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18445
ANLIr.-ANT'TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL -PLUMBING; MECHANICAL PERMIT NUMBER 18445 .. BUILDING ADDRE=s©� 0 OWNER'S - zS� -1133 NAME�f QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION P , 5 CNTRA OC P'S NAME ,'U UTLETS;- SWITCHES -RECEP 10.00/1.00. LIGHTING FIXTURES 10.00/1.00 uc. NO ACONTRACTOR 's DRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT DR EN 4(F�� / «ER��L /"` c N 0_- ' L (ENG. PANELS (OVER 200 AMP).- 20.00 PLAN CHECK FEE P.C.. NO. - SIGNS TRANS. 3.00 ARCH OR .. .y- C%�i /'D bN41 7AArMA S,J, z(P.7, 2' M SPECIAL CIRCUIT 5.00 P RMITVALIDATION `` x'99 ,7 �ry,//� r'w/��/. EMP. METER OR POLE INS.. 20.00APPLICANTS /�/// AD �}5 S n� / v I vZ hi(J O MOTORS. SEE FEE SCH: SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARA'T'ION I hereby affirm that I am licensed under provisions of Chapter 9 (conumencing with Section 7000) of Division 3 .1 the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Dae Contractor SUANCE DATE - - '' BLO ELECT. I ❑ PLG. ❑ MECH. ❑ BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hen by utfrin that 1 am exen,d frons tine Contractor', License Law for the following reason. (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any ,structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License MISC. - ORD PERMIT ISSUANC 10.00 VALUATION 0�{ 2_0c/ $/FT. ELEC. CONTR. LIC. NO. �, LEG TOTAL PERMIT TO - OTY. PLUMBING PERMIT FEE r Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe Iftuiness and Professions Code) or that he is exempt therefrom and SJEORIES T PE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): ALTER -DRAIN -&VENT -WATER IEA.) 5.00 ❑ 1,. as owner of the property. or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 DCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Cede: The Contractor's License Law don' not apply to an owner of property;wio builds or improves thereon. and who docs such work himself or through his own employees. provided that such improve ments arc not intended. or offered for sale. II', however, tire building - FIXTURES - PER TRAP -� 5.00 $D.F�OOORR AREA INNS TOTAL ACREAGE. GAS-EA-SYSTEM6.00 or improvement is sold within ane year oIcompletion. the Owner- builderEA. will have tine burden of proving that he did n riot build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with - . 'BUILDING USE RES IND CON PS ane, ❑ ❑ ❑. ❑ ❑ . INDUSTRIAL WASTE INTER30.00 licensed contractors to construct tire project (Sec. 7044, Business and Professions Code: The Contractor's License Law does mot apply to an owner at property who builds or improves thereon. and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 - ASSESSORS PARCEL NO. -ontoels for Inch projects with u eontraclor(o licenced pursuant to th ntrador's License Law. - SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NOI PARCEL NO. exempt antler Sec. ,B.&P.C. lar ibis - WATER HEATER W/VENT 6.00 re son Owner r Dale - WATER SYSTEM - 5.00 ACC.DATE ACC. FILE NO.. WORK It RS' COMPENSATION D!C�ATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a ecrhficae of consent to sell - insure. or a certificate of Workers' Compensation Insurance or a certified - ZONING - ENG. SITE NO. ` urpY thereof (See 3800, Lab.C.). . Policy No Company , FIRE SPRINK Y ❑ N ❑ ENERGY T-24'. Y ❑ N❑ ❑ Cenifiedcupye,herebyfur.ished. ❑ Certified copy is fled with the city inspection division. Applicant MISO- REFER TO ORD. CERTIFICA FE OI' EXEM1'1' ION FROM WORKERS" PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG, CONTR. LIC. NO. - PLG. TOTAL COMPENSATION INSURANCE [This seelt'n need mol be con...leted if the permit is'for one Y ❑ N ❑ V ❑. N❑ - hundred doll or'lS 100) or less.) I certity that in the nerfrommuh, of the work fur which this per- Lou is i ... Led, 1 shall not nnpkay any person in any manner sous to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING (. 00 become subject to the Workers' Connperrsation Laws of Calilorai:e- Date Applicant •' ALTER OR ADD TO MECH. `5.00 NOTICE TO APPLICANT: If, all,, making this Certificate of Ex- APPLIANCE 5.00 ' PLAN CHECK _ peniun cnnption, you should bccamc sobjcet to the Workers' Comsm provisions of the Labor Code, you [Trust forthwith comply with such provisions or this permit shall be deemed revoked FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 'AIR HANDLING UNIT 10MC.F.M.) 6.00 SEISMIC SEISMIC FEE - CONSTRUCTION LENDING AGENCY SI hereby affirm that mere is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 [fie performance of the work for which this permit is issued (Sec: 3097, Civ.C.). MICROFILM' y_- HEATING UNIT (TO 100,000 B.T.U.)- 8.00 'HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC - Lenders e Lender's Address A 1 certify that l have read this applicalion and slate that the above ,formation is correct 1 agree to comply with all city and county, ordinances and state laws relining to building construction. and VENTILATION 'FAN (SINGLE)'.- ,.4.00 PLUMBING .BOILER-ODMP I3 H.P. Dr 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) BEE FEE SCH. MECHANICAL hereby authorize representatives of this city ler enter upon tic above-mentioned property for inspection purposes. I _ MISC. - REFER TO ORD. (We): agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs Lou expenses which I in any way accrue against said City' in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 _ mating of this permit. MECH. CONT. LIC. NO. MECH. TOTAL TOTAL, Signatereo Applicant/Contractor Dale �' OFFICE COPY la OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING • - -, rE HMIT NUMBEN ' _ CITY OF CUPERTINO. 18445 INSPECTION DIVISION JOB INSPECTION RECORD . /^� )I� PE`RM�T.EXPIRAT.ION /VVYG" ^/ "" O JOB ADDRESS- UNIT# '• _LOT# PERMIT EXPIRES IF WORK CONTRACTOR • IS NOT STARTED WITHIN 180 DAYS.OF PERMIT ISSU ANCE OR 180 DAYS FROM INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: - ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF, „AST CALLEDINSPECTION. UFER PREGUNITE -' E v'IT vn[IDnTroN • CUPERTINO STANDARDS.' - /�Jp / `�7 •� / GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ,/ U�— ISSUANCE DATE UNDERGROUND/SLAB; PLUMBING ELECTRICAL MECHANICAL- .. TB c ELECT. PLC: MECH. .. city ofNTIL El DO NOT POUR FLOOR UABOVE HAS BEEN SIGNED ( BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION _ IIFT.. r'•'�• PLUMBING MECHANICAL ELECTRICAL - _PERM nT FRAMING: INSULATION- _ STOHIES TYPE CONSTR . ... - - OCC. GROUP HES. UNITS PLACE -NO SUBFLOOR UNTIL ABOVE. HAS BEEN SIGNED ' ,. ROOF NOTE: NO FINAL INSP.BHALL BE MADE BEFORE. THE CONSTRUCTION TAXIS PAID $N.FT-FLO�R AREA _ \ �/ .{, TOTAL ACREAGE DIAPHRAGM BUILDING USE ROOF SHEATHING - - HES IND coN PB OU. El Ll El El El- -UNTIL - APPLY NO ROOFING ABOVE HAS BEEN SIGNED FINALS DATE - INSP:• ASSESSOHS PARCEL NO, ROUGH SANA _ ' 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 - .FIRESPRINK r N ENERGY TQE Y NE] • MECHANICAL': COVER NO'WORK-UNTIL ABOVE HAS BEEN SIGNED HEATING -- EXTERIOR SHEAR. ELECTRICAL RELEASE FLODD ZONE Y. 0 N A. L. u. C. N(:). INTERIOR SHEAR � � - FIRE DEPT. SHEETROCK .: GRADE - -. FEE SUMMARY EXTERIOR LATH BUILDING.- BUILDING INTERIOR" LATH' TEMPORARY APPROVALS - SCRATCH,COAT ELECTRIC - PLAN. CHECK FEE - GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED. OCCU,FANCY - SEISMIC FEE T;r17 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BYBUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC PLUMBING �� ONE WORKING DAY'BEFORE REQUIRED INSPECTION. O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z"' -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX " 'IMPORTANT! TOTAL (O• / 7 PLEASE READ REVERSE SIDE BEFORE ' CALLING FOR"FINAL INSPECTION. OFFICE COPY