15523 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY
' -' BUILDING PROJECT IDENTIFICATION - PERMIT NUMBER
ADDRESS
APPLICATION & P.ERMIT 1 CC��
AooREss q �1 f J J
?i/7o0 AA/A/P?L9w C T BUILDING — ELECTRICAL—PLUMBING—MECHANICAL fe
OWNER'S
Z•;O /G , 7•L�
1 NAME PLAN CHECK VALIDATION
FH Ps (40A''eL57 S73it OTY` ELECTRIC PERMIT FEE
ONE
CDNTRAcroRs
NAME OUTLETS-'SWITCHES-RECEP 10. 00/1.00
uc.NO, LIGHTING,FIXTURES 10.00/1.00
noon ESETORS PPLIANCES-RESIDENTIAL 4.00
PHONE PANELS 10,00
ARCHITECT PATE OF APPLICATION u
OR PANELS (OVER 200 AMP) 20.00 "PLAN CHECK FEE P.C.NO.
ENGINEER _ r
LIC.NO. SIGNS TRANS. 3.00
ARCH.OH ENG.
ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP. METER OR POLE INS. 20.00
AOGRESS T E MOTORS
SEE FEE SCH.
SERVICE CHANGE 20.00
Foo LICENSED CONTRACTORS DECLARATION
a Z I hereby effum that I am licensedantler provisions of Chapter 9'
waw (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE
e-w a Professions Code,and my license is in full force and effect, BLDG. ELECT. PLG. MECH.
z o m— License Class Lie,Number
H w Date Contractor ❑ ❑ ❑ ❑
Ic y E J
g ¢ w It OWNER-BUILDER DIiCLARATION BUILDING PERMIT
w3 LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION
r ..m j Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10 00 ATION S/FT.
� m'0 Code
y city or count y which rcyuiresa permit toconstnequher,
¢ ¢ ¢ O '"Prove,denudish,ar repair any structure,prior to ite Issuance,also ELEC.CONTR. LIG.NO. ELEC. \
LL rey vires The applicant for such Permit m file a signed statement tlmt TOTAL x)
¢ w m he is licensed pursuant to the provisions of The COntr:ctor's License ,,pp���� PERMIT TO
NZQ Law(ss a n d"U'cnmmenCde) Seclinn 7000)o(Division3nl'the � ���
Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT )C �.
¢ r the basis for the alleged exemption.Any violation of Seclinn 7031.5 STORIES TYPE CONSTR.
u3 � by any applicant for a permit subjects the appliwnl tnacivil Penalty ALTER-DRAIN& VENT-WATER
al'notmore Itch Clve hu nd red dollars(5500).1 (EA.) 5.00 -
❑ I,asowner u'The property,or my employees wish wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
imenticd nr offered
for
sole (Sec 7044, Business and I'rofeasir f DRAINS-FLOOR,ROOF,AREA,COND. 6.00 ary^'-.n
Cade: The Co.Hart.,'s License Luw docs oat apply to un owner of
Property who builds or improves employees,
pr and who docs such work FIXTURES-PER TRAP 5.00 5 EO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own mops, es,provided the]such improve;
meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00
,improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
prove for purpose ofs,le.l.' INDUSTRIAL WASTE INTERRES IND CON PB Other
. 30.00
❑ I,as owner of the Properly,am exclusively contracting with ❑ E] El Elac
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 600
and Professions Code,The Contractor's .
License Law does not ai,ply - ASSESSORS PARCEL N0.
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00
contracts for such projc is with a conlractoGs)licensed pursuant Rr
the Contract 'p L'All. Law. �.. SEWER-SANITARY-STORM EA.200ft/10.00 TRgCr No. PARCEL ND.
❑ 1 um is",
•r See.' BAP.C.for this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM 5.00
ACC.DATE 'ACC.FILE NO.
WORm,thaC avec ertiONDECLARATION fcWATER TREATING EQUIP. 5.00
I hereby affirm That I have u pent tion of consent m scl Fissure,
or a certificate of Workers'Conopensalion Insurance,or a certified ZONING ENG.SITE NO.
copy thereof Bee. Lab.
Policy ompanyy
EICertert CCoified copy is hereby furnished.
z Z ❑ Certified copy is tiled with the city inspection division, RE SPRINK ENERGY T�Z4
H p Applicant FIMISC.- REFER TO ORD. Y ❑ N❑ Yo N❑
CER'TIFICA'IE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00
W COMPENSATION INSURANCh PLG.CONTR. FLOOD ZONE" A.L.U,C.
p ,
1 "
(This ars need nut be complcicA if the permit is for LIC.NO, PLG.
Z one _
U O hdoll
hundred dollars($100)or less.) - .TOTAL Y[] N Y [3 N
I certify That h the performance of the work for which this per- OTY MECHANICAL PERMIT FEE SUMMARY
LL U mit is issued, I to
not employ any person in any manner so is hl FEE
O W become subject m the Workers'Compensation Laws ol'Culiforniu.
1 NOT Applicant ALTER OR ADD TO MECH. BUILDING /O uTb
} m NOTion,TO APPLICANT: If,after making this Certificate of ion 5.00 _
Provision you should become subject m IIIc Workoo'Cont
comply cion APPLIANCE such Prov
tunsons io the ties pe Code, you most drevoke comply with 5.00 PLAN CHECK
U such provisions or Oois permit shall be deemed revoked:' Alfl HANDLING UNIT(TO 10,000QF.M.), q,00 FEE
'CONSTRUCTION LL'NDING AGENCY AIR HANDLING UNIT(OVER 10MC.F,M.) 6.00 SEISMIC FEE e(p3
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT( 500
3007,Civ.C,). HEATING*UNIT(TO 100,000
the performance of the work for which this .
permit is issued(Sec. MICROFILM
B.T.U.) 6.00
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Icertify that 1 have read thisxpplicotionand state that the above VENTILATION FAN (SINGLE) 4.00 -
information is correct, I agree to comply wilt all city told county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,0008.T.U.) 6.00
hereby authoriec representatives of this city To emer upon the
ah-vi,-mentioned property for inspection purposes, _ BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harndess the City of MISC.- - REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which
OR, in an w a rue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
ranting to
MECH.CONT. LIC.NO. MECH. r
.TOTAL �,
igna re of Applic 1/,onlrac or Date TOTAL p 10J
OFFICE COPY
£� POST THIS CARD'NEARFRONTOFBUILDING RMI1NUMREA
' CITY OF LUPERTINO: 15 23
INSPECTION DIVISION .
'JOB INSPECTION`RECORD
• - _ - ". .. PERMIT EXPIRATION
JOB ADDRESS—27O0 Rflirib.Qw COUT't UNIT# "_LOT# - pERM1T EXPIRES IF WORK 1
I ..
OWNER Ph1 S comm AcroR IS,NOT STARTED WITHIN
INSPECTION ' DATE INSPECTOR INSPECTION RECORD 160 DAYS OF PERMIT ISSU
"FOUNDATION- ANCE OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER. - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vAi:IDnnoN
CUPERTINO STANDARDS.
GARAGE SLABS ,* ,,...
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -1g S C I j . .•A' `-a'" "" `
l -tl
UNDERGROUND /SLAB •� .. � � .. , _ '
PLUMBING
ELECTRICAL - - 'ISSUANCE DATE
` MECHANICAL . awO Er.ECT. . PLG. - MECR.;
❑1 ❑., ' ❑ :
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED. BUILDING PERMIT
''WOOD,FLOOR INFORMATION
VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL
PERMIT TO
' - - \\ ��/�y�,ELC..
FRAMING
IN6`
INSULATION .� V sroRiES TYPECONSTR. r
OCC.GROUP RES UNITS'
TPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
\ s ` SCI.FT FLOOR AREA IOTAL AC IAGE
'ROOF- NOTE:NO'FINAL INSP.SHALL BE MADE BEFORE.
DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID
ROOF SHEATHING'" RES iNOUILOING USE
CON PB ov,.,
"APPLY NO ROOFING.UNTIL ABOVE'HAS BEEN SIGNED FINALS` DATE INM ' ❑ E ❑ ❑ D
ASSESSORS PARCEL NO.
ROUGH - - SAN.#
PLUMBING - ELECT;ENERGY
' TUBS&SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO
MECHANICAL MECH.ENERGY
- -
' ELECTRICAL � BUILDING ENERGY' -ACC.DATEACC.FILE NO.,,
FRAMING _ ELECT.FINAL TEST
ZONING ENG.SITE NO.
'
INSULATION•," PLUMBING - -
GAS TEST - GAS'
FIRE SPRINK ENERGY T:]4
- .4 ' � MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑' ❑ N❑
,
EXTERIOR SHEAR ELECTRICAL.RELEASE - -
FLDOD ZONE A 0C
INTERIOR SHEAR FIRE DEPT. Y❑ .,N❑ v ❑ NEI
SHEETROCK . GRADE - :� FEESUMMARY-
EXTERIOR 'LATH - - BUILDING = 2?( - ,
INTERIOR'LATH - TEMPORARY APPROVAL DINE
SCRATCH COAT' ELECTRIC' - . PLAN CHECK
GAS FEE:
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY. , ' SEISMIC FEE +. q
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING F INALISSIGNED BY BUILDING INSPECTOR. MICROFILM
- ' ARRANGE FOR I'NSPECTI,ON BY PHONING 252=4505, .. ELECTRIC
!u'--�'. ONE WORKING DAY'BEFORE REQUIRED INSPECTION. PLUMBING'.,„
z, PLEASE GIVE JOB ADDRESS WHEN,PHONING.
- SEE PERM'I.T FOR E,XPI RATION DATE -, MECHANICAL
I,MPORTA'NT!` CONST.TAX
.., PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
,
OFFICE COPY-