17344 (2) �I APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
4 PERMIT NUMBER
ti BUILDING PROJECT I DENTI FICATION APPLICATION & PERMIT 1 7344
�LDING ' I
aD L0 /3/ ' N6r Or• BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OwNER'S ! - PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE ,AD
r e n PRDNEzS 9S s v ��g 6 O'
CONTRACTOR'S
N (� --y OUTLETS-SWITCHES-RECEP 10.00/1.00
/ f c �, t uc No. ,` LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS 14,31T �
�"' PHONE PANELS 10.0Q DATE OF APPLICATION
ARCHITECT PANELS IOVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR -
ENGINEER --
uc.NO, SIGNS TRANS. 3.00
ARCH.OR ENG, SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
21P EMP.METER OR POLE INS. 20.00 // Eh��/•
APPLIANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE -20.00 �I
w o o LICENSED CONTRACTORS DECLARATION J O��/ � V�
a v I hereby afOnn '],at 1 am licensed under provisions of Chapter 9APR ISSUANCE DATE
a w (conuneocing with Section 7000)of Division 3 uf'he Business...¢I BLDG. ELECT. PLG. - MECH.
wi Professions CodeealyL y license is in full for •a 6to Q ❑
z o - License Clus��--yyam� Li<.NumbY1�/1 p;�xE
0 z H DalC�b�O�CmI'mCt0f4L�1• city at
Q y f J BUILDING PERMIT
¢ 2 w sr OWNER-BUILDER DECLARATION
oA MISC.- REFER TO ORD INFORMATION
F.
3 0 y 1 hereby aft irm That I am exempt from the me,sand License
u_ oa Law for the following reusan.(Sca]031.5,[iusinessand Professions PERMIT ISSUANCE 10.00 yOlj VALUATION S/FT.
r - Code:Any city or county which requires a permit to construct,alter, n ^^^^
Q improve,demolish,or repair any sl Hartle,prior to illi issuance,also ELEC.CONTH. LIC.N0. ELEC. / ,
O¢ recluires the applicant for such permit to file a signed statement that TOTAL ' PERMIT TO ..11 (�
o. w es n he is licensed pursuant to the provisions of tire Contractor's License A DIS,
HZi Law(Chapter 9(emnmencingveith Section 7000)ofDivision 3 ofthe RJ
�j�y�
- a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE 'N I 1 Cb/
R r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500j.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP BEs.UNITS
sok compensation,will do the work,and the structure Is not
intended at offered I'or sale(See. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 50.FT.FLOG AREA r0rAL ACREAGE
himself re through his own employees,provided that sot11 improve-
ments
mprove- -.
mmselfo not ommen ded hisowoffereoyers,prove. ided
flathowee such
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 I/Lb
LImpnrveruenl is sold within rule year of cumlPletion, the owner GAB-EA.SYSTEM-OVER 4 (EA.) 2.00 B ILDIrvG USE
builder will have the burden of proving that Int did not build or int-
proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as owner of(tic 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 Code:'Ihe 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
contracts for such projects with a contmchats)licensed pursuant to
the Contractor's License Law, SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ I:un exempt un der Sec. .B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 AOC.DATE ACG FILE NO.
W'ORKF.RS'COMITNSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby uffvml dual I have a ccrificate of cmroutlo self-insure. ZONING
or u certil'ice a of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy thereof(Sec.3800,LadE C.).
Policy No. Company
0 O Ceriliedcopyisherebyfahrnlshed. FIRESPRINK ENERGY T-24
Z Z ❑ Cer'ifiad copy is Bled with the oily inspeclion division. MISC.- REFER TO ORD.
O Applicant Y ❑ N❑ Y ❑ No
K rn CERTWICAFF OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LOU > (7041'NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
O This Section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑
Z hundred dollars IS 100)or less
U O 1 ecHity that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person mLapnWy limner so as to
U beco qc h cc Itc Workers j�O polsa ' /IS C�11To�t�:to.
Use Uu'iL�_b-ll\Applicant.lS.�-,VV �IS 1�+- ALTER OR ADD TO MECH. 5.00 ,Q(' BUILDING Ib
} N NOTICE: '10 APPLICANT': II',:I J making this Certificate of IEx-
♦- Z eruption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK-,,
provisions Of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be devoted revoked. AIR HANDLING UNIT(TO I0=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 6P
1 hereby affum that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the wrlommoo" of the work for which this permit is issued(Sec.
3097,Civ.C.) HEATING UNIT (TO 100,000 B.T.U.) 6.00 MICROFILM -
.
Lender',Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lenders Address ELECTRIC
1 certify that 1 have read this application and statecity a the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply b with all city and county PLUMBING
ordinances and scute lows relating b+ huilJing construction, and BOILER-CUMPI3 H.P.or 100,000 B.T.U.I 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000BTU)SEE FEESCH. MECHANICAL QQ'
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any w y acur a against said City in consequence of the PERMIT ISSUANCE 10.00 z.(�
rainlj�: Of etmi MECH.CONT. LIC.NO. MECH.
K TOTAL a� ob TOTAL / I(-�/2
Signa tire of Applica I ontractor Date
OFFICE COPY
I
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 17344
INSPECTION DIVISION
I � JOB INSPECTION RECORD
'PERMIT E%PIRALON
JOB ADDRESS qn rde �UNIT# _LOT# r
C L \J
I h PERMIT E%PIKES IF WORK
OWNER J� F`S �� CONTRACTOR _/-+• IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD TIRE DAYS OF PERMIT ISSU-
FOUNDATIONANCE 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 VA[jGATTON
PREGUNITE CUPERTINO STANDARDS. '
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB APR
b 1iJ•.
PLUMBING COY
upel 'm
w of C �� ,�-� ��• � (e.l
ELECTRICAL "W'1�� ISSUANCI-DATE
BLDG ELECT PLG. MECII
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
_ WOOD FLOOR 'IA
LUATION $�F T.
PLUMBING .i
MECHANICAL
ELECTRICALPERNIn TO
FRAMING �\ $T
ORIES TYPE CON$TR.
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
50 IT FLOOR nIIfiA TOTAL AGH SAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE I
DIAPHRAGM THE CONSTRUCTION TAX IS PAID IIyZ'(T.
BUILDING USE
ROOF SHEATHING TIES IND CON PB (IT4-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El E:) El El d
ASSESSORS PAR CE L NO
ROUGH SAN.#
PLUMBING ELECT.ENERGY
' f11AC1 NO. PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ACC GATE ACG FILE No
ELECTRICAL -/ w BUILDING ENERGY
FRAMING Iff"S ELECT.FINAL TEST
TONING ENG.SITE NO.
INSULATION —�� PLUMBING
GAS TEST GAS
FIRE SPRWK ENERGY 7 44
MECHANICAL , 0 1 1 ❑ No
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR-SHEAR ELECTRICAL RELEASE FLooD zorvE ALuc
INTERIOR SHEAR FIRE DEPT. v N� L' N_Q
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - - ^p
INTERIOR LATH TEMPORARY APPROVALS BUILDING lo, A
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE (03
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .�
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIClop
ID_ ONE WORKING DAY BEFORE REQUIRED INSPI`CTION. PLUMBING
z 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL �D
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY