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18710O Z Z P: O Cr T W > CL 0 DZ U_o U_ OW a � Z i f `LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI 1;DI NG o"ROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER r� O 18 r BUILDING ADDRESS � `%J OWNER'S NA(ry//E /w/ /�` J �N I it - lw� i7/ yaNE _ -619f %. -C. iv 7 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION CONTRACTOR'S NAME LIC. NO, I UTLETS -SWITCHES- RECEP 10.00/1.00 ILIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS A PHONE APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECTPANELS OR ENGINEER LIC. NO (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AARCH. OR DDRESS ENG. ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION O �'h/%I✓(/GG. ISSUANCE DATE' EMP. METER OR POLE INS- 20.00 APPLICANT'S ADDRESS 036, j %ICTL AVE, n' .10 MOTORS SEE FEE SCH. SERVICE CHANGE PA E).00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Number Date Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, 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 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 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as than of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not 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, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building 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- prov;for purpose ofsale.). 12, 1, as owner of the property, am exclusively contracting with nsed contractors to construct the project (Sec. 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 contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. B.&P.C. for this reason i T BLDG. 5d ELECT. 2 PLG. ® MECH. 1:1Lic. (�}�. City Of Cuoertl BUILDING PERMIT INFORMATION MISC. - REFER TO ORD VALUATION C $/FT. PERMIT ISSUANCE 10.00 .Z r L70 ELEC. CONTR. LIC. NO. ELEC. TOTAL SD PERMIT TO 1</ T 12e QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN &VENT -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - 1 INC.4 OUTLETS 6.00 Z GAS EA. SYSTEM OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other El El El 1:1 ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SAN ITARY-STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner001��PDate go 91 WORKERS'COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). Policy No. Company O Certified copy is hereby furnished. ❑ Certified copy is filed with the city Inspection division. Applicant WATER SYSTEM 5.00 ACC: DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 I ZONING ENG. SITE NO. FIRE SPR INK Y ❑ N ❑ ENERGY T-24 Y ❑ N ❑ MISC. REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 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 become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00 (70 FLOOD ZONE Y ❑ N ❑ A. L. U. C. Y ❑ N ❑ PLG. CONTR. LIC. NO. PLG. L TOTAL ` (> QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING SL ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT. If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). Lender's Name Lender's Address I certify that 1 have read this application and 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 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 upertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the pe rmi l -i1 ranXuiol�, APPLIANCE 5.00 PLAN CHECK FEE L AIR HANDLING UNIT (TO 10A00C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE S EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC 12SD VENTILATION FAN (SINGLE) 4.00 PLUMBING f BOILER -CUMP(3 H.P. Or 100,000 B.T.0-) 6.00 BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL 3o Si aplicant/C rac[or Date OFFICE COPY t32 24 ....�.......�.. 60 r 48 ACK 1 1 1 1 ' 1 1 +p•� 1 I t 1 1 T/C •a �rww�w��r�����w��l���������A��11r�n'�'�A�w���r�+Aw � 1 TILT -QST ' IL i 2 FULL EXT. GLIDES ON 2 BOTT06 DyA$ Q P IN ACCCR rE,ATND H THE C GF\ CUPERTINC CC ORDI A ES SIGNED This set oi• P. na:;c; .c;,ti ns MUST be kept an t� a`. -.; I .rs and it is un- lawful to rna; . is c :-r a or alterations on sarnF .n ;:e-n]ssion from the buiid:�+, �: i ,tn,3. The stamp.'11 r;:; peciircations SHALL NO'l b p.;, Mit or t approval ;;# )f any City C, or S.Me E3►.DG• CITY OF 1C �J J 1 T CA l.tN� iN�Vt fij— —17F—D t,-Tt �rmaw K—, Z �� �) 1 f �.1 1 �' C�...'-�b'�.l L_ 5 r� r� C- Z X12 j L r ,ti, i.v C t_ 13 E.- £ L 17r- L 1 dv 1 ti► n1 C 4ti t-E`t L H ftiZ.,S c: .2 �: ► < 5 { Zfi Z r ,'3- I jut ,.J t i l' I. � i 1. • � � �. � �� Ju JLDG. 4NSPE6: 1100 DEPARTMENT CITY OF CUPERTINO �•. �C�'�-t�� 1 jam..._,,, `r` �.�`�-.S `�y�, Ckj A G" W7 wfffi W 306 9M - The elegant beauty and superb performance of the Quintessence is also available in the 30" model with two 12,000 BTU and two 9,000 BTU burners.It has all of the features of the 36" including sealed burners, Perma-Flame 'instant re -ignition, Smart -Flame, perfect heat control and alloy burner caps. Most Important, the DACOR Quintessence Is backed by,a . r by any other gas glass cooktop. This warranty is for five ye f il and labor plus an additional four -years on all functional com - ' — _ Of course, the ultimate In style and performance is ct' in OiLU6 ltt� nee -._.. gas Blas$ w9k1w with the DACOB "Gonvec inn Plus" _ which is truly "A reflection of your good taste " Overall Dimensions - - -- - -- ---Put-out Dimon GGC 304 (30"x 21W x 3") <GGC 304 (267Wx 18 e GGC 365 --- (36"x 21%'L x-39)-- dl.�,or • WafTarir Note: The" dimensions are not Intended for use as a final instsilation a ecificallons.-fi�ir -- to instafiation Instructions packed with unit for complete Information. Constant product Improvement makes some features and specifications subject to change without notice. J - - ®�--- U.STED A reflection of your good taste:" -- 850 South Raymond Avenue, Pasadena, California 91109,(818) 799-1000 � ' -- POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER 18710 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION / ' JOB ADDRESS _1Q3G 3 A/0 e4_- /9/�'V e' UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER /�- GAJ 06N5®T9A/ IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF UFER PREGUNITE PERMIT VALIDATION CU ER INOSTA GARAGE SLABS aeJi�l� CJS>t �4 ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED v v I PAJD UNDERGROUND /SI.AB PLUMBING 'j OCT j n�� ELECTRICAL MECHANICAL BLDG ELECT PLG MEC City of P..Ilnprfin,) I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION-7$/FT PLUMBING �Fp / r n 6 /�'�`` r-� d MECHANICAL ELECTRICAL 4 PERMIT TO FRAMING INSULATION --• 'r` �V 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 TAX IS PAID SQ FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB o,hrr, ❑ El El ❑ El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.# ASSESSORS PARCEL NO PLUMBING r2 S 97 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 ZC� `+� PLUMBING ZONING ENG SITE NO GAS TEST GAS MECHANICAL FIRE SPRINK v F N[] ENERGY T 24 v E N[:] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE V N ALU C Y L7 N INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING Cy CO v 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 ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC i S� I"I- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX /- IMPORTANT! TOTAL 3� PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY