MECH. 5.00
0NOTICE TO APPLICANT: IL after making this Certificate of fix-
? emption,you should bmm
ecome hjecl the Workers'C...hN..saiion APPLIANCE 5.00 PLAN CHECK
provisions of lire Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000CF.Ii 4.00
CONST'RUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 - SEISMIC FEE
I 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(Sea MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lenders Nan
Address
HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's AAddress ELECTRIC
1certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 QQ
information n correct. I agree m comply with all city andmoi county PLUMBING
ordinances and late laws rebting to building construction, and BOILER-CONP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city V enter upon the BOILER-COMP (0,r 100,000 BTU)SEE FEE SCH. MECHANICAL ( O
above-mentioned property for inspection purposes. r
(We) agreeto save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments,costs and expenses whichCONST.TAX
may in any way accrue against said City in consnluence of the PERMIT ISSUANCE 10.00JZ-OD
ant hu IL MECH,CONT. LIC.NO. MECH.
�� TOTAL OC TOTAL
Slgnalur APPlieant Contractor Date '�t
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
" - PERMIT NUMBER
CITY OF CUPERTINO 17623
INSPECTION DIVISION '
JOB INSPECTION RECORD
/J �^ \��/� ( - PERMIT EXPIRATION
- JOB ADDRESS 1 L ti
f 2– e -/J Y— UNIT# _LOT# PERMIT EXPIRES IF.WOR K.
OWNER VL 'D I11 CONTRACTOR ' IN— -e IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
i - TO COMPLY WITH THE APPROVEDTLANS AND CITY OF CEEMIP VALIDA11UN
PREGUNITE CUPERTINO STANDARDS.
GARAGE SLABS
i
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '
UNDERGROUND /,SLAB -
PLUMBINGn.�;
ELECTRICAL . "ISSUANCE DATE
MECHANICAL - BLDG TFEEE7F7G.
❑ - ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR vnw AnoN• siPr.
PLUMBING
MECHANICAL
ELECTRICAL, /1/f0 PE Rrnt 1a
FRAMING I
STORIES TYPE CONSTR,
INSULATION
v
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
,$(IIT.FLCOH4REA 101A1-ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BEMADE BEFORE
'WINDIAPHRAGM? THE CONSTRUCTION TAX IS PAID
BUILDING USE
_ ROOF SHEATHING RES IND CON PB "l–
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. 11 ❑ 11 ❑ [D
ROUGH SAN.# ASSESSORS PARCEL No
PLUMBING ELECT,ENERGY - '
LRACT NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
NO.
ELECTRICAL � BUILDING ENERGY ACC DATE ACC.FILE-
FRAMING ELECT.FINAL TEST '
ZONING ENG,SITE NO.
INSULATION � PLUMBING
GAS TEST, GAS
FIRESPRINS ENERGY L24
MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y 11 N❑ ` ❑ D
OZONE
EXTERIOR SHEAR - ELECTRICAL RELEASE FLOO
INTERIOR SHEAR FIRE DEPT. Y ❑ NO
AL U C,
❑ N❑
SHEFTROCK GRADE FEE SUMMARY-
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUICDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
0 Z � ONE WORKING DAY. BEFORE REQUIRED INSPECTION.' PLUMBING'.
PLEASE GIVE JOB ADDRESS WHEN PHONING.
-'_SEE PERMIT FOR EXPIRATION DATE = MECHANICAL �,pD
IMPORTANT! CONST.TAX
' PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY