17174 (2) Z*' APPLICANT TO FILL, IN INFORMATION WITHIN RED LINES - USE BALL POINT.PEN ONLY:
BUILDING PROJECT IDENTIFICATION - pERMITNUMBER
ADDRESS APPLICATION & PERMIT I�
ADDRESS r
pay. pR �}uG�712 tom- BUILDING-ELECTRICAL=PLUMBING -MECHANICAL
,t OWNERS " - PLAN CHECK VALIDATION
r �R"ME
y.IN�t�T L�FEBI% `9 �j//yy 11((JJ QTY. ELECTRIC PERMIT FEE
r iNONE 7W l 7I
"CONTRACTORS -� nJQOUTLETS-SWITCHES-RECEP 10.00/1.00 -
•"•M LIGHTING FIXTURES 10.00/1.00 -
LI0.N
coo
TRAc AA R' 11 f1 APPLIANCES-RESIDENTIAL 4.00
(I/( P PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
oR '0 C7 PANELS (OVER 200 AMP). 20.00 ,
ENGINEER
Lie.No ISIGNS TRANS. 3.00 ^'
ANCHOR ENG. • PERMIT VALIDATION .
ADDRESS ]616 - SPECIAL CIRCUIT. 5.00
zIP EMP.METER OR POLE INS. 20.00
APPLICANT'Ss!�/ �.. Q w T MOTORS SEE FEE SCH.
ADDRESS
V YDY 3 SERVICE CHANGE 20.00
o a LICENSED CONTRACTORS DECLARATION
Q U - I hereby affirm that 1 am licensed under provisions of Chaplet 9 ISSUANCE DATE
H G m (commencing with Section 7000)of Division'3 of(lie Business and BLDG. ELECT. I PLG. MECH.
r-w z Profusions Codu, d my license is in full for Int iflj;Lt Q1 - ❑ ❑ ❑
z o m - License ClassLic.Number -
4z Datc__�,_IJJ'q Contractor`a r f �__ OWNER-BUILDER R-BUILUIik BUILDING PERMIT
ce ¢ w u UECLA RA'1'1 N
F
3 A. H I hereby affirm that I am exempt from [hu Contractor',License MISC.- REFER TO ORD INFORMATION'
LOa Law lbr the follDwing reasun.ISec.703 L5,BuxinessanA ProfVALUATION S/FT.
essions PERMIT ISSUANCE - 10.00
� - Code:Any city or county which reyuiresa permit to construct,alter,
2 R ¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. V `
- o¢ requires the applicant for such permit to file a signed aIalemmut that - TOTAL PERMIT TO
w w he is licensed pursuant to the provisions of the Contractor's License
F z i Law lChapter 9(commencing with Section 7000)of Division 3 ofthe
- < Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT 'FEE -
¢1-p the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to.civilpenalty ALTER-DRAIN -WATERIER.) 5.00
of not more Ill..his,hundred dollars($500).):
❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
-- intended or offered for sale (Sec. 7044, Business and Profusions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 t
Code:rThe Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself re through his own ffered lorss provided that such improve-
mmselfenutingh In, or empldl'urs provided
that such
building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) . 2.00 BUILDING USE
bulkier will have the burdenof proving that he did not build or in.
prove for purpose of sale.). ' E INDUSTRIAL WASTE INTER. 30.00 Irvo cory PB o,ner
,.a ,O_I,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑
� liccused card m.nmtocon,imctthe po),v,t(See. 7044,.Business LAWNSPRINKLERS-1INC 5V.B. 6.00 ASBESSORSPARCELNO.
and Profe
ssions Code:The Contractor's License Law docs riot apply
to an uwner of property who builds of improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
- contracts for such projects with a conlrumorts)licenmd_punumd IO
G,c Contmctoh Lieemel.aw. , ' s SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO.. PARCEL NO.
❑ 1 am exemptunder Sec. .B.&P.C.for this
K WATER HEATER W/VENT 6.00
reason
Owner - `Duro: WATER SYSTEM s,L N 5.00 ACC.DATE ACC,FILE No,
WORKEIRSI COMPENSA'n ON DECLARA'I'[ON WATER TREATINGEOUIP.
1 hereby affirm that I have a certificate ofconsent to sell-insure. 4 ZONING, ENG.SITE NO.
. or a certificate of Worker,'Com pen anion Insurance,or a certified IAN
cop.thercnl'ISv,.3B60,Lab.CJ�'.
Policy No. Company
O ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY TZA
Z Z ❑ 'Certified copy is filed with the city inspection division.
O Applicant MISC.- Y ❑ rv❑ Y ❑ N❑
CC T Ch RTIhCA'IT UIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 C.
Lu > 'COMPENSATION INSURANCE PLG.CONTE. . ❑c.NO. PLG. Y❑ N❑� Y ❑ N❑
Q• O I'llo, section need not be completed if the permit is fur one TOTAL
� Z hundred dollar,0100)or lc,,.) -
• U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued, I shall not employ any person in any manner so as to - -
U become subject to the Workers'CompensutiomLaws of California.
O, w Pam Ap licunt - FELECTRIC
a p ALTER OR ADD TO MECH. 5.00
} rn NOl'ICE TO APPLICANT: If,after making this Certificate of lis-
? emption,you should beaunne subject to the Workers Compensation APPLIANCE 5.00 .
provisions of the Labor Code, you most forthwith comply with
U such provisions or this permit Shull be deensd revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 If 15,1
I hereby affirm that there is a u,nstructiun lending agency for EXHAUST HOOD.(WITH DUCT) 5.00
the performance of the work lot which this permit is issued(Sec. -
3097,Civ.C.).• HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 Lender's AAJress --
hcurtify that I have readthis application a.J state that the above VENTILATION FAN (SINGLE) 4.00
information n correct. I agree to comply with all city and county PLUMBING
ordinances and sate laws relating to building construction, and BOILER-CCNv1P(3H.P.'or 100,0008.T.U.1 6.00
hereby autlmrim representatives of this city to"enter..upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. '
. OVO agree to save, indemnify and keep handless the City of ' MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,'costs and expenses which CONST.TAX'
may in any way accrue 'list %I'City in consequence of the PERMIT ISSUANCE - 10.00
o his pen IMECH.CONT. LIC.NO. MECH:
CvS( TOTAL TOTAL q LS
Signature o App ant/Contractor 1 to • -
OFFICE COPY
POST THIS CARD NEAR FRONT'OF BUILDING- 17
.PEF�1111N."�R74
_ . . .CITY:: OF CUPERTINO : •
INSPECTION`DIVISION
JOB INSPECTION RECORD' "
PERMIT EXPIRATION
J08'ADDR ESS y�l!-TN �M-- I Imo-•UNIT# LOT# '
PERMIT EXPIRES IF WORK''
1 G
OWNER CONTRACTOR IS NOT STARTED WITHIN .
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMITISSU-
.ANCEOR 180 DAYS FROM
FOUNDATION ' NOTE:' : LASTCALLED INSPECTION.
UFER. 1 " ALL-GRADING AND DRAINAGE.SHALL BE INSTALLED
+ TO.COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VAUDAnUN
PR EGUNITE CUPERTINO STANDARDS.. . ` +1�
GARAGE SLABS ' - i - - �`�"")I -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -
UNDERGROUND'/SLAB - - - ~.• , ,-
PLUMBING - - -
ELECTRICAL _
" ' 1 "'I' 'ISSUANCE DATE'
MECHANICAL - aLUc. eLecr PLG. . meta
00 NOT POUR FLOOR UNTIL ABOVE'HAS BEEN SIGNED BUILDING PERMIT
INFORMATION.
'WOOD FLOOR'
VALUATION $TFT.
PLUMBING
E MECHANICAL ',
PEamll i0
ELECTRICAL 1„ , •1' -
FRAMING - i- -
STORIESTYPE CONSTR
.INSULATION .
. ucc.GI uP nPs.VNITS
- „PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED `
ROOF ' -t NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO'`r,FLOOR AREA tOlAl ACRSACL•I
DIAPHRAGM, - :1 THE CONSTRUCTION TAX IS PAID
_� BUILDING USE,' ROOF SHEATHING � - -- +Es IND coN' Pa D
NAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - FINALS DATE INSP: ❑ .
n$$E$$OR$PARCEL NO
ROUGH. SANA! , - -
PLUMBING ELECT.ENERGY '
TRACT NO. • PARCEL NO,
' TUBS 8 SHOWER PAN' - PLUMBING ENERGY - ,
MECHANICAL - MECH.ENERGY
ACC.DATE ACC,FILE NO. ,
ELECTRICALBUILDING ENERGY,
_ .FRAMING' - -\ ELECT.FINAL TEST
INSULATION PLUMBING ZONING COG.SITE NO
GAS TEST _ - GAS -
FIRESPRINA "ENERGY L4J
MECHANICAL'-
. COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR - ELECTRICAL RELEASE \ %FLOOD ZONE. , A.L.U.c,
INTERIOR SHEAR FIRE DEPT. � Y , N� -� ❑ No
SHEETROCK ' ^' ' GRADE - FEE SUMMARY
EXTERIOR'LATH BUILDING,
INTERIOR LATH .I - TEMPORARY APPROVALS Buli.DwG
SCRATCH COAT . ' �- _ ELECTRIC .- PLAN CHECK.,
GAS' FEE
NO TAPE OR PLASTER UNTIL ABOVE HASBEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY CV OFBUILDING ISNOT PERMITTED UNTIL BUILDING FINALIS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE•FOR INSPECTION BY PHONING 252-4505, '. . .. ELECTRIC
LU ONE WORKING DAY BEFORE'REQUIRED INSPECTION. PLUMBING
�� PLEASE;GIVE,JOBADDRESSWHEN.PHONING.
- SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! coNST.,TAx ..
PLEASE READ•REVERSE SIDE BEFORE TOTAL j
CALLING FOR FINAL INSPECTION. n
OFFICE COPY.