09788 (2) APP}�JCANT TO FILLIN INFORMATION WITHIN RED LINES - USE-BALL POINT PEN ONLY
BU7 COING PROJECT 1 DENTI FICAT APPLICATION & PER - PERMIT NUMBER
;% BD LDING
- A
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
09788
wN H' -
NAME PLAN CHECK VALIDATION
�
CITY. ELECTRIC PERMIT FEE
PHONE
DUNTNAME OUTLETS
OUTLETS-SWITCHES-RECEP 10.00/1.00
1 /G NG Coy1(ST uC:No.f126809Z LIGHTING FIXTURES 10.00/1.00
y aooeess oRs f't✓G - PPLIANCES-RESIDENTIAL 4.00 -
UE'LLOSt, PHONEY/f 367 BY% PANELS 10.00 - DATE OF APPLICATION ,
ARCHITECT PLAN CHECK FEE P.C.NO.
on
,r� p ,-j y-��T���rI PANELS (OVER 200 AMP) 20.00 p
ENGINEER 7'•Lr /?.V////134zf_K NO.'lC_ /'✓ SIGNS TRANS. 3.00 PAI
ARCH.OR ENG. NR MIT VA LIDATION
ADDRESS (/LU�/U/Y'-^- " SPECIAL CIRCUIT 5.00 /n11/
3yo� �nIUGST �EnlO 'IIP9 T EMP.METER OR POLE INS. 20.00 V V .1 985
ADDRESSTs - MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00 .City of Cupertino
woo LICL'NSED CON'TRAC'TORS DECLARATION TEMP.POLE 30.00 .
¢to
u I hereby affirm that I am licensed under provisions o1'Chapter 9
4-2 w
ISSUANCEw 4 (comm 'DATE(commencing with Section]000)of Division 3 nC the Business and _
BLDG. ELECT. PLG. MECH.
H L i Professions Code,on<I}py license is in(all fo¢e;ln� f�1L ❑ O ❑ ❑
Z i a O License Class �,'- Lic.Number
6
Uate---1Yz Contractor '
Q y E J
OW Nfi R-BUILDER DECLARATION BUILDING PERMIT
woa INFORMATION
; LL y I hereby affirm that I am exempt Item the Contractor's License MISC.- REFER TO ORD '
to u O 4 Law for the following reason.(Sec.7031.5,Basinessand Professions VALUATION $/FT.
J PERMIT ISSUANCE 10.00
m_y Code:Any city or county which regwresupermit to construct,alter,
'
Q M 4 0, Improve,demolish,or repair any structure,prior to Its issuan Ce,also ELEC.CONTR. LIC.N0.
ELEC.
DLL requires the applicant for such permit tri Elle a aignod stulemmd that TOTAL - PER TO
n w m hC is licensed pursuant to the provisions of the Contractor's License
HZi
Law(Chapter 9(commencing with Section 7000)OfOivision 3oFthe
i a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE 112501 M11 1%-,
¢ r the basis for the alleged exemption.Any violation of Section 7031.5 -
a ; by any applicant for a pemtll subjects the applicant to civil penalty STORIES TV E CONSTR.
of not more than five hundred dollars(5500).1: ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ I,as owner of the property,or my employees wisttuh wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation;will do the work,and the stn¢ e is not OCC.GROUP RES.urvfrs
intended or offered for sale (Sea 7044, Business and Prul'essions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00
Code:The Contractor's License Law does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
• himself or through his own employees,provided that such improve-
meats are not intended or offered for sale.11,howeveq the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will have the burden of pmving that lie did not build or im- BUILDING USE
Prove for purpose of sale J. - RES IND CON PB Other
❑ 1,as owner of the property,ant czcblgvely contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ O O
licensed contractors to construct the Project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 8.00 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
contracts for Snell projects with a contniews)licensed pursuant to
the Conlr:mtor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lute exempt under Sec. ,B.&P.C.for this
on WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORK I7RS'COMPI:NSA77ON DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certiricale of consent to ulf-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. _
copy Ihcrcof(Sed 3800,Lnb.CJ:
Policy No. Corilpuny r
O ❑ Ce Tiedcopyishcr• y1f mashed. FIRE SPRINK ENERGY Z rti ed p de w dy>�o vction division. 24
H O pplicant MISC.- REFER TO ORD. Y t3 N❑ y ❑ NF]
LUN T FICATI7 OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOOZONE A.L.u.O.
W COMPENSATION INSURANCE - PLG.CONTR, ❑C.NO.
1 O PLG.
.Z (This section aced not he completed if file permit is for one TOTAL _ y❑ N y N
O
humped drdo liarss($ 00) .p
1 certify that in tileperformance
performance of the work for which this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
0 U mb
mit is issued,I'sha11 not employ any person in any manner so to
M1ecoe subject to the Workers'Compensation Lows O(CulifornisLEI .
y Date Applicant - ALTER OR ADD TO MECH. 5.00 ;DN OU
} to NOTICE'TO APPLICANT: 11,after making this Certificate n1'F..x-
F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with suh provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT ITO I0=QF.M.)• 4.00CONSTRUCTION LENDING ACF.NCYAIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 I herebyaffirm that there is a construction lendingagenyfarEXHAUST HOOD (WITH DUCT) 5.00
the performance of the work for which this emit is issued(Sec.3097,Civ.C.). • + HEATING UNIT(TO 100,000 B:T.U.) 8.00Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 I certify that I have read thisapplication and slate that filo above VENTILATION FAN (SINGLE) 4.00
information n correct 1 agree to comply with ;III city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
ordinances and slate laws relating IO building Constar con, and
hereby authorize representative,ec this city to enteruponthe BOILER-COMP (Over 100000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which - CONST.TAX
may in any way uc against Said City in consequence of the PERMIT ISSUANCE 10.00
gualingoflhispe it, MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
Si arc of Ap ¢nn[/Contractor Date V�f.
OFFICECOPY .
J j POST.THIS C NEAR.FRONT OF BOILDIN6
yt r ® rfi RMIT NUMBED
CITF CUPERTINO
INSPECTION DIVISION 09788
` JOB INSPECTION RECORD
+//////,, .-r{{��/�•/,/�) - PERMIT EXPIRATION
JOB ADDRESSF!/�'/D� '0I(,U/Ul IV/ UNIT + LOT# ' - PERMIT EXPIRES IF WORK
OWNER _ - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTIO " ECORD 180DAYS OFPERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
LIFERx .� - �O .. I ,LAST CALLED INSPECTION.
�Fbu Lkr
V
PREGUNITE PERMIT VALIDATION
ers u;tidcr E i z-ib _.. ^' PAID
.POUR NO CONCRETE UNTIL ABOVE HAS BEM SIGNED
UNDERGROUND /SLAB Nov - 11985
PLUMBING .
ELECTRICAL : (,`tl• �1�P�f11DO
MECHANICAL - i B Dr. ELECT, I PLO I MECH.
- - ❑ ❑ ❑ a
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
SIFT.
PLUMBING VALUATION '
MECHANICAL
ELECTRICALPERMIT
FRAMING
INSULATION � STORIES TWIT CONSTR.
P _ OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS.BEEN SIGNED
- ROOF j sU.Fr.FLOORAREA TOTALACREAGE
DIAPHRAGM • '
BUILDING USE
H' IND CON PB 011'.
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1 ❑ ❑ ❑ ❑
ASSF.SSOHS PARCEL NO.
ROUGH
' c
MFRAMING
TRACT NO, PARCEL NO'l.
I
acc.DATE ACC.FILe No.
FINALS DATE INSP.
+ - SAN #
PLUMBING ZONING ENO.SITE NO. '
GAS
FIRE SPRINK ENERGY TZE
I. MECHANICAL +
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEDHEATING Y ❑ N❑ Y ❑ N;
LATH—INTERIOR ELECTRICIL FLOOD ZONE A.L.U.C. '
LATH—EXTERIOR FIRE DEPT. Y❑ No Y L
SHEETROCK GRADE FEE SUMM'
SHEAR INTERIOR BUILDING -
SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING
FIREWALLS:, ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
'ARRANGE-FOR INSPECTION BY PHONING 252-4505, ELECTRIC
a� t ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE'GIVE JOB ADDRESS WHEN PHONING.
Z
-,SEE PERMIT FOR EXPIRATION DATE - MECHANICAL
IMPORTANTI CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY