17549 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATI ON PERMIT NUMBER
BUILDING I APPLICATION & PERMIT
ADDRESS '1 u 2'. 17549
O 1 G1VC\\ �� . BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S
NAME LOTH PLAN CHECK VALIDATION
�L CJ`/J U1J2<<-1 CITY. ELECTRIC PERMIT' FEE
GXONE
CONTRACT t- L
NAME �'1Ff> Sy,= -Ln-3-101UTLETS-SWITCHES-RECEP 10.00/1.00
LIc.No. LIGHTING FIXTURES 10.00/1.00
AONTLEACT-O�R'S
L O L APPLIANCES-RESIDENTIAL 4.00
FPANELS)a* N
10,06 DATE OF APPLICATION
OgcHITEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P. NO.
ENGINEER
LIC.No. ISIGNS TRANS. 3.00
ARCH.08 ADDRESS ENG. SPECIAL CIRCUIT 5,06 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00
ADDDREDRESSS S (`iL)
AMOTORS SEE FEE SCH.
o SERVICE CHANGE 20.00
X z Joe -}O��IJ
F o o LICENSED CONI'RACIORS DECLARATION ` -[
a i w I hereby affirm that I am licensed under provisions of Chapter 9 APRISSUANCE DATE
¢ m (commencing with Section 7000)of Division 3 of the Business and BIG.. ELECT. PLG. MECH.
H D z Professions Coll- en license is in full to 'e -�
a o}� - Liccaus5.Clan - {._Lic.Number_ -
9 y F Date�.F- - Contractor Siy'U
¢ r E C* of BUILDING PERMIT
¢ w ¢ OWNER-BUILDER DECLARATION -
o a u INFORMATION
w ; LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLLOa, Law forthe following mason. 7031.5,Business and Professions PERMIT ISSUANCE 1U 00 VALUATION $/FT.
Code:Any city or county which requia.a pumtit to construct,alter,
EE 2 Q 2 improve,demolish,or repair any structure,prior to its issuance,also ELEG CONTR. LIC.NO. ELEC.
- 0 u require,the applicant for such permit to Glc a signed statement that TOTAL Aq PERMIT TO
E
$ he is licensed pursuant to the provisions of the Contractor's License
za Law(Chapter 9(cummencing with Section 7000)n f Division 3 of the A `�
4 o Business and Professions Code)or that he u exempt thercfrum and OTV. PLUMBING PERMIT FEE C
C F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n , by of more
fove hundred
subjects the a0plicamtoucivil penalty ALTER-DRAIN -WATER (EA.) 5.00
Of not mom woeharn fiveethe prop dollars 1my cre1:
❑ 1,as owner of the property,or my employee with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
then sole compensation,will Jo the work,and the amcnlm Is not
intended or offered for sale (Sec. 7044, Business and Pforesslom DRAINS-FLOOR,ROOF,AREA COND. 5.00
Code:The Contractor's License Law dots not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SM FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employctn,provided that such improve-
Ientsare not intended oroffered lot sale.It,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.1 2.00
builder will have the burden of proving that he did not build or ire- etLLOwG USE
prove for purpose of vale). RES IND CON PB Orher
❑ I,as owner of the pro,efty,ant L.LhUlvely contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project IS,,. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Calc:The Contractor's License Law does not apply
. In an owner of proportY wbo build,or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts forsueh projects with a contructorls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Lew'. TRACT NO. PARCEL NO.
❑ lam exempt under See .B.&BC.for this WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00 Ace.DATE ACC.FILE NO,
WORK ERS'COMPIiNSA1'ION DFCI-ARAIION WATER TREATING EQUIP, 5.00
I hereby affirm that 1 haw a certificate of consent to self-insure,
or a certificate of Workers'Compen nation Insurance,or a cenitied ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. CDntpuuy
U ❑ Certified copy is hereby furnished.
Z Z ❑ Certified copy is riled with the city inspeclion division. FIRE SPRINK ENERGY TY4
F O Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑
� N CER'rIFICA'rEOFEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
(this seal ion need not he completed if life Permit is for u TOTAL Y F] NN[_ Y [:j NEI
hundred dollars IS 100)or less.) one
U O I certify that in the Mrformance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL I- mil is issued, I shall not employ any person in any manner so as to
Q Ed become subjyt''Juple Workers' 'ore c do w li on
ia.
Dale- A hcant_ ALTER OR ADD TO MECH. 5.00 B BUILDING
} 0 \OTIC:TO \PP ICANI': If,after making Ifi Curl it irate of Ex-
? emption,you should become,nhjcct In the Workers'Colnpenvd ion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you nest lisethwah comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10SWCF.M,) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM) 6.00 SEISMIC FEE
I hereby affirm but there is a construction lending agency for I 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 Nanta H EATING UN IT,(O V E R 100,000 B.T.U.)9.50
Lender's Name ELECTRIC
1 certify that 1 have read phis application and swm thw ibcahovc VENTILATION FAN (SINGLE) 4,00
onfornalion is correct.I agree to comply with all city and county BOILER- (3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
Nm inances and state laws relating to building construction, and �1
herebhereby enticed rope xnfor ins of this city to carer upon the BOILER-COMP Carr 100,0008TUI SEE FEE SCH. �/ D D
y
out
above-mentioned property lite inspection.1 un purposes. MECHANICAL v� F
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against lisb'hies,judgments, costs and expenses which CONST.TAX
'y in y way a•''vst said City in conseluce'e of life PERMIT ISSUANCE 10.00 ( •py
ting f chis per a, MECH.CONT, LIC.NO. MECH.
' TOTAL TOTAL
SignplutIot Applicant/ metmc Du c -
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO
17549
INSPECTION DIVISION
• JOB INSPECTION RECORD'
PERMIT EXPIRATION
JOB ADDRESS ml `-' E �GVL Q UNIT## LOT#
-�} •�T PERMIT EXPIRES IF WORK
OWNER Q ( J !/�B CTOR �IJvL 1 'l. S]�i 'NCS IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RE XRD 180 DAYS OF PERMIT ISSU-
FOUNDATION 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 ,� PEHIZIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED-
UNDERGROUND /SLAB
IGNEDUNDERGROUND /SLAB
PLUMBING ^1{{�� R�jp� J�` /'T V��' V`i ✓tL�
ELECTRICAL lyy of ^r'� ISSUANCE OA IE
MECHANICAL BLoc ELEc r. PLC. I meCH.
❑ I ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR - INFORMATION
VALUATION $/FT.
PLUMBING
MECHANICAL _ -j -
ELECTRICAL _ PEUNII TO
FRAMING " eC
INSULATION STORIES TYPE CONSTR
- N Pil. LVa?Z_ N OCG GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED `/ -VV
SO.FT.FLWHAREA 101ALACHLAGI,
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING HES IND CDN Pe 0,1-
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ,❑ ❑. El
ROUGH SAN.# ASSESSp RS PARCEL NO
PLUMBING ELECT.ENERGY
TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO
MECHANICAL - MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO
FRAMING ELECT.FINAL TEST
INSULATION PLUMBINGZONING ENG.SITE NO.
GAS TEST - GAS
MECHANICAL FIRE SPHINK ENERGY L]i
� .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING & Y [] N ♦ E N[D
EXTERIORSHEARELECTRICAL RELEASE FLOOD ZONE A.L U C.
INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y ❑ N❑
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS - BUILDING
F SCRATCH COAT JELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I . . SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNT ILBUILDING FINALIS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
/
ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN PHONING.
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL p O
IMPORTANT! * CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL /OD
CALLING FOR FINAL INSPECTION.
OFFICE COPY