The URL can be used to link to this page

15259 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY _ /IU LDING PROJECT IDENTIFICATION PERMIT NUMBER B nUrLDINl APPLICATION & PERMIT ' 15259 �' _ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL �t 2 ( E 'S PLAN CHECK VALIDATION 13 /J NPME.c— E 6Lt14 glei1/ GNoQ� TY ELECTRIC PERMIT FEE CONNAMERAciDRs UTLETS-SWITCHES-RECEP 10.00/1.00 (ZF P4VA419U (D. LIGHTING FIXTURES 10.00/1.00 r,DNTRAciDRs SDOR ssRLII PPLIANCES-RESIDENTIAL 4.00 / E '[ �,— 111 y ✓ .4;J PHONE /��/� PANELS 10,00 DATE OF APPLICATION on RCHITECi PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER ' tic.No. SIGNS TRANS. 3.00 ADDREss ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLI ESS MOTORS SEE FEE SEH. ADDRESS SERVICE CHANGE 20.00 / D ¢ i o o LICENSED CONI'RACI'ORS UECI.A RATION <u o I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE H z (commencing with Section 7000)of Division 3 of the Business and x Q n BLDG. ELECT. PLG. -MECH. H m z Professions CoJc nJ y license is N full for 11 of L ❑ ❑ g .00 ;; License-a �' Lic.Number G Dulc Cont rector C t-L'/« H < m s , BUILDING PERMIT ¢ ¢aa OWNER-BUILDER DHCLARATION u INFORMATION K H I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD .. o st Law for the following reason,(Sec.7031.5,Businessand Professions VALUATION S/FT. I _ PERMIT ISSUANCE 10.00 Code:Any city or county which requires u pemrit to construct,alter, acau¢ 0 Improve,demolish,or repair any structure',prior to Its ssuanec,atSa ELEC.CONTR. LIC.NO. ELEG - u w-O u requires the applicant for such permit to rile a signed stxlcmcnl that TOTAL PERMIT TO m he is licensed pursaonf to Oe provision'of the Contractor's License �g Hzus "W(Chupter 9(Commencing with Section 71700)of-Division 3 of the Lip(' i o Business And Professions Code)or that he is exempt therefrom and fq] ' PLUMBING PERMIT FEE ¢ F the basis for the alleged exemption.Any violmion of Section 7031.5 �! STORIES TYPE CONSTR. A, 3 by any applicant for a permit subjects the applicant w ricivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,ax owner of the property,or my elnpluyccs with wages as BACK FLOW PROTECT.DEVICE 4.00 GCC.GROUP RES.UNITS their Sale compensation,will do the work.and the structure Is not intended or offered for sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND.—5-.lCoda The Contractor's License Law does act apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- nwntsall net intendedoroffered lot it.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS .00 or improvement is SaId within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4( .00 builder will have the burden of proving that he did not build or ins- BUILDING USE prove for purpose of sale.). INDUSTRIALWASTE INTER. 30 RES IND CON PB 'other O 1,as owner of the property,am exclusively contracting with ❑ ❑ 0 ❑ ❑ licensed contractors to construct the project(Sec 7044,Business LAWN SPRINKLERS-1 IN ASSESSORS PARCEL NO. anJ Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV E (EA.) contracts for such projects with a contractors)licensed pursuant to the Contractors Llceoee Law. SEWER-SANITARY-STORME I TRACT No. PARCEL NO. O lam exempt under Sec. ,B.&P.C.for this ,.AmWATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a cenific.le of consent In self mxurr. or a certificate of Workeri Compensation Insurance,or a certified ZONING ENG.SITE NO. copy lh ereof(Scc.3800 Lab.C.I Policy No. Company �� 0 Cl Ce n ifi<d copy isherchy fume J FIRESPRINK ENERGY T-24 z Z - O Ceni5ecity spectim, division. FOD Applicanf )ljC�� MISC.- REFER TO ORD. YQ, NE] YE] NE] LU N CERTIFICATECERTIFICATE OF BEI'INS PROM WORKERS' PERMIT ISSUANCE —FLOOD ZONE A.L.uL. W CO.MYESCSATIOION INSURANCE PLG.CONTR. LIC.NO. PLG. Z ('flus section need nut be cunmeted if the uennit is for one TOTAL �� Y❑ N� Y ❑ N❑ hundred Dollars to performance FEE SUMMARY U O I certify that h the performance of the work for which this per- QTY MECHANICAL PERMIT FEE W H mit is issued I shall not employ any prss<m in Laws Ina nnerw as to U become subject to the Workers'Compensation Laws of California. 0- Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W Noricr '10 APPLICANT: 11,after making this Certif cam or Fx- F-. ? eruption,you should become subject to the Wofkeri 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 decnred revoked. AIR HANDLING UNIT(TO 10)000CF.M.) 4.00 , CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C-F.M.) 6.00 SEISMIC FEE 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,Civ.Cf. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I terrify Ila,I have read this application and store that the above VENTILATION FAN (SINGLE) 4.00 • information n correct, I agree to comply with all city ucti county PLUMBING i ordinances and state laws r e to c m comply with construction,ndU and BOILER-COMP(3 H.P.or 100,000 B.T.U.1 6.00 hereby authorise representatives ec the city to enter upon the BO LER (Over 100,000 BTU)SEE FEE SEH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Jay per[ino against liabilities,Judgments, costs and expenses which CONST.TAX in any way acerae against said City in consequence of the PERMIT ISSUANCE 10.00W of Inas p MECH.CONT. LIC.NO. MECHTOTALTOTAL natum o Applicant/Con racmr ate OFFICE COPY POST THIS CARD'NEAR FRONT OF BUILDING PERMIT NUMBER f CITY OF CUPERTINO 15259 INSPECTION DIVISION JOB INSPECTION RECORD L_ - PERMIT EXPIRATION JOB ADDRESS,Zqs /n/fes V6 UNIT# LOT PERMIT EXPIRES IF WORK OWNER �7 L CONTRACTOR �,� �r [, IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION NOTE: ANCE OR 180 DAYS FROM UFER , � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS, GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED (_ .-� • " UNDERGROUND /SLAB . /� - � PLUMBING ELECTRICAL I - ISSUANCE unre MECHANICAL BLDG ELECT, I PLG. MECH ❑ L ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1p .BUILDING PERMIT WOOD FLOOR ' 'INFORMATION PLUMBING VALUATION S/FT. MECHANICAL MD ELECTRICAL PEHMn To FRAMING INSULATION ,• STORIES TYPE CON STR I I OCC,GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF �,a.FT.FL(WH AHUA TOTAI.ACIILAc,P NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILD IND USE ROOF SHEATHING RES Irv0 CON Pe APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.p PLUMBING ELECT.ENERGY TUBS 8 SHOWER PANPLUMBING ENERGY LRAC1 NO PARCEL NO - MECHANICAL MECH,ENERGY ' ELECTRICALBUILDING ENERGY ACC DATE _ }ACC.FILE NO FRAMING ELECT. FINAL TEST I NSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T.2< COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y [_j "❑ ` ❑ N EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC INTERIOR SHEAR FIRE DEPT. Y [-] INTERIOR N SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANC4 SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING y� Z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! coNsr. TAx PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY