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15028APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' "flUICDINGPROJECT IDENTIFICATION?2 APIULICATION & PERMIT UILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER Q. 1502 8 BUILDING ADDRESS a CC /^L Ai CANNOT S NAMEAMII II Es t .SIS IG PHDNE2SS 4645 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - DATE OF APPLICATION - N°NTRACT°Rs t.1 PAEC7 TI, S15� uc. NO.S QZ R55 UTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S A°°REss _ 100 1. SC_LTI"o PROIsE25 S'4{S N APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCMITEL$..,Q2e'^� (-1r! OR IP (.ro Vi.J NGINEER LIC. NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE .. P.C. NO. SIGNS TRANS. 3.00 ARCH, OR'ErvG. ADDRESS qoS �'n+ER-T4 WGV B CA 7So3� L o 5 G;7 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION / •-- /µ.-+-+�n�"`-`^'--'• -7� 7 /1/ OOOOfff ISSUANCE DATE BLDG. ELECT. PLG. MECH. EMP. METER OR POLE INS. 20.00 15S ADOREss S / GN% S T yN�p �/ 1 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (co mnencing with Section 7000) of Division 3 of the Business and Professions Cod and my license is in full focrCe a M�' �j Il'enfl'CIa55 - I.le. Nt; 111 : � l.i Datei�--Contract owNCR-BUILDER D nRATION 1 hereby affirm that 1 am exempt from the Contractor's License.- c Cow: Any ilyfollowing reywhi(See Code: An ycityor countywh icy requirese permit1oconsuancalter. equir1 a perminess t tocndtrut, alter, requires improve, demolish, or repair any structure, prior n its issuance, talsohat requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Low fChand ProfessionsCodecing ) with Shahan is exempt00) theua3ofthe Business and Professions Code) or that he is exempt theFcfrom and the basis far the alleged exemption. Any violation of Secliun 703 t.5 by any applicant fire permit subjects applicant ran of not more than five hundred dollars (5500).5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds of improves thereon, and who does such work himself or through his own employees, provided that such improve- meats are not intended or offered for sale. It'. however, the building or improvement is sold within one, year of completion, the owner - builder will have the burden of proving that he did not build or I'll- prove for purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with it contraetons) licensed pursuant to the Contractor's License Law. ❑ lam exempt under Sc,.-, IS &P.C. for this reason - S` BUILDING PERMIT INFORMATION MISCREFER TO ORD PERMIT ISSUANCE 9@BB VALUATION $/FT. �PERMITTO roft ES TYPE CONSTR. ELEC. CONTR, LIC, NO. ELEC. / 9 TOTAL f�J OTY. PLUMBING PERMIT FEE ALTER-DRAIN 5.00): BACK FLOW PROTECT. DEVICE 4.00 Oce. GROUP �_ 3 RES. UNITS / DRAINS -FLOOR, ROOF, AREA, 5.00 FIXTURES - PER TRAP 5.00 GAS- EA. SYSTEM - 1 INC. 4 OUTLETS 6.00 SO. FT, FLOOR AREA ` V TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES RE I❑ ❑N El❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 3Z fe, Z4 • 10 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 WORKF;RS'COMPENSATION DECLARA-FION 1 Imo by affirm that I have a certificate of consent to sdi-insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.1� Policy No. Company Oh/7 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. 0 O Certified copy is hereby fffLLLrnahed' C• Nilo copy is filed will- ith [hc tysPectiml division. Applh ----1- `I - FIRE SPRINK Y E] N[] ENERGY T-24 Yo NE) MISC. - REFER TO ORD. ;R1'IFICATIi OF Ii XF,M PTION FROM WORK ERS' CObt ENSATION INSURANCE (I his section need nut be cumplmed it the pc nnit is far one hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner w asto become subject to the Workers' Compensation Laws of Californiais . Date Applicant PERMIT ISSUANCE 36060 /C-� FLOOD ZONE Y❑ NO A.L.UC. Y ❑ NEI PLG. CONTR. LIC. NO.PLG TOTAL OTY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING �� O ALTER OR ADD TO MECH. 500 NOl'ICIi TO APPLICANT: If, after making this Certificate of Ex- emio ptn, you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency Icor the performance of the work for which this permit is issued (Sec 3097, Civ.C.T Lender's Nomc APPLIANCE 5.00 AIR HANDLING UNIT (TO 1O=C.F.NL) 4.00 PLAN CHECK FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Leader's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby enthorire ropertyforins of this city m enter upon the hereby emtioned property for inspection purports. (We) agree to Save, indenmify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses whidl ,nay in any ay accrue against said City in consequence of the �f this permit. ) p/� _ S- 3,e HEATI NG UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 63 �j VENTILATION FAN (SINGLE) 4.00 PLUMBING (,[. BOILER- COUP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP 100,0008TU) SEE FEE SCH. MECHANICAL N� _• MISC. - REFER TO ORD. ._ PERMIT ISSUANCE 7p;gp��- CONST. TAX MECH. CONT_ LIC. NO. MECN. TOTAL &3 sl TOTAL 3S3 // Si arc of Applicant/Contractor Late OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING ' -"� CITY OF CUrERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS l // 61d2y1 ��/'Q�= UNIT# _LOT# '�- OWNER V17 St f CONTRACTOR A" d PERMIT NUMBER ' 15028 PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION R CORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE PERMIT ,ALIDATIoN _ �� • "- ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL uLUG eLEcr. PLG, NIECR 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDP - D BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING _ . j.S"• Ei JUL VALUATION r ., SIFT. MECHANICAL 7 1y: iJO ELECTRICAL /7- Ay- 8r /�� \M�. YI, PERMIT TO C��""UPI+U� _! FRAMING / INSULATION STORIES ,rY P�R �RES VH ✓:- C9 /Lqy .rr-��O-�z_ C\.GROUP — I - UNITS K; PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP, SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so F. FLooR AREA - TOTAL ACREAGE DIAPHRAGM ROOFSHEATHING Hes IND CON ILDINNG USE o....., ' El 1:1 El El ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# /56d,, ASSESSORSLARGE L NO c�:.'1=�, Z —A PLUMBING — ELECT. ENERGY TUBS B SHOWER PAN MECHANICAL _ PLUMBINGENERGYTRACT MECH. ENERGY 3, NO PARCEL NO ELECTRICAL FRAMING INSULATION �. G - kC BUILDING ENERGY ACC. DATE ACC.FILE No ELECT. FINAL TEST PLUMBING 70NING ENG. SITE NO. GAS TEST M —7 ECHANICAL _ FIRE SPRINK Y ❑ No EN ERGY T 2 Y ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR _ ELECTRICALRELEASE FLOOD20NE Y ❑ N❑ A.L UC. v ❑ N❑. INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING _O�' INTERIOR LATH �a- TEMPORARYAPPROVA SBu1LDiNG SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o� ONE WORKING DAY -BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC 3 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE� CALLING FOR FINAL INSPECTION. 4MECHANICAL OFFICE wry