17269APPLICANT TO FILL IN INFORMATION WITHIN RED -LINES _ USE BALL POINT PEN ONLY
AN rBU I LDING PROJECT I IDENTIFICATION
_ APPLICATION &PERMIT
BUILDING - ELECTRICAL --PLUMBING - MECHANICAL
PERMIT NUMBER.
d.1726
r.*'- �J
9
ma FDI)RE55 _
NAME R'G•
NA / - ��Z_CITY.
rt/! Cco PRONE
ELECTRIC PERMIT FEE
-
PLAN CHECK VALIDATION
•
-
" -
"
DATE OF APPLICATION
O TRACTOR'S
NamE 1 \^-
Ip 2AV1 LIC.NO. S�ZZ
OUTLETS - SWITCHES -;R ECEP _10.00/1.00
LIGHTING FIXTURES 10.0011.00
CONTRACTOR'S -
ADDRESS yy�r 415439rCg8"(
I l R- 2- PRONE
APPLIANCES -RESIDENTIAL-' t 4.00
f PANELS " 10.00
ORCHITECT yAA,R_nNe.L„1 . 5„(53
ENGINEER, -
i(� ,LIC. No.
PANELS (OVER 200,AMP) 20.00
PLAN CHECK FEE I P.C. NO.
SIGNS TRANS. 3.00
ADDRESSE
SPECIAL CIRCUIT 5.00
PERMIT VALIDATION
zIr
TEMP. METER OR POLE INS, - 20.00
APPucANrs
AUC4
MOTORS - " SEE FEE SCH.
AXYL_ `�
"
SERVICE CHANGE - 20.00
- LICENSED CONTRACTORS DECLARATION.-
LOW .' bLIV4(n-��SOC I% K_
' I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and
Professions Codc my license is in full f f c
License Class Lic. Number11
Uate � Contmcmr
COM QO L "� 7-A' ✓ '-
.ISSUANCE DATE '
G. ELECT. - PLG: MECH.
11
IAAR-
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Law far the following reason. (Sec. 7031.5, Busuessms! Professions
Code: Any city or county which requires a permit to construct, alter,
BUILDING PERMIT
INFORMATION '
MISC. -
PERMIT ISSUANCE- 10.00 -
VALUATION
$/FT.
.ELEC. CONTE. LIC. NO.
'
ELEC.
TOTAL'
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
he i5 licensed Porsuant to the provisions of the Contractor's License
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and
�2 �•%l
'
PERMITTO
GN^1.,R. tQ t61 L.•c
a
QTY. PLUMBING PERMIT FEE
Ilse basis for the alleged exemption. Any violation of $eClio0703.$
by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).)
STORIES
TYPE CONSTR.
'
ALTER -DRAIN & VENT -WATER (EA.) 5.00
❑ 1, as owner of the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 400
OCC. GROUP
RES. UNITS
DRAINS -,FLOOR, ROOF, AREA, COND. 5.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of
FIXTURES - PER TRAP 5.00
-
GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00
- or, •Ierty who builds or improves thereon, and who does such work
el/ or through his own employees, provided that such improve-
t sa. n untended or offered for sale. ll, 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 mr im-
prove for purpose'of Sale).INDUSTRIAL
O 1, as owner of the property, am exclusively contracting with
SO. FT. FLOOR AREA
TOTAL ACREAGE '
- . - . .
GAS EASYSTEM 4 IEA) 200
BUILDING USE
RES IND CON PB Diner
❑ ❑ .❑ "' ❑
WASTE INTER. 30.00
licensed contractors to construct the project (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
LAWN SPRINKLERS- 1 INC 5 V.B.- 6.00
ASSESsoRS PARCEL NO. '
_
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
contracts for such projects with a eontraetons) licensed pursuant to
the Contractor's License Law.
❑ I Um exempt under See. .B.&P.C. I'or this
reason
SEWER -SAN EA. 200ft/10.00
TRACT NO,
PARCEL N0.
WATER HEATER W/VENT 6.00
Owner Dam
WATER SYSTEM 5.00
ACC. DATE
ACC. FILE NO.
WATER TREATING EQUIP. 5.00
WORKERS'COMPFNSATION DECLARATION
- 1 hereby affirm that I have a certificate of consent m self -insure,
ora certificate of Worker Compensation Insurance, orsa certified
X I Q
ZONING
ENG. SITE NO.
L A)6
-L-vs n'1Qi�lVi`R'L
copy there f . e) �f-•
Policy No. p 1� 1l.aL•%11.
. q Certif led copy is hereh unishel r d.
!3\Cedl' y Is Ir with the city inspection division.
npplicu -
a
-
FIRE SPRINK
Y ❑ N❑
ENERGY T-24
Y ❑ No
MI REFER REFER TO ORD.
PERMIT ISSUANCE 10.00
CERTIFICATE O EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
F (This section need not be Completed if the permit is for one
FLOOD ZONE
Y ❑ N ❑
A.L.U.C.
N
Y ❑ ❑
PLG. CONTE. LIC. NO.
S
1 THA
hundred dollars IS 100) or less.) -
-
Icertify that in the performance of the work for which this per-
mil is issued, I shall not employ any person in any manner so as Io
QTY MECHANICAL PERMIT _ FEE.
FEE SUMMARY
BUILDING
lY
become subject to the Workers' Compensation Laws of California.
DAppli
ate cant
Appli
_ ALTER OR ADD TO MECH. 500
. .
NOTICE TO AI'I I': If, after making this Certificate of E x-
emption, you should"become subject to the Workers' Compensation
provision., of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked -
APPLIANCE - 5.00
AIR HANDLING UNIT (TO 10=11F.M.) 4.00
'PLAN CHECK
FEE -
^Q" c
4Y0r �.%
AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00
SEISMIC FEE
e5O
CONSTRUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 5.00
I hereby affirm that there is a construction lending agency for
the 3097 Part
Cie,C)nce of the w rk for which this period is Issued (Sec.
MICROFILM
•�
HEATING UNIT (TO 100,000 B.T.U.) 8.00
'Lender's Nume _
Lender's Address
HEATING UNIT (OVER 100,000 B.T..U.)9.50
ELECTRIC
VENTILATION FAN ISINGLE) 4.00
Icerlub that l havcread this application and state that the above
-
Ifonn• \.;..cruet. I agree to comply with all city and county
nnfi state laws relating to building construction, and
nercay authorim representatives of this o t
o city tenter upon the
bove-m4nlioned property for inspection purposes, o
-(We)jagree to Save, indemnify and keep harmless the City of
PLUMBING
-;
BUTLER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
- BOILER -COMP (Over 100,000 BTUI SEE FEE SCH.
MECHANICAL
r
MISC. - - - REFER TO ORD.
upertino against liabilities, judgments, costs and expenses which
may in ny way accrue against Said City in consequence of the
Onto of this `• t.
2- _
PERMIT ISSUANCE 10.00
CONST. TAX
MECH. CONT. LIC. N0. MECH..
I TOTAL
TOTAL
[
a of Applicant/ tractor Date
OFFICE COPY
r
POST THIS CARD NEARFRONT OF BUILDING
CITY OF• CUPERTINO
INSPECTION DIVISION
'JOB INSPECTION.RECORD
I '_, ,_,•'
JOB ADDRESS '� � • Z. QC\ � -t , rTUNIT# LOT#
-" /�{_ //T
OWNER �_�. CONTRACTOR 1. 1 S'p ..Sp r
PERMIT NUMBER
17269
PERMIT EXPIRATION
PERMIT EXPIRES IF WORK
IS NOT STARTED WITHIN
ta0 DAYS of PERMIT ISSU.
ANCE OR 180'DAVS FROM
LAST CALLED INSPECTION.
0INSPECT ON DATE INSPECTOR
• INSPECTION RECORD
FOUNDATION _
-
NOTE:
ALL GRADING AND DRAINAGE SHALL.BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY. OF
CUPERTINO STANDARDS.
LIFER -. -
PREGONITE
PLNMIT VALIDATION •�
_
''
/
-.Ise ANCBUATE
GARAGE SLABS
„;POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED�1
- MAR 03 tya�i
I UNDERGROUND /SLAB
PLUMBING ,( '-
- u
C+tV /y,� .�,,�
ELECTRICAL' -
MECHANICAL -
-
Boa• ELECT.
PLc. MACH.
•11)0 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BUILDING PERMIT
INFORMATION
WOOD FLOOR
VALUATIONS+PT.
.. _Z200
.
PLUMBING .-
< -
MECHANICAL
ELECTRICAL ,_
-
PERMIT TO IJ1
FRAMING
INSULATION -
STO IES,
TYPE CONSTR.
;IP,I!ACE'NO'.SUBFCO.ORIrUNTIL ABOVE HAS BEEN SIGNED
,•
OCC: GROUP
RES. UNITS -
• -SO,
ROOF.
NOTE: NO'FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FT. FLOOR AREA
TOTAL ACREAGE
iArHGM -
ROOF.SHEATHING
Res IND CON BUILDING USE PB
❑ ❑ ❑ ❑
'APPLY NO 900FING UNTIL ABOVE HAS BEEN SIGNED
- . ,.FINALS, .: -- .'DATE., INSP-
ROUGH•
SAN.a
ASSESSORS PARES TOO
PLUMBING
ELECT. ENERGY - -
TUBS 8 SHOWER PAN
PLUMBING ENERGY
TRACT NU.
PARCEL NO ,y
MECHANICAL
MECH.ENERGY
ELECTRICAL . ., -
,.
BUILDING ENERGY
ACC DATE
ACC, FILE NO
FRAMING
ELECT, FINAL TEST
INSULATION
PLUMBING
ZONING
-EIRE
ENG. SITE NO,
GAS TEST
GAS -
MECHANICAL'
SPRINK
° "ED
,ENERGY T 24
° Q NF]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR -
ELECTRICAL RELEASE
ROOD ZONE
Y ❑ "❑
A.L U.C.
Y ❑ "�
INTERIOR SHEAR _
FIRE DEPT. •
SHEETROCK
GRADE
FEE SUMMARY
EXTERIOR LATH -
BUILDING'
BUILDING'
3-LQI�-
.INTERIOR LATH
_ TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
-
PLAN CHECK
FEE
3
-
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
OCCUPANCY
SEISMIC FEE
i'I -',•
OCCUPANCY OF BUILDING I S NOT PERMITTED UNTI L B UILDING FINA L IS SIGN ED BY BUI LDING INSPECTOR.
MICROFILM
-
ARRANGE'.FOR INSPECTION BY. PHONING 25274505,
ONE WORKING DAY BEFORE REQUIRED INSPECTION.
,f -"PLEASE GIVE JOB ADDRESS WHEN PHONING. -
-.'--SEEPERMIT;FOR,EXPIRATIONDATE-
ELECTRIC
PLUMBING
MECHANICAL
CONST, TAX
• `IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
I,( OFFICE COPY