17180 (2)_ APPLICANT TO FILL IN INFORMATION WITHIN.RED LINES - USE, BALLPOINT PEN ONLY ''
-BUILDING PROJECT IDENTIFICATION. .PERMIT NUMBER _
BUILDING APPLICATION & PERMIT . 71 ^j(
ADOREss J. .1 • I;,VO
;f 0S BUILDING-ELECTRICAL=PLUMBING"MECHANICAL o
NWNER's,,, PLAN CHECK VALIDATION
.� TY., A ELECTRIC PERMIT FEE - .PD
CONTRACTORS
NAME
OUTLETS-SWITCHES-RECEP 10.00/100 O'
G� LIG No.'', LIGHTING:FIXTURES: 10.00/1.00
ApDRE55 TOR'S v !
/ /( PPLIANCES-RESIDENTIAL 4.00
PHONE�4A - Y4 y PANELS - 10.00 PATE OF APPLICATION
ARCHITECT _ PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0.
ENGINEER
LIC.No, SIGNS TRANS.' j '3.00
ARCH.OR ENG, PERMIT,VALIDATION'
ADDRESS,,, - - SPECIAL CIRCUIT. 5.00 -
xlP ` EMP.METER OR POLE INS. 20.00
A \ MOTORS SEE FEE$CH. '
ADDDRESSDRESS / a
19/609�7�w�d C SERVICE CHANGE 20.00 SInC AI•
o � z.
H 0 0 .LICENSED CONTRACTORS DECLARATION t, ;
a z w' 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE
ai a (c'ommemm�g with Scown 7000)of Division 3.of the Business Bud .-.1 BLOC. .ELECT. PLG. MECH.
r D z Professions Codc,and my license is in full Dune and effect. - - - ED
o°J, License Class Lic.Number - - ,
,a m r Uric - Contractor -
a ,: BUILDING PERMIT
Wrt w a - OWNER-BUILDERDECLARATION, - -
F. o A 0 - .INFORMATION
w 3 LL F. I hereby:dl'irm thut,l am exempt from the Contractor'S,License t MISC.- • REFER TO ORD
u O j Law far the following reason.(Sec.7031:5,Business and Professions s VALUATION .$/FT.
- - PERMIT ISSUANCE �; _ 10.00 ,0
Code:Any city or county which requiresa permit taconslnmLaher, ^ �O
QB, ¢0. improve,demolish,or repair any structure,prior to its issuance,also ELEC.DDNTR, LIC.NO. ETEC. yJ
d'wDLL requires the applicant for such permit to filen signet statement that TOTAL �•l,\(� PERMIT TO
m he is licensed pursuant to the provisionsofthe Contractor's License ,
rz ¢ Law(Chapter.9(cmimencing with Section 7000)of-Division 3 of the
i
< . Business and I'nsfessions Code)or that he is exempt therefrom end. QTY. - PLUMBING PERMIT _ FEE t �� �
IT-
Or I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
5_: by by any applicant for a permit subjects the applicant loacivil penalty.mALTER
-DRAIN&VENT-WATER (EA.) 5.00 O
• of not more than five hundred dollars 155007:1: -
❑ I,as owner of the property,or my eployees with wages as BACKFLOW PROTECT. DEVICE 4,00 OCC.GROUP RES.UNITS
their Sole compensation,will do the work,and the structure is not
-" Intended or offered for sale (Sec. 7044:Business Bud Professions': DRAINS-FLOOR,ROOF;AREA,COND. 5.00 "
Code:,I'he 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 21 01D SO.FT;FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improvmGAS-EA:SVSTEM-11NC.40UTLETS 6.00 -
merits are not intended orofl'cred for sale.l L however,the building -
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 proving that he did not build or int - BUILDING USE
p[ove for purpose of sale.). - INDUSTRIAL WASTE INTER3000 - RES IND CO .PB Otho,
r$'- I,as owner of the property,am exclusively contracting with . . ❑ El El~ ecnsed contractors to construct the project(Sec. 7044,113usiness LAWN SPRINKLERS- 1 INC 5 V.B. _ 6.00 - ASSESSORSPARCEL NO.
and Professions Code:The Contractors License Law does not apply -
to an owner of property who builds of improves thereon.and who LAWN SPRINKLERS=OVER 5(EA.) . 1.00 ,
contracts forsuch projects witha contractims)licensed pursuant to - $EWER-SANITAR V-STORM EA.200ft/10.00
the Con tractor's,License Law. TRACT NO. PARCEL NO.
❑ I am ex em pt under Sec. " ,B.&P,C.1orthi, WATER HEATER W/VENT 6.00 .
reason
•, Owner - -'Dat - WATER SYSTEM 5.00 , - ACC.DATE ACC.FILE NO.
wORKERS'contrft Al ION DECLARATION WATER TREATING EQUIP. 5.00 _
'1 hereby affirm that I have a cerlificm,ofCmwB t to scl-uSLne, '-t I - ZONING ENG.SITE N0.
or a certif¢me of Workers'Compensation Insurance,or a certified
' copy Ihereof(Sea 3800,Lab.C.). - -
policy No d ' company r
O ❑ Certified copy is hereby furnishedFIRE SPRINK ENERGY T 24
_Z Z O Certified copy is fled with the city inspection division.
CC OApplicant - MISC.-.. R I RD. 'Y F] N❑ Y ❑ No
PERMIT ISSUANCE . 0 (Z
LU - CERTII'ICATIi OF EXEMPTION FROM WORKERS, 100 \C� FLoOO ZONE A.L.U.C.
W COMPENSATION INSURANCE „ PLC.CONTR.. LIC.NO."
L-�
Z hiS section mol need be completed if the permit is for one
1TG\.p� Y❑ " N❑ V ❑ ry❑ ,
bandied d.11m,IS 100)or Iess.L -
U O 1 certify thatin the perfonnami,of the work for which this per- QTY. • MECHANICAL PERMIT' FEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any person in any manner so as to
O w become subject to the Workers'Compensation Laws of California.
a. Date ApplicantALTEROR ADD TO MECH. 5.00 1 BUILDING
} rn NOTICE TO APPLICANT: If,after making this Certificate of fix- - •-
? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.0 PLAN CHECK• ,'. _
provisious.ofthe Labor Code, Ym; most forthwith comply,with FEE' v
U - Snch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000QF.M.) X .00
CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MCfielt6.00 SEISMIC FEE
\ .
I hereby affirmth there is a construction for is agency for EXHAUST HOOD(WITH DU 5.00
the performance of the work for which this'pennit is issued(Sec. MICROFILM It
30ader', .am . HEATING UNIT(TO 100,90 B.T.U.) 8.00
Lender's Name HEATING UNIT(OV 100,000 B.T.U.)9.50 2�t�0
Lend rs Address - . - ELECTRIC
I c rkly that I have read this application and stale that the above , VENTILATION F (SINGLE) 4.00 '
Information is Correct I agree to comply with all city and county
ordinances and state laws relating to building construction, and BOILER-COMP H.P.or 100,000 B.T.U.) 6.00 PLUMBING (p\p0
hereby unhorine representatives of dus.Ehy In anter upon Ih°
above-mentioned property for inspection purposes. --BOILERMP 10var 100,000 BTU)SEE FEE$CH. MECHANICAL
(We) agree to save, indemnify and keep harnlcss'the City of MISC REFER TO ORD.
upertino against liabilities,judgments, costs aid expenses which r P MIT.ISSUANCE 110.00 - CONST.TAX -
cry In By way accrue against said ity in corp,uence of the -
Lran g f is per I. MECH ONT. LIC.NO. MECH �j q
Al, -_y / TOTAL " TOTAL D21 IS
S' azure of App iwnl/ ontrado Date
OFFICE COPY
PO ST THIS CARD NEA4kFR'ONT OF BUILDING
PERN11T NUMBER ' +
1
`{ CITY 'OF CUPERTINO ,f
1 711 80
INSPECTION DIVISION
JOB'INSP,ECTION RECORD
{PERMIT`EXP RATION
JOB'ADDRESS _� (INS STF.�a GF\..�SL�]Q� UNIT# LOT# t
-'4 PERMIT EXPIRES IF WORK y
OWNER'' �"(QrwJt�� ���}- �j OCA' CONTRAC`Toar`' IS NOT STARTED WITHIN
. INSPECTION'.. DATE` JINSPECTOR. INSPECTION RECORD - - 'iBo,ogvs of PERMIT Issu '�'
FOUNDATION ,�. j x,.-u 'ANCE OR{,180.DAVS FROM
NOTE: LAST.CALLEDINSPECTION.,- '�
UFER •" - ALL•GRADING AND DRAINAGE SHALL BE INSTALLED 1 �. :
TO COMPLY,WITH THEC4PPROVED PLANS AND CITY OF PERMIT vau DATION
PREGUNITE - " > •',i•, CUPERTINO STANDARDS +.,
GARAGE SLABS µ• " °- .' s - L 3-� �� _ 'e
POUR NO CONCRETE,UNTIL ABOVE HAS BEEN SIGNED -
' • UNDERGROUND /SLAB, _ ,, °' - •'�O ��
PLUMBING - -
ELECTRICAL ''ISSUANCE RATE
MECHANICAL
LBLDD. ELECT. PLG MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN'SIGNED + . . ,-BUILDING PERMIT'
- WOOD FLOOR - e 'y. r- INFORMATION
VALUATION .$IFT,
PLUMBING-
MECHANICAL "tib'
' • . F -,OK-' PERMU To
ELECTRICAL eKe
FRAMING _ _a�.GIVlCLYYN F^o1p�'emS0.r ;
INSULATION 4'>-S-S"l •eP�"�•c..4+' cr�vYK�.@K pC<oLL sroRlEs' TYPE comsrR.
:i"•, s . Av �-�Cor-'P?!',-...r r fess;, of c,.:. .. ', .
- - OCC,GHO UPS . HES UNITS
IC
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
•� ROOFNOTEINO•FINAL INSP-.SHALL'BE MADE BEFORE 5°,`r FL°ol�al�Ln To:nL ACREAGE
DIAPHRAGM THE CONSTRUCTIOWTAX IS PAID
BUILDING USE
ROOF SHEATHING HES I•IND CON-., PB .o,l--'
^AP,P,CTYkNO';ROOF.INGzUNTIL"^ABO_VE,HAS`BEEWSIGNED,, Y „FINAL'S?; " '.°`F? n'+DATE,'"`:, „.ANSP; = � � ` � -'�' �
_ nSSESEGHK PARCEL NO.
ROUGHSAN.N ..{ :Lr=
Y 'PLUMBING 3- . ELECT:ENERGY
• TRACLNO. PARCEL NO
-- TUBS&SHOWER PAN,:- * ^',r ` "PLUMBING ENERGY. -
' MECHANICAL” MECH.'ENERGY
ELECTRICAL > - BUILDING ENERGY..i -� . nce.°are ACG FICe No.
a FRAMING ELECT.FINAL TEST _ -
r. INSULATION ; PLUMBING -I' SNG ENG SITE NO.•,
GAS TEST - • 'r. GAS•- _g .G -
.FI SPRINK ENERGY T 24
COVER NO WORK UNTIL ABOVE MECHANICAL +
HEATING ""� NE]HAS BEEN SIGNED
,FLOOD ZONE A:L,U C.
EXTERIOR.SHEAR: ELECTRICAL RELEASE -
INTERIOR'SHEAR,' • - FIRE DEPT �(.,' 6 " Y Q'. NCl - .�N ❑" NE] r'
SHEETROCK •' ' GRADE �„< r�„ FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING- '
INTERIOR LATH "`' TEMPORARY APPROVALS
4 . . SCRATCH COAT - ELECTRIC PLAN CHECK
_ FEE.
. „ S.,,.
, ,I
GA -a
NO TAPE OR PLASTER UNTIL ABOVE,.HAS BEEN SIGNED, OCCUPANCY ? ,: sElsNil.c FEE r. • �^ �4g'
OCCUPANCY OF BU I LDING IS NOT PERM ITTED UNT,IL•BU I LD ING F I NAGS SIGNED BY BUI LDI NG INSPECTOR MICROFILM
w. . ARRANGE FOR INSPECTION BY PHONING 252,4505 ELECTRIC s IJ t
F- • . ,NONE-WORKING .DAY BEFORE REQUI.REDlLNSPECTIONPLunneiNG`
z PLEASE.GIVE,JOB ADDRESS WHEN PHONING G '
' = SEE,.PERMIT FOR EXPIRATION DATE MecRANICA '
IMPORTANT[ co vsr'Tax
`
PLEASE,REAO'REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL �S�GI
OFFIQE COPY