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18539 (2) AP LICANT TO FILL IN INFORMATION WITHI RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS r �..' 18539 L4r" -ELECTRICAL-PLUMBING�MECHANICAL OWNER'S - - PLAN CHECK VALIDATION NAME �3 �- CITY. ELECTRIC PERMIT FEE o (aa ebur►(ONE c 2 CONTRA RS G. OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC,NO. - LIGHTINGFIXTURES 10.00/1.00 CONTRACTOR'S - - ADDRESS APPLIANCES-,RESIDENTIAL 4.00 r - ' PHONE PANELS 10.00 DATE OF APPLICATION 7' ARCHITECT PLAN CHECK FEE 4 P.C.NO. OR , PANELS(OVER 200 AMP) 20.00 , ENGINEER LOC.NO. SIGNS TRANS. ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS ADDRESS Q Fa Q�tY MOTORS .SEE FEE SCH: r �,L, tea tlY1O SERVICE CHANGE 20.00 w O O LICBN iD CONT'RACTORS DECLARATION a u I hereby affirm that I am licensed under provisions of Chapter 9Q C7 P ISSUANCE DATE w4 y (commencing with Section 7000)of Division 3 of the Business and OG. ELECT. I PLG. MECH.- H z Professions Code,and my license is in full force and effect. ❑ ❑ :.❑ o i H o License Class Lic.Number (�� p..roi , F L H J Dale COntraatof 04.otVYA', 2 m¢ a OWNER-BUILDER DECLARATION BUILDING PERMIT _ r w INFORMATION Wase' MISC.- REFER TO ORD ; LL y I hereby affirm that I am exempt from the Contractor's License' VALUATION S/FT. r U.0 4 Law for the following reason.(Sec.7031.5,Businessond Professions' PERMIT ISSUANCE 10.00 Q Cade:Any city or county which requires a permit to construct,alter, Q 2iOr Or 40mprove,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO! ELIC. A m, requires the applicant for such permit to file a signed statement that TOTAL T$ d. n w he is licensed pursuant to the provisions of the Contractor's License r z i Law(Chapter 9(commencing with Section 7000)of Division 3 of tlhe SC` a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEEIs -d 12POkA ¢moo thebasis for the alleged exemption.Any violation of Section7031.5' STORIES TYPE CONSTR. i ;m by any applicant for a permit subjects theapplicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($5000): ^k I,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 do the work,and the structure is not intended or offered for sale (See. 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 SO,FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mends arc Got intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner. GAS-EASYSTEM-OVER 4(EA.) . 2.00 BUILDING USE builder will have the burden of proving d .rat he did not build or im- RES IND CON PB Other prove for 1,as owner ofsale.). INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the properly,he exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors : construct the project La 7044,Business LAWN SPRINKLERS-1 INC5 V.B. - 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to antr owner of property who builds or improves thereon, sua who LAWN SPRINKLERS:OVER 5(EA.) 1.00 contracts for suchprojectsLwitha contructots)licenced pursuant to SEWER-SANITARY-STORM'EA.200ft/10.00 TRACT NO. PARCELNO. the 1 am License Law. ❑ Ium exempt under wner Sec. A-_,B.&.P.C.for this WATER HEATER W/VENT 6.00 ason �� ODare` WATER SYSTEM - � 5.00 ACC.DATE ACC.FILE NO. WORKES'COMPENSATION DECLARATIONf,rr WATER.TREATING EOUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING or a certificate of Workers Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sce.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. . O Applicant Y❑ N❑ Y ❑ -N❑ m PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU - CIiRTIFICCOMOPSATION INS PROM WORKERS' DJ > COMPENSATION INSURANCE PLG.CONTE. LIC.N0. I.G.PY❑ N❑ Y❑' NF] -(This section need not be completed If the permit is for one TOTAL hundred dollars 1$100)or less.) U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY U. F mil is issued,I shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California. s of Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING e } In NOTICE TO APPLICANT: If,after making this Certificate of F . 2-17 F. Z emption,you should become subject to the Workers'Compensation qPP LIANCE 5.00 . 'PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE e U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10P00C.F.M.)-6.00 SEISMIC FEE ' t 2- 1 1 hereby affirm that there is a construction lending agency I'or _ EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 I. MICROFILM 3097,CN.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address 'ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE)., /" '.4:00 information is rate correct. I agree to complywith all city and county PLUMBING ordinances and olaws relating to with construction, and BOILER-CON813 H.P.or 100,000 B.T.U.1 6.00 hereby.authorize representatives of this city to enter upon the - BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-nhontioned property for inspection purposes. . (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue againsts id City in consequence of the PERMIT ISSUANCE 10.00 f,puting trait. MECH.CONT. 'LIC.NO. MECH. TOTAL TOTAL Signature o pplicant/Contractor �lc OFFICE COPY POST THIS CARD NEAR FROOT OF BUILD L 'PERMIT NUMBER CITY OF CUPERTI 1 $539 INSPECTION DIVISION JOB INSPECTION RECORIy��1p --/� '/ PERMIT EXPIRATION' JOB ADDRESS—�� 6 G��y�/ / rrip J%\ UNIT# LOT*f �y'11 `` 11 ( PERMIT EXPIRES IF WORK OWNER yOt1 G �-� CONTRACTOR r IS NOT STARTED WITHIN INSP CTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - - ANCE OR 180 DAYS FROM Q NOTE: LASTCALLED INSPECTIOW UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION - CUPERTINO STANDARDS. GARAGE SLABS 1c -POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL• ��!l1777 ISSUANCE'UATE MECHANICAL - LUG, ELECT PLG, MECR DO'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT,:,. INFORMATION PLUMBING' WOOD FLOOR VALUQTjpN SIFT. MECHANICAL Q ELECTRICALG^ A E D B - - �I ITKE,� D FRAMING - _\ IL STORIES TYPE CONSTR. _ INSULATION lLi - OCC GROUP RES.UNITS I PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SRI,, FLOOR AREA TOTAL ACREAGE 1 ROOF NOTE:NO SHALL BE MADEBEFORE t. - DIAPHRAGM THE CONSTRUCTION TAX $PAID e UI LOPING USE . ROOF SHEATHING RES IND .CON PB OD'd APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE, - INSP. ❑ ❑ F-1 -❑ ❑ ASSESSORS PARCEL NO ROUGH SANA PLUMBING - ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO - MECHANICAL MECH.ENERGY - ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE NO FRAMING -a- Mr, ELECT.FINAL TEST - INSULATION PLUMBING ZONING ENG.SITE NO. ' GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No ,Y ❑ N❑ EXTERIOR SHEARELECTRICAL RELEASE FLOOD ZONE A.L U.c, .INTERIOR SHEAR F Y❑ N❑ Y ❑ No SHEETROCK - GRADE ' FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS eu DING SCRATCH COAT CTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv sEISMIc.FEE •� OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY.PHONING 252-4505, ELECTRIC LU WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - MECHANICAL —'SEE PERMIT FOR EXPIRATION DATE IMPORTANT! coNsr:TAX PLEASE READ REZRSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY