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16250 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY LDI NG PROJECT I DENTI FICATI ON IT .PERMIT NUMBER[ -APPLICATION & PERM- - 16Z5O pGOREss BUILDING ELECTRICALPLUMBING MECHANICAL AU160 N74C. L - OWNER'S PLAN CHECK VALIDATION NAME //� 1 4•� / ELECTRIC PERMIT FEE j t C t 1 E ri fiE PHONE 2 -(y C P CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00 /"ANE / LIGHTING FIXTURES 10.00/7.00 f,ONTRAC TOR', 1$ APPLIANCES-RESIDENTIAL 4.00 Aon RE Ss 110 2Np A(J PHONE 471-142 PANELS 10.00 F11IbATE OF APPLICATION RCHRECT �L �p PANELS (OVER 200 AMP) 2O. LAN CHECK TEE P.C.NO. OR O ENGINEER LIC.No, ISIGNS TRANS. 3.0 •n� ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS t, ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH APPLICA SERVICE CHANGE 20.00 . � o O o LICENSED CONTRACTORS DECLARATION 1- s (/ u 1, 1 hereby affirm (hot 1 ulicensed under provisions of Chapter,9 ISSUA CE GATE N m rt w (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH. .r mz Professions CoJ,Gde license is in full to x,an 0 d ❑ ❑ ❑ z g License Clnss �pK my Lia Nun r w' Uate_ffi=,?_ •+ Contractor a y 'ya w a OWNER-BUILDER BUILDING PERMIT R-BUILDER DLCL ION INFORMATION wLL H UL I hereby affirm Him I air exempt from tire Contractor's License MISO.- REFER TO ORD VALUATION $/FT. Foo J Law for the followingreason.(Sec.7031.5.Busmessand Profc,mons PERMIT ISSUANCE 1 o Code:Any city or county which requires a permit to construct,alter, Q ¢ ¢ 0 improve,demolish,or repair any structure,prior to its iIt anee,also ELEC.CONTR. LIC.NO. ELEC. 3/ La -O M requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License 5 Hit Law(Chapter 9(commencing with Section 7000)OfOivision 3 ofthe CL� a Business and Professions Code)or flat he is exempt therclrlm and OTT PERMIT FEE D H the basis lot the alleged exemption.Any violation III Section 7031.5 STORIES TYPE CONSTR. i; by any applicant for a permit subjects thin applicant toacivilpenalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hundred dollars(S500).1'. ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (Sec 7044. Business and Professio,o DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE oupts are not hrough ownemployees,oilL.If,however.thtsuch improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 himse are not Intended or.Rercd for sale.IL ed the building or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 200 BUILDING USE builder will have the burden of proving that he did not build or int . . . - RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to ems true, 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 to on owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contacts forsa,h projects with a contract orfs)licensed pursuant t. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT N0. PARCEL NO. lire Contract.,',License law. ❑ I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason owner Ute WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 ^�/ I hereby affirm that I have a certificate of conseln to"ItGiusure, ZONING ENG. ITE NO. or a certificate of Work• n�p�en'saattion Insurance,or a certified copy mereo-fL ]��.LT�-/1�/k I'ohcy NI , Tray O O Cerliticdcopyl IICRb f m)I i TIRE SPRINK ENERGY T$4 Z Z ❑ CeriI is f �m tl y e 1 division. MISC,- - REFER TO ORD. O Applicant V ❑ N❑ Y ❑. No c = CERTIFICAITOF EXEMPTION IsROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.LLC. UJ >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. LG. �- 0 (This section need not be einartrool if the permit is Tot ono OTAL Y❑ N❑ Y❑ N❑ Z hundred dollars f S 100)or Iess.l V O I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT 1 FEE FEE SUMMARY LL N mit is issued,I shall not employ any person in any Runner so as to U become subject to tire Workers'Compensation Laws of Calhornia' BUILDING W Date Applicant >_ a NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 H emotion,you should beconm s.niot to the W.,ke,s'Compunsatioll APPLIANCE 5.00 PLAN CHECK provisions of lire Labor Code, you must forthwith comply with FEE V such provisions or this permit sha11 be deemed revoked. AIR HANDLING UNIT ITO 10PMC.F.M.) 4.00 CONs'fRUCT1ON LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F4M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Cie.C.). Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC 3 I nottio that I have read this to comply and state that me above VENTILATION FAN (SINGLE) 4.00 - ordinnation is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relining m building construction, and hereby authorim representatives of this city to enter upon the BOILER-COMP (Over 10,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property lot inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, osis and expenses which PERMIT ISSUANCE 10.00 CONST.TAX nlay in any ay :m c aga' st ifonScquence of the Tantl f S pa MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Ignature of Applicant ontrnctor Uu[e OFFICE COPY 9 POST THIS CARD NEAR FRONT OF BUILDING PERMIT ROME ER CITY OF CUPERTINO 16250 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION / I JOB ADDRESS ( V/�S U �dL�� UNIT# L #OT ' PERMIT EXPIRES IF WORK /l IS NOT, STARTED.WITHIN OWNER ` Lr�� CONTRACTOR a INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION ,CUPERTINO STANDARDS. F GARAGE SLABS -- POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -I " UNDERGROUND /SLAB PLUMBING (� r/�' / :. ELECTRICAL ISSUANCE DATE BLDG ELECT PLG, MF.CR MECHANICAL El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WINFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL PENM11IT TO ELECTRICAL 6_/,C7- FRAMING staNlESEs f rvPE CorvsTH. INSULATION OCC GROUP HES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.ET.I'IOOH AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING use _ ROOF SHEATHING Res No CON Pe o✓... El 0 El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ASSESSOR S PARCfa.NO ROUGH SAN.N PLUMBING ELECT.ENERGY TRACT NO PARCEL NO+ TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING END SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY i-04 MECHANICAL v ❑ N❑ E N0 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE nLUc, EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. Y❑ NEl ❑ rv❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT - ELECTRIC PEEN CHECK GAS NO TAPE 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 131 1113L Il' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. 1 Z ' — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY