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15787
APRLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY PERMIT NUMBER GING 1'L'DING PROJECT IDENTIFICATION . APPLICATION & PERMIT � [7 Q�� BmLOttvc J r Q �. ADDRESS l©�S BUILDING—ELECTRICAL-PLUMBING—MECHANICAL ON'.AVMERS D M �tA /�Ya PLAN CHECK VALIDATION * �r rF QTY. ELECTRIC PERMIT FEE ® PHONE CO.T"CTOR s UTLETS-SWITCHES-RECEP 10.00/1.00 Genf uc.No. / 4�3G LIGHTING FIXTURES 10.00/1.00 ADDSCACTORs `_� PPLIANCES-RESIDENTIAL 4.00 AooRE65 CO,tisPK , 7f0ea Ives PANEL$ 0.00 DATE OF APPLICATIONS OARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE EX.NO. ENGINEER uc.NO SIGNS TRANS. 3.00 nooARCH.EOR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP:METER OR POLE INS. 20.00 �I / AwucSMOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 ,7/ 00 wY Foo LICENSE[)CONTRACTORS DECLARATION a i Pi 1 hereby affirm that 1 am licensed under provisiuns of Chapter 9 ISSUANCE DATE leo mnumeing with Section 7000)of Dykinn 3 s the Businessand G G BLDG. ELECT. PLG. MECH. F h i I'rofesstons Cod J y license is in full fur d if t ❑ ❑ ❑ z o m Liansc CI _Lie.Number Is F Date Cantmcomic Y rc ¢777 - OWN ER-B UI LDFR DECLARATION BUILDING PERMIT INFORMATION wa y I herebya111rm that I am exempt from the Contractor's License MISC.— REFER TO ORD a.0 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 1000 VALUATION {/FT. . Code'Any city or county which requires o permit to construct,alter, Sor ¢ improve,demolish,of repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. — o u requires the applicant for such permit to file a signed statement that TOTAL A w$m he is licensed pursuant to the provisions of the Contractors License PERMIT TO F z � Law(Chapter 9(commencing with Section 7DXbof Division 3 ofthe 4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE X F 0 the basis fnr the alleged cxcmptiun.Any violation ufS,ct,.e 7031.$ STORIES TYPE CONSTR. n ; by any applicant for a permit subjects the applicant toacivil penalty of not more than five hundred dollme(55001.): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will du the work,and the structure is not intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improves tlemon,and who docs such work FIXTURES,PER TRAP 5.00 so.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- ments are not intended or offered for sale,If,however,the building GAS-EA.SVSTEM-I1NC.40UTLETS 6.00 or neprovmnent is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 200 builder will have the burden of proving that h - . - . . e did not build or im- BUILDING USE prove for purpose ofwleJ' INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Other ❑ I,a owner of the property,am 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: rhe Crui ructur's Licces:Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts forsuch projectswith a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.2001)/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ t are exempt under Sec. ,B,&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORK ERS'COMPE NSA'rION DECLARATION WATER TREATING EQUIP. 5.00 I hc¢by Whirm that I have a certificate of nsew to ulf-insure, ZONING or a certilecate of Workers'C umpen 'on Irayy qqny"L n u ccHiNd ENG.SITE N0, copy thereat IS<c.3800,Leb.CJ ;;1X9� _ Policy N'o. Company G.F_ Q ❑ Ccrtificdcopyishcmbyfuru ishcd' FIRE SPRINK ENERGY T24 Z PKCertife copy fled Ih the city Inspection division. MISC- REFER TOO npphcant - r_Q �,d_i_;- y ❑ N❑ y ❑ N❑ CCN PERMIT ISSUANCE 1 0 O � — CERTIFICATECOMPENSATION INSURANCE RANI WORKERS' FLOOD ZONE A.Lu.C. W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG q a Ifhis union need nut be completed if the permit is for ono TOT } y❑ N❑ y ❑ N❑ Z IN hundred delta.IS 100)or less.) 31 U O 1 certit'y that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to ED m heconsubject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.001BUILDING } N NOTICE'f0 APPLICANT: If,after making this Certificate of I!x- ? eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Comply with 409 FEE U such provisions or this permit shall he deem00G ed revoked. .3 AIR HANDLING UNIT ITO 1Q0F.M.) lf33 CONSTRUCTION LENDINGAGENCY - AIR HANDLING UNIT(OVER 10=C.F.M.).6.00 SEISMIC FEE I 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. IQIICROFILM 3097,Ci,C.). ,Y HEATING UNIT(TO 100,000 B.T.U.)Q&60 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Name ELECTRIC I ceHify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) -408 information is correct I agree to comply with all city urea county PLUMBING ordinances and state laws relating to building nao-uction, and BOILER-CONP(3H.P.or100,000B.T.U.) 6.00 hereby eathuriae representatives of the city to amen upon the BOILER-COMP(Over 100,000eTU1SEE FEE SCH. MECHANICAL 760 above-mentia�d property for inspection purposes. (we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertimn oguinst liabilities,judgments, costs and expcuws which CONST.TAX ay in any way accrue against wi City in conseq ucnm of the PERMIT ISSUANCE 'TOW Isli is permit. MECH'CONT. LIC.NO. MECH.oTAL74` TOTAL gnalur Applicant Contmct Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING, PERMIT NUMBER CITY OF CUPERTINO 15787 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS /oi'u / l'✓sz;K Ayli UNIT# LOT*f PERMIT EXPIRES IF WORK OWNER 7 {C�/J-� CONTRACTOR `�'� L Nom- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION NOTE: ANCE OR 180 DAYS FROM UFER. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PR EGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHMrt VALIDATION CUPERTINO STANDARDS. GARAGE SLABS . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB - - PLUMBING ELECTRICAL ISSUANCE uAtE MECHANICAL BUTc ELEcr PLG. MECH. ❑ ❑ ❑ ; DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR I INFORMATION PLUMBING VALUATION , S/FT. MECHANICAL - � L ELECTRICAL J PEaMIL�D O FRAMING INSULATIONSTORIES TYPE CONSTR i I UCC GHOUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORF,� s YT+ILWRAVEA TOTAL Acve Aee - THE CONSTRUCTION TAX IS PAID - �' DIAPHRAGM I �,`� ' V ROOF SHEATHING Iµ�BUILDING USE PB OIIir, T1IFF1) CON APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE 1 - ❑ ❑ ❑ ❑ ROUGH SAN.p ASSESSOR SPARCEL NO ' � - PLUMBING ELECT.ENERGY ' TUBS 8 SHOWER PANPLUMBING ENERGY TvncT No. PARCEL No MECHANICAL MECH.ENERGY ELECTRICAL ' BUILDING ENERGY ACC DATE .ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG,SITE No, GAS TEST GAS j MECHANICAL FIRE SPRInrc ENERGY 1 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' Y ❑ N❑ ` ❑ N❑ EXTERIOR SHEAR 7 ELECTRICAL RELEASE FLOOD ZONE , A.L U.C. INTERIOR SHEARFIRE DEPT. Y❑ N❑ ❑ N[] SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR .LATHTEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK' GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o�ONE WORKING DAY BEFORE REQUIRED INSPECTfON. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. ZO1 ' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL / IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY