15049 (2) APP,.LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT IDENTIFICATION PERMIT NUMBER -
BUILDING } / / APPLICATION & PERMIT 15049
AOUT 7 V/y b ,ro f'I Y
BUILDING-ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME' I C l ITV. ELECTRIC PERMIT FEE
o PHDNE 2 7-4781
CONTRACTORS
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME r
-'L F UC.mU LIGHTING FIXTURES 10.00/1.00
ADDTRADTDR's DRESS APPLIANCES-RESIDENTIAL 4.00
sFIm -,(- PHONE )/'+/� t' PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
EMP.METER OR POLE INS. 20.00 /s APPLICANTS
MOTORS SEE FEE SCH.
ZIP T
ADDDRESSDRESS
SERVICECHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
a U u I hereby alfinm that 1 am licensed under provisions of Chapter`) ISSUANCE DATE -
h <w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F m z Professions Code,and my license is in full force and effect. _
z o m - License Class Lia Number El 11 ❑
9 w in Data Contractor
" - E \ B�1J�ING PERMIT
rc re w¢ OWNER-RUILDIiR DECLARATION '(lh►1E
0A " MISC.- REFER TO ORD ORMATION
w3 LL H I hereby affirm that I am exempt from the Contractor's License
u o a Law I'of the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
r WCode:Any city or county which requires a permit to construct,alter,
¢4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
¢ requires the applicant for such permit to tile a signed statement that TOTAL PERMITTO ��g1.(/
a w m ol he is licensed pursuant to the provisions of the Contractor's License , AA''�
FZQ
Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �L,L7(r'• E.Qie(/7 .ckZa�P i/
Businessand Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
¢ f O the basis far the allcgcd exemption.Any violation of Section 7031.$ STORI S TYPE ONSTR.
i; by any applicant for a pemlit subjects the applicant toa civil penalty
of not more than live hundred dollars($500t): ALTER-DRAIN III VENT-WATER (EA.) 5.00
❑ 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(Seo. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
{ Code:The Cmmmvtur's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00
SO.ET FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such in,prove-
mous are not intended or offered for sale.It,however,the build ing GAS-EA.SVSTEM-11NC.40UTLETS 6.00
of improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or int- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to aonstrud the project IS,,. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property MS.builds or improves Ihemun,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts orsuch projects with a crair.c or(s)licensed purxuont of
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I an,exempt under Sec.-.B.&P.C.nor this WATER HEATER W/VENT 6.00
remora
Owner r-eN WATER SYSTEM 5.00
ACC.GATE ACG FILE NO.
WORK ERS'CONIPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby aIflrm that I have a certificate ol'consent if,w1Gineure ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy IhereotISce.3800,Lab.C.).
Policy No. Company
Q ❑ Certificdcopyishcrehyfurnishcd. FIRE SPRINK ENERGY T 24
Z Z ❑ Cerliticd copy is fled will, em city inspection division. MtSC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ N❑
M y CER'I'IFICA'I'F OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W �_ CO.MPI NSATION INSURANCE PLG.GONER. LIC.NO. PLG.
CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars($100)or Ica.)
U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
W H mit is issued, 1 dull not employ any person in any manner so as to
U become sublcd to the Workers'Compensation Lows of California.
U) BUILDINGDam TPPlicant ALTER OR ADD TO MECH. 5.00
>_ N s
C�
NOT ICE APPLICANT. If.alter making this Certificate of Ex-
f" ? emption,you should become subject to the Worker Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit slid]be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE
I hereby atfirnn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work liar which this permit is issued(Sec. MICROFILM
3097,Civ CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I testily that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct, I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordiisances and state laws relating In building construction,and
hereby authorise representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for lnspeclion purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against liabilities,judgments, costs and cxpens'es which CONST.TAX
ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
ran ng of is pyrmn. t MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Signature of ApplicantlContractor Date -�
OFFICE COPY
- POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 15049
INSPECTION DIVISION
JOB INSPECTION RECORD
00 ,I ,, PERMIT EXPIRATION
JOB ADDRESS /0(0 S UNIT# LOT# PERMIT EXPIRES IF WORK
OWNER c- 'a CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION
P R EG UN I TE CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -do-88 uTSm
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
FLOG ELECT PLG. MEC.
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
mo INFORMATION
WOOD FLOOR [[''dVALU4TIlIN - SIFT.
PLUMBING v c -
MECHANICAL Al a - ee
ELECTRICAL PERMI* TUB- ,L
FRAMING •S�y 01 (a`ty Of cups iRO.
STORIESI ` TYPE CONSTR
INSULATION
OCC.GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.I t FLooR nmPA TorAL ncRPnee
�`-
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING use
ROOF SHEATHING Res IrvO CON PR Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ ❑ El El
ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TNACI NO, PARC[L NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
AC DATE ACG FILE NO
ELECTRICAL BUILDING ENERGY
FRAMING ELECT,FINAL TEST
F7_iNc eNc SITE No.
INSULATION PLUMBING
GAS TEST - GAS
IRE SVHINK ENERGY T,24
MECHANICAL
Y
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N r ❑ N�
O UALNE AUC
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR - FIRE DEPT ❑ NE:l ❑ N❑
SHEET-ROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
PDN
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC -
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR.
ARRANGE FOR INSPECTION BY PHONING 252-4505,
� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY