The URL can be used to link to this page

12708 APPLICANT TO FILL IN INFO I ATION WITHIN RED LINES - USE BILL POINT PEN ONLY BUI LDI NG PROJECT I DENTI FICAIW, APPLICATION & PEPERMIT NUrM�BER So ILDING R 1 Z I O ADDRESS /OZ/ 0 fZ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'$ - PLAN CHECK VALIDATION NAME 1/IS CITY. ELECTRIC PERMIT FEE HON NAM>ERAcrons NUTLETS-SWITCHES-RECEP 10.00/1.00 Ic.NO. ' LIGHTING FIXTURES 10.00/1.00 �l CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 ADDRESS 4 { PHOFE PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. Ofl FNGIN ER erva LIC.NO. SIGNS TRANS. 3.00 ADDRESS SPECIAL CIRCUIT 5,00 PERMIT VALIDATION di0q) Ex- zIP y EMP.METER OR POLE INS. 20,00 APPLICANT'S MOTORS SEE FEE SCH. ADDRESS 1 SERVICE CHANGE 20.00 , %' a,T woo LICENSED CONTRACTORS DECLARATION T a v v 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE w z (commencing with Section 7000)of Division 3 of the Business and N Professions Code,and my license is in full for aappd effect ❑ ❑ Z o m - License Class-13 - Lia'Number_�4A47 C,� - D Date lJ�G�7 Contractor YP 9 rc se¢a OWNER-BUILDER D17CLARATION G PERMIT o s D - REFER TO ORD ORIMATION X w I hereby affirm that I am exempt from the Contractor's License MISC.- w 3 Y P _ VALUATION $/FT. Fwo J Law forthefollowing reason. 7031.5,Business Professions PERMIT ISSUANCE 10.00 �- Nm Code:Any city or county which requires a permit to construct,alter, a¢<0O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. requires the applicant for such permit to file a signed statement that TOTAL PER a w m m he is licensed pursuant to the provisions of the Contractor's License TSO, aLaw(Chapter 9(commencing with Section 7000)of Division 3 ofthe2 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FE¢ H the basis for the alleged exemption.Any violation ofSection7031.5 T PEC N TR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ofnot more than five hundred dollars($500).)❑ I,as owner of the properly,or my employees with wages asggCK FLOW PROTECT.DEVICE 4.00C.GROUP RES.UNIT$ their sole compensation,will do the work,and the structure is no[intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves flu reon,and who doessuch work FIXTURES-PER TRAP 5.OD .FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments 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 BUILDIN usE > builder will have the burden of proving that he did not build or am- qES IND C PB Omar prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,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 ASSESSO RCEL 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 a contractoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 Thereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or u certificate of Workers'Compensation Insurance,or a certified copy thereof(Sea 3800,Lab.C). Policy No, Company 41!BETLTr/ MLfT13(pAl.. O ❑ Certified copy is hereby furnished.WC2LJ(a 11a $O/ FIRE SPRINK ENERGY T-74 ❑ Certified o rs filed with the Illy inspection vision. ZZO Applicant ` V►. ' '4D�,i"7 MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No F va , ^� � Y � PERMIT ISSUANCE 10.00 R IF 'ATE E XEMPTIO FROM WORKERS' FLOOD ZONE A.L.u.C. W � CO P- SATION INSURANCIi PLG.CONTR. - LIC.NO. PLG. d O (This section need not be completed if the permit is for one TOTAL V❑ N❑ V❑ N❑ Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mil is issued,I shall not employ any person in any manner an as to U become subject to the Workers'Compensation Laws of California. i Dale Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ W NOTICE TO APPLICANT: If,after making this Certificate of -x-- I.. Z emption,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 lomr-F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000C.RM.) 6.00 SEISMIC FEE 1 hereby affirm That (here is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders AddHEATI NG UNIT(OV ER 100,000 B.T.U.)9.50 ELECTRIC ress I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information n correct. I agree to comply with all city and county PLUMBING ordinainformacestion and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purpoms. (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 way accrue again id City in consequence of(be' PERMIT ISSUANCE 10.00 granting of th' ermit. MECH.CONT. LIC.NO. MECH. / TOTAL TOTAL atureo Applic t/ ntractor D OFFICE COPY POST THISC NEAR FRONT OF BUILDING ' - • _ PFA AIIT NUMBER CI.TAF CUPERTINO 12708 ` INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION - - JOBIADDRESS lOZll Bubb Rd. UNIT# LOT# .Iy` < - PERMIT'EXPIRES°IF WORK OWNER Bubb Partners 'CONTRACTOR Vance Brown and Sons IS NOT STARTEDLWITHIN ' INSPECTION DATE I INSPECTOR INSPECTION RECORD iuu DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE ;11 'tj (67 ar ��I rod PERMIT VALIDATION 4z& ` c � > POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ��./f - o� 1 T e ti UNDERGROUND /SLAB PLUMBING :FraPnC V erwN' cco OK 11-30.8 ELECTRICAL ISSUANCE DATE MECHANICAL - SLOG ELECT. PL❑G. ME❑CR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT WOOD FLOORINFORMATION ' PLUMBING VALUATION SIFT® MECHANICAL I f, ' ELECTRICAL FRAMING INSULATION. s ORIES TYPE CONSTR. ' I OCC.GROUP RES.UNITS (PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLOOR AREA . TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE RES IND CON PB 00", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ • 9 ❑ ❑ 'ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST pp _ - TRACT NO. PARCEL NO. -5-07 MECHANICAL ELECTRICAL F.I MAILS . DATE INSP. Acc.GATE AcG FILE No. FRAMING SAN * INSULATION PLUMBING / ZONING ENG.SITE NO. • GAS FIRE SPRINK ENERGY T.IC MECHANICAL — J ❑ N❑ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED' ' HEATING LATH-INTERIOR - ELECTRICAL r� I YNY ❑ N PL000 ZONE A.L.u.c. ❑ ❑ ❑ LATH-EXTERIOR ' � FIRE DEPT. - SHEETROCK 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 JOCCUPANCY SEISMIC FEE •1 /}! OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN'PHONING.. "v1>/ Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL ' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL • .. OFFICE COPY -_--- ------ _--- -- --