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15541ZZ P.0 = T EU - d 0 =)Z UQ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES 1�1..'tSE BALL POINT PEN ONLY ' BU{LDING PROJECT IDENTIFICATION ° APPLICATI &Q RMIT BUILDING - ELECTRICAL PLUM NG -MECHANICAL PERMIT NUMBER . . `15541 BINISG T %ooREss c-� OWNER'S V14 n, " E - ONE 7 OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION T/ LSI L' DATE OF APPLICATION: CONTRACTOR . ', OUTLETS -SWITCHES - RECEP10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR ADD EAC }''OTG ' f % ONE % / PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 - ARCHITECT - /- °R yj4,QC - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ' ENGINEER a�l+� ' LIC. NO. nooaEss PRO .J�� _ s` SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20,00 r zlb p r - A AP�PL^ICA_ O6��G efb�- 157-%/ SERVICE CHANGE 20.00 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 Cnde, a I my license is in fall farce ; nr effect. License Class Lie. Number ISS ANCE DATE ELECT. PLG. MECH. EL 9 Date _,.��Conlrador I U O NF: R -B UILDIiR DECLARATION I herebyaffirm that I am exempt from the Contractors License Law for the following reason. (See. 7031.5, Business and Professions Code: Any cityorcounty which requiresa permit to construct, alter, _ BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE •-iBAO / l �. OC VALUATION 'lS� 0C $tFT. ELEC. CONTR. LiC. NO. ELEC. I` TOTAL / improve, demolish, or repair any structure, prior to i6 Rsumme, also requires the applicant for such permit to file a signed statement that Ill•IS licensed 9(copRosumu to the with Section 7000) Law (Chepler 9 (commencing with Sect ion )c fDislorn 3 tithe of Division 3 of the PERMIT TO I � Business and Professions Come) or that he is exempt therefrom and is exc QTY. PLUMBING PERMIT FEE the basis for the alleged exemption. Any violation of$edion 703 L$ by any applicant for a permit subjects the applicant lot civil penalty of not more than five hundred dollars ($5000.): STORIES TYPE CONSTR. �, V 6, - gLTERDRAIN&VENT-WATER (EA.) 5.00 O 1, as owner 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 Contractors License Law does not apply to an owner of BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP R -3 RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 - GAS - EA. SYSTEM -11 NC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such Improve. meats arc not intended or Offered for sale. If, however, the building 50. FT. FLOOR AREA TOTAL ACREAGE 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- prove for purpose of sale.). 0 1. as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) .2.00 BUILDING USE RE INO CON PB OR., '❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct 't be project (Sec. 7044, Business and Professions Code. The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. / � _ /(0- odp LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contractsfor such praisers with u contractor(s) license) pursuant to Contractor's the Contractor's License Law. ❑ l am exempt under Sec.-, BAP.C. for this reason ,3 SEWER -SANITARY -STORM EA. 200ft/10,00 TRACT NO. PARCEL NO., WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'C'OMPENSA'I ION DECLARATION. 1 hereby affirm that I have a certificate ofconsent to set6insure, or a certificate of Workers' Compensation Insurance, or a rertifiem ZONING ENG SITE NO. MISC. - REFER TO ORD. copy thereof(See.3800,. party ). /TNr .1l Policy No. Company �? ❑�/ Certified to hereby furnished. )d Certified fled vi I Om cjry iniPection division. Applicant FIRE SPRINK Y N ❑ ❑ ENERGY T-24 Y N ❑ ❑ _ CERTIFICATE OP F.XEMP'G.N FROM WORKERS' COMPFNSATION INSURANCE (This section need not be completed it the permit is for one PERMIT ISSUANCE - .1&9B/A. - FLOOD ZONE Y ❑ N ❑ A.L.U.C. Y ❑ N ❑ PLG CONTR, LIC. NO. PLG.. TOTAL hundred dollars IS 100) or Icss.) I Certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to DTV MECHANICAL PERMIT FEE FEE SUMMARY BUILDING /6 rd become subject to the Workers Contpenwtlon Laws of Calllorria. Dale Applicant ALTER OR ADD TO MECH. 5.00 NOTICE: '1'0 APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 AIR HANDLING UNIT (TO 10=CF.M.) '4.00 PLAN CHECK FEE ` emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE •�-7,VD I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the perl'ornance of the work for which this permit is issued (Sec 3097, Ci, C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address � HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC /.S VENTILATION FAN. (SINGLE) 4.00 1 c'uldy that I have read this application and state that the above information is correct. I agree to comply with all city and county orAinances and state laws relating 10 building construction, and hereby lomlac representatives of this city to enter .,on the shove -mention cry for inspersion purposes (We)ug a to r •, indemnify unci keep hunnless the City of Cupertia. ugains abilities, judgments, costs and expenses which mSy in n accrue against said City in consequence of the PLUMBING /S BOILER- CDMP(3 H.P. Or 100,00.0 B.T.U.) 6.00 801 LER-COMP love, 100,000 BTUI SEE FEE SCH. MECHANICAL / /J MISC. - REFER TO ORD. / PERMIT ISSUANCE 1 a CONST. TAX rani lh' rm it r t Sig t eor App nntr to U egoo MECH. CONT. LIC. NO. MECH. TOTAL TOTAL e _ �� OFFICE COPY a• POSTTHIS CARD NEAR FRONT OF BUILDING CITY OF .CUPERTINO. INSPECTION DIVISION JOB INSPECTION RECORD ��. JOB ADDRESS /USA $6 S�.,/79 �UG//J- /\0 UNIT # - -_LO - - OWNER /}LO ✓/S'T/j /.V/ E'(, ,IL1eN • CONTRACTOR f p//N/ PERMIT NUMBER, 15541 -• PERMIT'EXPIR' TION .PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN ' 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS -FROM LAST CALLED INSPECTION. INSPEC I,ON K ATE I IN PECTOR FOUNDATION (((e - INSPECTIONRECORD - NOTE; ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUN(TE PERMIT VALIDATION /,4,' / a,'f`�r.. .'AJc-� SUANCE DATE GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING .. _ ELECTRICAL. MECHANICAL - p{w ECT, PLc. MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION w WOOD FLOOR VALUATION . fy, $IFT, PLUMBING f-1* - 'MECHANICAL -�=g� ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. - - - OCC GROUP ^ • 4 RES UNITS / N'RLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS.PAID SO IT FI.OURATIA ( TOTAL!CIIEAGE ' DIAPHRAGM .pp ROOF SHEATHING -�D�OI BUILDING u5E Res IND CON PR ou,.•. E ❑ I] cl ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE; INSP. ' ROUGH SAN.H / ASSESSORS PARCEL NO 31f ---%b — )AP PLUMBING — C�/! ..j43 - ELECT. ENERGYSME TUBS & SHOWERIPAN,.ta.v' - L - PLUMBING ENERGY ' TRACT NO PARCELING ,I 'MECHANICAL dC/_gy j MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC.DATE ACC, FILE NO. �I - FRAMING - /_Z. (�- 'j i ELECT. FINAL TEST INSULATION � PLUMBING. ZONING ENG. SITE NO. GAS TEST 2£( GAS MECHANICAL ,• EIRE SPRINrc, ° "EJ ENERGY Tza ` "o COVER NO' WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR _` � � ELECTRICAL RELEASE PLOOU ZONE v 0 No , ❑ N❑ INTERIOR SHEAR , D- FIRE DEPT. SHEETROCK �. GRADE FEE SUMMARY EXTERIOR,LATH _I A4A BUILDINGy BUILDING v� / _ INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE' GAS IND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCYSEISMIC FEE �fZ7 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR, MICROFILM LU ARRANGE FOR.INSPECTION BY PHONING 252-4505, -ONE WORKING DAY BEFORE REQUIRED -INSPECTION. ,.. PLEASE -GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING ,y— MECHANICAL/S. CONST. TAX 'IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. ` ' TOTAL OFFICE COPY