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1461501 O Z_z Fv00 Ir UJ L2- 0. 0 Z) z UQ LL U Ow a F- N I- ? `i. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING IDENTIFICATION APPLICATION &PERMIT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL PERMIT NUMBER 146150 t BUILDING 4DIS gI p�� OWNER'S �y '1PLAN NAME100 114--, GNE / /F7 v�� Q ELECTRIC PERMIT FEE CHECK VALIDATI�J 7 (//.�. yr'�/1 / NAME OUTLETS OUTLETS- SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 UC.rvo. CONTRACTOR'S AC - ADDRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION . RRCHITECT OR ENGINEER LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. N0. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS SPECIALCIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ' ZIP �a-04 Imo% ADDRESS APPLICANT'S - MOTORS SEE FEE SCH. ez 1� J l,3 p e SERVICE CHANGE 20.00 LICENSED CON 'I'RACfORS DECLARATION 4W I hereby affirm that 1 am licensed under provisions of Chapter 9 s% ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie. Number .10 b➢ L G. ELECT. ❑ ❑ PLG. MECH. , ❑ ❑ Date Contractor ' BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARA'T'ION 1 hereby affirm that I am exempt from the Contractor's License Law for the following mason. (Sec, 7031.5, Businessland Professions Code: Any city or county which requires a pernitconstruct, 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 Licen Law (Chapter 9 (commencing with Section 7000) of Division Sof 11 e Business and Professions Code) or that he is exempt therefrom and MISC.- REFER TO ORD VALUATION y(0/ $/FT. O^ PERMIT ISSUANCE 10.00to - - - ELEC. CONTR. LIC. NO. '-- ELEC. .--5 TOTAL / PERMITTO I IT%Pfll 0 PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis far the alleged exemption. Any violation of Section 7031.5 byanyapplicanl for a permit subjects [lie applicant to a civil penally of not more than five hundred Aollars ($500).1: ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, 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 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, GOND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to un owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve.' menti are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 GAS-EA.SYSTEM-11NC.40UTLETS 6.00 50. FT. FLOOR AREA . TOTAL ACREAGE or improvement is sold within one year Of completion, the owner- builder will have the burden of proving that he did not build or frit. prove for purpose of sale.). Cl I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM- OVER 4 ( >i .00 BUILDING USE - RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 j licensed contractors to construct the project (Sec. 7044, Business and Professions Code: *The Contractor's License Law does not apply to an owner of properly who builds or improves (hereon, and who contracts for such projects with a. conlractrr(s) licensed pursuant to the Contramo License Law.. LAWN SPRINKLERS - 1 IN � V)B. 46)00 LAWN SPRINKLERS - OV EA.) 1.00 O ASSESSORS PARCEL NO. SEWER -SANITARY -STORM :raOP(1,10;00 TRACT NO. PARCEL NO. . ❑ I an, c c Hit umd Sec. ,B.&P.C. fur this reason - WATER HEATER W/VENT 6.00 Owner )alr . _ WATER SYSTEM 5.00 ACC.DATE ACC. FILE NO. WORKER 'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to wlt-mim e, or m certificate of Workers' Compensation Insurance, or a cerircc - - ZONING ENG. SITE NO. - copy (hereof (Sec. 3800, Lab.C.). Policy No. -Company - _ MISC. - REFER TO ORD. FIRE SPRINK Y N ❑ ❑ ENERGY T-24 v N ❑ ❑ • ❑ Certified copy is hereby furnished. - ❑ Certified copy is fled with the city inspection division. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one PERMIT ISSUANCE 10.00 Q 1 FLOOD ZONE Y❑ N❑ A.L.U.C. Y❑ IN C] PLG. CONTR. LIC. NO. PLG. OO�..- TOTAL hundred dollars IS 100) or It,.) 1 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 MECHANICAL PERMIT FEE FEE SUMMARY BUILDING�� become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE. TO APPLICANT': If, after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE ' emption, you should become subject to elle Workers'Compensation Provisionsofthe Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10 F., Ij) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT (OVER 10 IF.M.)6.00' SEISMIC FEE 9 oC I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sea 3097, CN.C.). EXHAUST HOOD (WITH DUfe'. l 15,001 MICROFILM HEATING UNIT IT 100p00 BlT. .) 6.00 Lender's Name Name 100,090 TxU:1.. _ H EATI NG UN I T(OV ER 9:V01 ELECTRIC 'y Lender's VENTILATION FAN (SINGL-EP 4.00 I certify that I have read this application unit state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building, construction, and PLUMBING J/ 601LER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP IOver 100,000 BTU) SEE PEE SCH. MECHANICAL 9 OkV hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (W) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. up t no .,air liabilit • intents, costs and expenses which m y i any ay ac I it .said ity in c rise uence of the • a t g of t s per CONST. TAX PERMIT ISSUANCE r 10.00 V MECH. CONT. LIC. NO, MECH. TOTAL a3_ TOTAL �5�. Ignaturel pp scant/Contractor e OFFICE COPY 7 APPLIC 1'dl -1 BILL IN I1Vl-01-0MAI IOIV VVI TI-imi 1'iED Ll Id1 - USE HALL I'D INT PEN ONLY j BUILDING PROJECT IDENTIFICATION f/'`/1/Y/° APPLICATION & PERMIT BUILDING- ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 1 A /M� 1 - 1 TV 1 5 BDILDIND AUDR 55 I/ n OjYj P -Y OWNER'S NAME 'lune (-�/-& V [ ! OT , ELECTRIC PERMIT FEE PLAN CHECK VALIOATIf��+ IrCINIHACIGHS NAME IIH OUTLETS - SWITCHES -RECEP 10.00/1.00 LIC No. LIGHTING FIXTURES 10.00/1.00 rIONTRADORE55 TORS PPLIANCES- RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ORRCHHECT .., .. ENGINEER LIC. NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE D.C. NO. SIGNS TRANS. 3.00 FA-IIAOOUR155 LN` SPECIAL CIRCUIT S,OQ PERMIT VALIDATION Po, TEMP. METER OR POLE INS. 20.00 `� �D�,��� APPLICANT'S ADOE55 MOTORS SEE FEE SCH. =T• %- SERVICE CHANGE 20.00 /`- LICENSED CON I'k,\Cl'ORS Df:CLr\RA'I'ION/(C`/�S I hereby all!,,,,thm I ant ficenWd under pro. isiun, of Chapter 1) Iconnnencutg wall Seclion 70001 o1' Divi,lon 3 of the Rosiness and Poll (lode, and nq l Li i, in full f orce and rU2cI. Liecnu' Cha„____ Lie. Number_..__ Lio,assi Class---- (` fist \'. ho f <. ISSUANCE DATE ,',BLOC. ELECT. PLG. MESH. ❑ ❑ ❑ ❑ Uaa_ _l'untrucwr-___. __-- _ BUILDING PERMIT INFORMATION Oa Il,It-If IIILDIik UP:('L.\RA'Il(1N I hlreny Infirm tial :m cxetn,l iron the colo rnelor's Lieemr. Law for the 1'mluwing reaxnl. 15ec. 70J T.5. Ihnineo,o.. I'nno,hnn Code: Anv 1itY "I euuloy which nyuimsa permit b,eurutruet, uheq lrlpmve, demolish, of re Pail any structure. Prior In'1% issumae, alio requires the applicant lot,uch permit to file x signed ,tatalC Hl Ilial In: is Chaped'1u,oanl to tn1 with Stuns oI the Convaaoll Liven Low (Ca,.Y,dter '>Icunotmo ingthe oxv,ilo, I7000101'Divisira,looH 3Ili the MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 Q -- vnwnTloN M� $ � $/FT. ELEC. CONTR. LIC. N0. ELEC. TOTAL �r� PERMIT TO Ilmi Bev and P11111ssluns Code) 01 tial be is Cunrtpl Ommtnnn and O PLUMBING PERMIT FEE '-"' •Tr "�% the basis lin the allege) e.olnpliun. Any violaliml of Sccliuo 7031.5 by any a,plicarnbuapen..it+Btj,,t, the applicant, a civil penalty of nal Intro, than Iis, In11Wmd dollars 1$5001.1: STORIES TYPE CONSTH, ALTER -DRAIN -WATER IEA.) 5.00 S� ❑ I, a owner of He property, or my einployces u'im wage, m RILL' role c nganaoliun, will dtr the work, and the Iru,Hoe is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or ,IlI,,d Iur ,ale (See. 7044, Business and Prulc,,mal Code:'fhu Conl,a,baS Lleen,e Law Jon not apply w an owner of property who buinhor improves tha'eon,und who do es such work n imscll or through hi, own anpWyees, provided that v¢n iniloosc- anents are not immndle ar ollemd ria sale. If, howcvrl, the bulldiog FIXTURES - PER TRAP 5.00 GAS-EA.SVSTEM-11NC.40UTLETS 6.00 50. FT. FLOOR AREA TOTALACREAGE or hnprueenent is sold within one year of completion, me owner- builder will 4avo.lhe Lurdena,l proving Ibub nee did aur hold or III ,rave for Purpose ofs:de.1' ❑ I, as owner of the Property, ant exclusively eomracting with GAS - EA. SYSTEM - OV ER 4 ( 0. L .00 BUILDING USE RE5 wo CON PB Door El 11 1:1 El Ellicensed INDUSTRIAL WASTE INTER. 30.00" commem, IN consln¢I the Pmjea ISec. 7044, Uminv„ and 1'rofessioos Code: 'I'he C'on Oxeb.,% Licenw Law due. Hill apply to in owner of properly who builds or im,ruves thereon, and who contracts l'ur,uch proiecl+with it contraeturls) Ceased ponoaol to the ('unlmclo License Low. LAWN SPRINKLERS - 1 INC-�,V:B, 6:00 LAWN SPRINKLERS - OV R'6'(EA.I 1.00.. ASSESSORS PARCEL NO. SEWER -SANITARY -STORM EA: 2001t'/10.00 TRACT NO. PARCEL NO. ❑ I um c c Rpt andyyy(((ticc._ _ If.ti l',('. La Rita Owner- _ (F�'//K'1•II•'i/-j� WATER HEATER W/VENT 6.00 WATER SYSTEM 5.00 ACC. DATE ACC FILE NO. WATER TREATING EQUIP. 5.00 WORKER.'('OMPENSA'I'ION DEC LARATR)N I IteMh)allina Ilial I h,,II a eetlilieale of eult,cal to ,a ll�in,ae. Or a n'RlLcal, of Iv,ok"' Cn..I,LH inion Inwmnce, ill a "Hilic.l ZONING ENG. SITE NO. cut)) thereof ISec. 1H00. Lnb.C.1. Polley No. Conpany ❑ Cctlilled copy' i, hcrtby luntished' ❑ Cetlxied copy i, pled will, Nt1 dro htaleaiult ,bti,iu°. Applicant fIHE ,PRINK Y ❑ N ❑ ENERGY T P4 Y N ❑ ❑ MISC. - REFER TO ORD. CERTIFICA'I'G ❑F FXI MPRON FROM WORKERS' PERMIT ISSUANCE 10,00/0- FLOOD ZONE A.L.U.S. (IOMPIi NSAI'ION INSUkANCE 1'I his wcflmt need nut be cont Pleted if' the'11111111 i, fir one PLG. CONTH. LIC. NO. (LG Y❑ NE] Y❑ N❑ It uHJred culla, (N1001 or less.) I a,Oly ma to the psob nnanee of the work Ibr wilwh this pe it i, i1ueJ, I ,lull not anplo, any ""sto, in an. urs Inlet su a. lu T MECHANICAL PERMIT FEE FEE SUMMARY Il (,tea I,,tran, suhyo m Inc Wink,W Compensation Law -1 Catilunua. Date ApplicamBUILDING ALTER OR ADD TO MECH. 5.00 NOIIC'F. '10 All LIC\N'I': II', alter snaking this ('ei Gl'ieale of 1.,- APPLIANCE 5.00 PLAN CHECK FEE rnn,,U.n, you should bean..•subject to lne Worker,'(' alnpen,mioH p.m'i,inns u1 the Labor Cuda, you Blast hurt nwillI colnply with such provisions or this permit ,hall be JecnmJ revoked. AIR HANDLING UNIT ITC 10 Q.F. M:U 4.00 CONS' I' RUCI' ION LIiNDING AGENCY AIR HANDLING UNIT(OVER 10 C.F.M.16.00 SEISMIC FEE tr� I hereby of irrn that mere is a constrocti,n lending agency Ibr pmonnxn,e of the work III, which eni Illi, Pnis issued ISI,. 3097, ciy('.1. EXHAUST HOOD (WITH DUCT).j /, "5,00fie MICROFILM HEATING UNIT (TO 100000 B1111 8.00 Lender's Nano Lenders AJJo,x HEATING UNIT (OVER 100,000 O.TiUJ9.50 ELECTRIC I er,lily that I bate o,aJ Otis a,,licaBoH and state Ilut fhc anus.• VENTILATION FAN ISINGLEI' 4.00 lot onnation is mract. I agree I,, compo' ,Ili, all Lily and coBrHy ordinances and stale law, 1e Wring to building construction, and PLUMBING / BOILER -COMP 13 H.P. Or 100,000 B.T.U.) 6.00 BOILER -COMP IOmr tO0p00 BTU) SEE FEE SCH. MECHANICAL ) ,7tJ hereby authori,I leprncmalise, of mi, city w c,it II span D"' ubuvantcntionr-d properly fur inspection Puq,uxs. (W •1 agree to save, indannily and keep hart des, lite City of C/up t no agair 't hatiilo I I"BeHl" malts and a "Imes which 111}y nny ay aL, z I sadity it tscttcc ill arc t go10 seer S, ,✓ I4nulurr l . PV u'anl/Contractor 1., MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 'Q MECH. CONT. LIC. NO. MECIL TOTAL 3 - TOTAL �, s '-• UFI'ICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ^ ��11 JOB ADDRESS lO 34"Z L1, /'d._7� L MVc "UNIT# _LOT# OWNER 4--q-3 C CONTRACTOR PERMIT NUMBER .14615 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN . 180 DAYS OF PERMIT ISSU- ANCE OR-180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION•- NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PR EGUNITE PERMIT VALIDATION o ISSUANCE DATE. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 9 .9 c?-" /b JL UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL ttLWG ELECT. PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED\.1 - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. 1400 PLUMBING MECHANICAL ELECTRICAL PERMIT i0 '( i.�✓ FRAMING INSULATION STORIES TYPE CONSTR, OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAXIS PAID ' SO FT FLOOR ARPA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING HUIIOI USE TIES IND CON Pe oma. ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# " ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY TUBS &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 .2y, ZONING - ENG. SITE NO. , GAS TEST GAS " MECHANICAL 2 FIRE SPR INK Y ❑ NEI ENERGY L19 Y ❑ N[j COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR t_ _ ELECTRICAL RELEASE FLOOD ZONE v� N� A.L U C Y L NI] 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 OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, ; "J ONE WORKING DAY BEFORE REQUIRED INSPECTION. . Z PLEASE GIVE JOB ADDRESS MEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM JELECTRIC 8 PLUMB+NG ; .✓ MECHANICAL :-_T CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY