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HomeMy WebLinkAbout14788 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT-PEN ONLY ' BU I LDING PROJECT I DENTIFICATI ON - - PERMITNUMBER - ;1 BUILDING APPLICATION &'PERMIT 7R f -0 3 f/C7✓�S ' �� ) BUILDING'= ELECTRICAL-PLUMBING-MECHANICAL OWNER'S - 1 - PLANCHECKVALIDATION - NAME.+vNITZ6S 2-7j- .. - - DTV. ELECTRIC PERMIT T FEE Vy PHONE CONTRACTOR'S . NAME n OUTLETS-SWITCHES-RECEP 10.00/100 P'J71-0 PCU mf5. - LICNo. C 6 LIGHTING FIXTURES 10.00/1.00 r,DDIRESS ons - PPLIANCES-RESIDENTIAL 4.00 , 3 .C2A-!2 n PHONC ,L,,,¢ /7J_ / • PANELS _ - 10.00 - DATE OF APPLICATION ' ARCHITECT , PLAN CHECK FEE NO. OR .C PANELS (OVER 200 AMPI' 20.00 - ENGINEER +1 - - - s ' LIC.No. . SIGNS TRANS. 3;00 ADDRESS Ervc. SPECIALCIRCUIT 5.00 L ' PERMIT VALIDATION - zip TEMP.METER OR POLE INS. 20.00 - APPLICANTS MOTORSR• SEEFEESCH. ' ADDRESS _ SERVICE CHANGE - 20.00 : ` o o +,LICI NSLD COM'RAC1ORS DECLARATION ex u I herehy;dltan that l atn'llcensed un er pn Wsions of Chapter 9 . + '� "I SUANCE DATE ,•, H a Icmunumnem,with Section 7000)of Division 9 c t the Business and _� n < BLDG 11 V er�frfo REGI ME❑CH.. H 7 i` Professions Code ,Ind my license i m full fore and effect. P r 1,C ILhJA/ Z 0 w- '^ License Class I¢ Number - - - s 0 w Dat, _rte Contractor_ ° 76� a SEE - BUILDING PERMIT ¢ ¢o a o _ OWNIi R-BUILDER DIiCLA RATION ' . INFORMATION. , F 5,� N 1 hereby.affion that'I am exempt from the Contractor's License' MISC:'- - a REFER TO ORD u0et Law for Inc following reason.(Sec.7031,5,Bmime.and Professions- VALUATION $/FT. _ PERMIT ISSUANCE'- .10:00 . . i. Code:Any city or monty whiny structure, peonit toconstantehitt... r ¢ G 0. ' improve,demolish,or repair any structure,a it sin its issuance,also ELEG,CONTR. LIG-NO. a wO u requires tire uppiclutt for such permit.In file II signed sndement that - - a - TOTAL -.PER MIT TO $ Law licensed pursuant to fire provisions of tire Contractor's License „f' - F z a Business (Chard Profession, Codemg With Section is excerpt of D therefrom and ` t {•--v/ BE 4 0 the ha is for Professions Code1 m that he is exempt therefrom and DTV.' PLUMBING PERMIT - FEE 1-^•' - ¢ t- $ : the basis for the alleged exemption.Any violation of Section 7031.5 f' STORIES ITYPE CONSTR. a by any applicant for a permit subjects the applicant to acivil pendly gLTER -DRAIN& VENT-WATER (EA.) 5.00 of not more than live hundred dollars(5500).): r ' ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 UNITS y their sole compensation,will do'the work;and the structure is not OCC.GROUP RES., intended or offered for sale (Sec. 7044, Business:aid Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ' Code:-'The Contractor's License se.Iaw docs not apply to an owner of Property Who builds or I mproves thereOn'rod who does such Work FIXTURES-PER TRAP , ,'° ^ . 5.00 SO.FT.FLOOR AREATOTAL ACREAGE himself or-through his own employees provided that such improve. mems are not intended oroffered for sale,It,however,the building PAS-EA,SVSTEM.-11 INC.4 OUTLETS 6.00 ® or improvement Is said within one yearof completion,the'own er- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that tic did not build or Im- - BUILDING USE prove for purpose of sale.). - INDUSTRIAL WASTE INTER •3000 ' RES IND CON PB Omer O. 1,as owner of Ihe property,am exd . . with oiively contracting w0 El El 1:1 -11 licensed contractors to construct the projecl tSec.7044,.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Gestic"Phe Conv3dar's License Law does not apply - to an owner of properly Who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.0.0 contracts for such projects with a contractorls)licensed pursuant to SEWER-SANITARY-STORM EA.•200ft110.00 thv Coutruclor's License Law. TRACT NO. PARCEL NO.' O 'I am exempt order Sec.' ,B.&P.C.forthis WATER•H EATER W/VENT 6.00 ' reason Owner Dale WATER SYSTEM 5.00 ACC:GATE -ACC.FILE NO. -,WORK ISRS,COM PENSAT1ON DECLARATION - WATER TREATING EQUIP. 5.00 ' I hereby affirm that I have a certificate of consent to self-insure, - ZONING moa certificate of Workers'Compensation Insurnee,or a certified ENG.SITE NO. c0py't h eraof(See. 00„Lub,CJ. s ''a policy cY Nany. ' - - O + Certifie en laherehyfunu a FIRESPRINK ENERGY T34,e " Z Z" -O Ceaifl pY : Elcd w'! c city t.l ctiOO divisiini.' O Applwam - - MISC.-- REFER TO ORD/ 'Y❑, NQs v ❑ NF Fro L PERMIT ISSUANCE 10.00 FLOOD ZONE A,L.U.C. CIiRTI PICA -Oh IiXfi MPT10Ny71 1 WORKER SRS' �� W COh1I'IiNSAT10N IN UIIANCIi PLG.GONTR(,. .. 'LIC:N0. PCL LG. )�r+•T� y N 'v ,N� Z, (This section need not be-completed if the permit is for one _ TOTAL (-V hundred dollms(S 100)or less) , U O I certify that in the performance of the work for which this per. CITY. MECHANICAL.PERMIT FEE - FEE SUMMARY W F mit is issued;FOudl not employ any person in any moaner so us to OtU`s. bccorm suhj,ct to-0m WOrkers.COmpensntion laws of California. - - .Go Dine' ' - + "AI°plicant ' . , BUILDING0. . , > w: NOTICE TO APPLICANT': If,after making this Certificate Of lis- _ ALTER OR'ADD TO MECH. 5,00 ^F Z emp6011,YOU shoidd become subjectio the Workers Compensation APPLIANCE 1 5.00 PLAN CHECK_ provisions of the labor Code, you must forthwith comply with �0 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10fMC.F.M.) 6.00 SEISMIC FEE 1 hereby+affirm that there is-a construction fending agency for EXHAUST HOOD (WITH DUCT) 5.00 - tire performance of the work for which this permit is issued(Sec. - MICROFILM 3097,Civ.C.)1 °- z HEATING UNIT(TO 100,000 B.T.U.) 8.00 st, lender's Nom HEATING UNIT ER 100,000 B.T.U.)9.50 Lender's Addr a ELECTRIC I certify th t I have mailapplication'and tate that the above VENTILATION FAN (SINGLE)• 4.00 ✓ - 'nlormation is correct I agree to omplywith 'II city and county PLUMBING. ordinances and scam Iwo rclaNng to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 �0• hereby author¢ representatives of this city to'enter upon Ihe BAILER-COMP (Over 100,000 BTUI SEE FEE SDH. MECHANICAL above-menti ed property for inspection purposes. - (WeT a e int Te, in temnif and keep'harmless the City of MISC.- REF ER,TO ORD. - uperif 0 inst liabilities,j g ents, costs anti expenses which PERMIT ISSUANCE 10.00 CONST.TAX - may way nccme a+ Ins said City in consequence of the •rants f this perptit. .r MECH:CONT. LIC.NO. MECH. �� -' � TOTAL TOTAL v, igna ore of licant Contmc[grf Ua[ OFFICE COPY L. POST THIS CAR'D,NEAR FRONT'OF BUILDING !••'' y PERMIT NUMBER ' CITY -OF ..CUPPERTINO 1'4��8' INSPECTION DIVISION'• • JOB INSPECTION RECORD ' 265J & 275 PERMIT EXPIRATION JOB ADDRESS .20195 STEVENS CREEK BLVD. UNI r#& -LOT# - ' + - - PERMIT EXPIRES IF WORK„ ', owNEd` W D .T coNrRAcToa METRO PLUMBING '. IS NOT 'STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD ! 180 DAYS OF PERMIT.ISSU. ' 'I_•. FOUNDATION. -' .v ' - A.NCE 180 DAYS FROM NOTE :LAST CALLED INSPECTION. UFER. - �:” TALL GRADING'AND DRAINAGE SHALL.BE INSTALLED' I P,R EGUNITE,`+ - TO COMPLY WITH THE APPROVED.PLANS AND CITY'OF PERK IT Vnr 1 ATION .CUPERTINO STANDARDS GARAGESLABS - r 'POUR NO.CONCRETE UNTIL ABOVE HAS BEEN SIGNED - • r . UNDERGROUND /SLAB .`. ' . . P141D 111 R 6 PLUMBINGIIIY11\_ .. ELECTRICAL ,•,'; `' ' sI ISSUANCI,unrE MECHANICAL - > - I ty 0 Opal 13y�G ELOr. P©r M -p �. �IIFjJ-t j DO NOT POUR FLOOR UNTIL,ABOVE HAS.BEEN SIGNED ,.! - ,. - BUILDING PERMIT ; r INFORMATI WOOD FLOOR VAWu TION . •S/PT. PLUMBING � ' a. MECHAN ICAL ELECTRICAL. FRAMING INSULATION - - - STORIES TvvE CONsrw. C.GROUP • RES UNITS 3-IS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED •. ROOF - INOTE:NO FINAL INS°:SHALL BE MADE BEFORE sn.PT lNUDR nRr_a rDTai.ncveaGe CONSTRUCTION TAXIS PAID - DIAPHRAGM THE - BUILDING USE ROOF SHEATHING - ' ^' - + REs IND CON P9 o .," .„..APPLY NO ROOFING,UNTILABOVE HAS BEEN SIGNED ..FINALS "" ^ DATE :INSP: 0 [:]r •'❑.. '❑ ' O nSSES50RS PARCEL NO •! ROUGH - SAN.# - - - PLUMBING �m.,or - ELECT.ENERGY ^ TRACT NO. PARCELNO TUBS&SHOWER PA,. ; • ' PLUMBING ENERGY ' : MECHANICAL [ICTS /D -� - MECH.ENERGY. ELECTRICAL _-p.- BUILDING ENERGY, ' - • .Acc DATE ncc,PiLE No. FRAMING-'' - ELECT.FINAL TEST " +' ZONING -ENG.SITE NO. ' INSULATION - _ v, - PLUMBING + .T GAS TEST - - - GAS MECHANICAL FIFESPRINK% ENERGY T 24 :;o' 'No ' '1%0 No' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' - ' FLODD ZONE A LLLC, ' EXTERIOR SHEAR ' - ELECTRICAL' RECEASE Zrf. � '• , --. + INTERIOR SHEAR FIRE DEPT. - ° N❑ ° L SHEETROCK - GRADE p- i FEE SUMMARY - EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS 'BUILDING .. - v u - PLAN CHECK '' e•SCRATCH COAT:COAT ;,�� ��' � ELECTRIC GAS FEE; ' ` NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ',SEISMIC FEE'i' ' OCCUP,ANCY,OF BUILDING'ISNOTPERMITTED UNTIL BUILDI NG FINALISSIGNEID BY BUILDING I NSPECTOR. MICROFILM I t ARRANGE INSPECTION BY-PHONING 252=4505, ELECTRIC H, ONE WORKING DAY,BEFORE,REQUIRED INSPECTION. d PLUMBING p� . PLEASE GIVE JOB ADDRESS WHEN PHONING. • Z' - ' MECHANICAL' —.SEE PERMIT FOR EXPIRATION DATE IMPORTANT! CONST,TAX 4,: . PLEASE'READ REVERSE SIDE BEFORE _ �w TOTAL r "' CALLING FOR FINAL-INSPECTION (f^ OFFICE COPY '