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15745 .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENT]FICATI ON PERMIT NUMBER BUILDING^ ,7 �rL� AVS - r. APPLICATION U PERMIT '. 15745 AUILDIN VY'Ts I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAME P LAN CHECK VALIDATION H L v �M y .y,a- QTY ELECTRIC PERMIT FEE vNON X0.0 a / 6 7 NAAMTE TIFRACTOEs OUTLETS-SWITCHES-RECEP 10.00/1.00 -7 C LIC.No, LIGHTING FIXTURES 10.00/1.00 ADDSFES roEs APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ORRCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. - 'SIGNS TRANS. 3.00 ADDRESS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 '09 0o LICENSED CON"TRACTORS DECLARATION �f(�A�O/ ¢is rHj I hereby affirm that I am licensed under provisions of Chapter 9 `I�Sf/ANCE DATE P, (commencing with Section 7000)of Division 3 of the Business and B G. ELECT. PLG. MECH. H w z Professions Code,and my license is in full force and effect. qU Zo 0 t'o License ClassLic.Number Q n 1 lyl m F j Date Contractor a a: BUILDING PERMIT ¢ ¢ w OWNER-BUILDER DECLARATION INFORMATION 1 hereby affirm that 1 am exempt from the Contractor's License MISC- . REFER TO ORD FIc0 < Law forthe followingreason.(Sec.7031.5,Business and Pfessions PERMIT ISSUANCE ,I� VALUATION S/FT. ro � ,.m0J Code:Anycilyor county which requiresa permit to construct,alter, - /Q ¢ ¢ ¢ O improve,demolish,or repair any slmcture,prior to its issuance,also ELEC.CONTE. LIC:NO. ELEC. III O ¢ requires tiro applicant for such permit to file a signed statement that TEL rte[ w m Ic he is licensed pursuant to the provisions of the Contn¢toi s License PERMIT TO Fi 'a Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe s 4 o Business cad I'rofessiams Code)or that he is exempt therefrom and SEH $ the basis for the alleged exemption.Any violation of Section 7031.5 DTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. a 3 by any,applicant fore Hundred dollars $5000.he licunuoacivil penally ALTER-DRAIN VENT-WATER (EA.) 5.00 of not more titan five hundred Dollars(8500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCL.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 docs not apply to an owner of »� property who builds or improves yeescou,and who docs such work FIXTURES-PER TRAP .-♦nw00 SO,FT.FLOOR AREA TOTAL ACREAGE himselforLor ante his own employees,provided leve such improve- memsarcnotintendedoro(fcred for sale.If,however the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- � GAS-EA.SYSTEM-OVER 4 (EA.) 2,00 builder will have the burden of proving that lie did not build or im- - BUILDING USE prove for Purpose ofsale.). RES IND CON PB Other {( 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 11 ED F-1 EDIidASseit contractors to construct the project(See.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 /I - to an owner of property who builds or improves thereon.and who ,- LAWN SPRINKLERS-OVER 5(EA.) 1.00 commets for such projects with a contructODS)licensed pursuant to � SEWER-SANITARY-STORM EA.200ft/10.00 tea Contactor s License Low. TRACT NO. PARCEL NO ❑ I am exempt under Sec. ,B.&P.C.for this - I WATER HEATER WIVENT 6.00 '- reason Owner - at - ' WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECf.A A'1'ION ATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. Copy thereof(Sen 3800,Lab.CJ. Policy No. Conhpany O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYT]4 FZO ` ❑ Certified copy is tiled with the city inspection division.Applicant IMISC.- REFER TO ORD. y ❑ NE:] v 11 No CC CERTIFICATE OF EXEMPT ION PROM WORKERS' PERMIT ISSUANCE 449-60 �. FLOOD ZONE A.L.uc. W COMPENSATION INSURANCE PLG.CONTE. ❑C.NO. PLG. 1 o (flux section need Rol be completed if the permit is for one TOTAL V❑ NF] V❑ N❑ ::) Z hundred dollars IS 100)or less.) 62 U O 1 certify that in the performance of the work for which this per, OTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.I shall net employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. LU Danc Appresyd ALTER OR ADD TO MECH. '-596 BUILDING } to NOTICE TO APPLICANT: If,after nmking this Certificate of Ex- F ? emplion,you should become subject to the Workers Compensation APPLIANCE 5.00 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 10=C.F.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 SEISMIC FEE ao 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 tlte'performance of the work for which this permit is issued(Sec. MICROFILM 3(197,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 / Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 � H Lender's Address ELECTRIC I certify that 1 have read this application and ,are that the above VENTILATION FAN (SINGLE) 4,00 information is correct.I agree to comply with all city and count PLUMBING a ordinances and state lows relating to building construction, ti BOILER•COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives ec this city es enter upon Ihu BO (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 against liabilities,judgments; sts anJ expenses which PERMIT ISSUANCE gpbQ CONST.TAX may in any way etre against said Ci in consequence of the I'M go tisp ,i[. ; 'J �_ / rs�,. MECH.CONT. LIC.NO. MECH. �•/s D Y^- v'I / .�lI1Mr• TOTALI/`/✓ TOTAL hg azure of Applicant Contractor Date OFFICE COPY - POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15745 INSP©'#Z)N DIVISION JOA INSPECTION RECORD ` JOBADDRESS C/" �TL'�� ��% PERMIT EXPIRATI ON UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER r,�' - E[,* w�4n/c- CONTRACTOR IS NOT STARTED WITHIN INS ACTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION W• NOTE: ANCE OR IOU DAYS FROM LIFER - ••�� WTQ„Q ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION • SLABS CUPERTINO STANDARDS. GARAGE pp' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING , _ ��• / ��+ , ELECTRICAL ISSUANCE DATE MECHANICAL c ELECT PLO. MEC” 0 i ..I Q�l 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED %) ` ��(`HU ILDING PERMIT 1 WOOD FLOOR Cp C� INFORMATION PLUMBING VALUATION gIFL, MECHANICAL - ELECTRICAL - ��"-' PERM,rt�,�I�/U FRAMING - 71 /71V v; INSULATION - STORIES. TYPE CONSTR. OCCGROUPRES UNITS PLACE NO SUBFLOOR.UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT iLOOR AREA TOTAL ACILAGE NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON-. PB ORP.., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ A SSESSORS ROUGH SANS PARCEL NO � PLUMBING - ELECT.ENERGY •�' TUBS&SHOWER PAN 1 Q 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 MECHANICAL FIRE SPRINT: ENERGY TZa COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ Y ❑ "❑ - EXTERIOR SHEAR ELECTRICAL RELEASE _ FLOODZONL A.L UC. INTERIOR SHEAR FIRE DEPT. ' Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATTEMPORARY APPROVALS BUILDING H SCRATCH COAT ELECTRIC PLAN CHECK _ GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC a6 oo ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECF'AwcAL dy IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL y CALLING FOR FINAL INSPECTION. / OFFICE COPY