16886 APPLICANT TO FILL IN INFORMATION WITHIN RED LIf JSE BALL POINT PEN ONLY
BU LDI NG PROJECT IDENTIFICATION .PERMIT NUMBER
SoILIING APPLIO> ro & PERMIT 16886
ADDRESS
2•Z��S C _ _ r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,
ML
OWNER'S PLAN CHECK VALIDATION
NAME DTY. ELECTRIC PERMIT FEE
• G CAE )C, PHONE 2 S7'1 .1
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 e, D
NAME
a L1..No. ZcJ86 70 LIGHTING FIXTURES 10.00/1.00 00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
Tpyyl PHONE_S' � PANELS 10.00 DATE DF APPLICATION
ARCXITECT
PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE v.c.No.
OR
ENGINEER 3.00
uc.NO. SIGNS TRANS.
ARCH.OR ENG. S.00 PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT (�
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH. l
ADDRESS
SERVICE CHANGE 20.00
0 0 o LICENSED CONTRACTORS DECLARATION
< v w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
in a n (commencing with Section 7000)of Division 3 of the Business and LDG. ELECT. PLG. MECH,
r y i Professions C La d my license is in full forge gLld�ffrcts I .(---I IVl fbf
Z o w License Class L1c.Number 4 LL tCJ'- p X�J C]I I�-
9 w Date%A..ag.-$.(.'_Contractor LJ Of CUPQ[tIOO BUILDING PERMIT
w OWNER-BUILDER DECLARATION INFORMATIONMISC.-
o REFER TO ORD
E
A I hereby affirm that 1 am exempt from the Contractor's License VALUATION S/FT.
uoa Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 LOO DO
rW a Code:Anycity orcounty which requires a permit to construct,alter,
Q a¢0 Improve,demolish,or repair any structure,prior to Its issuance,also ELEC. LIQ NO. ELEC Io- OD D
a O IS requires the applicant for such permit to file a signed statement that TOTAL E( 0 PERMIT TO
E
m he is licensed pursuant to the provisions of the Contractor's License �p I
z i Law(Chapter 9(commencing with Section 7000)of Division3of the 1 /-- %/1AO CCE
1 a o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
M 1-a the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
i ;m by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars(8500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.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,ROOF,AREA,COND. 5.00
Code:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 2,0%) SO FT.FLOOR AREA TOTAL ACREAGE
.• mems are not hrough
ownemployees,for sale.
If.ed that however,
the
improve- GAS-EA.SYSTEM-1 6.00
mems are not intended or offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Other
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with El El El E] El
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Cade:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contraclons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.20011/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATER WIVENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure, 20NING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD, y❑ ry❑ y❑ NO
O Applicant
~ va PERMIT ISSUANCE 10,0014, FLOOD ZONE A.L.U.C.
LU CERTIFICATE E EXEMPTION FROM WORKERS'
W �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. TOG. /s�� y❑ N❑ Y❑ N❑
1 O (This section need not be completed if the permit is for one TOTAL O
D Z hundred dollars IS 100)or less.) FEE SUMMARY
V O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE
LL F mit is issued,I shall not empI y any person in any universe,as to
U becorrry'�y�b�jectt�p}he Workers Rrym on Lawsof.CaliforNa. BUILDING 37. O
0 w Dale/t��1tY.Applicant ALTER OR ADD TO MECH. 5.00
} t0ia NOTICE TO APPLICANT: If,of a ing this Ce tificate of Ex.
F ? emption,you should become subjec tnaorkers'Compensation APPLIANCE 5.00 PLAN CHECK T
provisions of the Labor Code, you must forthwith comply with FEE �s�../
V, such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10A00C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY
AIR HANDLING UNIT(OVER IOAOOC.F.M.) 6.00 SEISMIC FEE )Sp
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. - MICROFILM
3097,CPL.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 jJ Lender's Name HEATI NG UN IT IOV ER 100,000 B.T.U.)9.50 qMECHANICAL
Lender's AddressI certify that I have read thisapplication and stale that the above VENTILATION FAN (SINGLE) 4.00information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or/00,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 1DD,000 BTU)SEE FEESCH.
above-mentioned property for inspection purposes.
(We) agree to'Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 (2-D OIing of this pe IIIMECH.CONT. LIC.NOMECH._ TOTAL/b ,SO ��1I;
Signa[ re fA plicant antra or Date 1
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER
CITY OF CUPERTINO 16886
INSPECTION DIVISION
JOB INSPECTION
�RECORD
JOB ADDRESS
• 3 - ` �P��("'F' GUNIT# _LOT# PERMIT EXPIRATION
//++v 2PERMIT EXPIRES IF WORK
U
OWNER - � C e (G CONTRACTOR � SP Y✓�1�V}" IS NOT STARTED WITHIN
INSPECTIONDATE INSPECTOR INSPECTION RECORD• 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS �1 „' '�- ��•
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,
UNDERGROUND /SLAB _
PLUMBING .L`
ELECTRICAL ISSUANCE DATE
.BLDG ELECT gPLG MECH
MECHANICAL iz z
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - i ,,,r BUILDING PERMIT.KJ(
W - INFORMATION
WOOD FLOOR
VALUATION $/FT.
PLUMBING g-
MECHANICAL y �v
ELECTRICAL 'T'— PE MIT To --/
FRAMING F�es.7 ll <J Ckk
STORIES TYPE CONSTR.
INSULATION
OCC GROUP RES,UNITS
PLACE NO SUBFLOOR'UNTICABOVE HAS BEEN SIGNED City of CUPBf1lDO
50 FT FLOORAREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING N
RES IND
aDlOCON N PB Oq^rr
APPLY NO ROOFING UNTIL ABOVE HASlEEN-SIGNED FINALS '.a:epi°S� DATE , INSP: ❑ ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SAN.#
PLUMBING ELECT.ENERGY
TRACT NO. PARCEL NO
TUBS B SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY J,/
ACC DATE ACC.FILE NO,
ELECTRICAL BUILDING ENERGY
FRAMING 2 ELECT.FINALTEST - ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS /
FIRE SPR INK ENERGY h2a
MECHANICAL 1 Y ❑ N❑ v E] N❑
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED` HEATING N
FLOOD zorvE AL.0 c.
EXTERIOR SHEAR ELECTRICAL RELEASE
INTERIOR SHEAR FIRE DEPT. A- v ❑ N❑ v ❑ N
SHEETROCK GRADE / - FEESUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS BUILDING Y
31�Y;b
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE 1 f p
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ¢
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC /8-0 U'
IW—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ,f kIV U
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
z• — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL lb.
IMPORTANT! CONST.TAX - -
PLEASE READ REVERSE SIDE BEFORE TOTAL V
CALLING FOR FINAL INSPECTION.
OFFICE COPY