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14708 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY ; _DLIILDING PROJECT IDENTI fICATION ' PERMIT NUMBER , RDD,NG ' APPLICATION & PERMIT ADDRESS 0BUILDING-ELECTRICAL-PLUMBING-MECHANICALLU55 e/ e Su; e 7 O OWNER'S PLAN CHECK LIDATION NAME ly ILL QTY. ELECTRIC PERMIT FEE 7 7j CONTRACTORS OUTLETS-SWITCHES-.RECEP 10.00/1.00 VG11 p e- kotn+''p beckL LIC.NO. W LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ' ADDRESS APPLIANCES 4.00 O R 011W a PHON__EE PANELS 10.00 DATE OF APPLICATION A CNI PLAN CHECK FEE P.C.NO. OR �] PANELS (OVER 200 AMP) - 20.00 - ENGINES � t o.L'Qd9 SIGNS TRANS. - 3.00 ADDRREsseec. 7�1. SPECIAL CIRCUIT _ 5.00 ry . PERMIT VALIDATION -1 I lk ZIP EMP. METER OR POLE INS. . -120.00 - /- APPLICANTS - MOTORS SEE FEE SCH. Y-7 ADDRESS SERVICE CHANGE 20.00 17cer woo LICENSED CONTRACTORS DECLARATION O d ri,G I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE m < m (commencing with Section 7000)of Division 3 of the Business anJBLDG. ELECT.' PLG. MECH. F 2 Professions Code,anti my license is in full force and effect - LD 1:1 � Elo i= o License Class Lic.Number Date Contractor _ 1 a Y s�t BUILDING PERMIT rca OWNER-BUILDER DECLARATION - 0 ic u INFORMATION Axa ; r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO OR w VALUATION $/FT. FUNJ Lew for the following ountyReason.which requires perminess t to Professions PERMIT ISSUANCE 10.00 2 m� Code:Any city or county whiny requires.p prior to construct. also C Q p improve,demolish,or repair any structure,prior,o its issuance,also ELEC.CONTR. LIC.NQ ECSC. (O to C u requires the applicant for such permit to file a signed statement that %UTAL PERMIT TO L he is licensed pursuant to the provisions of the Contractor's License ` HiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the Ii1/7aQj'd.o, f 4 o Business and Professions Cnde)or that he is exempt therefrom and GTY. PLUMBING PERMIT FEE MI_ r� the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER'.(EA`) 5,00 of not more than five hundred dollars(55000.): ❑ I,as owner of the property,or my employccs with wages as BACK FLOW PROTECT. DEVICE' 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES:UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5000 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 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such'in prove- mentsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-I INC.40UTLETS 6.00 J 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 GAS-EA.SYSTEM-OVER 4 (EA.) - ,2.00 BUILDING USE ' prove of sale.). INDUSTRIAWASTE-INTER. - 90.00 .RES'. IND CON PB Other 1:1 1:111C11,I,asas owner L;wnernee 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:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS.OVER 5 (EA.) 1.00 ' contracts for such projects with a contraciono licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the.CgPfractol License Law. _ TRACT NO. PARCEL NO. I am ext undtrS c. ,B.&P.C.for this WATER HEATER W/VENT 6.00 - reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. ORKERS'COMI'I:NSATION DECLARATION WATER TREATING EQUIP. - 5.00 hereby affirm thud 1 have a certificate of consent In self-insU`re, or a certificate of Workers'Compensation Insurance,or a certified ZONING ' ENG.SITE NO. copy thereof(Sec.3600,Lab.CJ. Policy No. Com any ` O CICeUilied copy,s h eby furnished. FIRE SPRINK ENERGY T¢4 Z Z B�Certified copy w it t inspection division. - O Apphcant (,�..,�(it�i misc.- REFER TO ORD. YEJ N❑ 'Y❑ N[ P: rn PERMIT ISSUANCE 10.00 2 - CERTIFICATE OP EXEMPTION FROM WORKERS. ZONE A.L.u.c. LU COMPENSATION INSURANC17 PLG.CONTR. - LIC.NO. PLG. CL O (This Section need not be completed if the permit is for one TOTAL Y[3 N Y❑. N 0 Z hundred dollars(8100)or less./ - - - - O 1 certify that in the perlirrnnnce-fine work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any 1g on in any - O W become s bjecl Workers'Co p A�,'p .aw a Dater,. applicant l' ALTER OR ADD TO MECH. 5.00 BUILDING } N NO O PPLICANT: If ❑e to:ing this Certificate of Ex= ? emption,you should become filter to the Workers'Compensation APPLIANCE - 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C7 such provisions or this permit shall be deemed revoked - AIR HANDLING UNIT(TO 10MC.F.NL), 4.00 CONSTRUCTION LENDING AGI7NCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE ' /L 1 hereby affirm ilia, there is .,construction lending agency for, EXHAUST HOOD(WITH DUCT) -5.00 - the performance of the work for which this permit is issued(Sec. _ •.MICROFILM 3097,Civ.CJ.- - HEATINGrUNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) - 4.00 information correct. I agree In comply with all city and county DQILEH- JWPI3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. Wile) agr a to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino amst liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 - CONST.TAX may in ay accrue against said City in consequence of the tariff of fruit. MECH.CONT. LIC.NO. MECH. '- �JylyL_ a TOTAL TOTAL ��7 6�' natur fApplican l/Contractor Dae - OFFICF,COPY ' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER ^a CITY. OF CUPERTINO X4708 INSPECTION DIVISION a � JOB INSPECTION RECORD _ �o> /�I( PERMIT EXPIRATION JOB ADDRESS ��TQ " ��� �"� '�- 14ye UNIT# _LOT # PERMIT EXPIRES IF WORK OWNER. (X- U7TJ Lir= CONTRACTOR 41 IS NOT STARTED WITHIN 'INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - NOTE: ANCE OR 160 DAYS,FROM - UFER - � _ ALL GRADING AND DRAINAGE SHALL BEINSTALLED LAST CALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �( ' ,: -•r _ UNDERGROUND /SLAB_ PLUMBING. ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG. ELECT PLG. MECH • - ❑.} ❑ ❑ El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION 'S/FT. PLUMBING MECHANICAL W �/ ELECTRICAL - PERMIT To FRAMING INSULATION STORIES TYPE CONSTR. OCC GROUP RES,UNITS `. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50 FT FLOOR.NEA TOTAL ACREAGE - ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE- .,(+�'�" ROOF SHEATHING RES IND CON PB 0,, APPLY NO'ROOFING'UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP, 0 ❑ 11 ❑ ❑ ASSE55ORS PARCEL NO ROUGH SANA PLUMBING ELECT.ENERGY ' i TUBS&SHOWER PAN ' � - PLUMBING ENERGY .TRACT NO PARCEL'NO. MECHANICAL MECH.ENERGY' ' ELECTRICAL BUILDING ENE ACC DATE ACC.FILE NO. FRAMING ELECT.FINA INSULATION - PLUMBING zoNlNc ENG.SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T-24 - YE:l COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� "❑ FLOOD ZONE A.L LLC. EXTERIOR SHEAR - ELECTRICAL RELEASE v N� INTERIOR SHEAR FIRE DEP.T.rAvlo CIJIP7� SHEETROCK IGRADE _ FEE SUMMARY EXTERIOR LATH BUILDING " - - . NTERIOR.•LATH' TEMPORARY APPROVALS BUILDING �6 SCRATCH COAT - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE a•- OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFIN'ALISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING z RES PLEASE�GIVE JOB ADDS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE MECHANICAL 'IMPORTANT! CONST..TAX" 'PLEA$E READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ' TOTAL ' O•F,FICE COPY.