15431 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES 5 USE BALL-POINT PEN ONLY ;
• BU I LDING PROJECT'IDENTI FICATION - _- ' PERMIT NUMBER • �;,
"..LR - APPLICATION &'PERMIT "'
AGGRESS �a�s e��, geek i' 154'31
Q BUILDING - ELECTRICAL-PLUMBING=MECHANICAL '-
OWNER'54; E- - .„ - PLAN CHECK VALIDATION
NAME N aSAWJ1 °LO^V77'✓<TV " DTV ELECTRIC PERMIT" •• p FEE -
cEA7 t FSE d �47oRE 3 - o
\/ CONTRACTOR'S owrR � e.Qa7rzo N +�
�• X NAME OUTLETS-SWITCHES-RECEP: 10.00/1.00
-.5 _ uc.No.ay / LIGHTING FIXTURES I `' 10.00/1.00
" CONTRACTOR'5 't
\ y ADDRESS a?Q60 AmwG r_e,,;A/ AV& _ PPLIANCES-RESIDENTIAL �a- 4.00
Y �,�HaNE 7 PANELS ' 10.00 DATE OF APPLICATION
. 08cwrecr PANELS (OVER 200 AMP) - 20.00 ..PLAN',CHECK'FEE P.C:ND.
ENGINEER - 4
_ uc.No. SIGNS TRANS. 3.00 '
ARCH.OR ENG. - - - - - - PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00 _
'ZIP - EMP.METER OR POLE INS.' 20.00
ADDDREDRESSS S
AMOTORS , SEE FEE SCH.
SERVICE CHANGE j 20.00
Foo LICL'NSED CONTRACTORS DECLARATION - s`.•� ' ' � S l� A - '
ao 1 heruhy uflinn that I:un-licensed under provisions of Chapter 9 #AACE DATE
H z w (commencing with Section 7000)of Divisimi 3 of the Business and - J. L G. ECT. PLG. MECH..
H N z Professions Code FndJJ��y license is in full fore I -v.^ '
Z 0 m- License Classlial Lic.Number : •a
Q a H 0 lute , ED.. UI_Contraelor I `!i'
P M s 4 _ i3 G GE,J�p7,ZLN ON L1/LC .' BUILDING PERMIT
¢ tc w,a OWNER-tl UILDIiR ECLA RATION
O a 0 INFORMATION _
X ; u N " I herehy affirm that I rill exwnpt from the Contractor's License MISC.- "q REFER_TO ORD
no ¢ Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE •^ -10:00 'VALUATION SIFT.
Code:Any city orcounty which requires a permit In construct,alter,
�'� ELEGCONTR. LIC.NO.
¢ p'Q O
improve,demolish,o[repair any sl mel arc,prior to issuance,Oso , ECEQ-
0 ,
requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
rl w $m he is licensed pursuant to the provisions of the Contractor's License _ `� yN•P.%]}[a.
Law(Chapter 9(commencing with Section 7000)of Division 3 of BuC,
i p Business'and Professions Code)or that he is exempt therefrom and DTV-. .. PLUMBING PERMIT, - FEE a 0=
w H$ the basis for the alleged exemption.Any violation of Section 7031.5 - - I I STORIESTYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER IEA:) 5.00
ofml more than five hundred dollars($500).1: -
❑ d,as owner of He property,or my employees with wages as BACK FLOW 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 and Professions DRAINS-FLOOR,ROOF,`AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves(hereon,and who does such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
improve-
ment,
t, re lot into his own employees,for sale.
Provided that such im ilding - -
mCthrouhdeooroemployees, moiled thathowevsuch
building GAS-EAeSYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,tam owner- GAS EASYSTEM OVER 4 (EA) 200
builder will have the burden of proving that h - . - . .
e did not build or im- BUILDING USE
Prove for purpose ofs:d'.)' INDUSTRIAL WASTE INTER:>' =30.00 . RES IND„ CON PB Omer
..
TJ-1.as.owner of the properly,am exclusively contracting with 0
licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
mud Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5,(EA.) . 1.00
rs '
contracts forsuch projects with a contractmfs)licensed pursuant to - - '
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT No. PARCEL NO. .
❑ I an,exempt under Sec. ,H.&P.C.I'..this
reason WATER HEATER W/VENT 6.00 ' '
Owner Date WATER SYSTEM 5.00 ACC.GATE ACC,FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP.'• 5:00
I hereby affirm that I have a certificate of consent to self-insure, ZONING
or a certificate of Workers'Compensalion Insurance,or u certified , , ENG,SITE NO.
co the 40 80/0ry,Lab.G
❑
r"Oil L, is acreby turitis •tl. - FIRE SPRINK ENERGY T24
-Z � ❑ CerIi' o y.is I wit w civ Ins cutin division.
MISC- REFER TO ORD.
pr APPIiCant - v❑• No Y N� .
CC rn PERMIT ISSUANCE 10.00
LU CIiRTIPICCOM E SATION INS WORKERS' ,FLOOD ZONE A.L.U.C.
CL COMPENSATION INSURANCIi a PLG.CONTR. LIC.NO. PtG,
CL O (This section need not be completed if the permit is for one _ TOTAL Y N❑ Y ❑ N❑
� Z hundred dollars($IOD)nr less.) - a
U O 1 certify thatin the performance of the work lot which this Iver- DTV. MECHANICAL PERMIT r FEE FEE SUMMARY '
.,IL F- mit is issued,1 shall not employ any person in any manner so as to r
O W become subject to the Workers''Compensalion Laws of California. -
a Date ApplicantALTER OR ADD TO MECH. 5.00 BUILDING s �J
} N NOTICE'10 APPLICANT': If,after making this Certificate of I:x-
F 2 CmPion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
Provisions of the Labor Code, You must forthwith 111ply with - :FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10, C.RM.); '4.00 '
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 -SEISMIC FEE
I herehy affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the 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 HEATI NG UN IT ER 100,000 B.T:U.)9.50 1
Lender's Address - ELECTRIC Tu(sI
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - - -
information is correct. I agree to comply,with all city and county - 'PLUMBING
ordinances and slate laws relating to building construction, and BOILER-COMP 13 H.P.Or 100,000 B.T.U.) 6:00
hereby authoriec representatives ec this city es enter upon the BOI LEA-COMP toner 100,000 BTU)SEE FEE SCH. , MECHANICAL
above-mantionv property forinsp of
purposes to.
(Wc) agree to save,'indemnify and keep harmless the City of MISC. - REFER TO ORD.
Cupertino against liabilities,judgments, costs and Cit Penses•which - - 'CONST.TAX'`
naay in any way accrue 'insl said City in consequence of the .PERMIT ISSUANCE - ,::10.00
•ranting of this Perot . MECH.CONT. LIC.N0, MECH.L
+ ^
I a ure o pplicant/Contr r - Datc NOTAI TOTAL q0
OFFICE COPY sE,'
,. ,POST THIS'CARD NEAR FRONT OF BUILDING +
PERMIT'NUMBER
-CITY= OF CUPERTINO 154315: '
— — 4. o'INSPECTION DIVISION "
JOB'INSPECTION,RECORD '
{ P E RM IT XP I RATION'
JOBADDRESS- ��"� �'' ol—J `J T��"�"g'"� ` /v�-✓A�UNI�T# _LOT-#
PERMIT EXPIRES IF WORK
OwrvE�gN-7 .IQ—G. —' .�' ,��:$ CONTRACTOR pW'�;�Z (�-L;,�/ -t l/ •v cam" IS NOT,STARTED WITHIN
INSPECTION DATE INSPECTOR 18WAYS OF PERMIT ISSU;"
FOUNDATION q -ANCE OR 180 DAYS FROM
NOTEr -�1� '� 1 LASTCALLED INSPECTION.,
UFER 'ALL.GRADING.AND�ORAIf H�LL BE INSTALLED r
PREGUNITE _ .�' TO COMPLY'WITH THE APPFit9VED P�LyA.y$$( @�(�Q1'OF PIRMIT vnl.IUATION
CUPERTINO STANDARDS. �E V�GUV�'-
GARAGE SLABS C�`7
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - i i +✓ f '
UNDERGROUND'/SLAB - - '� f; ff , .i•
PLUMBING .
ELECTRICAL - ISSUANCE DATE `
MECHANICAL HLDGf ELECT. PLG. - 'MESH.
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATIONe
WOOD FLOOR' vnwnnDN . s/Pr.
PLUMBING -T +
MECHANICAL ``^z
' - PERMIT TO /
ELECTRICAL 4{-'+.:
FRAMING
STORIES TYPE CONSTR.
INSULATION '.. -
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF - NOTE NO FINAL INSP.SHALL BE MADE BEFORE SO.FT.FLOOR AREA .'ICTAL ACRKAGE T
DIAPHRAGM THE CONSTRUCTION TAX IS�PAID
BUILDING USE
ROOF SHEATHING - - RES IND CDN PB
--�- _ "'APPLY'NO.ROOFING UNTIL ABOVE•HAS BEEN SIGNED ' FINALS ,r;'DATE-.: - r INSP:'. , ❑ ' El ❑'` ED El
ASSESSORSPARCLL NO
ROUGH SAN.a- '
PLUMBING. I ELECT.ENERGY rRncIND� PARCEL No
TUBS 8 SHOWER PAN - PLUMBING ENERGY - -
. MECHANICAL MECH'.ENERGY
ELECTRICAL , AO
-
BUILDING ENERGY - C;DATE ACC,FI CE NO'.
FRAMING ELECT.FINAL TEST
TINSULATION' �,+', PLUMBING' ZONING - ENc.517E No.
GASTEST' - GAS
MECHANICAL FIRE SPR w(; - ENERGY 1 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N'❑ ❑ Np
FLOODZONF. A,L.U,C
R
EXTERIOR SHEAR e ELECTRICAL RELEASE v� N� v L' rv❑
INTERIOR SHEAR ' " FIRE DEPT.
SHEETROCK I - , GRADE FEE SUMMARY
EXTERIOR LATH BUILDING - -
' 'r' ,INTERIOR.LATH ' .. TEMPORARY APPROVALS BUILDING, 7,.m
SCRATCH COAT, JELECTRIC. PLAN CHECK
_ GAS - FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCV'OF B U ILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM •}
LU' ; ARRANGE FOR,.INSPECTION.BY PHONING 2574505, `T ELECTRIC
I—� .' ONE WORKING DAY BEFORE REQUIRED INSPECTION. '
'PLUMBING
o ' PLEASE GIVE JO.B,ADDRESS WHEN PHONING.
Z MECHANICAL
—SEE PERMIT EXPIRATION DATE '—
M„ CONST.TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE'
CALLING-FOR FINAL INSPECTION. TOTAL •• r
OFFICE COPY