15790APPLICANT TO FILL IN'INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
•�-•,.
"4p.ILDING PROJECT I DENTIFICATION
APPLICATION & PERMIT
BUILDING - ELECTRICAL- PLUMBING --MECHANICAL
-PERMIT
1NUMBER
5790
BUILDING -
ADDRESS O� I _ /JO ,\
OwNER's '[�(( '
NAME � �/��t /� N 9 C
' • ..NSI I�H ^"'V'- i V�
QTY. ' ELECTRIC PERMIT FEE
PLAN CHECK VALIDATION
,
DATE OF APPLICATION
CONTRACTOR'S
NAME
61' l.�;jkj�`�tJ�` (�o.
UTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES 1400/1.00 Tj
DDRESS ars
AoS 6AT�
rNTRA,
p) J
PPLIANCES- RESIDENTIAL .,4.00
PANELS 10.00Z(
ORcmiwT
OR
ENGINEER / //
C. /E�, uc. No.
-H
PANELS (OVER 200 AMP) 20,00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS .3.00
OR ENG
ADDRESS ENG. a /� y,.i`
O SU < ` m`!aL
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
-�
I
��JC'IISSUANCE DATE
EMP. METER OR POLE INS.. 20.00
APPucarvrs
AooREss
3t ✓S.0 Ct jaar
MOTORS SEE FEE SCH.
SERVICECHANGE 20.00
LICENSE' I) CONIRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chuplcr 9
(commencing with Section 7000) of Division 3 ofthe Business and
Prllfl'S1'IUn6 C.'UJ' 1J Illy IICCnIe IF In 11111 forty 0 d C11 .
Li cense Class Lic. N bar Y/g%7V �-�
Data % -/ y- e3 ContraR�tt If
OWNER.BUILDER DEION
I hereby affirm that I am exempt from the Contract is License
Law for the following reason. (See. 703 1.5, Businessand Professions
Code: Any city or county which requires a permit to construct, alter,
Improve, demolish, or repair any structure, prior t0 its issuance. also
requires the applicant for such permit to file a signed stale Ment that
Contractor's License
he is licensed pursuant to the provisions of Ilia)(itDivision
Law (Ch and P,d'ontmenc ode) ornis ,cu,f Dthircto,,and
Business and Professions mupl or thus he is ,cu,,t Section 70 31.5
the basis for the allege) cxcnhplion. Any violation ul Section 7031.5
by any applicant for a permit subjects the applicant on civil penalty
of not more than five hundred dollars (5500).):
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will Jo the work, and the structure is not
intended or offered -for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who docs such work
himself Or through his own employees, provided that such improve-
mentsare not intended oroffered for sale, If, however, the building
or improvement is sold within One year of completion, the owner-
builder will have the burden of proving that he did not build or im-
",eyefa,"caposcnlsal°')'
❑ 1, as owner of the property, am Exclusively contracting with
licensed contractors to construct the vroject (Sec 7044, Business
and Professions Code: The Contractor's License Law docs not apply
to an owner of property who builds or improves thereon. and who
such pects with a contractoR9 licensed pursuant m
contracts for projects
the Contractor's h roLaw.
❑ I am Exempt under See.-, B . &P,C. for cis
rczson
D ELECT.
❑
PLG-/ -MECH.
J
IL'Lv11
•.
Q UILDING PERMIT
INFORMATION
MISC. - REFER TO ORD
-
VALUATION
)
I� oo�
S/FT.
PERMIT ISSUANCE 10.00
ELEC. CONTR. LIC. NO.
ELEC, CC
TOTAL aC
PERMIT TO
e • �� t A
tG�ll
QTY. PLUMBING PERMIT FEE
STORIES
'
TYPE CONSTR.
ALTER-DRAIN&VENT-WATER (EA.) 5.00
BACK FLOW -PROTECT. DEVICE 4.00
OCC. GROUP
RES. UNITS
DRAINS:FLOOR, ROOF, AREA,COND. 5.00
FIXTURES - PER TRAP 5.00 O
SO. FT. FLOOR AREA
TOTAL ACREAGE
GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
GAS - EA. SYSTEM'- OVER 4'(EA.)' 2.00
BUILDING USE
RES IND - CON Pe 00er
❑ ❑ - ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 30.00
LAWN SPRINKLERS - 1 INC 5 V.B. 6.00
ASSESSORS PARCEL NO.
'
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
SEWER -SANITARY -STORM EA. 200ft/10.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 6.00
Owner Dale
WORKERS'COM PENSATION DECLA RATION
I hereby affirm Thal I have a certificate of consent toself-insure,
or a certificate of Workers' Compensation Insurance. or a certified
Copy thereQ� .ec. 3800, Lab.C. mat
PolicyNo. F-TZLr/Tompany,^i%(itdd.Z! /,tyyNy lZ�L
❑ J copy 1' crab}' umishad.
❑ d cop is IeJ wait the c' 'nspection division.
Applicant
WATER SYSTEM 5.00
ACG DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
ZONING
ENG. SITE NO.
-
FIRE SPRINK
Y ❑ N❑
ENERGY T 24
Y ❑ N❑
MISC- REFER TO ORD.
CERTI FICKPIi OI7 1:XEMP N IRON WORKERS'
COMPENSATION INSURANCE
1'I'In, section need nut' he cont Plated if the Permit is for one
hundred dollars (5100) ur less.)
I cerdy that in the parfor.nan,e of the work for which this per-
net is issued, 1 shall not employ any person in any fanner so as to
become subject to the Workers' Compensation Laws of California.
Data Applicant
NOTICE TO APPLICA N'I': If, afer making this Certificate of Ex -
Caption, you should become subject to the Workers Compensation
provisions of the Labor Code, you most forthwith camplY with
such provisions or this permit shall be deemed revoked.
CONS'I'RUC'1'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the pedvConce yf the work for which this permit is issued (Sec
Lcndcr's Name
PERMIT ISSUANCE 10.00
FLOOD ZONE
V ❑ N ❑
a. L. u.c.
v ❑ N ❑
PLG. CONTR. LIC. NO,
-
PLG.
TOTAL
-
QTY. MECHANICAL PERMIT FEE
FEE SUMMARY
BUILDING
p
/�0 .
ALTER OR ADD TO MECH. 5.00
APPLIANCE 5.00
PLAN CHECK .
FEE
AIR HANDLING UNIT (TO 10)000C.F.NL) 4.00
AIR HANDLING UNIT (OVER 10p00QF.M.) 6.00
SEISMIC FEE
EXHAUST HOOD (WITH DUCT) 5.00
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) 8.00
HEATING UNIT(OVER.100,00013.T.U.)9.50
ELECTRIC
23,M
Lend, r Address
I certify that I have read this application and state that the above
information is correct..) agree to comply with all city and county
ordinances and state laws -relating to building construction, and
hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of
ino against liabilities, judgments, costs and expml2es which
tiny way cpnm against said City in come! ace of the
it `-
kiver"
VENTILATION FAN (SINGLE) 4.00
PLUMBING
1A,
-
BOILER -COW Q H.P. or 100,000 B.T.U.) 6.00
BOILER -COMP (Over 100,000 BTU) SEE FEE SCH.
MECHANICAL
21100
misc.- REFER TO ORD.
CONST. TAX
- 'PERMIT)SSUANCE 10.00thlspeI
MECH. CONT. LIC. NO. TMECW
OTAL
qTOTAL cCre
o App ¢ n
ontract Date
V
POSTTHIS.CARD NEAR FRONT'OF BUILDING'
CITY OF CUPERTINO
PEHMITNUMBER,,
5790
INSPECTION DIVISION
JOB INSPECTION RECORD
t1
' ' )•
•
PERMIT EXPIRATION
JOB ADDRESS O S^�' •��''ood B_ �� UNIT#. - _LOT#- 1
'• -
.
PERMIT EXPIRES IF -WORK
OWNER s r CONTRACTOR. U �. l...o A($S7
IS NOT STARTED WITHIN
180 DAYS OF PERMITISSU-,
ANCE OR 180 DAYS FROM
INSPECTION ElAf E I INSPECTOR
INSPE ION RECORD
-
FOUNDATION
_
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
LASTCALLED INSPECTION.'
UFER iL7
PR EGUNITE'
PEHMIT VALIDATION
CUPERTINO STANDARDS.'
-
ISSUAN E DATE
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
' UNDERGROUND /SLAB
PLUMBING* 171
.M, ,
ELECTRICAL'
MECHANICAL
g
w0.
E ECT,
PLL:. MEcn.,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
c ` 1^RMATION
BUIjJwNIG PERMIT
WOOD FLOOR
DA ALDATIDN SIFT.
J 1�/ t,+'`�
•.'•�!{L'Lrl�.
PLUMBING
' ••
MECHANICAL
ELECTRICAL �
'
^ EMIT
I�r�I
�STORII.S
TO
FRAMING VC
INSULATION �
-
_
a
TYPE-CONsrR:, -
- 0-.26
OCC. GROUP
RES. UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF
NOTE: NO FINAL SP. SHALL 8E MADE BEFORE
THE CONSTRUCTION TAX IS PAID
so ,P r. PLooR AREA
TOTAL ACREAGE
DIAPHRAGM
BUILDING USE .
ROOF SHEATHING
,RLS IND CON vB al,,,
!] ❑ El . 1:1 1
APPLY NO ROOFING. UNTIL ABOVE HAS BEEN SIGNED,
FINALS DATE INSP.
• ASSESSORS PARCEL NO.
- ROUGH
SAN.#
PLUMBING - 6- •
ELECT. ENERGY
TUBS &SHOWER PAN-•
PLUMBING ENERGY
. TRACT NO.
PARCEL NO
i
MECHANICAL-'6-vY
o
MECR ENERGY
ELECTRICAL j- J..
BUILDING ENERGY- -
ACC. DATE
ACC, FILE NO.
FRAMING
ELECT. FINAL TEST
INSULATION -� _
PLUMBING' -
ZONING
ENG SITE NO.
GAS TEST
GAS -
FIRE $PRINK
ENERGY T -?9
'
MECHANICAL -
- Y ❑. ND
Y ❑ , Nt
COVER -NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR - -
ELECTRICAL•RELEASE
FLOOD ZONE
�. N�
A,0.0 C.
v ❑ N❑
-
INTERIOR SHEAR
FIRE DEPT..
SHEETROCK f -C
GRADE
FEE SUMMARY .
EXTERIOR. LATH
BUILDING. 1 zv
BUILDING
ou
,�.
INTERIOR LATH`- "
-TEMPORARY APPROVALS
SCRATCH COAT- -
ELECTRIC
PLAN CHECK
FEE
..
•
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY,
SEISMIC FEE
.Ir.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR 1NSPECTI"ON BY PHONING 252-4505,
ELECTRIC
3rd;vl'
PLUMBING
(�Q�
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
O �. PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
Z
- SEE PERMIT FOR EXPIRATION DATE -•
CONST. TAX
IMPORTANT!
TOTAL
q"
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
OFFICE COPY