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16607 ' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION 'PERMIT NUMBER APPLICATION & PERMIT � ��(�� A, uolNc ADDRESS LJ ZZ/oZ� F�ov'Ci•/ 'DP.IV BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME /� I.nn CC /�/r, �f }� TV. ELECTRIC PERMIT FEE K( /NI—J cowl C_ PHONE ZS 7-A /0 CONTRACTORS C-53 - UTLETS-SWITCHES-RECEP 10.00/1.00Z7Afll ' LIC,NO. 120177 LIGHTING FIXTURES 10.00/1.00 'CONTRACTOR'S AD R ss � 1 .,SJ 951ZF APPLIANCES-RESIDENTIAL 4.00 C. �• /NC46-5574APSRONE .2ial PANELS - 10.00 DATE OF APPLICATION e4 OOARCHITECT - - PANELS (OVER 200 AMP) 20.00 PLAN CH ECK FEE P.CDNO. ENGINEER -' LIC.NO. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. C J ADDDRESSDRESS SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION I///Qlpp <U U I hereby affirm that I am licensed under provisions of Chapter 9 000L ISSUANCE DATE H <m (commencing with Section 7000)of Division 3 of the Business and f - BLDG. ELECT. ,PLG. MECH. o z Professions CoJ�,an license iin full fore /ylrrJJ,,e((7 z o L - Contractor License Class �%� s Number ams -+ BUILDING PERMIT a OWNER-BUILDER DECLARA'T'ION o i" REFER TO ORD INFORMATION E: ; a I- 19mrcby affirm that I am•exempt from the Contractor 5 Lic-ensu MISC.- w VALUATION $/FT. u o a Low for the folluwin reason.(Sec.7031.5,Business and Professions r _ g PERMIT ISSUANCE a' b5c,�_•, r Cade:Any city or county which requires a permit to construct,alleq SC 2 ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. p� iL m Contractor's requires the applicant for such permit to file a signed statement that TOTAL `:bL.�L- PERMIT TO I n w i he is licensed pursuant to the provisions of the Coclnr's License 1MMi N 1 z Law(Chapter 9(commencing with Section 70000ol'Division 3 ofthe 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE Ir:1- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 � by any applicant for a permitmIliects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of net more than five hundred dollars(8500).1: ❑ I,as owner of the property,Or my employees with wages as BACK FLOW PROTECT.DEVICE Y� OCC.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,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and wile does suet,work FIXTURES-PER TRAP 5.00 $O,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meat,are not intended or offered for sale.If,however,the building ar imm proveent is sold within one year of completion,the owner- GAS-EA.SYSTEM•OVER 4(EA.) 2.00 builder will have the burden of proving Ilia(Ira did.,at build or im- BUILDING USE prove lot purpose of sale.). INDUSTRIAL WASTE INTER30.00 RES IND CON PB be Or , - ❑ 1,as owner of the property,am exclusively contracting with . ❑ ❑ ❑ ❑ ❑ �\ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSES50HS PARCEL NO. and Profe,cions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.I 1.00 contrthe Cons mirsuector'shceneeLwithacontracmrlsl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. - TRACT NO. PARCEL N0. ❑ lam exempt under Sea ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 - ACC.GATE ACC.FILE NO. ��W//O(,Ryf.'tC:/$�O(�MPF.NS TION DECLARATION WATER TREATING EQUIP. ''-0C' Emily a 11 'tat l�al I llvvartiBCale of COnum to self-insrllC, ZONING o certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. cop ercof(Sec.3800,Lab.C.)).� PNicy ❑ Certified copy is hereby furnished. Q.O FIRESPRINK ENERGY T 24 Z 2 ❑ CcR�ifly�.opy is filed with the inspect inn division. MISC.- REFER TO ORD.0 APPlicau Y ❑ N❑ Y ❑ N❑ 0y CERTIFICATE OF EXEMQ0NFROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. (�1l CL Z( This section need not be completer) if the permil is for one TOTAL Y❑ . NE] Y ❑ N❑ hundred do]]ars(S 100)or less.) L) O I Certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mit is issued,I shall not employ any person in any manner so as to 0 U become subject to the Workers Compensation Laws of California. Date Applicant BUILDING a ALTER OR ADD 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 provrslons of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10G00C.F.M.) 4.00 CONSTRUCTION LENDING AG IiNCY AIR HANDLING UNIT(OVER l0,000GEM.) 6A0 SEISMIC FEE I hereby affirm that there is a construction]calling agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is i@sued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name L•�;Fa Lender's NameAddre HEATING UNIT(OVER 100,000 B.T.U.)9.50 �i� ELECTRIC 00 ' ( certify tis correct. reaagree application and al city t d county VENTILATION FAN (SINGLE) 4.00 ordinances n correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating 1n building construction, and BOILER-COW 13.H.P.or 100,000 B.T.U.I 6.00 hereby authorize representatives for ins of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL !� hereby actioned property for inspection purposes. •� . (We) agree to save, indemnify and keep harmless 01e City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE _yp,00 CONST.TAX may in any way accrue against said City in consequence of the mntingofthls permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL CrA2� Signature of AprilicantEpractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16607 INSPECTION DIVISION, • JOB INSPECTION RECOD ' PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# 1PERMIT EXPIRES'IF WORK OWNER L AT CONTRACTOR ;)O,z—z IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR I NSPECTIONr RECO RD180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION ,((X 4/-'J• " NOTE: LAST CALLED INSPECTION.' UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIT/OF PLRMIT VALIDATION CUPERTINO.STANDARDS. GARAGE SLABS - „ „• POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ?n PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG ELECT, I PLc, MEw 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. 'PLUMBING •�i MECHANICAL ELECTRICAL PEHNLT TO //'' FRAMING 6wi M'1 ` d L INSULATION STORIES TYPE CONSTR. - OCC GROUP RES UNITS RPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED Sp,IT FL00l+AR Ea TOTAL ACR EDGE ROOFNOTE:NO FINAL INSP.SHALL 8E MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING Hes IND CON PR owri APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ' 0 El D ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN' PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH,ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION, PLUMBING ZONING ENG SITE NO. GAS TEST GAS F[RESPRINK ENERGY T 24 MECHANICAL Y ❑ NE] v NE] NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING F100D 2DNE /iL U,C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK ' GRADE FEE SUMMARY EXTERIOR LATH BUILDING u r INTERIOR LATH T MPORARY APPROVALS BUILDING p!t,• , SCRATCH COAT ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ,MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, * ELECTRIC IW—� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. 0 -� Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX /q PLEASE READ REVERSE SIDE BEFORE• •TOTAL CALLING FOR FINAL INSPECTION: OFFICE COPY