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12892
I, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT 1 DENTI FICATION PERMIT NUMBER AD ,. APPLICATION & PERMIT - 12892 ADDRESS L-o-r•a BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S O Q PLAN CHECK VALIDATION r.44411 yv " fF /^ O STV. ELECTRIC PERMIT FEE CONTRACTOflS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 Gb C�oLIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 /(00 W ADDRESS PRONE d[ PANELS 10.Q0 DATE OF APPLICATION AQ Atli 16( ARCHITECT ♦ PLAN CHECK FEE P.C.NO. ,X- ENGINEER PANELS (OVER 200 AMP) 20.00 LIC.NO. SIGNS TRANS. 3.00 ADDRESS ENG. SLA/J$ _ SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS �L .QS W, Lqr gIP Za3>f EMP.METER ORP L INS. 20.00 PA'p noon ssTs MOTORS EE SCH. %,/J� -7 fAv<, D,, SERVICE CHA 20.00 'ryl(y 13/1 0 0 o LICENSED CONTRACTORS DECLARATIONGity S ¢U U I hereby affirm that I am licensed under provisions of Chapter 9 Z, w (commencing with Section 7000)of Division 3 of the Business and ¢ n BLDG. ELECT. PLG. MECH. r m i Professions Code rd my license is in full fo !\cty3= C z x n License Cl,Tss Lic.Number_ r m r Js Dale a m E I BUILDING,PERMIT ¢ ¢u u OWNER-BUILDER DECLARATION INFORMATION X I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD rn VALUATION $/FT. a.a. Law for the following reason.(See.703 IS,Business and Professions PERMIT ISSUANCE 10.00 /O tN -' Code:Any cityor county which requires a permit to construct,alter, 9 ¢ <of improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. Q pQ Es m¢ requires the applicant for such permit to file a signed statement that TOTAL OC 0/• PERMIT TO A' w he is licensed Pursuant to the provisions ol'the Contractor's License H i i La..(Chapter 9(commencingwith Section 7000)of Division 3 ofthe /V 9(d-- FA'Tl1 4 ao Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢s- the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TY P CONSTR. d ; by anyapplicant fora permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 Z of not more than five hundred dollars($5001.): �V ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 Dec.GROUP Res.UNITS their sole compensation,will do file work,and the sl ructure is not intended or offered for sole(Sec. 7044, Business mid Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 - 3 Code:The Contractor's License Law does not apply to an owner of • properly who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 70 so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 6.00 neents are not intended or offered for sale,If,however,the building Q or improvement is sold within one year of completion,the owne builder will have the burden of proving that he did not build or ir- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 m- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RE IND CON PB Omer ❑ 1,as owner of the 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�OVER 5 (EA.) 1.00 3 contracts for such projects with a conlracmrls)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-ST U 200ft/10.00 - TRACT NO. PARCEL NO. ❑ I am exempt under Sac..,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner - Date WATER SYSTEM 5.00 ACC.OATE ACC.FILENO. MAY WORK IIRS'COMPENSATION DECLARATION WATER TREATI EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurance,or a certified city Of Cupertino ZONING ENG.SITE NO. copy thereof(Sec.3500,Lub.C.). O Policy No. ConipanY ❑ Certified copy is hereby fur n is h o7 - FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is Filed with the city mspectmn vl ion. MISC.- REFER TO ORD. APPlicmt � Y ❑ N❑ Y ❑ N❑ NCERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.L.U.C. LU - COMPENSATION INSURANCE PLG.CONTR, LIC.NO. PLG. 1 Cl (This section need not be completed if the permit is for one TOTAL /07 Y❑ N❑ Y❑ N❑ Z) Z hundred dollars IS 100)or loss) L) O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY IL U mit is issued,1 shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. /3�O -, Date Applicml ADBUILDING d" U.1 ALTER OR D TO MECH. 5.00 } to NOTICE TO APPLICANT; If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 1 C.F.M.) 6.00 SEISMIC FEE I hereby affirm that (here is a construction lending agency for EXHAUST HOOD (WF W 1 5.00 the performance of the work for which this permit is issued(Sec MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 .) 8.00 Lender's Name 0 .U.19.50 Lender's Address ELECTRIC1 certify that I have read this application and state that the above1HEATINGUNIT VENTILATION FAN (SINGLE) 4.00information is correct. I agree to comply with all city and CountyBOILER•COMP(3 FI .) 6.00 PLUMBINGQ 7 ordinances and state laws relating to building construction, andhereby authorize representatives of this city to enter upon theB01 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 3 �z int- above-mentioned property for inspection purposes. (We) agree to save, indemnify and,keep harmless the City ofMISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which accrue PERMIT ISSUANCE 10.00 �' CONST.TAX `JO may in any way acce against said City in consequence of the a �3 9 0 g! g o his permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL 7-07 '\ Signature of Applicanl/Conit kor Uute OFFICE COPY / POST THIS CARD NEAR FRONT OF BUILDING PrRMiT NUMBER CITY OF CUPERTINO 12892 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT-.EXPIRATION JOB ADDRESS 22611 PODDW Drive - UNIT# LOT# 1 1 . PERMIT EXifrI ES IF WORK OWNER Richard Guzman' - CONTRACTOR C & R Construction ISINOT,STARTED WITHIN INSPECTION T INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION -2.I-�? w L1.4 or p Lp• ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. LIFER h.1Jic-.LT `-p cute p{-eI1-C✓Q.u�i PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - - UNDERGROUND /SLAB PLUMBING E / ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. ELECT. PLG. MECH. t 6 d� ❑' ❑� © _N 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIG ED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING -4Y ii� MECHANICAL ELECTRICAL PERMIT TO FRAMING STORIES TVPE ONSTR. INSULATION OCC GROUP PES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO.FT.FLOOR AREA TOTAL ACREAGE ROOF J � DIAPHRAGM BUILDING USE RES IN CON PB 0"", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING - GAS TEST r TRACT NO. PARCEL NO, MECHANICAL ACC.DATE ACC FILE NO. ELECTRICAL _2 - FINALS DATE INSP. FRAMING / SAN a I INSULATION PLUMBING _ U zDNING ENG.SITE NO. GAS F IRE SPRINK ENERGY T24 MECHANICAL -/ _ 'Y ❑ N[] r ❑ N[3 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE ALU,C. LATH-INTERIOR II_ _ ELECTRICAL /I/- v� N� Y0 N❑ LATH-EXTERIOR FIRE DEPT, SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL BUILDING %' U FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE A OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC n 4f o -7 WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING F •� Z PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE - MECHANICAL } y IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL / t CALLING FOR FINAL INSPECTION. OFFICE COPV