09699 (2) /
APPLICANT TO FILL IN INFORMATION'WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT
PERMITNUMBER
Bull ABUILDING -ELECTRICAL-PLUMBING-MECHANICAL 09
n
OwaPLAN CHECK VALIDATION
CITY.
ELECTRIC PERMIT FEEcMON V
-
coNrRAcrons UTLETS-SWITCHES-RECEP 10.00/1.00
ab r CaY LIC.N LIGHTING FIXTURES 10.00/1.00
coxTRAcroRs U 3 PPLIANCES-RESIDENTIAL !_.GO
AOOREss
PANELS 10.00 DATE OF APPLICATION
ORRCHITECT CIG /_'� PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
ENGINEER .J�QOI k,��
�S`xlASSOCLIC.NO. SIGNS TRANS. 3.00
ADDRESS ENO. "V_�l Gnm lal SPECIALCIRCUIT 5.00 PERNNaj`yQyIWT ON
ADDRESS R C�POr r MAY
k QLrd xIIAL110 10 TEMP.METER OR POLE INS. 20.00
APPLICANT p�
AP - - MOTORS SEE FEE SCH. .MAR 2 o 1,Jn
ADDRESS
I �3 Ot"SlID9 SERVICE CHANGE 20.00
wo LICENSED CONTRACTORS DECLARATION TEMP.POLE . 30.00 City, of Cupertino
Q w u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
Z (commencing with Section 7000)of Division 3 of the Business and
BL E T. "PLG.
r y i Professions s nd my license is in full r a ec
Z o,.t- License,C1 ss Cmr Number / -
w t w Date -` Contractor-J)P CC
ir ac X a OWNER-BUILDER DECLARATION BUILDING EMIT
K
;n y I hereby affirm that I am exempt from the Contractor's License
MISC.- REFER TO ORD INFORMATION
r u-Oj Law for the following reason.(See.703 1.5,Businessand Professions PERMIT ISSUANCE 10.00 fAa
VALUATION $/FT.
,A i Code'.Any city or county whichrequiresa permit to construct,altar,
10.
ac rt Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
e w m he is licensed pursuant to the provisions of the Contractor's License
F Z Law(Chapter 9(commencing with Section 7000)of Division 3 ofthc
a
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M 1-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i by any applicant for a permit subjects Ota applicant toe civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the 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 Contractor's License Law does not apply to an owner of
property who builds at improves thereon,and who does such work H FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA .TOTAL ACREAGE
• himself re through his Own offered
fors,provided that such improve-
hients mself c not through his or employeesale.Iided that r.such
building GAS-EA.SYSTEM-1INC.4OUTLETS 8.00
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 proving that he did not build or am. BUI DING USE
P
for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 E IND CON pB Other
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ 11
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASS ESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply /
to an owner.o(property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractorts)licensed pursuant to SEWER-SAN EA.200ft/10.00
the Contractor's License Law, T CT NO PARCEL NO.
❑ I am exempt under Sec..,BAP.C.for this I WATER HEATER W/VENT 6.00
reason
owner - I Data WATER SYSTEM 5.00 ACC.OA ACL.FILE NO. ^
WORKERS'COMPENSATION DECLARATION WATERTREATING EQUIP. 5.00
I hereby affirm that I have a certificate of consent loself-insure,
of a certificate of Workers Compensation Insunaanee,or a certified ZONING ENG.SITE NO. a
copy thereof(Sec.3800,Lab.C.I. 1 ,S, F�y t .
Policy Na Company V
0 ❑ SSertified copy is hereby furnished. FIRE SPRINK ENERGY TZ4
Z Z �cary4RN�e�-�gqppppyy��ii;�d 1 th ;it t pection division.
F O Applicant` f-1_ MISC.- REFER TOORD. Yo NE] Y C] No
W CERTIFICATEOFE)8MPTIO I' OMWORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INPRANCE PLG.CONTE, LIC.NO. PLG. /
Cl (This section need not be completed if the permit is for one TOTAL V N� Y Nr
hundred dollars($100)or less.)
U O 1 certify that in the performance of the work for which this per OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mit is issued.I shall not employ any person in any mannerso as to
CJ become subject to the Workers'Compensation Laws of California.
Q.W Date Applicant BUILDING
} to NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00
I.. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK J/r
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 10)030C.F.M.) .4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10p00C.F.M.) 6.00 SEISMIC FEE 0 �
I hereby affirm that there is a construction tending agency 1'or EXHAUST HOOD (WITH DUCT) 5.00F?.
the performance of the wor for which thisMICROFILM
permit is issued(Sec.
3097,Civ.C.). y
Lenders Address
HEATING UNIT(TO 100,000 B.T.U.) 6.00 /
Lender's NamtI ��/ � �`^ HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
YT
I 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 state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00
hereby authorize representatives of (ties city to enter upon the BQI LER-COMP (Over 100,000 BTU)SEE FEE BCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue against said City inns
coequence of the
grant] oft B.Pe MECH.CONT. LIC.NO. MECH.
Q TOTAL 1 TOTAL l 5
guature o licant/Contractor Data
�I /
OFFICE COPY '
t
1.
POST THIS CARD NEAR FRONTOF BUILDING
PERMIT NUM R
-CITY OF': CUPERTINO
r INSPECTION DIVISION
M - JOB,INSPECTION RECORD.
U�fJ I I PERMIT EXPIRATION
4 II _ L ,.
JOB ADDRESS UNIT LOT#
L-- - - - PERMIT EXPIRES IF WORK
OWNER coNTRAcroR IS NOT STARTED WITHIN .
INSPECTION DATE INSPECTOR INSPECTION RECOR •-180.DAYS OF'PERMIT ISSU
, FOUNDATION OR 180 DAYS FROM ,
UFER LAST CALLED INSPECTION.
r ..
PREGUNIT Y. , . i .P _ o TICN
a
POUR NO CONCRETE UNTIL AB VE HAS BE MAR 2 q
SIGNED " '��®((� .. •
UNDERGROUND /SLAB . {?'
PLUMBING - - ,City of CupB�IDA�
ELECTRICAL - '
ISSUANCE DATE
'MECHANICAL - - eLo_ . EL r. PLG. MECH.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDINGPERMIT/
WOOD FLOOR - 'INFORMATION
PLUMBING - VALUATION S/FfT. .
Yl- w j
MECHANICAL
ELECTRICAL PERMITTO
I j
FRAMING
,y
INSULATION' srORIEs TYPE CONSTR.
_ I ;;�,•. ' r"'':iii ��'•�"'- .
OCC.GROUP 'RES.(UNITS
L PLACE NO SUBFLOOR UNTIL ABOVE HAS B EN SIGNED V.I ?. f
L r1� ROOF SD..FT.FLOGRAREA ,TOTALACREAGE
Y yqt,
la DIAPHRAGM �,.. _''��"i " , .•
.BUILDING USE
�. ; RES IND CON ' PB O n
s" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED N", ❑ •❑ `❑ ❑: "
- - ROf
OUGH ,+� ASSESSORS PARCEL,NO.
+ PLUMBING '.'n j_ -
GAS TEST' TRACT NO PARCELING
MECHANICAL' r" Vzi: E
ELECTRICAL _ ACC.UAL ACC,FILE ND=s
0- FINALS DATE `'INSP. •• Via.
FRAMING' — SAN
INSULATION - PLUMBING - zow NG+ + :ENG SITE No.^ ,
GA
CHANI AL; "FIRE SPRINK :.ENERGY T 2E �c
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED qEATIJING Y.❑ N[_ ' � N❑
LATH—INTERIOR' LECTRICALj 'FLOODZONE A.L.LIC. .
. LATH-EXTERIOR '- F EDEP Y❑ NC] �rv❑ N❑'
SHEETROCK ' GRADE �•IQi FEE SUMMARY.
SHEAR INTERIOR - BUILDING _
SHEAR EXTERIOR - BUILDING !- p
6- 6 TEMPORARY APPROVALS
FIREWALLS ELECTRIC p_ PLAN CHECK
GAS FEE
•x
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY i SEISMIC FEES
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUI LDING FINAL ISSIGNED By BUILDING INSPECTOR."
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC {. k+ll
F " ONE WORKING DAY BEFORE REQUIRED INSPECTION. i
O ' ` 'PLEASE GIVE JOB ADDRESS WHEN PHONING. PcumBlNc
z — SEE PERMIT FOR.EXPIRATION DATE MECHANICAL:`' ) '
hCONST.TAX
IMPORTANT! ..
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL' ?i
OFFICE COPY