15749 (3) 'APPLICANT TO FILL IN INFORMATION WITHIN REDDLINES —.USE.BALL POINT PEN ONLY
BUI LDI NG PROJECT I DENTI FICATION ,•. 'PERMIT NUMBER
7UILDING -' - APPLICATION,8i PERMIT'BUILDINGq. 57 49
ADORADORE" 1. 5749 J 1 �7
�•' 1je- —ELECTRICAL—,PLUMBING—MECHANICAL •I,
UWNCuiis s_8 CeO-� PLAN CHECK VA ATION
NAME JCC/ DTV. ELECTRIC PERMIT 'FEE' �'p
��U PRnNE(/�J.A-lam'
CONTRACTORS 1f-rfj UTLETS-SWITCHES-RECEP 10.00/1.00 . U "
NAME r
UN�Nb-h! �/ sec.mO. - 'LIGHTING FIXTURES- 10,00/1.00 , ^'
CONTRACTOR'S
ADDRESS NT- APPLIANCES-RESIDEIAL 4:00'
C .
PHONE PANELS - 10.00 �, DATE OF APPLICATION •'
OARCHITECT - .PANELS (OVER 200 AMP) 20.00 IN CHECK FEE C.No.
ENGINEER I p� ,
TIC.NO, SIGNSTRANS. 3.00' ' l�
ARCH,OR ENG. -' I RMIT VALIDATION
500 }:
ADDHESS - SPECIAL CIRCUIT ,
ziv EMP.METER OR POLE INS. 20.00 VN"
APPLICANTS MOTORS SEEFEE SCH.
ADDRESS hf... �N
[i 5 , SERVICE CHANGE 20,00 Iv, � �J�
o¢ z -
'Foo- LICI!NSI!D CONTRACTORS DECLAR TION
rt U w I hereby:dlirm;thxt 1 an licensed i nder provisions of Chapter 9 - ISSUANCE DATE
y a N- (commenting with Section 700e i f Division 3 til the H 'mess unit BLD '.ELECT. PL❑G. MECfi.
r a z Professions Code,and my 7000 is in full force J he Bus LIEV1I( �IYY-�J1
Z 0 y o License Class Lie.Number
m H
Date Contractor _
Q Y 4 j
¢ ¢w u - OWNF R-BUILDER DECLARATION BUILDING PERMIT
w ;n 1 hereby afOrn that I am exempt from the Contractors License 'I MISC.- a T REFER TO ORD • INFORMATION
y
F u o so Law for the following reason.(Sec.7031.5,Businessand Professions' PERMIT ISSUANCE 48 BQ . VALUATION S/FT.
m� Codo Anycily orcounty whichrequiresapormil roconaructrtdlerr, - - -- 45—
¢ Q p improve,demolish,or repair any structure,prior to ifs issuance,also ELEC.CONTR. LIC.NO. ELED.
E c ¢ requires the applicant for such permit to file a signed statement that F TOTAL
a. w m he is. licenscd pursuant to IIIe provisions of the Contractor's License
Hwa Law(Chapter 9(conimencingwith Section 7000)of Division 3 oflhe //VT ,/00-
4 a Business and Professions Code)or lha''he is exempt therefrom and OTV. PLUMBING PERMIT FEE
Or H m the basis for the alleged ex tan IF tion.Any viola limn of Sect ion 703 1.5 m STORIES TYPE CONSTR.
by any applicant for a permit suncebs the applicant to a civil penally ALTER-DRAIN& VENT-WATER (EA.)•5.00
of not mom than five hundred dollars(S500)J:
❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP �
their sole coni pensalion,will do the work,and the structure Is not RES.UNITS
- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,'AREA,COND. 5.00 -
Code:The Contractor's License Law does not apply to an owner of
properly who builds Or irnp,.,c,IIICIC in,and whin does such work FIXTURES-PER TRAP5.00 50.FT.FLOOR AREA .TOTAL ACREAGE
himself or through his own employees,provided that such inuprove-
. , mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00
or improvement is sold within one your of completion,Die owner-
builder will have the burden of proving that he did'not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 - -BUILDING USE
Prov•for purpose of sale.I INDUSTRIAL WASTE'INTER. 30FRES IND CON PB Omer
jQy, I,as owner of the PrnPurly,ani ex Elusively Contracting with, .00
11 �-
IiL'eZed contractors to construct the project(Sec. 7044,Busines's LAWN SPRINKLERS-1 INC 5 V.B. 6.00 'AssESSORSPARCEL NO.
El ED
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.unit who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractorts)licensed pursuant to -
theContractorsLicenselaw. SEWER-SANITARY-STORM EA.200ft/_10.00 TRACT NO. PARCEL NO.
❑ lam exempt undor Sec. ,B.&I'.C.for Ibis
reason WATER HEATER W/VENT'. 6.00 ' '
Owner - Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO..
WORKERS'COMITNSAI ION DFCLARAT ION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent to self-insure, -
nr o certificaw of Workers'Compensation Insurance,or a certified ZONING' ENG.SITE NO,
copy thereof(Sec.3800,Lab.CJ. - - -
Policy No. Company
O ❑ CetliGcd copy is hereby fHDa,hed.
CeRE SHRINK ENERGY T-Z4
Z Z' '❑
Certified copy is bled with the city inspection division.
O Applicant MISC.- REFER TO ORD. Y C IN Q' Y [] N[:3
' 1 M N
CERTIFIC'AfH OF I KFMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COAIPFNSATION INSURANCE 7 PLG.CONTR. LIC.NO.0- 0 _ PLG.
a('fhis at'n in need 'nal be conmleted it the permil is for ane TOTAL Y N(_ Y IN
U O hundred dollars IS 1001 or less.) - : .
I certify That in:Um,pedormunce of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL l- mit .issued,9 Shull not employ any Person in any manner sir as to
O Ubecome subject to the Workers'Compensalion Laws of California.
0.WDat° Applicant ALTER OR ADD TO MECH. 5.00 BUILDING n 1
} m NOTICE '10 APPLICANT: If,after raking this Certificate of Ex-
♦— Z emplion,you should become subject to the Workers'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 derailed revoked., AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
_
-CONS'fRUC1lON LENDING AGENCY;< AIR HANDLING UNIT(OVER 10=C.FM.) 6.00 SEISMIC FEE
I hereby,affirm that then, is a cunstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 •- .
the performance of thee work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's AAAress - ELECTRIC I �; •
•Ecertify that I have"read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct 1 agree to comply with all city and county PLUMBING.
ordinancesand state laws relating to building construction, and - BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby ernioriae representatives for fusee this city to enter upon the r BOILER-COMP (Over.100,000 BTU)'SEE FEE SCH. MECHANICAL
hereby
In authorize
ed property tativesP of till purposes. `
(We) agree to'suve, indemnify and keep harmless the City of MISC.- REFER TO ORD.
u pertino against liabilities,judgments,costs and expenses whichONST.TAX
may in any way accrue against said`Cily in consequemce'of the PERMIT ISSUANCE .10:66 ,
�r mg hof this permit. /� /� MECH.CONT, LIC.NO. MECH. - I ¢
�-t � Leo PG(� DTALr'I TOTAL ��D (�J
Signature of APP i anl)COntmc[or Date 1' r
OFFICE COPY
POST THIS CARD NEAR.F.RONT OF BUIEDING
-7 - PERMIT NUMBER
CITY OF CUPERTINO 157. 49 .
INSPECTION DIVISION m
JOB INSPECTION RECORD
PERMIT'EXPIRATION
JOB ADDRE*SS,�&s UL 7-f. UNIT# - �, LOT#
PERMITEXPIRES IF WORK'`
OWNER CONTRACTOR IS NOTSTARTEDWITHIN
INSP CTION ATE INSPECTOR INSPECTIONRECORD " - 1ea Ogvs of PERMIT lssu +
FOUNDATION I WA
OR 180 DAYS'FROM -
NOTE: KASTCALLED INSPECTION,
UFER - •ALL GRADING AND DRAINAGE SHALL BE INSTA�
PR EGUNITE - TO-COMPLY WITH THE APPROVED PLANS AND CITY OF - T-PERMIT VALIDATION
• CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETEUNDERGROUND /SLAHAS B BEEN SIGNED j O`�UQ8�1n0 �'E�I;�.�P'`?I,1' {
` PLUMBING x ISI �r..�"✓Ci
- ELECTRICAL •. p�� ISSUANCE DATE
MECHANICAL " - .I +- • RJc, ILECT.. .rO m(E-CN.
-,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDQp8 Q BUILDING PERMIT
.
INFORMATION
WOOD FLOOR -
VALUATION, .$/FT.
• .PLUMBING - - � � )
MECHANICAL
ELECTRICAL. _ . - - PERM T�r(Y�
FRAMING ��I� �O'�lXG UCI�G_
INSULATION- p q .GSL Go STORIES - TYPE CONSTR.
OCC.GROUP RES,UNITS'_
PLACE NO SUBFLOOR•UNTIL ABOVE HAS BEEN SIGNED •• - ' '
ROOF - _ • 'NOTE:NO FINAL INSP.SHALL BE MADE BEFORE Y S°.`T.FLODi+AREA roTAi ACREAGE ;
DIAPHRAGM' - THE CONSTRUCTION TAX IS PAID - ,I
., -
ROOF SHEATHING - - - RES NBUILDING LSE
D - CDN PB Om.
. ' APPLY NO ROOF.ING.UNTIL ABOVE HAS BEEN SIGNED FINALS',', DATE INSP. ❑ ❑ ❑
ROUGH, - SAN.a, - - -.ASSESSORS PARCEL NO
PLUMBING - - ELECT.ENERGY TRACT NO PARCEL NO.
TUBS&SHOWER PANS - PLUMBING•ENERGY � - -
MECHANICAL - MECH.ENERGY. - ~
'ACC DATE ACC.FILE No.. .
'ELECTRICAL .' ' � - .� �- .' 'BUILDING ENERGY � � � . .
., FRAMING - ELECT.FINAL TEST
ZONING ENG.SITE NG..1
'INSULATION+ PLUMBING - -
GAS TEST ' _ � '� GAS _
FIRE$PRINK ENERGY.T124
MECHANICALS Y ❑,,,, N❑ v ❑ 24
COVER NOWORKUNTIL ABOVE HAS BEEN SIGNED HEATING _
FLOOD ZONE A.LU.C.
EXTERIOR SHEAR. - ELECTRICAL RELEASE `, T ,
INTERIOR'SHEAR" FIRE DEPT.
Y❑ N UIQ' NEI
-SHEETROCK . GRADE �• FEE SUMMARY
�' EXTERIOR LATH BUILDING BUILDING ' g -7 Q�;l
INTERIOR LATH - TEMPORARY APPROVAL
SCRATCH COATELECTRIC _ 'F' ` 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 IS SIGNED BY BUILDING INSPECTOR: MICROFILMn -
•°
. . w. ARRANGE FOR INSPECTION'BY*PHONING 252-4505; ELECTRIC
F
-ONE WORKING DAY.BEFORE REQUIRED,INSPECTION „ PLUMBING
O PLEASE GIVE JOB ADDRESSWHEN PHONIN_ G.
�. Z - MECHANICAL
—'SEE PERMIT FOR EXPIRATION DATE'.
IMPORTANTI
CONST.TAX
PLEASE READ.REVERSE SIDE BEFORE , TOTAL p
CALLING FOR FINAL INSPECTION
OFFICE COPY . ter:
-