13100 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
�BUI LDING PROJECT IDENTIFICATION - PERMIT NUMBER
SOILDIN6
ADDAPPLICATION & PERMIT �� o0
RESS
BUILDING-ELECTRICA L-PLUMBING-MECHANICAL
OwrvER' -L-G 1UJ PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
MA► 1rrZeo R2AN�GHDNE2SS-olgZ /3 3 n
CONTRACTOR'S 2
NAME G.{^! UTLETS-SWITCHES-RECEP 10.00/1.00
C.(. LIGHTING FIXTURES 10.00/1.00
LIC.NO.
CONTRACTOR'S
ADDR Ess APPLIANCES-RESIDENTIAL 4.00
PHONE r PANELS .10.00 ,Q1 DATE OF APPLICATION
ARCHITECT .PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER j
uc.No: - SIGNS TRANS.' 3.00
ARCH
.OR ENG: SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP FFEMP.METER OR.POLE INS. 20.00 /,7A j�
APPLICANTS - MOTORS f /iSEE FEE SCR. A'9
ADDRESS f
SERVICE CHA GE V - 20.00 �`i, ra
,00 LICENSED CONTRACTORS DECLARATIONpp yy,,��
a u U I hereby affirm.lhat I am licensed under provisions of Chapter 9 � .106 Q{ISSUANCF DATE
y 3 i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECTer LIIP,LG. MECH.
r�Dz Professions Code,and my license is in full force and effect.
z 0 m - License Class Li,.Number
0 r o Date Contractor
a yBUILDING PERMIT
a ¢ OWNER-BUILDER DECLARATION INFORMATION
¢ o a 0 MISC.- •REFELt TO ORD
,.XS y I hereby affirm that I am exempt from the Contractor s License
LLoa Law for the followingreason.(Sec.703 L5,Businessand Professions ',PERMIT ISSUANCE r 10.00 .) VALUATION g/FT.
- N Code:Any city or county which requires permit to construct,alter,ac
2Q 0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO: ELEG
- O m requires the applicant for permit to files signed statement that TOTAL PERMITTO
n w'm he is licensed pursuant to the provisions of the Contractor's License '•
H z r
Law(Chapter 9(commencing with Section 7000)of Division 3 of the d`
G Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
Eio
rc r o the basis for the alleged exemption.Any violation of Section 7031.5 '.. STORIES TYPE CONSTR.
a3e2 by any applicant for a permit subjects the applicant to a civil penaltyVINDUSTRIAL
DRAIN -WATER (EA] 5.00
of not more than five hundred dollars(5500).):
❑, I,as owner of the property,.or my employees with wages asOW PROTECT. DEVICE 4.00 DEC.GROUP- PES.UNITS
their sole compensation,will do the work,and the structure is not
_-
intended or offered.for sale(Sec. 7044, Business and ProfessionsFLOOR,ROOF,AREA,GOND. 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 workES-PER TRAP 5.00 SQ.ET.FLOOR AREA TOTAL ACREAGE
himselforthrough his own employees,Provided that such improve-
hients mself c not through
or offered employees,
or provided
that such
building .SYSTEM-l 6.00
or improvement is sold within one year of completion,the owner- .SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or um -
provyl'orpurposeofsale.). IAL WASTE INTER. '30.00 RES IND CON PB Omer
3� I,as owner of the property,no exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(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(s)licensed pursuant to SEWER-SAN ITARY-STORM EA.200ft/10.00
the Contractor's Licel se Law. TRACT NO. PARCEL NO.
❑ I a s �xemPl under Sec. B.&BC.f r tl is WATER HEATER W/VENT 6.00 '
mason t9 t I , P- 1
Owner � WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORK F-RS'COMPF,NSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate Of consent to self-insure. ZONING ENG.SITE NO.
or a Certificate of Workers'CompensationInsurance,or a certified
ropy thereof(Sec.3800,Lab.CJ.
Policy No- Company
O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
O Applicant v❑ N❑ Y ❑ N❑
CCN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.D.D.
W > COMPENSATION INSURANCE PLG.CONTR. LIG.No. -
d O (This section need not he completed if the permit is for o TOTAL �' V❑ N❑ Y ❑ N❑
Z hundred dollars($100)or IcV,J nc
U O 1 certify that in the performance oC the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any person in any manner so as to
U bemms b' [o the Workers' ensatiotLws}FCrolifo12
BUILDING
� w6 Dale Applicam rl�y,l�m� �'AM ALTER OR ADD TO MECH. 5.00
} W NOTIC T PPLICAN 1: If,after making 11,Ls Certificate of Ex-
emption,Z emption,you should become subject to the Workers'Compensation APPLIANCE - - 5.00 PLAN CHECK �J
provisions of the Labor Code, you must forthwith comply with FEE /
O such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY , AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3
I hereby 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..Swed(Sea MICROFILM
3097,Cm.C). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -51Lender's Address'
HEATING UNIT(OVER 100,000 B.T.U.)9.50 . ELECTRIC
I certify that I have reed this application and state that theounty VENTILATION FAN (SINGLE) 4.00
information is street I agree to amply with SII city and county PLUMBING s�.i
ordinances and state laws relating to building construction, and "BOILER-COMP(3 H.P.or 100,0006.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Ova,100,000 BTU)SEE FEE SCH. MECHANICAL
abovementionedproperty 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 CONST.TAX
may in any ay accrue gains[ said City in conseque e o the PERMIT ISSUANCE 10.00
Ig
Of lhi permit��. MECH.CONT. LIF NO. MECH.
CbGl�..n� b�S �� TOTAL TOTAL
Signature of A lican t/Contractor - Date �-
OFFICE COPY
�r POST THIS CARD NEAR FRONT OF BUILDING
I'f'RMIT NUMBER
'CITY' OF CUPERTINO3100
-- — - - INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION '
` JOBADDRESS 10201 LEBANON DRIVE UNIT# LOT#
I PERMIT EXPIRES IF WORK
- OWNER MANFRED' FRANK' .CONTRACTOR - IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
CR 44 AS ANCE OR 180 DAYS FROM '
FOUNDATION �� - f V LAST CALLED INSPECTION.
UFER OF%
- �f 11 ,,,� � . nuonnoN
PREGUNITEOCTC '
Y 7 � ,. .
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,�-�- owvwA OK.. '141 W-10'A-
r�
UNDERGROUND /SLAB City6ft,piijnO
: PLUMBING ` - �115tpES lady.-'1'S blC.�o��• g . .
ELECTRICAROOK g Qh ^jo 045 ISSUANCE OAiE .
'MECHANICAL ELECT. PLc. MLCR.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
• INFORMATION
WOOD FLOOR VALUATION $/FT.
PLUMBING ,
MECHANICAL
PERMIT TO
- ELECTRICAL
FRAMING -
' STORIES TYPE CONSTR.
INSULATION -
OCC:GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- .. ROOF . SO.FT.FLOOR AREA TOTAL ACREAGE
1
DIAPHRAGM ^ -86r
ILDING ON USE
ODF 7 4(r _ /- Res IND coN PB . 'oa.„
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - El ❑ ❑ ❑ ' ❑
ASSESSOR SPANCELNO.
_ ROUGH. ,.
PLUMBING
TRACT NO. PARCEL NO.
GAS TEST
MECHANICAL' . '
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN # - _
ZONING ENG.SITE NO.
INSULATION PLUMBING -
GAS .
FIRE SPRINK ENERGY T24
MECHANICAL Y ❑ NC] Y ❑ N❑.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
FLOOD zorvE A.L.L.U.C.
LATH-INTERIOR - ELECTRICALS
LATH-EXTERIOR FIRE DEPT. Y NQ- Y ❑ N❑
SHEETROCK k�C-95y191 pub5i GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING - BUILDING
SHEAR EXTERIOR TEMPORARY APPROVALS:'
FIREWALLS ELECTRIC - PLAN CHECK _
GAS - FEE
. ..
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ? li
OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
e
I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
`L ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
�. PLEASE GIVE JOB ADDRESS WHEN PHONING.
Zl MECHANICAL r
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! coNST.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL r
CALLING FOR FINAL INSPECTION.
OFFICE COPY