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17921 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT 1 DENTI FICATION PERMIT NUMBER BUILDING\ APPLICATION & PERMIT 17/y� 1 - A.�Uaalarj S CELS �G v�Q- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL - 1 1 V Z 1 OWNER'S ( PLAN CHECK VALIDATION EON \lC.l.� o'(5S.-6q��j OTY. ELECTRIC PERMIT FEE , OrvE NT CONTRACTORS CA NA 66 < Q UTLETS-SWITCHES-RECEP 10,00/1,00 :r\1A/�� - 'LIC.NO. `-' LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ^I , qq APPLIANCES-RESIDENTIAL 4.00 10g4o �NnR1�GRLP �lYl -"0-PANELS 10.00 GATE OF APPLICATION y OPRCNIT Wi PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. ENGINEER LIC.NO. SIGNS TRANS. - 3.00 ADDRRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR-POLE INS. I,"'4a00 W ADSE)s f MOTORS SEE FEE SCH. J ft-bnctC:l'1LVN J'� Cr SERVICE CHANGE- PAIC) 20.00 .00 LICENSED CONTRACTORS DECLARATION - - in w I hereby affirm that I am licensed under provisions of Chapter 9 y z 19 ISSUANCE DATE (convncmmn action 7000)of Division 3 tit uaiysss and SLOG. LEC PLG. MECH. H z Professions ode, I my license is in full fol!$' ❑ ❑ ❑ 0 T o License Class Lic.Numbey� Date CDrnmctoF_la.nwl- €�-� Pt GROIN M S, w a OWNER-BUILDER DECLARATION BUILDING PERMIT w0 a O INFORMATION 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD H LL p¢ Law for the following reason.(Sec.7031.5,Nosiness and Professions VALUATION $/FT. J Code:Any cityorecunly which requires a permit In construct,alter, PERMIT ISSUANCE 12.`WAr00 �Z. 2 a Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.ND. ELEC. (7(J a¢ requires the applicant far such permit to file a signed statement that TOTAL .�Z. _ A' w Ire is licensed pursuant to the provisions of the Contractor's License PERMIT TO riQLaw(Chapter 9(commencing with Section 7000)of-Division 3 ofthe I i r Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE tc I-m the basis for the alleged exemption.Any.vinlation of Section 7031.5 STORIES TYPE CONSTR. a3� by any applicant for a permit subjects the applicant ton civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(55001.1: ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS sole compensatiom will do the work,and the structure is not _ intended or offered for sale (Sec. 7044, Business and 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 does such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meats are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 airimprovement is sold within one year of completion, the owner- builder will have the burden of proving that lie did not build or an- GAS-EA.SYSTEM.-OVER 4(EA.). 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ES IND CON Pit other lLas owner of the property,am exclusively contracting with licensed ccotmchns In 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 whit u contractors)licensed pursuant to, the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec, B:&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Data WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COAIPENSA'IION DECLARATION WATER TREATING EQUIP. '5.00 - I hereby affirm that I have a certificate of consent m self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(See.3800,Lab.C.L Policy No. Company O Certified copy is hereby fumishcd. FIRE SPRINK ENERGY TI4' Z Z ❑ Certified copy is fled with the city.inspection Division. H 0 Applicant MISC.- REFER TO ORD. y N Y E) N� CCN CER'I FICATF.OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE ALL.U.C. .L C04ENSAI ION INSURANC17 PLG.CONTR. LIC.NO. PLG. d 1'1'his section need ,or be completed if the permit is for one TOTAL V N Y N Z hundred dollars IS 100)or leas.) f..) O 1 certify that in tie purloin rf the k for which this per- QTY. MECHANICAL PERMIT FEE SUMMARY L 1- mit is i rod,I Tall not empl y Ln p.n i1 any m tier so as to FEE U hecol • eta' t( a Workers Cu ansa cos Culi (niu. i Datc [� _(2/Applicant ALTER OR ADD TO MECH. 5.001 BUILDING } W NOTIC' "1'0 PPLICCANT: If,after making this Certifl ale of Ex- F Z caption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions Of the Labor Code, you most forthwith comply with FEE' U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER1000C.F.M.) 6.00 SEISMIC FEE I.hereby affirm that there is a construction loading agency for EXHAUST HOOD(WITH DUCT) 5.00 , the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 1OQ000 B.T.U.) 8.00 Lenders Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 I' hereby authorize representatives of this city es crier Inion the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly representatives .1 th i purposes. %noa.g=a' sae, nemny and keep harmlessthe City of MISC.- . REFER TO ORD.g'' 'bilitiesjudgmmtiscosts and hihCONST.TAX yPERMIT ISSUANCE 10.00 1MECH.CONT. LIC.NO. TOTAL TOTAL 7ZO0 t/Contractor Uafe 1� 4 OFFICE COPY Y ' L POSTTHIS CARD NEAR FRONT OF BUILDING. PERM IT NUMBER CITY OF CUPERTINO. 17921 INSPECTION DIVISION, JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS I©I 1 J�l - �/� 'UNIT# _LOT.# d PERMIT EXPIRES IF WORK " OWNER I CONTRACTOR nl-p- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT.ISSU FOUNDATION ANCE OR. 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED • q1 PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' ' "p/�"��'�!' UNDERGROUND /SLAB' I� PLUMBING - ELECTRICAL ISSun NCI.On C MECHANICAL BLDG Le r PLc..• I MECH. AAlD ❑ ] ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDQQQ BUILDING PERMIT % ' WOOD FLOOR, MAY 241999 INFORMATION, PLUMBING VALUATION S/FT. • n MECHANICAL .Vlfyof.CuQ@nfiQo ELECTRICAL - P ERM IT TO 1 FRAMING - - �I�--lend �'r+". INSULATION STOHIEs .TYPE CONSTII ODCGHDUF HES,UNITS PLACE.NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED St).FT_FL[IOH AREA TOTAL ACHLAGE 'ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE- DIAPHRAGM - THE CONSTRUCTION TAX IS PAID 9uILOISli ROOF SHEATHING � � � � e TND COO ITS[ Pe GO— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El "❑ ❑ ❑ ROUGH.-•• SAN.k. 'ASSESSORS.PARCEL NO. PLUMBING - ELECT.ENERGY RAC,I NO `PARCEL NO TUBS&SHOWER PAN- r PLUMBING ENERGY "' MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC.FiLSNO FRAMING ELECT.FINAL TEST ZONING .ENG.SITE NO. INSULATION � PLUMBING GAS TEST GAS • MECHANICALFINE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NO ° ❑ "❑ FLaon zorve A,L.0 c. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. � Y❑ N❑ v ❑ N❑ SHEETROCK GRADE FEESUMMARY EXTERIOR LATH- BUILDING ' INTERIOR LATH ., TEMPORARY APPROVALS - BUILDING SCRATCH COAT ELECTRIC /� PLAN CHECK ' GAS FEE ' No rAPE'OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PER 1. FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX' PLEASE AEAD REVERSE SIDE BEFORE . TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY