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HomeMy WebLinkAbout17040 (2) 4i,7PILICtiANT TO FILL IWINFORMATION WITHIN RED LINES - USE.BALL POINT PEN ONLY. .-BLY LD1 NG PROJECT I DENTI FICATION •PERMIT NUMBER BUILDING APPLICATION & PERMIT ADORras SAMA CLARA AV. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ,,, 17040 OWNER'S - PLAN CH ECK VALI DATION NAME li I.1r ,TSAI 25, L)5 q Ol QTY. ELECTRIC PERMIT FEE T� Nom) Il PHONE ' w CONTRACTOR NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 �I ` 1c LIC.NO, LIGHTING FIXTURES 10.00/1.00 1_ g• 5�--+ conrRAcrofls AAPPLIANCES-RESIDENTIAL 4.00 DORES$ PHONE PANELS 10.00 DATE OF APPLICATION• • ARCHITECT ''1 fy PLAN CHECK FEE P.C.NO. I DR uJ�NDY HS�EN Lac./•� PANELS (OVER 200 AMP) . 20.00 ENGINEER r76rj SIGNS TRANS. 3.00 ARCH,OR ENG.IM� Ti\ /1 C -E SPECIALCIRCUIT 5,00 PERMIT VALIDATION ADDRESS ✓✓II JV O (YMIL ITAt, Q) IP 5035 TEMP.METER OR POLE INS.. 20.00 U�� (- APPIJCANrS ADDR MOTORS SEE FEE SCH, r .l E55 loq O CIIZ, I R , CH q5t 3S SERVICE CHANGE 20.00 o re o LICENSED CONTRACTORS DECLARATION d e_{�v1L okve � a i W I hereby affirm that lam licensed under provisions of Cha pier9 ISSUANCE DATE Z, Iv (commencing with Section 7000)of Division 3 of the Business and riv BLDG. ELECT. PLG. M�. F T z Professions Code,and my license is in hill force and of@ul. oi w o License Class Lic.Number r - m� Date Cmvructor y F J Ir: 0 w ¢ OWNIiR-0BUILDER DECLARATION BUILDING PERMIT a D a D INFORMATION m ; N I hereby affirm That I am exempt from the Contractor's License MISC.- REFER TO ORD Foo J Law for tlm following reason. 7031,5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires apennit to construct,aller, ',00 9^/ 000. pimprove,demolish,Or repair any structure',prior to its issuance,also ELEC.CONTR. LIC.NO. . ELEC. (i O 01 requires the applicant for such permit to filo a ligned's,aremm�t that TOTAL .3`311,60 he is licensed pursuant to the provisions of the Contractor's License PERMIT TO FZQ Law(Chapter 9(commencing with Section 7000)ofDivision3 ofthe 17 �� 4 o Business and Professions Code)Or(flat he is exempt therefrom and QTY. PLUMBING PERMIT FEE w M F m the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR, La by any applicant for a permit subjects the applicant to a civil penalty qq ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500)J: . I•� ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS sole compensation,will do the work,and the structure is not - intended or offered for sole (Sec. 7044, Business anti Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work 10 FIXTURES-PER TRAP 5.00 r L SQ FT,FLOOR AREA TDTALACREAGE himselforotintndhrough eownemredfors, le.Ifded that,however.thimprove- GAS OUTLETS 6.00 / e�[/i mems are not intended or emplJ for sale.If,however,the building (( or improvement is sold within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 p builder will have the burden of proving that he did not build or un- • 0 VBUILDING USE Pr for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON pit Omer `Fj( 1,as owner of the property,ani exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does nut upi ly to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts I'or such projects with it contracturfs)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ I unh exempt under Sec. ,B.&P.C.for th is WATER HEATER W/VENT 16.00 reason Owner Dmc+1_' WATER SYSTEM 5.00 1_ff ACC.GATE ACC.FILE NO. WORKERS'COMPENSAT ION DBCLARA'I ION I WATER TREATING EQUIP. 5.00 I hereby afl'inn (hat I have a certificate ofconsen(to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec..3800,Lab.C.). Policy No. Company O ❑ Cerified copy is herehy lumished. FIRE SPgINK ENERGY T-14 Z Z ❑ Cerlified copy is tiled with the city inspection division. MISC.- REFER TO ORD. F O. Applicant - Y❑ N❑ Y ❑ N❑ � y CERTIPICAT E OF EXEMPT ION FROM WORKERS' PERMIT ISSUANCE 10.00 ZAOD FLOOD ZONE A.L.U.c: LU > COMPENSA"PION INSLIRANCP: PLG,CONTR. LIC.NO. PLG. Z (' this section need not be completed if (he per nhit is for one - TOTAL O 1#D Y El ❑ Y ❑ N❑ hundred dollnre 1$100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL f mit is issued,I shell not mn ploy any person in any nhanner so as to O L) become subject to the Workers Compensulion Laws of Calll'ornla. ED Dam ApplicantBUILDING } N NOT ICE TO AI'PLICAN'I': If,after making This Certificate of Ex- ALTER OR ADD TO MECH. 5.00 F 1 d ~ Z emption,you should become subject to the Workers'Compensation APPLIANCE - provisions of the Labor Code, you mus( forthwith comply with 5.00 PLAN CHECK U such provisions or(his permit stmt(be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE CONS'I'RUC'I'ION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is r hick this p lending agency for EXHAUST HOOD(WITH DUCT) 5.00 Q the performance of the work for which this Penni( is issued(See MICROFILM 3097,x',Na). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.) '73-440 Lender's Address ELECTRIC I C 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 inforadvex is correct. I agree to comply with all oily and county, PLUMBING 9O.D(J onlinencm and star, lows.ee to In comply building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL Q�do 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, costs and expenses which PERMIT ISSUANCE 10.00 2 CONST.TAX Day in any way accrue against said City in consequence of the ranting of this permit, MECH.CONT. LIC.NO, MECH. TOTAL igma ^ M Sre of Applicant/Co r`'tor �e 3 TOTAL�' ('/�•V 713 1 OFFICE COPY I POST THIS CAR D.NEAR`IFRONTOFBUILDING CfiNh11T NUMBER CITY OF CUPERTINO 17040 INSPECTION DIVISION JOB INSPECTION RECORD / •� PERMIT EXPIRATION' .,. s` JOB ADDRESS_[ � L3�.� l1 _LOT# PERMIT EXPIRES IF WORK OWNER ( CONTRACTOR IS NOT STARTED WITHIN " INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMIT ISSU- 'I FOUNDATION, ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. I . UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIOAI IUN CUPERTINO STANDARDS. PAID GARAGE SLABS ,� Cf � POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p�1 I UNDERGROUND /SLAB {CNH A 5 1989 1 ' PLUMBING ^ F. �• JV c 1F, It '!A U4L ELECTRICAL City of COpWno ISSUANCI:DATE MECHANICAL I Luc ELecr: PLc. MecR .. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNE ��W ILDIPERMIT INFORRMM ATION WOOD FLOOR VALUATION STET. PLUMBING o D MECHANICAL S-3i_- GD ELECTRICAL PERMIT TO FRAMING N INSULATION • 1 n3 srUa r'PE coNSTR, �-l7" (I GHOUP RES UNITS h PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50.C; FLOOfi NHyA rOiAl.PCP EACE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE e(I}(J�' DIAPHRAGM THE CONSTRUCTION TAX IS PAID �� HUI LDI ON USE RODE SHEATHING Z [its IND cory Pe on..., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El 0 ED Q ASSESSOHS PARCEL NO, 'ROUGH SAN.N PLUMBING ELECT.ENERGY U S SHOWER PAN PLUMBING ENERGY THnCT No PAHCEI.No MECHANICAL MECH.ENERGY ELECTRICAL -`'Gf. BUILDING ENERGY ACC.DATE ACc.PILE NO FRAMING I ISO- ELECT..FINAL TEST zorvwc Ervc.SITE NO INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T.za MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v N❑ v [D ND EXTERIOR SHEAR w ELECTRICAL RELEASE FLOOR LUNE ALUC INTERIOR SHEAR FIRE DEPT. YE] Nov L, NL] SHEETROCK �,� GRADE FEE SUMMARY EXTERIOR LATH BUILDING 2:1%3(07 INTERIOR LATH if TEMPORARY APPROVALS - BUILDING ks-Tz SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM i µ ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ;3:F7r�2 NF Iw- ONE WORKING DAY BEFORE REQUIRED INSPECTION. O f� PLUMBING �`, PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL ,OD IMPORTANT! } CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 3 CALLING FOR FINAL INSPECTION. OFFICE COPY J- CI OF CUPERTINO acoavE , ..� f- I GAS SERVICE NOTICE r ` q119- I . .�.; To You are hereby authorized to connect the GAS service for Owner or Tenant At 10233 Sr� ►Jfi �LIgP. R F��F New Service u L , No. of Meters Reconnect ;• t,. No. of Add. Meters Move Service j _ _ r Move Meter PLUMBING INSPECTOR 11915 ©. f ELECTRIC SERVICE NOTICE P.G &E.COPY` BUILDING INSPECTORS NOTICE _ _ CITY OF CUPERTINO To w" You are hereby authorized�to Connect electrical service for Owner or Tenant 1 If,1 At 10-115 CI- A-P,- A P�SF iNo.of Wires Size of Wires Size of Switch !I Motor Load Voltage Phase Heating Load K.W. Volt age SEE) Light New Serv,ce�Reconnea ' No.of Meters Heat 120_Tnee Wne More Service _ No.of Add.Meters Power Three Phase M I ave Meter , 4 ELECTRICAL INSPECT OP ' BUILDING INSPECTOR'S OFFICE `°Dwrc,cop, f' CITY OF CUPERTINO t ❑ Backflow Device Sanitary Permit No. ❑ Sewer Connection Plumbing Permit No. 1'--L r)f"FQ ' 1 Q Plumbing Final Lot No. i. Owner or Tenant f 1�^I At_ f L�> J�� � \{A G� 4 Trott j Date Connected -19—Date Finol g`7�/ lq 111 I . o. )mss 'PLUMBING INSPECTOR