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15976 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY ,13671.DI NG PROJECT I DENTI FICATION PERMIT NUMBER RAIL NU # APPLICATION & PERMIT 15976 AppRE65 - erg a e, BUILDING —ELECTRICAL—PLUMBING—MECHANICAL OWNERS P PLAN CHECK VALIDATION 7NEL �//7NEXlo� QTY RS ELECTRIC PERMIT FEE PHONE NAIAEpncrpRs UTLETS-SWITCHES-RECEP 10.00/1.00 �-fL/J,✓CC ��/`��J ue No. Q�j LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S v APPLIANCES IAL 4.00 ADEN ESS �y / ''] �J '.x /V ✓'d .�"'A'/�� /� PRONE J'//W PANELS 10.00 DATE OF APPLICATION OR RCHIiECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. SIGNS.TRANS. 3.00 noonesSSS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 AApE55PDNCESS S MOTORS SEE FEE SCH. J— UUafT er>< SERVICECHANGE 20.00 ,00 LICENSED CONTRACTORS DECLARATION l Y a u I hereby affirm that I am licensed under provisions of Chapter 9 G i [eonnneneing with Section 7000)of Division 3 of the Buainess and ISSUANCE DATE BLDG. ELECT. PLG. - MECH. F N i Licem ions Cndc ^d y icenm is in full Number ccR ❑ ❑ O Z i m o Date lass Conc. ractor m E Dale�_l, Contractor Q y E J ac m w a OWNER-BUILDER DECLARATION BUILDING PE MIT R o a DMISC.— w g I- I hereby affirm that I am exempt from the Convector's License REFER TO ORD INFORMATION F u LL o LSw for the following reason.(Sec 7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. Code:Any city or rolntly which req uims a permit to emistruct,alter, QO improve,demolish,or repair any structure,prior to its isauancr, dw ELEC.CONTE. LIC.NO. ELEC. ac o LL requires the applicant for Rich permit to file a signed statement that TOTAL w he is liamed pursuant to the provisions of the Contractors License PERMIT TO F z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the Pz Q EE o Businessand Professions Code)or(hut he is exempt Iheretrom and QTY. PLUMBING PERMIT FEE /_` . IT I- the basis for the alleged exemption.Any violation of Section 7031.5 i g by any applicant for a permit subjects the applicant loss civil penally STORIES TYPE CONSTR. of not more than five hundred dollars(S500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my cmployccs with wages as BACK F LOW PROTECT. DEV ICE 400 — oCC.GROUP EES.UNITS their sale compensation,will do the work,and m the stcluna ¢is l 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 properly who builds or improve thereon,and who docs such work FIXTURES-PER TRAP 5.00 52 FT.FLOOR AREA TOTALACREAGE himsult or through his own cmployccs,provided that such improve- Trends are net intended or offered for sale.IL however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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 he did not build or int- BUILDING USE prove for pufposc of sole.). . INDUSTRIAL WASTE INTER. 3000 RES IND CON PB Omer ❑ 1,as owner of the properly,am exclusively contracting with Interested contractors to Construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. El 0 El D El 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 1 1.00 contracts for such po,tels with u<o.toactio,)licensed pursuant In STORM .200ft/ the Convecor's License Law. SEWER-SANITAR V- _—TRACT No. PARCEL No. rea❑nl am exempt under Sec. ,B.&P.C.for the WATER HEATER W/VENT O p Owner Dat, WATER SYSTEM _—ACC.DATE Acv,FILE No. WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 0` 0 I hereby affirm that I have u certificate afconscul to selfinuvc, or a c,t,r..le of Worker Comlcn.H.n Invumnec,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.IC /C Policy No. Company �- 0 ❑ Certifiedcopyisherebyfu 3h FIRE SPRINK ENERGY Z Z � Certif- m y -Ica Ih t - cit tion J' isinn. 24 ApN...it ZPLG.CONTR. REFER TO ORD. Y E] N� Y 0 N� CC e2 SSUANCE � CERTIFICATE N ION PROMW'ORKERS' — FLOOD ZONE A.L.UL. W � COMPENSATION INSURANCE LIC.NO. PLG.ELO (This section need Rol be compleled if the pennil is for one TOTAL Y❑ NV ryhundred dollars 15100)or I•ss.)I certify that in the perfcnnunce of the work for which this per- MECHANICAL PERMIT FEELL U mit is issued,I shall not employ any person in any mania so as to FEE SUMMARY become subject to the Workers'Conlpenmlion Laws of California.U a Dale Apphcam R ADD TO MECH. 5.00 BUILDING} IA NOTICE, TO APPLICANT: If,are,making this Certificate of lis- emption,you should become subject to the WorkersCompensalion „ APPLIANCE provisions of the Labor Code, you must forthwith comply wflh 5.00 PLAN CHECK U such provisions or this FIrout shall be deemed revoked. �. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OV 1Q000 C-F.1 ) 6.00SEI SMIC FEE I hereby utt'ino That them is a construction lending ugancy for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097.Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Uudcf's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that l have read this application and Gale that the Shove VENTILATION FAN (SINGLE) 4.00 e information is correct.1 agree to comply with all city and county ordinances and slate laws relating to building construction. and BOILER-CCW(3H.P.or100,000B.T.U.I 6.00 PLUMBING 6 hereby xuthoriee representatives of this city to enter upon lire g01 LER-COMP Over 100,000 BTU(SEE FEE SCH. alwvenm - enlioned property for inspection purpows. MECHANICAL (We) agree to save, indemnify and keep harmless the City ed MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may.in any ay accrue against mid City in ccr.,.cuce of the PERMIT ISSUANCE 10,00 CONST.TAX ono' �� MECH.CONT. LIC.N0. MECH. TOTAL TOTAL I�nature on", n Applicant/Contmcmr Dulc OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINOq INSPECTION DIVISION 15976 JOB INSPECTION RECORD • /,' - PERMIT EXPIRATION JOB ADDRESS_/ly�� F��` FIVE UNIT# LO T# . PERMIT EXPIRES IF WORK I OWNER -7 CONTHACTOR �Q/J..(/C� �L.B(y, IS NOT STARTED WITHIN I SPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT IS$U- FOUNDATION NOTE: ANCE OR 180 DAYS FROM LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF veHnur vALIOA noN CUPERTINO STANDARDS. ' GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING ELECTRICAL ISSUANCE DAL r MECHANICAL RLDc eLECr I PLG MECH ❑ ❑ `� ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL �1 PEun+Ir To FRAMING - _ • INSULATION ST ORICS TYPE CONSTR, D occ ,uOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ® .ROOF NOTE:NO FINAL INS°.SHALL BE MADE BEFORE SOFT FI.CORAREA IOTALACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING - `BUILDING USE RES O CON . PR APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El �I ❑ ❑ ❑ ASSESSORS PA ROUGH � SAN.p IPEL NO, PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL' BUILDING ENERGY ACC DATE AGC.FILE NO. FRAMING ' ELECT.FINAL TEST " INSULATION PLUMBING Z, zo"'Nc ERG.SITE No. GAS TEST GAS 1I MECHANICAL FIRESPRINK ENERGY T.N COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ "❑ ° [:], ❑ EXTERIOR SHEARI ELECTRICAL RELEASE FLOOD ZONE ALUC INTERIOR SHEAR - FIRE DEPT. °❑ IN Y ❑ "❑ SHEETROCK GRADE ` FEE SUMMARY EXTERIOR .LATH BUILDING INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT' . ELECTRIC PLAN CHECK GAS FEE NO TAPI OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY . SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 4 �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - z MECHANICAL IMPORTANT! CONST.TAX PLEASE READ'REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - I