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13299 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • � BUILDING PROJECT IDENTIFICATION PERMIT NUMBER aUILDING APPLICATION & PERMIT 13299 AGGR E550 l�il{I M� o n� ,'1 /' BUILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNERS PLAN CHECK VALIDATION "AMPearson _ T ELECTRIC PERMIT FEE PHONE+3801 I 1 CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 io '_ N , I/''• cf sem' I IL{V(l ( LIC.No. ( ( / LIGHTING FIXTURES 10.00/1.00 CONTRACTo sC ' [APPLIANCES-RESIDENTIAL 4.00 ADss � ' PHONE 10,00 DATE OF APPLICATION ARCHITECT IPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH,OR ENG. S00 PERMIT VALIDATION ADDRESS SPECIALCIRCUIT 1 . _ ZIP TEMP.METER OR POLE,INS!_ J — 120:00 ADDRESS '�/MOTORS SEE FEE SCH. J i4l�34 as JL VL SERVICE CHANGE ly 20':00 �/�/� w o o LICENSED CONTRACTORS DECLARATION a u U 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. w va w Professions Conion my license is in full force appd ffg t El License Class _I_Lie.Number 47 j "/a f t6_ 1 gi I SL L H•w Dale—Contractor. BUILDING PERMIT E S, w u OWNER-BUILDER DECLARATION INFORMATION w o m I hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD VALUATION 5/FT. H u Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 o _ J Code:Any city or county which requires permit to construct.alter, d or 5, Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. W DLL requires the applicant for such permit to file..igned statement that TOTAL PERp�IT TO F S he is licensed pursuant to the provisions of the Contractor's License EZ,Ls[�7 OL, H z i Law(Chapter 9(commnicingwilh Section 7000)of Division3of the a Business and Professions Code)or that he is exempt therefrom and G PLUMBING PERMIT FEE c the basis for the alleged exemption.Any violation of Section 7031.5 STORIES T E CONSTR. i;m mit by any applicant for a persubjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS til ' s- la compensation,will do the work,and the structure is not intended or offered for sole (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,CON O. 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 F IXTUR ES-PER TRAP 5.00 S— 50.FL FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are notintended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, 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 im- RES IND CON PB Omer prove Hu purpose of seleJ. INDUSTRIAL WASTE INTER. 30.00 El El ❑ El 1:1❑ I,as owner of tum property,am 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-OV ER 5 IEA-) 1.00 contracts for such projects with a contractorts)licensed pursuant to the Contractor's License law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ l an,exempt under See .B.&P.C.lin this WATER HEATER W/VENT 6.00 mason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. IS 5,00 I hereby affirm that I have a Certifleale of Consent to setf-usum, ZONING ENG.SITE NO. or a cerlificatc of Workers Compensation Insur lice,or a acrciyycA copy 0umyP/11'Se31U>1�,I,aJµC.1. I�14 � O Policy NcY. I �y[C�jfn�tl/NMy 1L w ❑ Cerldled copy is here by furnished. FIRE SPRINK ENERGY T-24 z Z ❑ Cerlified i fl ith t 'ty inspection division. MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ Applicant f— N CERTIFICATED fiXP;h1PTION PROM WORKF RS' PERMIT ISSUANCE 10.00 O'" FLOODZONE A.L.U.C. lL _ COMPENSATION INSURANCE, PLC.CONTR. LIC.NO. PLG. /`-- Y[D N C] Y C] NC]O (Phis section need not be completed if the permit is for one TOTAL V Z) Z hundred dollars(8100)or Ices.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY IL F• mit is issued.I shall not employ any person in any manner so as to O w become subject to the Workers Compensation Laws of California. BUILDING a Date Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F-. ? emption,you should become subject to the Workers Compensation APPLIANCE5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with - FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO'1�, RF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10.000C.EM.) 6.00 SEISMIC FEE I hereby affirm that them 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.C.) HEATING UNIT(TO 100,000 B.T.U[)In1S.00 Lender's Name HEATING UN IT(OVER•10Q000B.T.U.)9.50 ELECTRIC �46 Lender's Address I cenify'lhat I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 MI correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and LER ordinances I3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the ROILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino cainsl liabilities,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 l CONST.TAX may in n ay accrue against said City in consequence of the grantin o e nil. �_ TOTAL MECH.CONT. LIC.NO. /S— TOTAL -O 00 Sign e A plic, t/'ontruclor Alan, OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION �� JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10554 METEOR PLACE _ UNIT# Lor# PERMIT EXPIRES IF WORK OWNER Pearson CONTRACTOR Dou las Plauche IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE DLDG. ELECT. PLG. MECH. MECHANICAL ❑ fG• 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD.FLOOR PA00 VALUATION $SFT. PLUMBING MECHANICAL n 5 .a� MS�p G ELECTRICAL , `' GLE-v�•R /• —a61 FRAMING -• �� °f INSULATION ILy .. STORIES TYPE ONSTR_ OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT.[LOUF AREfl TOTAL ACREAGE DIAPHRAGM BUILDING USE Hes IND CON PB oin.' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT NO. PARCEL NO GAS TEST MECHANICAL ACC.GATE ACC.FILE:NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO, INSULATION PLUMBING GAS FIRE SPRINK ENERGY T-24 MECHANICAL Y ❑ NE:] Yo NEl COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE -A L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT, v v �] NE] SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC "• uJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z' ~o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY