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16925 �- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 41V PERMIT NUMBER ,. BUILDING PROJECTIDENTIFICATION BucumNG APPLICATION & PERMIT - 16925 ADDRESS (p2 IY%ESTY(� BUILDING -ELECTRICAL-PLUMBING-MECHANICAL A PLAN CHECK VALIDATION NAME ooD C/^^S QTY. ELECTRIC PERMIT FEE SA PHONE v 10A") croH's u UTLETS-SWITCHES-RECEP 10.00/1.00 - LOIZ�zS LIC.NO. I ��(� LIGHTING FIXTURES 0.00/1.00 noo ess TOR'S ^� •''� APPLIANCES-RESIDENTIAL 4.00 V G.. l PRONE PANELS' 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.NO. SIGNSTRANS. 3.00 noo ess ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 , / C-` 0� 1 ADDRESSPPLI r5 - - MOTORS SEE FEE SCH. E� 3�� AOOREss SERVICE CHANGE 20.00 FOO LICENSED CONTRACTORS DECLARATION ¢o-a 1 hereby affirm that I am licensed under provisions of Chapter 9 . ISSUANCE DATE y a tc (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F DEG I it 198a z Professions Codh�rwkZ license is in full forte�pi�(IIII. L--• z O - License Class_LV Lic.Numhcr_' /_ [ .J 2 y Date_LZ�7=' Cont roc Ear_Fk: C�S� City .. Cupertino ¢ Q w¢ OWNIi R-BUILDER DF.CLA RAT ION N� COpCIfIOU BUILDING PERMIT w- ° ' c' MISC. REFER TO ORD INFORMATION ; u m 1 hereby affirm that 1 am exempt trom the Contractor's License - u O j Law for the following reason.(Sec.7031.5,Business and Professions VALUATION S/FT. - g PERMIT ISSUANCE 10.00 Coda:Any city or county which req uires o permit to construct,alter, - ¢ ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. UG NO. ELEC. n O¢ requires the applicant for such permit to file a signed statement that TOTAL w m he is licensed pursuant(commencing the with provisions of the Contractor's License rn1 �1 PER MIT TO Fza Business w(Chand Professions ode)with that is 00)exemfttheen3 of tile E x O Business and Professions Come)or Ilett he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ I-o the basis for theuiora exemption.Any applicant of Section malty STORIES TYPE CONSTR. by any ore than fora permit subjects the uppbcanl toacivil penalty of not more than five hundred Joilars(55001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as ggCK F LOW PROTECT. DEVICE 4.00 __UCC.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,CON D. 5.00 Code:Th Tire Contractor's License Law does not apply to an owner of ® property who builds tlr improves Iluncon,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- menlsare notintended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or 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 of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB other ❑ I,as owner of the property,um exclusively contracting with 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 d conrructous)licensed pursuant to the Contractors License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. reason ,B.&P.C.1'nr mrs WATER HEATER W/VENT 6.00 n Owner Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK FRS'COMPIiNSA'I'ION DECLARATION WATER TREATING EQUIP, 5.00 1 hereby affirm that 1 have a certilicateofconscnt toself-insum, _ or u certificate of Workers Compensation Insurance,or u certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). - Policy No. Company O ❑ Certified copy is hewhy furnished. RE SPRINK ENERGY R Z Z yd CT f d opY rc filed with I `tY inspection inion. 24 F O A p13cm, MISC.- REFER TO ORD. Y N Y 0 NE] jr y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD TONE A1.0 C. L COMPENSATION INSURANCE, PLG.CONTFL LIC.NO. PLG. a_ 0 trials section need oat he completed if the amort is far one TOTAL Y 0 NEl Y E] NE] hundred dollars IS 100)or Ic s.l U O 1 terrify that in the performance of the work for which this per. QTY 'MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued, I shall not employ any person in any mmnner so as to U W become subject to the Workeri Compensation Laws ol'California. CL Dat` APPLICANT: - ALTER OR ADD TO MECH. 5.001BUILDING } m NOTIGIi TO AI'1'LICANT: If,after making this Certificate of Ex- ? emptlon,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE I hereby affirm than there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perlimnance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lenders Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certily that I hove read thisaPplication and state that the above VENTILATION ( INGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws refuting to building construction, and BOILER- (3 .P. x100,000 B.T.U.) .00 �� 1icreby authorise representatives of this city to enter upon the �Q V ahuve-mentioned property for inspection'mToses. BOILER-COMP 10ver 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 ex penes which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 ZA OV ranting of this permit MECH.CONT. LIC.NO. MECH, i- � � TOTAL (� TOTAL Stgna[ure of Ap11(mant/Contractor Date 1 OG DO OFFICE COPY POST.THIS CARD NEAR FRONT OF BUILDING •�r. - PERMIT NUMBER .CITY 01 CUPERTINO 16925 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION ! 'JOB ADDRESS_J—( /7 Z' f l /�1M[�S�V�Y UNIT# _LOT# n { PERMIT EXPIRES IF WORK OWNER l�"�� .1/11 a. C IJ CONTRACTOR - D�r Al C IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE _ TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERNUT VALIDATION CUPERTINO STANDARDS. ' ' GARAGE SLABS - � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I UNDERGROUND /SLAB PLUMBING - DEG 14 1988 ELECTRICAL r.;P, IssuArvcE uarE _ MECHANICAL BLOC eLecr, PEG ME�H. 1 El El ❑ g0�j( DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION SIFT. - MECHANICAL - - - . ELECTRICAL TO FRAMING INSULATION STORIES TYPE CONSTR UCC GROUP 11E5 UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 47© ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.IT,aooR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING uLUING USE iHES INDnCON FB ow� APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH n"ILSbUHS PARCEL NO - - - PLUMBING ELECT. - � ECECT.ENERGY TUBS 8 SHOWER PANPLUMBING ENERGY TRACT NO. PARCEL No MECHANICAL MECH.ENERGY ELECTRICALBUILDING ENERGY Acc.oarE -ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING l'pN1N6 ENG.SITE NO. GAS TEST GAS - MECHANICAL3-7_ FIRE SPR.NK ENEgcY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING os Y ❑ N'❑ ° ❑ N❑ EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE A.L U.C. INTERIOR SHEAR --)DEPT. Y ❑ N❑ Y ❑ N❑ •, SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH . BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY ' 'SEISMIC FEE 01CCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - I Lu ` ARRANGE FOR INSPECTION BY. PHONING 252-4505, ELECTRIC ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL• S1v)D IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDEBEFORE TOTAL CALLING FOR FINAL INSPECTION. . 3P,Dd' OFFICE COPY