12993 (4) APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
'OBUI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
Seat LONG APPLICATION & PERMIT 12993
ADDRESS MaLm Ave
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER's y PLAN CHECK VALIDATION
gE QTY: ELECTRIC PERMITFEE
J E
CONTRACTORS
1 UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
L...N LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
ADDRE PPLIANCES-RESIDENTIAL 4.00
46 ZIMMPHONE PANELS 10.00 C) ��' DATE OF-APPLICATION
ARCHITECT �� PLAN CHECK-FEE' P.C.NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
LIC.No, SIGNS TRANS. 3.00 --' rt _/
I
ARCH,OR END. - SPECIAL CIRCUIT 500 PERMIT VALIDATION
ADDRESS .
ZIP TEMP.METER OR POLE INS. 20.00 C,ht'
APPLICANT'S - MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00 p
w o o LICENSED CONTRACTORS DECLARATION ' p
< U W I hereby affirm that I am licensed under provisions of Chapter 9 •T� V t- - ISSUANCE DATE 7
(commencing wit eclion 7000)of Division 3 of the Business and s
rA D H a� �. � � BLDG. ELECT. PLG. M
0 w i Professions Code d my license isN full for /x :..n
p2B.W Licens ss Lic.Numbe _ _ (r U•Vf
Dale Contractor I^'hI Ct
¢ x .J, - ur J BUILDI G PERMIT
¢ ¢n OW ERBUILDER DE INFORMATION
'x w I hereby affirm that I am exempt front a Contractor's License MISC.- REFER TO ORD
F a. 0 J Law forthe followingmason.(Sec:7031.5,Businessand Professions PERMIT ISSUANCE 10.00 _ VALUATION S/FT.
� 0 Cade:Any city or county which requires a permit to con a rue(,alter,
¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
w C u requires the applicant for such permit to file a signed statement that TOTAL J Q PERMIT TO
A K$ he is licensed pursuant to the provisions of the Contractor's License n � a��
Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the x 1.G
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
f ¢ o
¢ H the basis for rite alleged exemption.Any violation oto action anally STORIES TYPE CONSTR.
by any applicant fora permit dollars the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars($500)):
❑ I.as owner the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
(S
their sole compensation,will the work,and rhe structure is not
intended or offered for sale (Sec. 7044, Business and Professions ons
DRAINS-FLOOR,ROOF,AREA,COINED. 5.00
e
Code:The Contractor's License Law neon not apply loan owner of
himself
who builds his improves employees,
provided
who does at such
work FIXTURES-PER TRAP 5.00 EQ FT.FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provide)that such ibuildi r
mems are not intended proffered for Sala If,however,the building I IGAS-EA,SYSTEM-1 INCA OUTLETS 6.00
orimprovement is sold within one 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 im. BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omar
O 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS.-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
con acts for
such
u ont ctor'sLicense Law.hecwitha contractor(s)licensed pursuantw
Contractor's SEWER-SANITARY-STORM EA:'200tt/10.00 TRACT NO. PARCEL NO.
fJ I am exempt under See.-,B.&P.C.to,til is WATER HEATER W/VENT6.00
reason
Owner Date WATER SYSTEM5.00
R r - ACC.DATE -ACG FILE N0.
WORK F-RS'COMPE-NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, J n E,2
or a certificate of Workers'Compensation Insurance,.or a certified M\1k Y 20NING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.I MI
Policy No. Company I•
U ❑ Certife y i eby fhrnishC FIRE SPRINK ENERGY T24
Z 2 � Certif r� py led with the city ins�•c iol
04 Apftcant MISC- REFER TO ORD, v ❑ N❑ v❑ N❑
F rn PERMIT ISSUANCE 10.00 d FLOOD ZONE A.L.u.c.
C '1 EOE EXEMPTION FROM WORKERS'
LU OMPENSATION INSURANCE PLG,CONTR. LIC.NO. PLG. q
or- '- Y❑ N❑ Y ❑ ❑
� Z hundred
dollars need not be completed if the permit is for one TOTAL N
hundred dollars(SWO)or form
U O t certify that h Ino performance of rhe work for which this per, QTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 U mil is issued,I shall not employ any person in any manner so is m -
U become subject to the Workers'Compensation Laws of California.
0 i Data Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of I..
? emption,you should become subject to the Workers'Compene tion APPLIANCE 5.00 PLAN CHECK
provisions of the.Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 'cd.6.00
the performance of the work for which this permit is issued(Sec. .r MICROFILM
3097,Civ.CJ. HEATING UNIT T000,0091107V.) 8.0
Lender's Name' HEATING UNIT(OVER 100,000B.T.U.19.50 ELECTRIC 3V'^V-0
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 �1 �
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon theO'U
above-mentioned property for inspection purposes. BOILER-COMP oxer 100,000 BTU)SEE FEE SCH. MECHANICAL 17
to e, indemnify and keep harmless the City of MISC.- REFER TO ORD.
mAay1ny
ins til Rin judgment, costs ends expenses which CONST.TAX
w Tue against said City in conequnce of the PERMIT ISSUANCE 10.00 O r L MECH.CONT. LIC.NO. MECH. _ TOTAL
(�
'` fApplicant/Contractor Dale TOTAL S
OFFICE COPY - -
POST. THIS CARD NEAR FRONT OF,BUILDING
PERMIT NUMBER
. . CITY OF CUPERTINO 112993
INSPECTION DIVISION
JOB INSPECTION RECORD
a' .,,, PERMIT EXPIRATION
1038WADDRESS 10062 MILLER 'AVENUE UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER HOME FEDERAL SAVINGS
CONTRACTOR JOHANSON CONST. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU�
FOUNDATION ANCE OR 180 DAYS FROM
LIFER
LAST CALLED INSPECTION.
'
PREGUNITE - PERMIT.VALID AT1UN
1
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB.
' PLUMBING
ELECTRICAL ( „ ISSUANCE GATE
MECHANICAL - BLOc• (ELECT. PLG. ME H
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING " - -
MECHANICAL
PERMIT TO
ELECTRICAL
FRAMING �...
STORIES' TYPE CONSTR.
' INSULATION '
UCC.GROUP RES,UNITS
&P.LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO,
' ROOF Fi.FLUOR AREA TOTAL ACREAGE
DIAPHRAGM '
BUILDING USE
RES IND CON BE Otl,e,
1:1 F-1APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑
ASSESSORS PARCEL N0..
ROUGH
PLUMBING-
GAS TEST TRACT NO. PARCEL NO.
MECHANICAL
ELECTRICAL ,FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #
20NINGENG`SITE NO.
INSULATION PLUMBING. Q 33�8�f
GAS
FIRESPRINK ENERGY T ZS
MECHANICAL
33_87 Y [] Np VO Np
COVER NO WORK UNTIL ABOVE HAS,BEEN'SIGNEO HEATING '
FLOOD ZONE A L.UD,
LATH-'INTERIOR ELECTRICAL 6-J3.d'9
LATH-EXTERIOR FIRE DEPT. v� NE] rL N[]
SHEETROCK GRADE FEESUMMARY
SHEAR INTERIOR BUILDING 0. 3.. �/ BUILDING . ,;
SHEAR EXTERIOR TEMPORARY APPROVALS
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS EENSIGNED OCCUPANCY SEISMIC FEE -�
OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
H ONE WORKING DAY,BEFORE'REQUI RED'INSPEGTIO,N, PLUMBING "n -
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
.? — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
CONST. Ax ,
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL 'F
CALLING FOR FINAL INSPECTION. - p'
OFFICE COPY /