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14734 APPLICANT TO FILL IN INFORMATIONVITHIN RED LINES'- USE BALL POINT PEN ONLY •PERMIT NUMBER . ,•BUILDING PROJECTADENTIFICATION APPLICATION & PERMIT . Lou G - - '14734 -" ADOou Cor BUILDING PLAN - PLAN CHECK VALIDATION OWNER'S i„ NAME �`\`1 //'�,r/ ,,/JCj�� OTY. ELECTRIC PERMIT FEE V-A Ck�-• � - \ PHONE /v/ / DO TRACTORS OUTLETS-SWITCHES-RECEP 10.0011.00 - - ♦` NAME uc.No. LIGHTING FIXTURES _10.00/1.00 CONTRACTOR'S - APPLIANCES-RESIDENTIAL 4.00 ADDR Ess PHONE PANELS 10.00 DATE K APLICATIONP ARCHITECT PANELS (OVER 200 AMP)*' 20.00 PLAN CHECK FEE P.C.NO. OR - SIGNS TRANS. 3.00 •¢� C.NO, ARCH.OR ENG. , • 5.00 , PERMIT VALIDATION ., ADDRESS - SPECIAL CIRCUIT . ZIP EMP.METER OR POLE INS. APPLICANT SNs MOTORS SEE FEE SOH. ADDRESS / Iu-,� '- "t . SERVICE CHANGE 20.00' woo LICENSED CONTRACTORS DECLARATION Z'Z�- `�,Q U v 1 hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE N< w (commencing with Section 7000)of Division 3 of the Business and BLDG.1 ELECT. PLG. MECH. H H z Professions Code,and my license is in fall force and effect. '� �+ ❑ a. o m - License Class Lic.Number - 0 r Date Contractor , a x E eg Al t> •BUILDING PERMIT X acX a OWNER-BUILDER DECLARATION IV1 [[� INFORMATION MISC.- REFER TO ORD w3 n H I hereby affirm that I am exempt from the Contractor's License VALUATIVN $/FT. woo Law fortilel'ollowingreasnn.(Sua 7031.S,tlusinessand Profuseions PERMIT ISSUANCE 10.00 _ UPa�LIllJ00 L - Code:Any city or county which requires a permit to construct,alter, 1MA Q D aQ ¢ FO Improve,deinollsh,or repair any structure,prior to Its Issuance,also ELEG.CONTH� LIC.NO. ELEC. r_ O u requites the applicant for such perant to file u signed'statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencingwith Sectim17000)Of Division 3ofthe a PLUMBING PERMIT FEE Business and Professions Code)or that he is exempt therefrom and DTV. Ci the basis for the alleged exemption.Any violation of Section 7031.5 - ST RIES TYPE CONSTR. 3: by by any applicant fora Permit subjects the applicant tit tacivil penalty ALTER-DR -WATER (EA.I 5.00 [Hot more than five hundred dollars($500).): - ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the struchrre Is not - I intended or offered for sale (Sce. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 -- Code:The Contractor's License Law does not apply to an ownLrr ol" properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa FT,FLOOR AREA__TOTAL ACREAGE himself or through his own employees,Provided that such insprove GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 men"are not intended or offered for sale.If,however,the building orimprovement is sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving Ilial he did not build or im- RES IND CON PB Doer Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ -❑ I,as owner of the Property,am,exclusivcly cornmeling with licensed contractors to construct the project(Sec. 7044,1tlusiness LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A65ESSORS PARCEL No. and Professions Code:1'he 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 fnrsuch projects with a contractoRd licensed purstumt to SEWER-SANITARYV-STORM EA.200ft/10.00 THACT NO. PARCEL NO. the Contractor's License Law. ❑ lam exempt un r9ec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 mon Ocean-CA-✓D3."_ Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. -W ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE N0w or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,LAC.). ' Policy No. Company Q ❑.Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z '❑*Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. y C] N❑ v [3NC] I- v0-i - PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. cc - CERTIFICATE OF EXEMPTION FROM WORKERS' w > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. - y❑ N❑ Y N❑ 0. O (Phis section need not',be completed if the permit is for one TOTAL Z hundred dollars($100)or less.) U O I�certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY mil Is issued,I shall not employ any person in any Inanner eo as to O w become subject to the Workeri COmPeasatlon Laws of Culibunia. BUILDING Date.Applicant ALTER OR ADD TO MECH. 5.00 )_ tan NOTICE TO APPLICANT: If,ahi,r making this Certificate of P:x- _ F Z emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK Provisions of the Labor Code, you must forthwith comply with FEE -71 U such provisions or 00s permit shell be duomeA revokal. - AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE . SD I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work lir which this permit is issued fSec. HEATING UNIT IT 100,000 B.T.U.) 8.00 - MICROFILM 3097,Civ,CA Lender's Name HEATI NG ON IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lelider's Address' " 1,certify that I have read this application and stale filar the above VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances avid state laws relating to building construction;and - hereby aullmaRic representatives of this city to enter upon the BOILER-COMP (Over 160,000BTU)SEE FEESCH. MECHANICAL _ a orvementioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. CONST.TAX Cupertino against Imbi dies,judgments, costs and'expenses which PERMIT ISSUANCE 10.00 may in any way ac ue against said City in consequence oft ranting ftl} p t. MECH.CONT. LIC.NO. MECH. .. � � TOTAL TOTAL Signature eoof/Applicant/Contractor Date ' OFFICE COPY POST THIS'CARD NEAR FRONT OF BUILDING - - PERMIT NUMBER 1 CITY OF CUPERTINO 14734 INSPECTION DIVISION -JOB INSPECTION RECORD PERMIT EXPIRATION 'JOB ADDRESS /J�/ r7 �'T�'�— ^-� UNIT# _LOT# PERMIT EXPIRES IF WORK OWN L, �ITA.C.O�/ coNraacroR - - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD -180 DAYS OF PERMIT ISSU. FOUNDATION - - - ANCE OR 180 DAYS FROM _ NOTE: LEER � ALL GRADING AND DRAINAGE SHALL BE INSTALLED - LeAST CALLED INSPECTION. PREGUNITE TO COMPLY WITH THE.APPROVEO PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS, GARAGE SLABS r - - - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' -, UNDERGROUND /SLAB - - Ifr+��y,,%(J/�,'�"�,',*yy(� PLUMBING .. ELECTRICAL _ - ���, _ � .,n0 ISSUANCE DATE MECHANICAL - • - - v.- BLDG r��Ecr•• PLG. MBCH I . ❑ ❑ DO NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - BUILDING-PERMIT ' WOOD FLOORINFORM ' ION PLUMBING VALUATION U S/FT, ' - - - n MECHANICAL _ ELECTRICAL PEHMn TD rr( FRAMING '}S STORIES T PE CONSTR, . INSULATION - - - OCC GROUP / RES UNITS bP,UACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED f^' • $O.FT FLOOR AREA TOTAL A ROOF NOTE:NO FINAL' INSP.SHALL BE MADE BEFORE frP E ACE r ,DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE •`ROOF SHEATHING - RES IND CON PB Go... ' -- -' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE -INSP. ❑ ❑ ❑ ❑ ❑ ASSESSOHS PARCEL NO. ROUGH SAN.n PLUMBING • IELECT.ENERGY TRACT NO. PARCEL NO ' TUBS 8 SHOWER PAN � � PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ACC.pnrE ACC.FILE NO ELECTRICAL BUILDING ENERGY - - FRAMING S ELECT.FINAL TEST ZONING ENG.SITE N0. - INSULATION - PLUMBING � �-/f— GASTEST GAS i FIRE SPRINK- ENFRGY T 24 I' MECHANICAL Y ❑ N❑ v ❑ N❑ - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR _ - � ELECTRICAL RELEASE FLOOD ZONE A.L.0 C. � - INTERIOR SHEAR . FIRE DEPT. Y ❑ N❑ ❑ N " SHEETROCK GRADE , " FEESUMMARY EXTERIOR LATH ,�•{ BUILDING - .INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC FEE CHECK' r —rr7~k GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y C OCCUPANCY OF.BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. .MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICUJ " ONE WORKING DAY BEFORE REQUIRED INSPECTION. aLUMBING 2 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. ' Z — SEE PERMIT FOR'EXPIRATION DATE _ MECHANICAL- IMPORTANT! ECHANICALIMPORTANT! CONST,TAX PLEASE READ REVERSE SIDE BEFORE'- r. CALLING FOR FINAL INSPECTION- - - TOTAL OFFICE COPY . .