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10758 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY 43UILDING PROJECT IDENTIFICATION PERMIT NUMBER So LOINc APPLICATION & PERMIT ADDRESS aO(,q�( SIPJPM5 //�_e31VJ a , NG—ELECTRICAL—PLUMBING—MECHANICAL 10758 II OWNER'S PLAN CHECK VALIDATION Y N�A/MEE�-//.y ,yarJI;C/W-lr— n /5 CITY. ELECTRIC PERMIT FEE r I�,1„ I/SItf�I/'rerv✓ PHONE ;Z52,355'2— CONTRACTORS crORs UTLETS-SWITCHES-RECEP 10.00/1.00 NAME 1 f�(J_vNat�) uCYrnLQ-1tNc.No. N LIGHTING FIXTURES 10.00/1.00 ADDRESS 's �1 ) PPLIANCES-RESIDENTIAL 4.00 ' ZO �� PHONE Z PANELS 10,00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER r LIG.ND. 13'111 SIGNS TRANS. 3.00 ARCH,OR ENG. SPECIAL CIRCUIT 5.00 ADD VALIDATION („ - E-aA MahP rrEMP.METER OR POLE INS. 20,00 I ADDRESS MOTORS SEE FEE SCH. / ADDRESS /+ - 1 gbby 5°�73✓PMS l (L•PQ14, r pSERVICE CHANGE 20.00 woo Is LICENSED CONTRACTORS DECLARATION < U w 1 hereby affirm that I am licensed under provisions o'Chapter 9 1 ANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. LECT. PLG. MECH. yi ProressionsCiI my licenscis in full l'urcc��Ld�eff¢�L ❑ Z,z w W License Class E] E]Lic.Number wZ� S�� Date Z—/. —Ytr, Contractor ¢ y f BUILDING PERMIT le¢ OWNER-BUILIDER DECLARATION ¢ o a UMISC.— REFER TO ORD INFORMATION w3 u H I hereby affirm that 1 am exempt from the Contractors License VALUATION FUO; Law for the following reason.(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00' $/FT. Code:Any city or county which requires a permit to construct,alter, Q Q Q Improve,demolish,or mpalr any structure,priorto Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. Or :O u requires the applicant for such permit to file a signed statement that TOTA PE IT TO w w he is licensed pursuant to the provisions of lire Contractor's License H Z< Lilly(Chapter 9(commencing with Section 7000)of Division 3 ofthe E E 0 Business and Profession$Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT : FEE M H o the basis for the alleged exemption.Any violation of Section 7031.5 STb ES TYPE ONSTR. i ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500)): ❑ 1,as Owner of the property,or my employees 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. 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- runts are not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA) 200 builder will have the burden of proving that h . . . e did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND PS Omar ❑ I,as owner of the properly,am exclusively contracting with Q ❑ co ❑ ❑ licensed contractors to construct the pFoject(Sec. 7044,Business LAWN SPR INKLERS-I INC 5 V.B. 6.00 ASSESSr 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 contractorls)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lumexemptunder Sec. ,B.&P.C.farthis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACO.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 here y a urm t I havec I ficate ofc.nsent to sell-insure, ZONING or car Ie c kers'C pe f n Ins mace,or a certifieJ ENG.SITE NO. c PD O ill ed cop here, Burnish FIRE SPRINK ENERGY T-24 Z o O- hlifie - i peclion di 'cion. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ Y N V N PERMIT ISSUANCE 10.00 14CATE OF F:%EM ON PROM WORKERS' PL000 ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Z (This section need not be completed it the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ hundred dollars(SI00)or less.) U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY LL'H mil is issued,I shall not employ any person in any manner so as to O Da become subject to the Workers'Compensation Laws of California. D. Date Applicant ALTER OR ADD TO MECH. 5.00 .BUILDING } N NOTICE TO*APPLICANT': If,Miter making this Certificate of Ex F ? emption,you should become subject to the Workers'Com pensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE 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 I0,000CF.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. HEATING UNIT(TO 100,(100 B.T.U.) 5.00 MICROFILM Lender's Name Lender f Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC --� I 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 H.P.Or 100,000 B.T.U.1 6.00 hereby authorize representatives of this city to enter upon the gQILER-COMP(Over 100,000 BTU)SEE FEE SCH: MECHANICAL ubove-mentioned property for inspection purposes: (We).agree to save, indemnify and keep h.nuless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in an way accrue ag}pinst said C' in consequence of the PERMIT ISSUANCE E 10.00 granting t s permit / MECH.CONT. LIC.NO. MECH. 0 �/%/ TOTAL TOTAL Gj L=ure of Applicant/contasittuar Date -✓ OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 10758 INSPECTION DIVISION JOB INSPECTION R CORD ' ;I PERMIT EXPIRATION JOBADOR T# OT# PERMIT EXPIRES IF WORK OWNER . I CONTRACTOR IS NOT STARTED WITHIN INSP TION DATE I INSPECTOR -INSPECYION RECORD –180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFERLASTCALLED INSPECTION. PREGUNITE - PEHMIT VAMID, r. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ( 6 UNDERGROUND /SLAB 1 ty'6f'Cupertino PLUMBING ELECTRICAL ISS aNCE DATE MECHANICAL BLDG. CT, PLG. I MECH. DO NOT POUR FLOOR UNTIL,ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR vA LDATGN a/FT: MECHANICAL PLUMBING '�'LY/ ELECTRICAL PE TO t f FRAMING i. 3 ST IE INSULATION � - � I YPE CO OCC.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED O.FT.FLOOH PHfP TOTAL ACREAGE ROOF DIAPHRAGM BUILDINGUSE " HES IND CON PB Oie— APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED (] oA o ❑ ROUGH - ASSESSOPARCEL NO. PLUMBING /J GAS TEST TRACT No. PARCEL No. MECHANICAL ELECTRICAL 1wFy,�•(1 Z,. -� FINALS DATE INSP. ACC.DATE ACC.FILE NO: FRAMING pcntid ( 1 b SAN # -zoNlNc ENG.SITE NO. INSULATION PLUMBING – GAS Ala/C/ �— FIRE SPRINK ENERGY T@4 MECHANICAL Y ❑ IN YIN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING El LATH–'INTERIOR ELECTRICAL 3 FLOOD ONE a.L.U.C. LATH–EXTERIOR FIRE DEPT. YQ NY ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING 10, SHEAR EXTERIOR T MPORARY APPROVALS BUILDING r 1' FIREWALLS ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEEOCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED By BUILDING INSPECTOR. MICROFILM I. ARRANGE FOR INSPECTION BY PHONING 252-4505, j— OFFICECOPY ELECTRIC i o0ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE-JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - ' MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. % %f - I '