17948 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTIFICATION PERMIT NUMBER emLu Nc APPLICATION & PERMIT
� � �/� �}U(^
ADDRE -
• �1' , BUILDING-ELECTRICAL-PLUMBING-MECHANICAL `y
J
OwNEH'S PLAN CHECK VALIDATION
NOME
VI d OTY. ELECTRIC PERMIT - FEE
CONTRACTOR'S
E tOUTLETS-SWITCHES-RECEP 10.0011.00 V
V15. uc.No. LIGHTING FIXTURES 10.00/1.00
CONTRESCTO Rs PPLIANCES-RESIDENTIAL 4,00
I 1 lA(Hl) 1 �1/�/• PHONE 4'�plq PANELS 10.00 DATE OF APPLICATIONOR
LL
ARCHITECTPLAN200 AMP) 2000 m PLAN CHECK FEE P.C.NO.
ENGINEER
LIC No. SIGNS TRANS- 3.00 '
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDI ESSTa MOTORS SEE FEE SCH.
SERVICE CHANGE P .00
---Z)VL V�r
'o o LICENSED CONTRACTORS DECLARATION
F,09 /•
a v I hereby affirm that I am licensed under provisions of Chapter 97 uAt•
2 i '0J I IYIJ ISSUANCE DATE
yam (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG- MECH.
H z Professions Code and my license is in full fore rld,cfJ',ecl.
z o y- License Cluss_CJ-(Z_Lic.Number_`•110 -
„ twt
- Date Crlmmo,_G_�� City o upe n ❑ ❑ ❑
Q y F J
M ¢ w a OWNER-BUILDER DECLARATION BUILDING PERMIT
- °' G MISC.- REFER TO ORD INFORMATION
E
;Ea H I hereby allinn that I am exempt from the Contractor's License
EEO 4 Law for the following reason.(Sec,7031.5,Businessand Professions VALUATION SIFT.
- PERMIT ISSUANCE 10.00
Code:Any city or county whila 0ny Structure.
permit prior
to construct,alter, •/�V
improve,Demolish,or repair any structure,prior to its issuance,also ELEC.CO TR LIC.NO. FEED '7 v/S
K o a, requires the applicant for such permit to file a signet)statement that _• TOTAL ,7j V PERMIT TO
u w m m he is licensed pursuant to the provisions of the Contractor's License -
ri >
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
E q o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
K H$ the basis for the alleged exemption.Any violation Elf Section 7031.5 STORIES TYPE CONSTF,
ea , . by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN III VENT-WATER (EA.) 5.00
of not more than five hundred dollars(S500)):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for Sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AR EA,GOND. 5.00
Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves t hereon,and who dues such work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE
reents l' through his own employers provided that such improve-
ments are rnot(hroutendcd or offered for provided
that such
he building GAS-EA.SYSTEM-1 1NC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
build,,will have the burden of proving that he did not build or im- BUILDING USE
prove 1,as ownerose
of sale). INDUSTRIAL WASTE INTER, 30.00 RES IND CON PB Other
e L as owner of the property,a.he exclusively contracting with ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 El
NO.
and Professions Code:The Contractor'sbuildsLicense s th docs not apply
to tr owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
Contracts for such projects with a rontragorl s)lie enaal pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 ,TRACT NO. PARCEL NO.
❑ Inaexempt exempt under Sec. - ,B.&BC.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.GATE ACG FILE NO.
WORK ERS'CI have a ATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby affirm that I have a certificate In consent to a certified
rtifed
or a certificate of Workers'Compensation Inxuranee,or a eetlil'ied ZONING ENG.SITE NO.
copy thereof(Scc.3 C. Lab.C),Policy N ll Company
0 O Ccrtifed o is hereby furnished.
z Z Certified y N ed shh a oily inapco ran division. FIRESPRINK ENERGYT24
O ApvliL'ant -- 'I MISC.- REFER TO ORD. YE3 NEl Y0 N�
D= w CF RI E OF :XEMPTION FROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU > COMPENSATION INSURANCE PLG.CONTR. IDG.NO.CL PLG.
Z (This section livedIlot be completed If Nle femur IS for one TOTAL YE] N 0 Y 0 NJ
hundred dollars(S 100)or less,)
U O 1 ecrtily that in the Perloroance of the work for which tiles per-
LL 1- mit is issued.I shall mot employ any person in any mumler so as to
O W become subject to tlm Workers'Compensation Laws of California.
O- Dat;. Applicant ALTER OR ADD-TO MECH. 500 BUILDING
} to NOTICE TO APPLICANT: If,after making This Certificate of Ex-
? eniption,you Should become subject to the workers'Compensation APPLIANCE 5.00 PLAN CHECK
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 iQOW CF.M) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,000QF.M.) 6.00 SEISMIC FEE
I hereby of irns that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this peril is issued(See.
3097,Civ.C). HEATING UNIT(TO 100,0008.T.U.) 8.00 MICROFILM
Lender's Name
Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC �b
Gcertity that l have read this application and state that the above VENTILATION FAN (SINGL- q,pQ E
Ddireences n correct I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building const r cion, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby araimedLtJRot, reP,,Iy Gtives of this city es enter upon the
above-mentioned property indemnify
and purposes BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(WC) agree 1st save, indemnify end keep hatless Inc City ch MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and ,xpemes which
ay in any y accrue 'Bg�ltst said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
rantingo h en t. /J MECH.COAT. - LIC.NO.
blgirGCH
yNrc of Apph aI nnactcur Date T . TOTAL
r
77- to
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO ' 17948
' INSPECTION DIVISION
JOB INSPECTION RECORD
pi
/L/,) , PERMIT EXPIRATION
JOB ADDRESS._p�O SD S WJNIT# _LOT#
< 1 l 1/j-_
1 PERMIT EXPIRES IF WORK
_,.�
OWNER V y-r r CL �,G CONTRACTOR e.\-r IS NOT STARTED WITHIN
INSPECTION DA E NSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION - ANCE OR 180 DAYS FROM
NOTE:
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.
PREGUNITE TO COMPLY WITH THE APPROVNO CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGN90 LIN_ b _ / L../ 7
UNDERGROUND /SLAB
PLUMBING _ (;ItY.O„ Upe nD j . 74 "A, �- Vi I't L
ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG. I ELECT I PLG. I MECI+
❑ lk El ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING
VALUATION SIFT.
� 3'
MECHANICAL
ELECTRICAL
PERMIT TO
FRAMING - B,e:L; [cd-
INSULATION STORIES rY PE cONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
V . ROOFSo.1T FLOORARPA TOTALncHSAGE
NOTE:NO FINAL INSP,SHALL BE MADE BEFORE
IIAPH RAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
AOOF SHEATHING�* RES IND CON PB Om.,
'N� APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑
ASSESSORS
ROUGH � SAN.k PAHCEL NO.
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN PLUMBING ENERGY - TRACT No PARCEL NO
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDINGENERGY - ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
INSULATION. PLUMBING ZONING ENG.SITE NO.
GAS TEST GAS
MECHANICAL FIRE SPRINN ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ No
EXTERIOR SHEAR ELECTRICAL RELEASE ?- �•. FLOOD ZONEA.L.U.c.
INTERIOR SHEAR FIRE DEPT. Y❑ •N❑ ❑ N❑
SHEETROCK ' GRADE'.' FEE SUMMARY
EXTERIOR LATH - BUILDING _
•"\ INTERIOR LATH TEMPORARY APPROVALS - BUILDING
SCRATCH COAT ELECTRIC PLAN CHECK
GAS • FEE
NO TAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE.
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING.FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
"J ONE WORKING DAY BEFORE REQUIRED INSPECTION.
?�. PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING
/
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. /F t r _
OFFICE COPY,