18436 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES'- USE BALL POINT PEN ONLY,
BU I LDING PROJECT.I DENTIF I CATION .,- PERMIT NUMBER
DRBUILDING. � APPLICATION & PERMIT '8438
x�
Ai (a(� I\EG t4�I. CANN +`JDRIVE BUILDING-ELECTRICAL-PLUMBING-MECHANICAL - n, 8 4 3 8
OWWNER SNAM 4�8 PLAN CHECK VALIDATION
/ � I`m WALKC 25?-12"88 - ' ELECTRIC PERMIT FEE
�f FXONEG O -
CONTRFCTOR'S O I
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 r - -
O(�NM LIC,NO. LIGHTING FIXTURES 10.00/1.00
ADDRESS APPLIANCES APPLIANCES-RESIDENTIAL 4.00 OQ "
SArAI PIIONC SAY WLE PANELS - 10,00 DATE OF APPLICATION G , `
^ AECluiecT • PLAN CHECK FEE P.C.NO.
_
OR PANELS (OVER 200 AMP) 20.00
ENGINEER +
LIC.NO. SIGNS TRANS. 3.00 -
ADD ESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP,METER OR POLE INS. 20.00 -
TPPLICANTTS MOTORS SEE FEE SCH, d ( V
ADDRESS
SA
W Q z vryN"C� SERVICE CHANGE , - 0.00 _ II __(b
vC�
H oo LICENSED CONTRACTORS DECI.ARA'1'ION _�•�,
,Q w I hereby affirm that I am licensed under provisions of Chapter 9 ^n 'ISSUANCE GATE
y , ac (commencing with Section 7000)of Division 3 of the.Business and L r1��
( r 2F :,P)fIns Code,and my(tearsc is in lrlbl force and effect. -
BLDG:
- Class Li,.Numer
0Z0 Dane Cotmelor ELECT. PLG: MECH.
'
01� 0 -
a y F J
a s OWNER-BUILDER DECLARATION BUILDINGORATION
a o a - INFORMATION
X ; LL E' I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD -
Fv_ o J Law for the following reason.(Sec.703 t.5,I{usinessanJ Professions PERMIT ISSUANCE - 10.00 z,ud UALUATON- $/FT.
i Code:Any city or county which requires.permit to construct,alter, /7
a ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEG '�qq 8.� D
O , requires(Ile applicant for such permit to file a signed statement that TOTAL 4 V 60
n w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
H i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
E i o �usiness and Professions Code)or that he is exempt tlmretioer and DTV. PLUMBING PERMIT FEE -
" a H$ the basis for the alleged exemption.Any violation of S"tion 7031.5 STORIES " TYPE CONSTR,
i3 - by any applicant for a permit subjects the applicant too civil penalty WATER IEA.15.00
of not nALTER-DRAIN& VENT-
wre than five hundred dollars(55001.1: 0
Cl 1,as owner of the property,or any employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS .
r their sole compensation,will do the work,and the structure is not _
intended,or offered for sale (Sec. 7044, I{u+iness and Professions ' DRAINS-FLOOR,ROOF;AREA,COND. 5.00 :Oz
Code:'fhu Contractor's License law does nor'apply to in owner of
Property who builds or improves thereon,'and who does such work. FIXTURES-PER TRAP 6.00
l S0.FT.FLOOR AREA ,TOTAL ACREAGE .�
h imselfre through his own tend fors provided ev such improve-'
omnis tionoteme intended oruttered
(i however,the bu
ilding GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or ide1LIII"will have
is sold within one year of co m pier ion,the owner-
builder will have the burden of proving that he did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00BUILDING USE
prtreif purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON RB Omer
If- --^ - - I,as owner of the Property,am exclusively contracting with - F ❑ 'a
licensed contractors to construct the project (Sec 7044,Business LAWN SPRINKLERS-1 INC 5 V.S. 6.00 ASSESSORS PARCEL ryo.
and Professions Code:The Contractor's License Law does not apply
a-. to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 -
contractsforsuchprojectswithacontractooUlicensedpursuantto SEWER-SANITARY-STORM EA.200ft/10,00
• [tic Contractors License Law. TRACT_N0, PARCEL N0.
❑ lam cxempumd Sri.-,IL&P.C.for chis
n•asnn WATER HEATER W/VENT. 6.00
owner Dam I WATER SYSTEM 5,002. 0 ACC.DATE ACC FILE NO.
'ORKERS'COM PFNSAT'ION DECLARATION WATER TREATING EQUIP. 5.00
1 h y.ffmn that I have a ertificale of conlint in lull-ins(re,
or il"ute of Workers'Conalwination Insiarniacc,(it a curt Ned ZONING ENG.SITE NO:
ulpy thereof(Sce.3800,L.b.C.). -
Policy No. Company -
�'- ❑ Certified cop)'is hereby furnished. FIRE SPRINK ENERGY T-24
- Z Z ❑ Certified ropy is fled Willi the city inspection division. MISC.- REFER TO ORD.
F O APPlicenl Y ❑ No Y ❑ N❑
IZ
PERMIT ISSUANCE 10.0D FLOODZONE A.L.U.C. -
CER'I'I PICATE OF F-Xf N('TION PROA1 WORKERS' t O
`IL > _ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. 7
�'Z .(This section need not be completed if the palmi( is for one TOTAL ..J r D� . 'v ry v ry
hundred dollars(S 100)or less.) t
V O I certify that in the performance DI thework for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL U mit is issued,I strait not employ any person in any nlannerso as to
{O L) become subject to the Workers'COmpensat ion Laws of Calitorma.
G.il
Date - ALTER OR ADD TO MECH. 5.00 Q Applicant BUILDING - -D
�} rNOTICE '10 APPLICANT': If,after making(his CcUifir to of Ex- / D.
enrptiml,you should become Subject to the Workers'Compensation ' APPLIANCE 5,00 PLAN CHECK z'
provisions of the Labor Code, you nst forthwith comply with REE
U sail(provisions or this permit shall b 'Hilldeemed ruvokcd. AIR HANDLING UNIT(TO IO,ODOC.F.M.) 4.00 r`r
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000GEM.) 6.00 SEISMIC FEE
g-
I hereby affirm that there is u hick this
mit is agency-for( ec. EXHAUST HOOD(WITH DUCT) 6.00 "
the ,Cie mance'of the work for which (his perinit is isucd(Sec. MICROFILM
3097,x',Na). - HEATING UNIT(TO 100,000 B.T.U.) 6.00
Lender's Name' HEATING UNIT(OVER 100,000 B.T.U. 9.50
Lundeis Address - ELECTRIC
I certify that I have read this application and Mate that the above VENTILATION FAN (SINGLE) 4.00 - -
information is correct.I agree to comply with all city and county PLUMBING 0
}y ordinances and State laws rebating 10 building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
I' hereby authorize representatives of this city to enter upon,tire BOILER 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes. �I00
-
A
(We) agree to'save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
.Cupertino ugainstHiabilities,jutlgmenla, costs and expenses whichQ CONST.TAX
'Iy in any wa accrue against Said City in consmplence of thePERMIT ISSUANCE 10.00, - •Z-�
(ling of th c tit.�p G' p MECH:CONT. LIC.NO. MECH.
�Yp+Cl pII"�O TOTAL':UU TOTAL'.
Si miure of Applicant/Contractor, ',Date -
OFFICE COPY
ru' POST THIS-CARD NEAR FRONT OF BUILDING: - PERMIT NUMBE
'CITY OF CUPERTINO
INSPECTION DIVISION. 84 "
,'•JOB INSPECTION RECORD
PERMIT EXPIRATION
- JOB'ADDRESS 1/61�02 _ WLd. C�y '�-�J 1" UNIT# LOT*fil
PERMIT EXPIRES IF WORK'
OVINER T' ,�� •'(le.� 'CONTRACTOR •--�� " IS,.NOT STARTED'.WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD' • 160'DAYS OF PERMIT ISSU,`
FOUNDATION - - ANCE,OR :180 DAYS FROM
1 NOTE: LASTCALLED INSPECTION. ,
UFER ALL GRADING AND DRAINAGE SHALLBE INSTALLED
IPR EGUNITE
TO COMPLY WITH THE APPROVED PLANS AND CITY OF'. Pi AIT VALIDATION .
_ CUPERTINO STANDARDS. q,p��I •'
. ;GARAGE SLABS - PAW, �1
.POUR NO CONCRETE UNTIL-ABOVE HAS BEEN SIGNED—
UNDERGROUND /SLAB
IGNEDUNDERGROUND /SLAB - - • };�J>r1 ',�.J 989 1 '^^
PLUMBING 'Mty .,{ IL-�,VCL I
fiW /)
ELECTRICAL" 9111cussunNCE un rc
- ��'•
MECHANICAL' BLDG ELECT NLG, r,R,
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED, BUILDING PERMIT
` INFORMATION
WOOD FLOOR VALUAI IONS./i SIFT.
PLUMBING - -
aa-
• MECHANICAL ' U,
ELECTRICAL• - - , tie I'ERMiTro ;;//
FRAMING .
711
"INSULATION
STORI[S. TYPE CONSTR.
' _ -
OCGGROUP ' RE:s UNITS
\�i. • ..
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .
6p,!'i'FI,fIO/lI�P1iF.A TOTAL.PGHF.Pfh
ROOF NOTE:NOFINAL INSP.SHALL BE MADE BEFORE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 1 D YF>
- - BUILDINGUSE
ROOF SHEATHING RES IND CON PB oud,I•
APPLY NO.ROOFING UNTIL ABOVE HAS BEEN SIGNED'.j INALS d,,, " DATE d:,,- INSP.., 9:1 ❑ ❑ 0 E
ASSESSORS'PARCEL ND.
ROUGH SAN.N
PLUMBING ✓ug ' ELECT.ENERGY - -
' TRACT NO; PARCEL NO.
TUBS&SHOWER AN .. PLUMBING ENERGY
MECHANICAL, ' MECR ENERGY j
ELECTRICAL" 5j— OUILDING ENERGY I - .^ c u e" ACC,FILE NO
FRAMING t34 91 =C, ELECT.FINAL TEST u LIV
O Irv, tdNG.siTE No.
" INSULATION - PLUMBING
GAS TEST GAS
' 'FIRES ENERGY T.j9
MECHANICAL '
'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y E 'NE] v 0'- NO
FLooD ZONB A,L.u.c.
EXTERIOR SHEAR .ELECTRICAL RELFi -
INTERIOR SHEAR ' FIRE DEPT. Y❑ N� }' ❑' N❑
SHEETROCK•• - GRADE • • - FEE SUMMARY
EXTERIOR LATH BUILDING, '
INTERIOR LATH + TEMPORARY APPROVALS'. BUILDING.
' -"yo0 —
SCRATCH COAT- ELECTRIC FFEN CHECK , .'NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SMIC FEE
OCCUPANCY OFBUILDING IS NOTPERMITTED UNTIL BUILDINGFINAL ISSIGNED BY BUILDING INSPECTOR. ROFILMARRANGE FOR INSPECTION BY PHONING•252-4505,. ECTRIC 0 0
opLuMeING io 0
ONE WORKING DAY,BEFORE REQUIRED'INSPECTION.
2 PLEASE GIVE JOB ADDRESS WHEN PHONING. '
4- — SEE PERMIT FOR'EXPIRATION DATE. r MECHANICAL Q
X
IMPORTANT! coNu T.TAX.:. ' . . _
PLEASE READ REVERSE SIDE BEFORE
CALLINGTOTAL.
FOR FINAL INSPECTION. ..
_ OFFICE COPY