18646 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
V _ APPLICATION& PERMIT
BSS -
EGA
ss/090 � �� {� '
/ ILDING-ELECTRICAL-PLUMBING-MECHANICAL 1864*6
OWNER'S PLAN CHECK VALIDATION
NAME I ' QTY. ELECTRIC PERMIT FEE '
. V/x/ vHo ✓v/, 9)
CONTRACTOR'S
NAME o OUTLETS-SWITCHES-RECEP 10.00/1.00
.N IIC.ND 8 LIGHTING FIXTURES 10.00/1.00
ADO EAS Tons APPLIANCES-RESIDENTIAL 4.00
J �, pE `02' �� PANELS 10.00 DATE OF APPLICATION
ARCHITECT - PLAN CHECK FEE P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
Lie No. SIGNS TRANS. 3.00
ADGAESS ENG, PERMIT CIRCUIT 5,00 PERMIT VALIDATION
z11 EMP.METER OR POLE INS. 2000.
nook SSTs MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 �4... '
O R 2 1 /I I I� I&J t
Foo LICENSED CONTRACTORS DECLARATION V ,�//_y_n,.I V
< u u I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
w a N Icommencmg with Section 7000)of Division 3 of the Business anJ - JAIll BLDG. ELECT. PLG. YAECH.
H w z Professions Cod�e�anQ.m licenu is in lull for yyygggJJJ qf�c
Z,o m u, License Class "L�Lic.Numbe ,,!� J Ix( 0
9 y m Datc l_ Coraracmr ',�a�G�/y�,� City Mill (41�n�}infl ICE-
n ¢ w a OWNER-BUILDER DECLARATION- BUILDING PERMIT
wX o a D INFORMATION
g I hereby affirm that I am exempt from the Contractors License MISC.- REFER TO ORD
LL04 Low for the following mason.ISca 7031.5,Buelnessandl'mfcssiot,, VALUATION $/FT.
r - � Code,An cit PERMIT ISSUANCE 10.00
Any y or county which,equ tune,prior
its issuance.
also
ce ,e ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed sWlenhent that TOTAL
A m m he is licensed pursuant to the provisions of the Contractor's License PE MI ATO
H :zaLaw(Chapter 9(commencing with Section 7000)of Division 3ofthe J
4 ° Business and Professions Code)or that he is exempt therefrom and
SE lhebasisfor the alleged exemption.Any violation of Section 7031.5 DTV. PLUMBING PERMIT STORIES TYPE CONSTR.
a ; _ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN of not more than five hundred dollars(S500).): (EA.) 5.00
❑ 1,as owner of tire FEE
property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not DEC.GROUP, RES.UNITS
intended or offered for sale IS". 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code The Contractor's License Law does not apply to an owner of '
S p operly who build,Ur Inlp...ve,Thereon,and who floes such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenolintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within Ellie year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or int- BUILDING USE
prove for purpose of side.) - INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orbe,
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPR IN KLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0.
and Professions Code.The Contractor's License Law docs not apply
to an owner of property who builds or improves lhercon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conlracums)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO.
❑ tato exempt under See. ,B.&I'.C.for this WATER HEATER W/VENT 6.00
on .
Owner - talc WATER SYSTEM 5.00
ACG DATE ACC FILE NO.
WORK fiRS'COMPIiNSA'I'ION'DECLARATION WgTER TREATING EQUIP, 5.00
I hereby affirm that I have a certificate ofconsent to self-insure,
or a certificate of Worke s'Compensatio Insurance,o a certified ZONING ENG.SITE NO.
copy eye ab.C.l. _ _
I'Elli m any_ - - -
O ❑ Cent So is Ile, by fantied.
z Z Certi 'e cop' is f 'd with Ilse city inspection divieiod. FIRE SPRINK ENERGY T-24
HO ant - MISC.- REFER TO ORD.cc v N v NE]N CHR 17 Writ Of EXEM PI ION 17ROM WORKERS' PERMIT ISSUANCE 10.00
W COMPENSATION INSURANCE PLG. •dy7 FLOOD=ZONEA..LU.C.CL O LIC.NO.2 (Phis section need not be completed if the permit is fur nuc TOTALOL) Y�
U O hundred dollars(SIDO)lir lass.l
1 certify that in the performance ut the work]or which this per-
LL U mit is issued, 1 shall not employ any person in any manner so OTY MECHANICAL PERMIT as lu FEE FEE SUMMARY
O tD become subject to the Workers'Compensation Laws of Califurnia.
u Date Applicant I ALTER OR ADD TO MECH. BUILDING
} Ed NOTICE: TO APPLICANT: It,after making this Certificate of fix-
5 00
F ? empliou.you should bemnm subject IT the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Cade, you must forthwith comply with
U 1.011 provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A0D11F.M.) 4.00 FEE
CONSTRUC'T'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F,M.) 6.00 . SEISMIC FEE
I hereby affirm that there is a cunstmetion lending agency for EXHAUST HOOD (WITH DUCT) 4 5.00
the performance of the work for which this permit is issued(Sec.
3097,CN.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct.1 agree to comply with all city and county _ PLUMBING
ordinances and state laws relating to building construction, and BOILER-CON1P(3 H.P.or 100,000 B.T.U.) 6.00 , O
hereby author ee repreumutiva of This oily 10 enter upon the
above-mention property for inspection purposes. BOILER-COMP 10vertOO.000BTUISEEFEESCH, MECHANICAL
(We) agree t mvc, indmnnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino ,gains liabilities,ju dgmeus, costs and expenses which CONST.TAX
ay in any way ecrue against said City in consequence of the PERMIT ISSUANCE 10.00
Sir tingof Ibis pe not. MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Si of ApplmaN/Contractor Uate
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
f FRMIT,NUM9E11
CITY OF CUPERTINO 18646
INSPECTION DIVISION
• JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDR ESS_IB ESq D _zuap__ Nk UNIT# _LOT#
PERMIT EXPIRES IF WORK
DINNER �,•Nj CONTRACTOR c-.e_ p b IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION'RE ORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE: ANCE OR 180 DAYS FROM'
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT v A LIRA TION
CUPERTINO STANDARDS.
GARAGE SLABSpiiIi
l
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB A&N 25 1990
PLUMBING
ELECTRICAL Cl i r of P,T-nrtinn ISSUANCE RATE
MECHANICAL eLDc ELECT. PLc. MECR
❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
. WOOD FLOOR INFORMATION
PLUMBING VALUATION $/FT.
MECHANICAL
ELECTRICAL pJ/�� PE RR&I T TO
FRAMING - P V\wL VL
INSULATION - STORIES ITYPE CONSTH,
UCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sD.FT.FLooR AREA TOTAL ACRLACE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING - BUILDING USE
RES IND CON PB on..,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ROUGHSAN.N ASSESSORSPARCELNo
-
MFRAMING
- ELECT.ENERGY
ER PAN PLUMBING ENERGY TRACT No, PARCELNO
' MECH.ENERGY
BUILDING ENERGY ACC DATE Acc FILE No
I ELECT.FINAL TEST
PLUMBING zoNlNc ENG SITE NOGAS
MECHANICAL FIRE SHRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ -1:1 V ❑ N❑
EXTERIOR SHEAR - - ELECTRICAL RELEASE FLOOUZONE A.L UC.
INTERIOR SHEAR, FIRE DEPT. Y ❑ N❑ Y ❑ N
- SHEETROCK GRADE
EXTERIOR LATHBUILDING _ FEE SUMMARY
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
SCRATCH COAT - - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
. o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z
PLEASE GIVE JOB ADDRESS WHEN PHONING. - 0.0
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. ( p17
OFFICE COPY