18611 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BIO ILDING PROJECT IDENTIFICATION PERMIT NUMBER
OU LOING APPLICATION'& PERMIT q p[�1 �,
ADDRESS1�
/ q�r� I
VY7 BUILDING —ELECTRICAL—PLUMBING—MECHANICAL .` v v I
OWNEN'9A^nL T��y/�_ p�O UcC PLAN CHECK VALIDATION
NAME /lTr Iz"�L 7CJ OV
DTV. ELECTRIC PERMIT FEE
PHONE
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 ' l `�!�-`k �'r}�
D]$zgJ4S/6NS rc� `
uc.No LIGHTING FIXTURES 10.00/1.00
CONTRALTO
AODREss PPLIANCES-RESIDENTIAL 4.00 ` D
3784- jy
FNONE PANELS 10,06 DATE OF APPLICATION
ORRCN TECT PANELS (OVER 200 AMP) 26,00 PLAN CHECK FEE P.C.NO.
ENGINEER �vI
LIC.No, SIGNS TRANS. 3.00'.
ARCH ADDRESS
R.SE.G. PE MIT VALIDATION
ASPECIAL CIRCUIT 5.00
ZIP EMP.METER OR POLE INS. 20.00 .I ..��L�
Ars
ADDDRESSDRESS MOTORS SEE FEE SCH. �/Lf
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION - --
a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Busineesand BLDG. ELECT. PLG. MECH.
y i Professions Code�try{.rty�llcense is in full fo ayyy444 pIV _❑ ❑
0 2 w o License lass "ri." Lic.NumberE G f
Date�1Contmclor- 1 L,
Q y s J u i
¢ ¢ ¢ a
OWNER-BUILDER DECLARATION BUILDING PERMIT
o
a , INFORMATION
X r.u I hereby affirm (hat I arm exempt from the Contractor's License MISC.— TO ORD
u O¢ Law for the following reason.(Sec.703 1,5.Business and Professions p VALUATION $/FT.
PERMIT ISSUANCE /y �
Cade:Any city Or county which requiresa permi((oconstrucLalter, I
¢ ¢QQ improve, or repair any 4n¢[ur4 prior to its issuance,uLa ELEC.CONTR. LIC NO. ELEC.
aa
O ¢ requires the applicant for such permit to file a signed statement that TOTAL - V./
w m u ( PER MIT TO
he is licensed pursuant to the provisions of the Contractor's License `
Hi> Law. and
(Chapter that
7000)ofDtherefo and ,
f 4 o the
Business for
Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE
w H o the basis far the alleged exemption.Any violation of Sed ion 7031.5 STORIES TYPE CONSTR.
Aim by any applicant fof a permitsubjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more titan five hundred dollars 15500.):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCD.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,RODE,AR EA,CONE). 5.00
Corin:'The Contractor's License Law does not apply to all owner of
. property who builds or improves Ihemon,and who docs such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve.
menu are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00
builder will[lave the burden of proving that he did not build or int- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 •RES - IND CON PB Other
❑ I,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I 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(hereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with it contractous)licensed pursoan(to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL N0:
❑ l am exempt under See. ,114P.C.for this
reason WATER HEATER W/VENT 6.00
Owner Dale WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate of comcnt to sdr-insure,
or a certificate of Workers'Compensation Inssvoor, 11a certified ZONING ENG.SITE NO.
copy them.1'(Sec.3800,Lab C.)/
Policy No. mP.RJ V,(
0 ❑ CeRifedc sherehyf isFFd.- �' FIRESPRINK ENERGY T-24
Z_ Z ?L' Certified :s f t h y Is ec('in division. MISC.- REFER TO ORD.
O APPlicanl V❑ N� Y N❑
~ �+ PERMIT ISSUANCE 10.00
LU Ch:R'fIFICCOMPE Ii 'MPT ION PROM WORKIiRS' FLOOD ZONE A.L.U.C.
CL COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, ❑ ❑ ❑ ❑
C (This section need not be completed if the permit is for one TOTAL Y N Y N
UZ hundred ertify that
tile
pe less.) -
LL O I certify , I in tlhe Performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, I shall not employ any person in any manner so as to
O w hecomo suhjttl to the Workers'Compensu(ion l.:iws of California.
Date Applicant - BUILDING [9,06
a ALTER OR ADD TO MECH. 5.00
} N NOTICE TO AIRLICAN'I': If,after making this Certificate of Gx-
F Z emption,you should become sah]aet to the Workers'Compensation APPLIANCE 5.00 PLAN C E K
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 FEE
CONSTRUCTION hENDING AGENCY AIR HANDLING UNIT(OVER 10MC.FM.) 6.00 SEIS R FrJ`v
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 issued(Sec. MI
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 E (UI/
Lenders Address
• I certify That I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
'I information is correct. I agree to comply will,all city and county .BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING .►�
ordinances and slate laws relating to building construction, and
hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANIC L
above-mentioned properly for inspection Purposes.
(We) agree to save, indemnify and keep harmless (he City of MISC.- REFER TO ORD. '
uperlino a OR liabilities, 'edgmen(s, casts and expenses which CONST.TA
may i way accrue nst said City in consequence of the PERMIT ISSUANCE 10.00
rang )I' pennit. ECH.CONT. LIC.NO. MECH.
TOTAL TOTAL
at p lican tractor Dam i�
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
a + � . PERM It NUMBER
CITY OF " CUPERTINO 18611
INSPECTION DIVISION
• JOB INSPECTION RECORD'
O� O q �� 7 �+rylm�T'�Fti%PIRAT,ION�
JOBADDRESS n //��,, UNIT# LOT# ,
ry-p/'LG TiCC� 600< "OA'��c� PERMIT EXPIRES IF WORK
owrveR CONTRACTOR - IS NOT STARTED WI�HIN
INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSUw
FOUNDATION ANCE OR 180 DAYS FROM
NOTE:
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PR EGUNI7E TO COMPLY WITH THE APPROVED PLANS AND CITY OF I PE r va uoA TION
CUPERTINO STANDARDS. �^,..
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - / 1/� ,`r
., UNDERGROUND /SLAB ✓
PLUMBING
ELECTRICAL pl 1UW`l ISSUANCE RATE
MECHANICAL LDO ELECT PLG. . MECH
r+, KL ❑ ❑
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING VALUATION s/ET.
MECHANICAL
� ,ry
• I
ELECTRICAL --- !. �• /,PERMIT 1,Ip J`
FRAMING - 1 ss
INSULATION STOP IES TYPE CONSTR.
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED '
SO FT I'I.UCIl AREA TOTALACHCAGF
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
euuowc USE
ROOF SHEATHING TIES IND co PR ale,., '
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑
_ nssessoas PARCEL NO
ROUGH SAN.k
PLUMBING - ELECT.ENERGY
TRACT NO, PARCEL NO
TUBS 8 SHOWER PAN PLUMBING ENERGY '
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST - GAS
MECHANICAL FIRE SPRINK ENERGY LN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ ❑ ` El ❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A L U.c.
INTERIOR SHEAR - FIRE DEPT, Y❑ IN I Y ❑ N❑
SHEETROCK ' - GRADE FEE SUMMARY S�
EXTERIOR LATH BUILDING BUILDING '1 �7 �L•/
INTERIOR LATH TEMPORARY APPROVALS ,
SCRATCH COAT ELECTRIC PLAN CI-IE' ��LrS1
GAS FEE ) 1I
AB1„ J
NO TAPE OR PLASTER UNTIL OVE HAS BEEN SIGNED OCCUPANCY SEI MIC F.e
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR.
L
Lu ECTR7 ARRANGE FOR INSPECTION BY PHONING 252.4505, �
~o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION' DATE - MECHANic L
IMPORTANT! coNs7.TA --
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY