5732 APP.,L'ICANT TO.'FILL-IN INFORMATION WITHIN RED LINESA. USE BALL POINT PEN ONLY
r r
UILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION BI PERMIT +'
/-
ADDRESS - D . ' BUILDING—ELECTRICAL-PLUMBING-MECHANICAL •' S'73'Z'
O ER'S Y' VALID7A
HECKEC TIy'N
PN
OTY. ELECTRIC PERMIT FEE PLAN C` C r I
aC.
"CONPHO E-
'OU -RECEP5.0011.00
NAMTTLETS,SWITCHES
0
-.
uc.rv0.
s 'ALIGHTING FIXTURES 5.0011.00 r'
'
I
CONTRACTOR'S `�J` APPLIANCES-RESIDENTIAL 4.00 .
PANELS'- 500 -:�, DATE OF APPLICATION '-
�/�;�/ ' r �'�Q-7' 2 SIGNS', 600 t;- PLAN CHECK FEE PC NO.
• LIC:o
NO. SIGNS TRANS.- 3.00
ARC
H.OR FNG. n ' .5.00 PERMIT VALIDATION
,ADDRESSy', SPECIALCIRCUIT `
ZIP TEMP.METER OR POLE INS. - 15.00
APPLICANT S *OIL MOTORS'' SEE FEE SCH.
`A SERVICE CHANGE 10.00
o o. ' LICENSED CONTRACTORS DECLARATION
<v w I hereby affirm but I am licensed under provisions of Chapter 9 -' - ISSUANCE DATE
N a u Commencing with Section 7000)of Division 3 of the Business and Y BLDG:• ELECT. ';PLG. MECH.
Professions Code y:license rs m full f d f L AUG .8 HE
z o License Class Lic Number - e❑
O Conhictor
' r Cit of Cupertino BUILpINO PERMIT
lea wo i y OWN:R-RUILDERDECLARATION IN RKAASION
.:`OA - - MISC — REFER TO ORD
R: LL�' I hereby affirm that I am exempt from the Conlractor's'License !q��Ty��11L� $/FT.
i. O¢ - Law for the following reason.(Sec.7031 S,Business and Professions'' PERMIT ISSUANCE 6.00 CSL'OLLJ
SW va Code:Anycity orcounty which requires a permit locunstrucl;alter, - J TT!!TT//'�x//``'r
, in 1 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR , LIC..NO. ELEC: - ,-
in M O m requires the applicant for such permit to file signed statenren Lthat` .;s. TOTALGo d ❑ PER
he is licensed pursuant to the provisions of the Contractor's License - �(fs7�1 14
Law(Chapter 9(commencing with Section 7000)of Division 3 of the - G/VJje_l 4A
Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
r w the basis for the alleged exemption.,Any violation of Section 7031.5 rs �Ey� 6PE CONSTI.
d ; � by any applicant fora permit subjects the applicant to a civil penalty lilt al lrUp6 tI�U
of not more than five hundred dollars($500).)
ALTER-DRAIN -WATER (EA.) 4.00 I .
❑ 1,as owner of the,property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2,00 OCC.GROUP RES.UNITS
their sole compensation; b will do the work,and,the structure,is no - -
intended or offered for sale.(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND.' 4,00
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 4,00 50.FT,FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve'-
'� ' ments are not intended or offered for Sale.If,however,(he building GAS-EA.SYSTEM-1INC.4OUTLETS 4.00
or improvement is sold within one year of completion,the owner, GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
builder will have the burden of proving[hal he diJ not build or im- - + RES IND CON" PB "Other
prove for purpose of sale.). ' INDUSTRIAL WASTE INTER.. 20.00
❑ I,as owner of the property,am,exclusively contracting with - - ❑ ❑ ❑ r❑ : '❑ f''
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1,INC 5 V.B. 5.00 - ASSESSORS PARCEL NO:
t and Professions Code:Jhe Contractor's License Law does not apply
to an ownerof property who builds or improves thereon,and who LAWN_ SPRINKLERS,-OVER 5'(EA.) 1.00
contracts for such projects with a 6onlraetons)licensed pursuant to
the Contractor's License Law. ' - SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO., •PARCEL NO.
❑ I am exempt under Sec. ;B.&P.C.for this WATER HEATER W/VENT ' 4.00
' reason -
" Owner. Dote' WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPF-NSATION DECLARATION- WATER'TREATING EQUIP, 4.00
I hereby affirm that I have.,a,tific.tc ufcomart to self-ins rs,
�[� or a certificate of Woke s Comp ns on Insurance or a ce tificd. ZONING ENG.SITE NO. -
/': copy thereof(Se
Policy No.—
O' ❑ .Ce,tdicdc Is hereby fprpi ed. FIRE SPRINK ENERGY T-24 r
Z; - ❑ Certified c py led wit i' a inn dmison. '
OA Applicant _ ,ii7 f ---'� - MISC. REFER TO ORD. Y❑ N❑, - Y ❑ N❑
~'rn PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
';X'] CERTI FICATF.OF EXEMPTION FROM WORKERS',
'LLI COMPENSATION'INSURANCE L, t PLG.CONTR. LIC.NO. - PLG.
SEL ❑ ;'(This Section need not'be completed if the'permil is for one - TOTAL Y❑ N❑ Y❑ N❑
.Z hundred dollar's($IOD)or less.)
- p�?L) 0 , I certify that in the'performance of the work for which this ver- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL_F mitis issued,I.shall not employ any person in any.canner so as to
U become subject to the W O'Compensation Laws of California.
�'m- [)are— ^p6JiFLiit -' ALTER OR ADD TO MECH., 4.00 — BUILDING •f'_,,
t�}ios NOTICE TO APPLICAMM` If,after making this Certificate of E. - -
• emption,you should become subject to the Workers'Compensation 'APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U• . spentoovisions or this'permit shall be deemed revoked AIR HANDLING�UNIT('CO 10 .) 3.00
CONSTRUCTION L17NDING AGENCY- AIR HANDLING UNIT(OVER . .M.15.00 SEISMIC FEE 5C•r
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DU T) .00
tlie'performance of the work for which this permit is issued(Sec., MICROFILM
'3097,Civ.C7. - - .,HEATING UNIT(Td A.T.LIP 4.00
Lender's Name" '' HEATING UNIT(OVER I OO OB.T. .1750 1
Lender,Address - ELECTRIC Q/
1 certify that I have read this application and state that thepbove VENTILATION FAN ( P I .00 t
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives,of this city to enter upon the
above-nientioned property for inspection purposes. BOILER-COMP Over tOD,0008TU1 SEE FEESCH. MECHANICAL . /
(We) agree to save, nify and keep 9immleas the City of MISC.- REFER TO ORD.
Cupertino .gains " ms, is and expenses hicb PERMIT ISSUANCE 3,00 'j'^ i CONST.TAX',
ma an 'y ace a gains) ty n con uen$f the
w mgo this perm, /� MECH.CONT. LIF NO. MECH, TOTAL 3d1
1 TOTAL TJ
Sgnater of Applin nl n Date - '
- • OFFICE COPY
CITY OF CUPERTINO INSPECTION RECORD
(OFFICE COPY)
PEPHTT 0. AUJJRh66 LOT NO.
�'Lfd OWNER
PERMIT ISSUED DA= ELECTRICAL DATE INSP.
RT ing
ectncal
Plumbing v Power Pole
Mechanical „ run
e as ec � griu. irzn
Solar Nails . . ,zo
Fire Sprinkler Ceiling
Sign F3.xtures Int/Ext
otors
Misc. mroipm__m_
t er
er
FINAL INSPECTIONS DATE INSP. Not Approved
Gas
Electric
Plumbing PLUMBING DATE INSP.
-Mechanical
.10 ar Backflow
oo run
Grading er oor
Planning Partial Rough
Fire Dept. 5 o_ug c ete
alt pt. �io ar ou i
Building Water ', Insulation
Other ain rain
R/of/S Drain
Gas
Other
BUILDING DATE INSP. Not rove
Pad Certification
oun ation. ELECTRICAL DATE INSP.
re- unite
S a - m rane Underfloor S.M.
ME eam Ducts & Insulation
Underfloor Girders - ire Dampers
oor teel Fireplace
ie owns Grease Duct 4 Hood
i a ramsnye Hour Shaft
eismecracin Condensate rain
HE -sane s Equipment An ora e
Frame Piues 4 Comb. r
Aftath er
MWallboards Int/Ext. of rove
Firewa s
TtTer
Not Approved