14324 (3) rl I
A'?hrCANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER
BUILDING APPLICATION & PERMIT q
to�REss p/� A1 I
aOSI rey, ,la Of. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNERS Ti � PLAN CHECK VALIDATION
NAME p Z
-pL/Z TY. ELECTRIC PERMIT FEE
q IA1 I I ((41 PHONE O /J
CONTRACTORS
NAMEUTLETS-SWITCHES-RECEP 10.00/1.00 3 �'
LIC.NO. LIGHTING FIXTURES 10,00/1.00 O
ACTOR's
ADDRESS PPLIANCES-RESIDENTIAL 4.00
ADDRE
PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT- PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.NO.
ENGINEER
- LIC.No. SIGNS TRANS. 3,00 '
AARH.OR
DDRESS ENG, - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 20.00
o o LICENSED CONTRACTORS DECLARATION
¢ U W I hereby nation that I am licensed under provisions of Chapter 9 1 ISSUANCE DATE
I- z (commencing with Section 7000)of Division 3 of the Business and
BLDG� PLG. MECH.
a Professions Cole,and my license is in full force and effect.
Z 0 o._ - License Class Lia Number
S) w w Dale Contractor
a m reBUILDING PERMIT
¢ a OWNER-BUILDER DECLARATION
a o w u INFORMATION
E:
;LL w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
u o¢
Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 Q / AtU�TIO�N g/FT.
� - Code:Any city orcounty which requires a permit to construct,after. / _
Q ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ��(( _
A' wDLL requires the applicant for such permit to file a signed statement that TOTAL �V PERMIT TO
'$ he is licensed pursuant to the provisions of the Contract...'..License
F z < Law(Chapter 9(cornmencing with Section 7000)of Division 3 oftlm
4 O Business and Prnfe,,mns Code)or that he is exempt therefrom:and QTY. PLUMBING PERMIT FEE
¢ r a the basis for the alleged exemption.Any violation of Secl ion 7031.$ I STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant ton civil penally ALTER-DRAIN -WATER IEA.) 5.00
of not more Hun)five hundred dollars($5000.)-
❑ I,as owner of the property,or my employees with wages as ggCK FLOW PROTECT. DEVICE 4.00
their Sole compensation,will do the work,and lite structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,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 2 FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE
himself or through his own employees,provided that such improve-
ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6,00
or improvement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 IEA.) 2.00
builder will have file burden of proving that he did not build or am- BUILDING USE
v prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Oar
13I,as owner of the property,am exclusively contracting with m❑ ❑ •❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
O I am exemppunder Sec. ,HAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
I hereby OUR,, that I have a certificule of consent to self-insure, ZONING -
or a certificate of Workers'Compensation Insurance,or u cerlifiod ENG.SITE NO.
copy thereof(See.3800,Lah.C.). _.
Policy NR. Company
0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT24
Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD.
p Q Applicant Y ❑ NO Y ❑ N
CC 'CFR'1'IFICATF-OF EXEMPTION FROM WORKEiRS' PERMIT ISSUANCE 10.00 O FLOOD ZONE A.L.U.C.
LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. (�-
1 Q fIhis section need not be completed if the permit is for BeoTOTAL 3U S Y❑ N❑ Y❑ No
::) Z hundred dollars IS 100)or less.)
0 O 1 certify that in the performance of the work for ww o this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY
ll. 1- mit is issued,I slyall not employ any son in.11p-J(finer so as In
O bcco/nc phl' �9yt/jt���1}{}�L Workers'C a ani&srniu. �l
LL y Datyi'�v�/a/Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 5P.7-
0
to NOTTIIC�:' Oddd��a111I'I'LICANT: If,aNcr making this Ccrl ificuta of fix
I- Z ¢Option, o shmtlJ become subject to the Workers'Campansmion APPLIANCE 5.00 PLAN CHECK
p, idsi ns of the Labor Code, you most forthwith comply with FEE 7
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4,00 fr!
CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10,000QRM.) 6.00 SEISMIC FEE d �
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00
the performance of the work]or which this perntil is issued(Sec. MICROFILM
3097,CIv.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Add e EATING UNIT(OVER 100,000 B.T.U.)9.50
Lender's i....a H ELECTRIC
I I certify that correct.
ns�oeiul
agrees to comply
and state that and
county VENTILATION FAN (SINGLE) 4.00
ordinances n correct I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING 3�T��
ordinances and state laws relating Io building conster non, and
hereby cmioauthorizerepresentatives inspection
this city es enter upon file BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
uhovcanemianed property for inspection purpoxs,
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
[rantingafth,
ertino against liabififs
eats,cos(S and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
in any way accruid City in consequence of the O
' 1MECH.CONT. LIC.NO. MECN.
TOTAL /� TOTALature 01 AppHemol Contractor ate
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF CUPERTINO 14324
- - INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION
'JOB.ADDR ESS 8051 PRESIDIO DRIVE UNIT# LOT#
_ __ PERMIT EXPIRES IF WORK
OWNER WILLIAM MC MILLAN CONTRACTOR IS .NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION NOTE:
ANCE OR 180 DAYS FROM
'
LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION.
PREGUN ?E - TO COMPLY WITH THE APPROVED PLANS AND CIT'OF PEHART VAL f ArION
CUPERTINO STANDARDS. -
GARAGESLABS,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB'
PLUMBING - H'E -�11
ELECTRICAL • Qu ISSUANCE DATE
MECHANICAL BLDG ELECT PLG.. Mc^^CH.
❑ ❑ U
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Y BUILDING PERMIT ..
INFORMATION
WOOD FLOOR VALUATION SIFT.
PLUMBING -
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING `-
STORIES 'TYPE CONSTR,
INSULATION
OCG GROUP RES UNITS
TPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
.
( _ ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5O ITFLOORAREA TOTALACREAGE-
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING - RES IND CON PB om'•
APPLY' NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑' ❑ ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANJI
PLUMBING- _ ELECT.ENERGY TRACT no. PARCEL No
Tk3036 SHOWER PAN - a PLUMBING'ENERGY
MECHANICAL ./ ,rd' MECH.ENERGY ACC onrE ACG FILE No
ELECTRICAL (,{-/Y3 BUILDING ENERGY
FRAMING ELECT,FINAL TEST zoNlNr, ENG SITE No.
INSULATION - PLUMBING
' GASTEST GAS
FIRE SPRINK ENERGY T ZE
r MECHANICAL
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1 1 ❑. "❑ ` ❑ "❑
EXTERIOR SHEAR ELECTRICAL RELEASE FLOODLONE AL UC.
INTERIOR SHEAR FIRE DEPT. Y❑ "❑ Y ❑ NEI
SHEETROCK GRADE FEE SUMMARY
EXTERIOR.LATH IBUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING
.SCRATCH COAT- ELECTRICFEEN CHECK
GAS.
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING Is NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
' - ARRANGE FOR INSPECTION BY PHONING 252-4505, 1 ELECTRIC
F ONE WORKING DAY BEFORE REQUIRED INSPECTION.
PLUMBING
0 . PLEASE GIVE JOB ADDRESS WHEN PHONING. '
Z
- MECHANICAL.
SEE PERMIT FOR EXPIRATION DATE -
' . IMPORTANTI CONST, TAX
PLEASE READ REVERSE SIDE'BEFORE r'
CALLING FOR FINAL INSPECTION. TOTAL l
OFFICE COPY