18650 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
_111.1I LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT PERMIT NUMBER
BUILDING Q C C O
ADDRESS d 0�/ UJ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
t•
OWNER'S - PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE'
PHONE b 0
cFITRAcroRs ! - UTLETS-SWITCHES-RECEP 10.00/.1.00 -
NA
/ � l^ LIGHTING FIXTURES 10.00/.1.00 •' "
uc rvo0`
- --
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
A RE
PHON �� PANELS 10.00
GATE K APPLICATION
A CHIT CT - - PLAN CHECK FEE .P.C.N0.
OR - PANELS MOVER 200 AMP) 20.00
ENGINEER '
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. PERMIT VALIDATION
ADOR Ess SPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 ¢7
APPLICANTS
ADDRESS - MOTORS SEE FEE SCH.
ADDRESS -
SERVICE CHANGEla'a ASP
00
'00
00 - LIC17NSEDCONTRACTORS DF.CL.ARATION /TTI,-�t-"(l 6 y-{W
¢ v I hereby affirm that I am licen sell under provisions of Chapter 910 2 5 191ISSUANCE DATE V -
m a m (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. 'MECH.
1 f ions Co n Been Lis In full fo W_�_
-
zo'w L cense Class Lic.M1umbcQ
o °w Date Contra tor_ • C�tv 0} CanPiOo
a x s 'BUILDING P RMIT
¢o aOWNIiR-BUILDER DECLARAINFORMATION
X g w 1 hereby affirm teat I am exempt from the Contractor's License MISC.- REFER TO ORD
w o a Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 10.00 VALUATION g/FT.
-�� Codd Any city or county whichrequiresa permit to ConstrucCAb,r.
¢ ¢¢ improve,demolish,ocrepair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC.
w
¢ ¢ requires the applicant lo,such permit to fi1C a signed statement that TOTAL PERMIT TO
w re ve he is licensed pursuant to the provisions of the Contractor's License _
Fz >
Law(Chapter 9(commencing with Section 7000)of Division 3 of the.
- a Business and Professions Code)or that he is exempt therefrom,and CITY. PLUMBING PERMIT FEE V wL [
IS o the basis for the alleged exemption.Any violation of Section 7031.5 1 STiORIES Typt CONSTR.
a 3 m by any applicant fora permit subjects the applicant toa Civil penalty
of not more than five hundred dollars(5500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
1
❑ ,as Uwncr of the property,or my employees with wages usggCK FLOW PROTECT. DEVICE 400 ore.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 or improves thereon;and who does such work FIXTURES-PER TRAP c 5.00 Sa.FT.FLOOR AREA TOTAL ACREAGE
hintas are of roighte his own emred for s lI provided,ho ever,t h improve- .v ..
mlustifenotintcndedoroffcrcdfirsa that CIl building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IUB CON PB Omer
Prove for Purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑
0 1,as owner of the properly,nm exchisively Contmeting.with
licensed.contiactors to construct the prmjc Cl(Sec. 7044,Business LAWN'SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and Who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such Projects with a contractor(%)licensed pursuant to
the Contractor's Licens,Law. _ SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ l am exempt under Seo. ,BAP.C.I'or this WATER HEATER W/VENT 6.00 f,D
reason
Owner - Dale WATER SYSTEM 5.00
ACG DATE ACG FILE NO.
,+ WORK ERS'COMPENSA1 ON DEC LARATION WATER TREATING EQUIP) .5.00
1 hereby affirm that I 'Sae a certificale of consent to sell-insure. A - ZONING
ENG.SITE NO.
or a tificatc of Workers CO
n Ins once, a Cev ified
cop y�.e r, 00.La .C.).
PofAJlf/.. Comps Y _ _ .
Q Cer5R [
opy ishereb fumished FIRE SPRINK _ ENERGY T-24
p Ce,' antcopy is Ole w'Ih Ihe.city inspL¢lion division. MISC.- - REFER TO ORD. 'y E] N� Y ❑ NE
Hy PERMIT ISSUANCE 10.00 ,Q� FL00.ZONE ' A.L.u.C.
LU C[ CATE COMPENSATION
ION FROMNCE 9 ERS'
CL CON not be ION(NSU if tho . PLG.CONTR. LIC.N0. - PLT. D YE] N Y ❑ N Qt.
C (This senium need not be completed if the pemtit is for one TOTAL
D Z hundred dollaa(5100)or less
-)
U O 1 certify that In the performance of the work far which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
'LL H mil is issued.1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California,
C. Datc` Appleait ALTER OR ADD TO MECH. 5.00 BUILDING
} to NOTICE TO APPLICANT: IL after cooking this Certificate oil Fx-
Z emption,you should become subject to the Workers'Compensation APPLIANCE '5.00 PLAN CHECK
provisions of the Labor Codi, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10)000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the pCrfonmancc of the work for which this permit is issued(Sea HEATING UNIT(TO 100,000 B:T.U.) 8.00 MICROFILM
3097,CIv.C.).
Lender's Namo HEATING UNIT OVER 100,000 B.T.U.)9.50 ' '
_ Cnnder's Address ELECTRIC
I
Certify that t I read this application and sial that me above VENTILATION FAN (SINGLE) 4.00
Ni ` correct.
r t 1 agree tcomply with all city and county PLUMBING QD
n
dmanc s' + and state 1 relating t building' L H
sl ucnt and
BOILER-COMP(3H.P.or 100,000 B.T.U.) 6.00
It,Lefty autm " representative, ,I this city to ant upon the BOILER-COMP (Over 100,000 BTU(SEE'FEE SCH. MECHANICAL
abo cmmFlion property lir inspection purposes.
(We) agree t Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
---- Cupertino against 'abilities,judgments, costs and expenses which CONST.TAX
I any way a Tae against said City in consequence of the PERMIT ISSUANCE 10.00
gra ing mf lh Is
perm MECH.CONT. LIC.NO. MECH. '
. - • TOTAL TOTAL
gna re of Applicant/Contractor 7F_
OFFICE COPY
POSTTHISCARD NEAR FRONT OF BUILDING
a PERMIT NUMBER
CITY OF CUPERTINO 18650
-� INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
JOB ADDRESS—( ` g� p�� l� . br UNIT# LOT# ' pERM1T EXPIRES IF WORK
OWNERS - ` comrgncroR •-e, ( IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR - INSPECTION RECORD mO DAYS OF PERMIT ISSU
ANCE OR 180 DAYS FROM
FOUNDATION NOTEi- - - LASTCALLED INSPECTION. .
LIFER - ALL GRADING AND,DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF .PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED. Pmp
UNDERGROUND /SLAB
PLUMBING ZIVW
ELECTRICAL ISSUANCE DATE
MECHANICAL Itp nt BLDG - ELECT. I PLG. MECH,
❑ " ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
• - \ \.: INFORMATION
WOOD FLOOR
VALUATION SIFT.
'PLUMBING ' -
MECHANICAL .
ELECTRICAL,
- PERraIT ro
FRAMING, s RIES TYPF CONSTR,
INSULATION
OCC.GROUP. RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SR,IT FwoR AREA TOTAL AllGE
ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM, THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES IND CON PB Onli•l
APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 1 ElEl
A SSESSOR SPARCEL NO,
ROUGH SAN,# -
..PLUMBING ELECT.ENERGY
nvncT No. PARCEL No
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICALMECH.ENERGY'
. ,
ELECTRICAL � BUILDING ENERGY ACCDATE. ACC:FILE NO.
FRAMING ELECT,FINAL TEST, _
ZONING ENG.SITE NO.
INSULATION " PLUMBING
GAS TEST - GAS
FIRE SPRINK ENERGY T 2N
MECHANICAL YL NL E) NF]
COVERAO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD ZONE A.L.U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. v NL v L NL.
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH - TEMPORARY APPROVALS BUILD wG
SCRATCH COAT ELECTRIC ' PLAN CHECK
FEE
GAS
. . . .�. ..,. .NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY,OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL 19SIGNED BY BUILDING INSPECTOR. MICROFILM
t
_ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
0�'... PLEASE GIVE'JOB ADDRESS WHEN PHONING.
Z MECHANICAL
SEE PERMIT FOR EXPIRATION DATE -
- CONST:TAX
-
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE TOTAL pD
1 CALLING FOR FINAL INSPECTION.
-OFFICE COPY