16169 APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
.A•;,�.-BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT 1616 9
�•�
ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
PLAN CHECK VALIDATION
OWNER'S � ,�E,JI _ Q�
rvnme '�YY�-$$�- 9 -" OTV. ELECTRIC PERMIT FEE
PHONE
CONTRACTORS ' - OUTLETS-SWITCHES-RECEP 10.00/1.00 '
NAME
_ LIC.NO, LIGHTING FIXTURES 10.00/1,00
CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00
ADDRESS
PHONE PANELS 10.00 DATE OF APPLICATION' '"
ARCHITECT ,
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
,
ENGINEER
uc.No, SIGNS TRANS. 3.00
AR. ENG. 6,00 PERMIT VALIDATION
ADDRESS
ss SPECIAL CIRCUIT
zip EMP:METER OR POLE INS. 20.00
APPLICANTS. - MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 20.00
w
02 LICENSED CONTRACTORS DECLARATION A ( O
< u I hereby affirm that lam licensed under provisions of Chapter 9 ISSUANCE DATE I
"I (Commenemg with Sectioli 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
iProfessions Code,and my license is in full force and effect. ❑
Z o. - License Class Lie.Number ❑ ❑ .
q w DContractor
t: ate BUILDING PERMIT
rt (e 4 OWNER-BUILDER DECLARATION INFORMATION
w u H I hereb affirm that I an exempt from the Contmetor's License MISC.- -REFER TO O
Y' P VALUATION $/FT.
F .. e.J Law for[lie following reason.(See.7031.5.Businessand Profl xaiols PERMIT ISSUANCE 10. 0 P `-k
Code:Any city or county which requires a permit to construct,alter, ♦a
S ¢ Q O improve,demolish,or repair any stnmture,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
EE D u requires the applicant for such permit to file a signed statement that TOT G y ,�O PERMIT TO N
EE
m he is licensed pursuant to the provisions Of the Contractors L.Cenu
Hii
Law(Chapter 9(conmmencingwith Section 7000)OfDivision3ofthe � Q Llf� y�N 6- �•utT%
a Business and Professions Code)or that be is exempt therefrom and CITY. PLUMBING PERMIT
r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIE - TYPE CONSTR.
n;m by any aPplica'm for a permit subjects the applicant loacivilpenalty ALTER-DRAIN -WATER (EA.) 5.00 /m
of not more than five hundred dollars(8500).):
❑ 1,as owner of the property,or my employees with wages us 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 or improves thereon,and who does such work FIXTURES-PER TRAP -5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
X himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
-
menus are not intended or offered for sale.If,however,the building
or improvement is sold within one year oIcompletion, the owner- GAS-EA.SYSTEM'-OVER 4(EA.) 2.00 BUILDING USE
builder will have the border of proving that be dill not build or im- RES IND CON PB One,
. prove for purpose of sale.). INDUSTRIAL WASTE'INTER. 30.00
❑ 1,as owner of the property,am 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 contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ -lam exempt under Sec,-,B&P.C.for Ibis WATER HEATER W/VENT 6.00
� reason
Owner�- - Dalll WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORKIiRS'COMPENSATION 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'Compensation Insuimnce,or a certified
copy thereof(Sec.3800.Lab-CJ.
Policy No. ' Company
Q ❑ Certified cop)'is hereby furnished. - FIRE SPRINK ENERGY T 24
Z 2 ❑ Certified copy is Filed wilh'thc city inspection division. MISC.- - REFER TO ORD. v N v N
~ in
CERTIFICATE EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU ; F
W _ COMPIiNSATION INSURANCE PLG.cONTR. LIC.NO. PLG. V❑- N❑ Y ❑ N❑
Q_ Cl (This section need not be completed if the permit is for one TOTAL
D Z hundred dollars IS 100)or WIS.)
V O 1 certify that in the performance Of 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 Runner s0 as to
O Ed become subject to the Workers'Compensation Laws of California. O/
BUILDING
0. Dam Applicant ALTER OR ADD TO MECH. . 5.00 O
} ED NOTICE 1'0 APPLICANT': If,aflcr making this Ccrtifhcutc of fix. ,
emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply will FEE
U such provisions or this permit shall be decn.ed iinvoked. AIR HANDLING UNIT,(TO 10.000 C.F.M.) 4.00
.CONSTRUCHON LENDING,AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 ' SEISMIC FEE
I hereby affinn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT)': 5.00
the performance of the work for which this permit is ieuted'(See HEATING UNIT(TO 100,000 B.T.U:) 8.00 MICROFILM
3097,Civ.C.).
" Lender's Name HEATING UNIT(OVER 100,000 B.T.U.19.50 ELECTRIC
Lender's Addre 5 -
I certify that l have read this application and Stam that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county BOILER-COMP H.P.Or 100,000.B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and -
hereby authorize representatives of this city to enter upon the BOILER-COMP love,100,000 STUI SEE FEE SCH. MECHANICAL
above-mentioned properly 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 in consequence of the
G It g fthis eL � MECH.CONT. `-LIC.NO. MECH.
7pr1 „ �` �a TGTAL TOTAL �a 03'
ign t PP tr to Dam � I
OFFICE.COPY.,
POST THIS CARD NEAR FRONT OF BUILDING
fr 41 POST
- - PERM IT NUMBER
Y�• > -,CITY 'OF CUPERTINO 16 .69
INSPECTION DIVISION,
•JOB INSPECTION RECORD
- - � - PERMIT EXPIRATION
+_' JOB'ADDR ESS' w3� C ,�-VCNr�4} /�-Vz' 'UN IT# •LOT# "
- PERMIT EXPIRES IF WORK .
I 'OWNER 'CONTRACTOR' .
- - - IS NOT..STARTED WITHIN
NSPECTION DATE'.. .INSPECTOR INSPECTION RECORD .Iso DAYS oFPERnnIY;Issu.
ANCE.OR 180 DAYS FROM
FOUNDATION 5 NOTE' " - r "
UFER - ALL GRADING AND DRAINAGE-SHALL BE INSTALLED LAST CALLED INSPECTION.'
PREGUNITE'. - 'TO COMPLY WIT..THE APPROVED.PLANS AND CITY OF ;PERM11 VALIDATION
CL PERTINO STANDARDS.
GARAGE SLABS • r �,, -'
. .." POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB - - r • r` 1
PLUMBING
ELECTRICAL • ISSUANCE DATE
MECHANICAL „ -" - - - BLDG ELECrg PLO. MEER. „
El El D
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT",
WOOD FLOOR
PLUMBING �9•p1 INFORMATION ,
,VALUATION $IFT
� • � � - � � .��
qq
MECHANICAL G 1
ELECTRICAL
FRAMING . - f `f,•� Gt. bV�<N�-l�'/Cr�. ( /"�/T,
INSULATION - V, sTORIE $4 lWPE CONSTR.
. OCC,GROUP, - RES UNITS
* f 111ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
`j ROOF ' ' NOTE NO FINALINSP.SHALL BE MADE BEFORE - so rr FLaoR AREA roTAL ACREArE
DIAPHRAGM' .
' THE CONSTRUCTION TAX IS PAID pp
- ROOF SHEATHING ONC S' BUILDING USE
T�d-VS ' RES IND CON• PB ol„
APPLY.NOROOFINGUNTILABOVE-HASB N-SIGNED• FINALS ,:x;.> ti;DATE�`';" INSP.', ❑. 0 ❑ 'E]
- _ ASSESSORS PARCEL NO
ROUGH= SAN.N-
--
PLUMBING - ELECT.ENERGY'
TRACT NO PARCEL NO
TUBS&SHOWER PAN :� 'PLUMBING ENERGY
MECHANICAL X77 z . .MECH.ENERGY -
�� 5 ACC DATE ACC.FILE•NO.
ELECTRICAL s P j ,'_ . - BUILDING ENERGY,..
FRAMINGELECT.FINAL TEST <•'
INSULATION J S' ' PLUMBING r ZONING - ENG.SITE NO.
'7�J'
- GAS TEST GAS -
FIRESPRINK ENERGY TZ4 t
w Cleo q=1 MECHANICAL
COVER NO WORT(UNTIL ABOVE HAS BEM SIGNED HEATING - Y 1:1 - "El ° "�
EXTERIOR.SH EAR -• ELECTRICAL RELEASE FLD O D ZONE AL.U.0
INTERIOR SHEAR FIRE DEPT: Y❑Y' NEI Y ❑ .,N❑
SHEETROCK 2—) - ! • `• GRADE - FEE SUMMARY
EXTERIOR LATH
,INTERIOR LATH Y,
TEMPORARY APPROVALS, : BUILDING,
n,
SCRATCH COAT . ELECTRIC PLAN CHECK -
- - - . .. ,.
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCYrn SEISMIC FEE
ILDING IN
Q r'
OCCUPANCYOF BUILDING ISNOT,PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUSPECTOR. 'MICROFILM
... .
LARRANGE'.FOR INSPECTION BY PHONING 252-4505 ELECTRIC
F•? ONE WORKING DAY,BEFORE, REQUIRED INSPECTION 'PLUMBING
PLEASE GIVE JOB'.ADDRESS WHEN PHONING
., Z..
MECHANICAL
- SEE PERMIY FOR EXPIRATION' DATE
- - CONST.'TAX
`IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE ': TOTAL , p
CALLING-FOR FINAL'INSPECTION. p
OFFICE COPY