17944 (2) APPLICANT TO FILL IN INFORMATION WITHIN.RED LINES - USE BALL POINT PEN ONLY
r " - PERMIT NUMB ER '•
"`•8UI LDI NG PROJECT IDENTIFICATION'
BUILDING
APPLICATION ,PERMIT•
AD REsaK � LBUILDING-ELECTRICAL-PLUMBING --MECHANICAL
Q A 4-
OWNERS
I PLAN CHECK VALIDATION
NAME DTV. ELECTRIC PERMIT FEE
I 6
'PHONE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1'.00
REV.1I�.'�� Ic.No. _V LIGHTING FIXTURES 1000/1.00 '
CONTRACTORS O 's' .�L� APPLIANCES`=RESIDENTIAL , 4,00 -
ADDRESS
I A)r 'PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
O PANELS (OVER 200 AMP.) 20.00 _
/ ucYNo. SIGNSTRANS: .' .3.00 '
ARCH.OR ENG. - - PERMIT VALIDATION
An REss .. SPECIAL CIRCUIT � - •5.00 ^ q
�x.,� ZIP EMP.METER OR POLE INS. 20.00'
ADDRESS i� as �a MOTORS - SEE FEE,SCH.
ADDRESS �r� ` `
((� SERVICE CHANGE 20.00 J • .44)roZQ LI LU
o o LICENSE[)COMI'RACI'ORS DECLARATION
a o - I hereby of umi,that I ain licensed uo Jerpmvisionsof Chapter9 IS6UANCE DATE i
y a i (commencing with Section 70001 of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
y.z I rofcyy// Ityyp�Grr��II ,a isp��y�y infullfor t. - Q
z o w- Lic�IR'FlwiY1 - ' 'E'Cant er .❑ ❑ ❑
o z r w [)ate-dl-�ee (,FQ_Contrucmr
A BUILDING PERMIT
¢ ¢ w ¢ OWR-BUILDIiR DECLARATION / -
o u o - INFORMATION
E
;,u y Lherchy al lion that 1 am exenlPLlrnin the Contractors License MISC.- RE fl ORD
-RU0 < Low for the following reason.(Sec.703 1.5,Busiitesseid Professions PERMIT ISSUANCE 1000 - VALUATION $/FT.
Code:Any city or county which requires a permit to construct,alter, _
Se ¢¢ impmve,demolish,or repair any slruclum,prier to its issuance,also EIEC.CONTR. LIC.N0. ELEC. r
DLLrequites the applicant for stich permit to file a signed statement Ihul TOTAL PERMIT TO
A w mhe is licensed puRumit to the provisions of the Contractor's License
H z a' Law(Chapter9(cmnmencing wit h Section 7000)of Division 3 of t he - `�� [/ ��
3 o Business and Professions Cole)"or that he is exempt therefrom and QTY. PLUMBING PERMIT- FEE-
¢ r m the basis for the allege)exemption.Any violation of Section 703 L5 i STORIES TYPE CONSTR.
d ; - by any applicant for a permit subjects the applicantloo civil peoully ALTER-DRAIN&VENT-WATER (EA.).5.00 "
of not more toll five hundred dollars(55001): _
❑ I,hs'owner of(lie property,or my employees with wages as BACKFLOW PROTECT. DEVICE . 4.00
their sole compensation,will JOH he work,and the slruetae is Hol OCC.GROUP RES.UNITE
-- - a
in ended.or•offered for sale (Sec. 7044, Business andTrofessious DRAINS'-FLOOR,ROOF,AR EA,CON D. 5.00
Code:'fhc Contractor's License Law docs not apply to an owner of -
property who build,orl Vllpmve5 drawn,and who does S,a,h work FIXTURES,PER TRAP-� 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,provided that such improve-
' ments mselfo not through his or of employees,
sule.H',ed that suhenTrongGAS-EA.SYSTEM-1INC.4OUTLETS 6.00 /
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200
builder will have the burden of,proving that he did not build or int - . . .
BUILDING USE
prove for purpose of sole.). .. INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
-0-1,as owner of the property,am,exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed commetors,to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. : 6.00 ASSESSORS and Professions Code on
The Contractor's Litems Law J0RS PARCEL NO.
oes not apply O
- to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) ' 1.00
contmets for such projects with a contructor(s)Iieen ed pursuant to SEWER-SANITARY-STORM 1000
-STORM EA.200ft/ .
the Contractor's License Law. ES .DO TRACT NO. PARCEL NO.
❑ lumexenipnmder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date / WATER SYSTEM 5.00 . 00' ACC.DATE' ACC.FILE NO,
WORKERS'COMPENSA'TION DECLARATION, WATER TREATING EQUIP., 5.00
I hereby Hlfirm•Omt 1 have a certificate of consent to self-instal, - ZONING -
or o certificate nfWorkers'Compunsation'Insumnce,NTH certil'ieA ENG.SITE N0.
copy thereppf��$$��gg3p
v Policy No%(JE+LI'C21� C1 �
0 - v❑ Certified copy a hereby II rnlshed : - FIRE SPRINK ENERGY T 24
z 2 /�CcNift�N o�nY tiled with the a ty py� Jgg t '
-Q IA'pleall _7_ . I�, MISC.- REFERTO'ORD. v❑ N❑ vQ N❑
~ w uYu b"RA - PERMIT ISSUANCE - 10.00/ a.0 FLOOD ZONE A.L.u.c.
LU CERTIFICATI.OF EXFMI'T ON'FROM WORKERS' � I Q
W CUM P17NSATION INSURANCE PLG.CONTR., r LIC.NO. PLG. �+
4. O (This section need not be completed if the permit is for one 's TOTAL J /. Q �Y❑ N❑ Y ❑ N❑
z h lmdred'dollxrsf$100)or less.) a
U O - I certify that in the performance of the work for which this per-' CITY MECHANICAL PERMIT FEE FEE SUMMARY '
LL 1- mitis issued,I shall not employany,person in any manner so as m .
O W become scluco to tic Workers'Cumpunsullmt Laws of Culikania. '
M Date Applicant BUILDING
} to NOTICE TO APPLICANT: If,after making thin Certificate of fix- ALTER OR ADD TO MECH. 5.00
r-, 2 emplion,you should become Subject to the Workers'Cornpcnsat ion. 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 16000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a cmistnwtinH loading agency for EXHAUST HOOD(WITH DUCT) 5.00 '
Ihc-•performance of the work for which this permit is issued(Sec. - MICROFILM
3097,Civ.C.). , r HEATING UNIT(TO.100,000 B.T.U.) 6.00
Lender's NamAdd
"- HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
beeHify that l la ad this appli 'llon amt (are thit the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING /9
oah ances.and state laws relating in building construction and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00
hereby aulhar¢e represetatly s al.this city to enter upon tile
above-mentioned property for Inspection purposes. BOILER-COMP (Over 100,000 BTU(SEE FEE SCH. MECHANICAL
,
e. (We) agree to Give;,indemnify and keep hont'dess tlic.City of MISC.-, REFER TO ORD.
opertino against liabilities,judgments, costs and expense`s which PERMIT ISSUANCE 10.00 CONST.TAX '
ma (in'any way accrue against said City in consequence of tile -2
'r' tiny thi a lit MECH.CONT. .LIC.NO. - MECH. �!
S TOTAL TOTAL
Signature of Appicant/ContractorTrall,
OFFICE COPY .
POST THIS CARD NEAR FRONT OF BUILDING :
- _ � � PEEMIT NUMBER
CITY OF CUPERTINO 17944
INSPECTION DIVISION. —
�' JOB INSPECTION RECORD
'- PERMIT EXPIRATION
t�/U� ' SUS. GJsi u
JOB'ADDR ESS OF 'UNIT# LOT#
PERMIT EXPIRES IF WORK .
-
OWNER ,�?;��AJcU —x coNrancroa A/� .' .IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD '18o DAYS'OF PERMIT ISSU-
+ FOUNDATION - ANCE OR 180 DAYS FROM'.
- -+ NOTE: LAST CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BE'INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .;TRMIT VAL'UATION
,GARAGE SLABS CUPERTINO STANDARDS. fo
� _ ^�A•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND)SLAB. �' Nra uCaj
PLUMBING
ELECTRICAL +: t ISSUANCEL)ATE
: [LECr., . PLG %gE cR
' ,MECHANICAL- BLDG
J � � :.❑ ❑ �
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT'
WOOD FLOOR citINFORMATION
PLUMBING vnwnnoN' .siPT.
MECHANICAL
ELECTRICAL PERMIT TO .
FRAMING am eAfkl,
'INSULATION - STORIES .+YVECONSTR,
7 •1C!T �,. Ver DCC-GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4T. o� / 3 - .....;,P'
• * - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE y -sa.r.ELoaR AREA TOTAL ACREAGE
DIAPHRATHE CONSTRUCTION TAXIS PAID '
GM
ROOF SHEATHING I+I_S ,IND 1°LON USE 8: 0111.1.
APPLY NO ROOFING UNTIL ABOVE+HAS BEEN SIGNED FINALS DATE , INSP. .0
..
'ROUGH SAN.N •ASSESSORS PAH CEL NO.,
' , �
PLUMBING' ELECT,ENERGY
TRACI NO. "PARCEL NO.
TUBS&SHOWERPAN PLUMBING ENERGY
MECHANICAL - " MECH.ENERGY T ,
ELECTRICAL ' BUILDING ENERGY , ACC DATE ncc.FILE No .
FRAMING- _ ELECT.FINAL TEST _
ZONING 'ENG.-SITE NO. +
INSULATION - PLUMBING -
GAS TEST - GAS
MECHANICAL . . - FI9ESPRINK ENERGY T.]a
1.
._ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ No Y [3 NE]
'EXTERIOR,SH EAR ELECTfLGDI1LONE A.L.U,C.
RIC RELEASE '� � v❑, _N❑ ;. +•y L ;N❑
'INTERIOR SHEAR � .. - I. FIRE DEPT.
. SHEETROCK ' GRADE 7 FEE SUMMARY
EXTERIOR`.LATH BUILDING '
INTERIOR LATH - TEMPORARY APPROVALS BUILDING
SCRATCH COAT', ' ELECTRIC` PLAN CHECK
GAS . .FEE.
NO TAPE OR PLASTER UNTIL ABOVEAAS BEEN SIGNED JOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM'
ARRANGE FOR.dNSPECTION-BY PHONI'NG'252-4505, ELECTRIC . '
o - . ONE-WORKING DAY BEFORE REQUIRED INSPECTION. " PLUMBING QQ
' 'PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z I , MECHANICAL=
SEE PERMIT FOWEXPIRATION' DATE
". 1MPORTANTI. CONST.TAX.•
PLEASE READ REVERSE SIDE BEFORE
CALLING.FOR FINAL INSPECTION.. TOTAL ..
' OFFICE COPY