12133 APPLICANT TO FILL IN IN7 QRMATION WITHIN RED LINES - USF 3ALL POINT PEN ONLY
BUILDING PROJECT I DENTI! ON - PERMIT NUMBER
APPLICATION & I3MI,T 12133
ADDRESS 20745 Stevens Creek�Blvd. BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
Cupertino, CA
OWNER'S _ELAN CHECK VALIDATION
NAME Sutra/GF¢I Realty Funds DTV. ELECTRIC PERMIT FEE Ra-Y(`/Y'
4 H)NE
CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 C
NAME 221
Bogard ConstructionLIC.NO. LIGHTING FIXTURES 10.00/1.00
CONTRACTOR'S - PPLIANCES-RESIDENTIAL 4.00 a
ADDRESS 350 Coral St. (408) v
P NE PANELS 10.00 PPLICATION
ORNCNITECT William Glass S OC. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C.NO,
ENGINEER
Architect SIGNS TRANS. 3.00
AR,OR ENG.
S.DD PERMIT VALIDATION
ADDRESS SPECIAL CIRCUIT
22245 Main St. , #100
CA TIP EMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS William Glass
M49 .Majn St , Hayward, GA 9454+ SERVICE CHANGE 20.00
/ f
woo / LICENSED CONTRACTORS DECLARATION
a v� I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. -MECH.
i Professions Code,and my license is in full force and effect F0_1 [Ell 11o 0= License Class Lic.Number
Date Contractor
a x M 4 UILDINQ PERMIT
¢ o w ¢ OWNER-BUILDER DECLARATION
oAsa MISC- REFER TO ORD INFORMATION
E
3 u I hereby Soho that 1 am exempt from lite Contractor's License VALUATION $/FT.
FuOa Law for the followingreason.(See. uiresa perBusmit
tocodtrct.al^ns PERMIT ISSUANCE - 10.00
Code:Any city or county which requiresa permit toconsua c alter, '1 �7
m r ELEC.CONTR. UC.NO.
IS
¢ O improve,demolish,or repair any stn¢Nre,prior o its issuance,also ELEC.
aa
O u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a w mh
e is licensed pursuant to the provisions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 of the C4A16r10y
a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
X the basis for the alleged exemption.Any violation of5eclion7031.5 STORIES TYPE CONSTR.
i ; by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars($500).): ALTER-DRAIN& VENT-WATER (EA.) 5.00
❑ 1,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 Contractor's 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 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenotintended(ir offered for sale.Il',however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year o1completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or in)-
Provefor Purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omer
L� I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
liva Id contractors to construct the project(Sea 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs 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 contmetoos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT N0, PARCEL NO.
❑ lam exempt under Sec. ";B.&I'.C.l01 this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARA'I'[ON WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofemsent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a cerlified ENG.SITE NO.
Copy thereof(Sec.3800,Lab.C.).
Policy No. Comp ny
} ❑ title c yi he mi.r ` FIRESPRINK ENERGY T-24
Z 21 de Colo a city Inspection division. MISC.- REFER TO ORD.
A plica v❑ NEI Y ❑ N❑
~ w+ PERMIT ISSUANCE 10.00
- CERTIFICATE OP EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C.
LuCOMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0- 0 a (This section need not be completed If the permit is for one TOTAL Y❑ N ❑ N
❑ Y ❑
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F- mit is issued,I shall not employ any person in any manner so as to
Ow become subject to the Workers'Compensation Laws ofCalifornia, BUILDING
o. Dma Applicant ALTER OR ADD TO MECH. 5.00
} to NOTICE TO APPLICANT: If,after making this Certificate of Es-
F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK -
provisions of the Labor Code, you must forthwith amply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE /71
'�. 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.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name H EATI NG UN IT(OVER 100,000 B.T.U.)9.50
Lender's Address ELECTRIC
1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and County PLUMBING
ordinances and slate laws relating to building construction, and BOILER-CO1VIP(3 H.P.or 100,000 B.T.U.) 6.00
hereby.authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in y way accrue against said City in Consequence of the
gran f is ` MECH.CONT. LIC.NO. MECH. p
TOTAL TOTAL O S .sa
i atureof Applicant/Contractor Date
OFFICE COPY ,
POST TH! ARD NEAR FRONT OF BUILDING
CI OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION 12133
JOB INSPECTION RECORD /
O ,Iv� / PERMIT EXPIRATION
JOB ADORE I �UIY:AIT/# LOT# PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
I SPECTI DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION
-r�, ANCE OR 180 DAYS FROM
IZ-1��0 v `r"e' r- LASTCALLED INSPECTION.
LIFER -t>-$� k,'V."I"rt' 7-p Q('"
/'7-�7
PERMIT VALIDATION 1
PREGUNITE - C A/+>�++,aX�.L.,+
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED o - A/ _E 'o
UNDERGROUND /SLAB p A
PLUMBING /-7-f T °tn' G EC 2 2
IN
ELECTRICAL
MECHANICAL �'7- aZ��; ❑ +
1447
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED4 u,. BUILDING PERMIT
WOOD FLOOR �8'f� � � At . INFORMATION
RATION $/FT.
PLUMBING - ,
MECHANICAL I'9$7 ` `' f Q-'A�'•a
ELECTRICAL - - PERMIT To
FRAMING- - /`/3-jw70;w,
T R S TVP C ST R.
INSULATION
C .
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED /'f3 '77 P
• ROOF /-/3 - 50.FT, .DOR nOEA TOTAL ACREAGE
DIAPHRAGM' a4 14-0
BUILDING USE
RES IND CON PB O'l—
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - El El ❑ .El Q
ROUGH ASSESISOHSPARCEL NO.
PLUMBING
GAS TEST
TRACT NO. PARCEL NO.
-
MECHANICAL -
ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO.
FRAMING SAN #' -
_' ZONING ENG SITE NO,
INSULATION PLUMBING
GAS
MECHANICAL .-� FIRE SPRINK ENERGY T 24
Y ❑ N o YF N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
LATH-INTERIOR ELECTRICAL FLODD ZONE A.L.R'C.
LATH-EXTERIOR .FIRE DEPT: YO N� Y❑ ; N❑
SHEETROCK GRADE FEE SUMMARY
SHEAR INTERIOR BUILDING 114f3lC
SHEAR EXTERIOR TEMPORARY APPROVALS
BUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING.FINAL IS SIGNED BY BUI LDING INSPECTOR. ' MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC
0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
Z PLEASE GIVE JOB ADDRESS WHEN,PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
TAX
IMPORTANT! CONST. "
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION. .
OFFICE COPY