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174877 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY p. ' BUPLOI NG PROJECT IDENTI FICA ON - APPLICATION &PERMIT-. BUILDING - ELECTRICAL- PLUMBING - MECHANICAL .I:PERM?NUMBER.• �•, q p �� I `i eDIIDING wognEss OWNER'S NAME OTY. ELECTRIC PERMIT FEE PLAN CHECK VA11DATION `1 , PNDNE ` DATE OF APPLICATION' Na A a / `, uC. NO. A14- OUTLETS 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS ►LLA J/PFHONE -I APPLIANCES -RESIDENTIAL .4.00 PANELS 10.00 ORcnrtscT OR /� NoC.,JW PANELS(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. 'SIGNS TRANS. 3.00 ADOHyess EN G.5.00 SPECIAL CIRCUIT PERMIT VALIDATION��EMP. METER OR POLE INS. 20.00 A ADDRESS ADDRESS � IC/ v - MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Co and y license is in full r X qd License CI Lic. Number 4 J I I x.1.1 1 BLDG. ` IKY�II ELECT. r/1 PLG. MECH. rX IXI X1. Date Contract., -0•� • CIN, Uf C. Veit O X11 /'-"� BUILDING PERMIT DECLt from RATION OWNER -BUILDER I am exempt 1 hereby Stolon that 1 so exempt from the inessano is License Professions Law for theity following reason. which Code: Any city or county which reyuiresa permitfoconstrucL Sher, re703 quires a permit to construct, improve, demolish, or repair any structure, prior to its issuance, also reylrlrCS IIIc applicant for such permit to file a signed statement that he is licensed pursuant to tie provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and' the basis for the alleged exemption. Any violation of Section 7031.5 INFORMATION MISC. - • REFER TO ORD VALUATION 5/FT. �/ 19 00 rP 1 L.ICJ - PERMIT ISSUANCE 10.00 1.O� ELEC. CON R. LIC. NO: 0 ELEC. TOTAL (� , PERMIT TO ' QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit subjects the applicanitoa civil penalty more of not more than five hundred dollars ($500).1: ALTER -DRAIN &VENT-WATER(EA.) 5.00 ❑ 1, as owner of lite property, or my employees with wages as their compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCG. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 ' intended or offered for sale (Sec. 7044, Business and Professions ' Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, $nd who docs such work himself or through his own employees, provided that such improve- mems are not intended or offered for sale lL.howeveq the building FIXTURES - PER TRAP5.00 5➢TQ}. Ar E'q 4 O IrL tLCR AGE _! Z GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or im prove for purpose of sale.).RES ❑ I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING -USE IND CON P8 1:1 El 0 1:1 El INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 " LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. _ hF7 SOI L f licensed contractors 10 construct the project fSec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contrectim s) licensed pursuant to the Contractor's License Law, ri❑ nl am exempt under Sec.' .B.&P.C.10, Wi, SEWER -SANITARY -STORM EA. 200ft/10.00 - TRACT Ng. PARCEL NO. WATER HEATER W/VENT 6.00 Owner - -Dale - WATER SYSTEM 5.00 -' A C. DATE ACC. FILE N0, WATER TREATING EQUIP. .5.00 WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate or consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. 74 _ copy thereof (Sec. 3800, Lab.C.). PolicyNo. Company - - •'"'t ❑ Certhie pyi he cbyf Dished. _<Cerf d fie it cc It inspection division. AppR<anCl..% FIRESPRINK v� N� ENERGY T-24 v❑ NE] MISC.- REFER TO ORD. CBRTIFI AT, 017 EXEMPTION FROM WORKERS' PERMIT ISSUANCE. 10.00 .b FLOOD ZONE U.C.A.L PLG. CONTR. LIC. NO. �( TOTPLG.AL /XI,2� . COMPENSATION INSURANCE (This section need Dol be completed if the permit is for one YEJ NNE]V� N� QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or less, I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant BUILDING ALTER OR ADD TO MECH. 5.00 OTICE 1'O APPLICANT: 11, after making this Certificate of Ex- . emptiun, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK p(osions of the Labor Code, you must forthwith comply with hviprovisions or this permit shall be deemed revoked. are AIR HANDLING UNIT (TO 10=C.F.M-) 4.00 FEE �� 1 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE 83 2G CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency ror EXHAUST HOOD (WITH DUCT) 5.00 the performance of -the work for which this permit is issued (Sec. 3097, Civ C.) MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT I0 VER 100,000B.T.U.)9.50 ELECTRIC Z�(s j� Lender's Name Lender's Address I certify that.I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING (2f,Z BOILER-coMP13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL CONST. TAX ✓ 12-'?, 2,r 3Q�E 62. hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of uperfino against liabilities, judgments, costs and expenses which may in a way accme aminst said City in consequence of the MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 Zr OD MECH. CONT. LIC. NO. MECH. TO/AL ?4.� TOTAL G/ Cb 6 ran' 11t' per it. �J , G I re A licant/Contractor ate OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING � - CITY.OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS 1�c 1 yau. Y �' jN # LOT# OWNER Q \ corvTRAcvoRV� K - e7 Vie � PERMIT NUMBER 174$7 , {Ye1 PERMIT EXTPIFI TIRAL� •. ,pI izzlT E PIRlES'I �W IS NOT STARTED WITHIN 180DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION .. - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE AP O LANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE - _ PERMIT VALIDATION ° r h iJ�I:Lrr•C-^"( ISSUANCE DATE GARAGE SLABS ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDJJ W RTC'R S 1911 IT 1K UNDERGROUND- /SLABPLUM _ City, af. Cupertino ELECTRICAL MECHANICAL L PEvPT $7¢ucT. tml¢-AN eLoc. ELEcr vla MECH . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w$Plah,O ,6) BUILDING ORM PERMIT INFORMATION ' WOOD FLOOR VALUATION _ §/FT! . PLUMPING — q-1 eIf ! I 11 , wnB'—V MECHANICAL ELECTRICAL O l FRAMING INSULATION rj�,y �� ,u�D STORIES rvPE corvsrR. 1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - OCC GROUP RTS. UNITS •} - ROOF, - NOTE:NO FINAL• INSP. SHALL BE MADE BEFORE?-- THE CONSTRUCTION TAX IS PAID 1: oaR Ar ToI FAYR,EpGE ' sl) //// 00 ,CT DIAPHRAGM ROOFSHEATHING i•]A.C_ I BUILDING USE I "- nes .IND CON ve 0m11 E1 [1 • 0 ❑ I] APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. OUCH SAN.N ASSESSOHSPAHCELNO. -%�-�'-��' PLUMBING ELECT. ENERGY71 TUBS 8 SHOWER PAN PLUMBING ENERG A TR CI N q D PARCEL NO _O-/� MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENER A C,DATE ACC FILENO FRAMING Q ELECT. FINAL T T rl 1.' INSULATION - PLUMBING ZONING ENG. SITE NO. GAS TEST, MECHANICAL FIRE SPRINK y C] N� ENERGV T.24 ` [] No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASEGLOGO ZONE Y [. N� A.Cuc. Y L N� INTERIOR SHEAR FIRE DEPT. SHEETROCK it GRADE FEE SUMMARY EXTERIOR LATH ;. BUILDING BUILDING IJ dl -INTERIOR LATH ' - TEMPORARY APPROVALS SCRATCH COAT - ELECTRIC PLAN CHECK FEE.__ GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM' w ARRANGE FOR INSPECTION BY PHONING 252-4505,- H ONE WORKING DAY BEFORE REQUIRED INSPECTIPLUMBING' PLEASE GIVE JOB ADDRESS WHEN PHONING. Z ' SEE PERMIT FOR EXPIRATION.DATE — ELECTRIC • T Lsl MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION.'TOTAL �6 OFFICE COPY