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18692
r OFFICE COPY POST THIS CARD NEAR'FRONT,OF BUILDING -`PfAry,IrNUMBER y CITY OF,'.CUPERTINO = 1$$92 INSPECTION DIVISION'" JOB INSP.ECT.ION RECORD - 'PERMIT EMfT PI RIATION... .., , -."� •� + ✓'©br-� UNIT# LOT# - .,, ... R.r ? " JOB ADDRESS r; Y1 t ! - PERMIT EXPIRES :I F.WORK. OWNER�','i' l -c— -D,e'comrancroR ,`e,-L'p j"' - IS'.NOT STARTED WITHIN ' IUU DAYS OF PERMIT ISSU.. 'ANCE',OR 1a0 DAYS FROM .LAST CALLED INSPECTION. ' INSPECTION 'DATE'" INSPECTOR -,+' - - INSPECTION RECORD. 'FOUNDATION - - NOTE. '�, r" "-• `' . �r•r, FADING; AND, DRAINAGE SHALL`BEJNSTALLED' MPLY,WITH THE APPROVED PLANS AND CITY OF 'LIFER - .°, r` PR EGUNITE �'- • " ;PERhnT VALIDATION .' - `' CUPERTINO STANDARDS `' ( f 4 C 1)fi �.� CELECTRICAL. GARAGE SLABS POUR NO -CONCRETE UNTIL ABOVE,HAS BE4EN.SIGNEO' - . r • UNDERGROUND/SLAB - PLUMBING ;,- . a , - '. +Y r.1 +✓ ,' y"'[ IssunNCE LATr ° , ^, MECHANICAL" d_ -r. r ECT. u, ,�y�. Pca.,,, mecr�.: rb�j +CMSt -;,•,, DO,NOT POUR.FLOOR UNTIL ABOVE HAS'BEENLSIGNED aulLDwc PERMIT INFORMATION '. WOOD FLOOR' ',+ � �' 'VALUATION - SIFT. _ PLUMBING � �' .' .' ' � MECHANICAL .ELECTRICAL - `s I q'-• T,. ea - ",:4 - Ub FRAMING INSULATION- TORIES- TYPE CONSTR., Q IT - "OCC-GHOUP:� HES.UNITS =PLACE NO'SUBFLOORUNTIL ABOVE HAS BEEN SIGNED .r. ROOF t - - NOTE' NO FINAL INSP: SHALL BE MADE BEFORE.r THE CONSTRUCTION TAXIS PAID" 'so rT,PLnoH AREA '-- j^; ,.C - 'Cc': 0 TOTALACHEAOE- r•'' - >, DIAPHRAGM`.. ' ewLOm use • ' ROOF SHEATHING ^s'', ".^, HES ,IND 'CONNPEl B 00h.,i`APP@Y„NO*ROOFING'UN,TIL-ABOVE;HAS,BEEWSIGNED '0 'El ElEl, , :.'IFINALSr' ? APPLICANT TO FILL IN INFORM ATIONVI.T.HIN,RED LINES: -'.USE BALL POINT PEN ONLY 'BUILDING PROJECT I'DENTI F,ICATI ON - APPLICATION & PERMIT. ,' � BUILDING ELECTRICAL—PLUMBING —MECHANICAL PERMIT NUMBER + 186 9 2 SuaolNc ADOREss 5 �r O NER NAM, ^' .,��• _ PHONE e + p + OTV. ,"; - ELECTRIC PERMIT - "' FEE PLAN CHECKVVALMATIO, r" yj '?, tltltltltltl ` t ' coNrRAcroR's NAME OUTLETS,.-SWITCHES-RECEP 10.00/1.00 -LIGHTING FIXTURES "'10.00/1.00 • 'mc. NO. . _.. A00DREAcroms ADOREss APPLIANCES -RESIDENTIAL" .4.00 PANELS - - '10.00 - -' PHRNE-�" DATE OF APPLICATION-� ARCHITECT` .. ENGINEER Q.. `jam((�� $ iIc�NR� � � : PANELS (QVER.200 AMP) .' 20:00 PLAN CHECK FEE PC, NO. " SIGNS TRANS .. '3.00; ADORERS ENG',`d ' u:. D QNIIK' '� S •I aS yftir 1 '21Pf SPECIAL CIRCUIT "' 5.00 PERMIT VALIDATION _ Z ' y. - EMP. METER OR,POLE INS'. "'20.00'' APPLAD�ICANTS s ' iJ q _ - ', MOTORS'. SEE FEE SCH.iv SERVICE CHANGE" 20.00 - LICENSED CONTRACTORS DECLARATION " 'v - .Ihereby affirm that �l am licensed under provisions of Chapter 9- ISSUANCE DATE-' ( ....nein, with Section 7000) of Division 3 of the Busmess'and' Professions Code, and my license is in lull force end effect. ' -- - - BLD ELECT. - •PLG. MECH- - .' �t- �v License Class Lie Number Date Contractor V - - .,i4OWNER-BIIILDERDLCLARATION .. ,y ,'BUICDIRMATIOPERMIT INFORMATION', ,;MISC.— •',REFER:TOORD I hereby 'afDrm that 1 am exempt from tire Contractor s License 031 5; Bum send Profes>,rms Law f Any dolor countywhich Code Any city o or ty it ch I ure permittee tract alter, also h any structure, to fie as to its! statement Or for such impnres demolish,applicant gned smmmcnl that requires the dp ursuat t to t ch i emit to fila a si ha.is licensed pursuant m the provisions of the Cm,lractoi s License Law '(Chapter 9nommencmgwith Section 7000) of Dlvision3 of the Business and 1 ifessions Colthim that Be is exempt therefrom and "VALUATION ffi/FT. PERMIT ISSUANCE � , .. '. 10.00 - - ELEC. CONTR. LIC. NO.. - . ELEG TOTAL _ $ R �R lap - w -'I r '�t - PLUMBING QTY.'. ;PLUMBING PERMIT -' FEE •i the basis for the alleged exemption. Any violation of Secti6n;7031-.$, by any applicant for a pemmt subjects the applicant toa civil penalty of not more than five hundred dollars ($500).): . ' 'r - STORIES v YP Co TR. , , -, - ALTER -DRAIN &VENT-WATERIEA.) 500 ' 1, as owner of the property, Or fny,employeca with wages as compensation, will do the Work -and the structure is not intended.or offered for sale (Sce.'7044, Business and Professions Code: The. CRnliactor's License Law does not apply to ai, owner of prOpertyWho hnlldSOrimproves thereon, and who does such work17 himself or through his own employees, provided that such iniprove- meri ere not intended or offered for sale, if, l weveq:the building s _ BACK FLOW PROTECT.'DEVICE , 4.00O - DCC. GROUP CC. ,tt RES. UNITS , -. 'C. DRAINS -FLOOR, ROOF; AREA,COND. -5.00 "-'% FIXTURES-PER'TRAP., 6.00 i SD. FT. FLOORA EA ` TOTAL ACREAGE ' GAS- EA. SYSTEM„ -4 1NC.40UTLETS -6.00 or improvement is sold within one year of comp) tion, the owner-. 6uildeewill have the burden of proving that he did not build 0,in,- prove for purpose of sale.). y'' ''. -'' ❑ 1, as owner of the, property„am exclusively contracting with licensed contortions to comtimc4 the project (Sec. 7044, Business ...I Profcysions Code: The Contractor's License Law does not apply to an owner oIproperty who builds or improves thereon, and who contracts, for such projects with a contra'ctor(sYlicensed pursuant Io the Contmetor's License Law:' OV ER,4 (EA) � 2.00 BUILDING NE RES- IND CON. PB 'Gans, ❑p -❑- ❑ ; ❑. -❑ INDUSTRI AL WASTE I NT ER,''' 30.00 - -� ” LAWN SPRINKLERS"�il INCi5''V.B. :.6.00'- � ' LAWN SPRINKLERS -,OVER 5'(EA1) 4 .1.00 - - ,- ASSESSORS PARCEL NO. -..� SEWERSANITARY=STORMEA.200ft/10.00 TRACT NO. PARCEL NO. o' Larn exempt under Sec. B&P.0"far IN, reueso0 n .', n . � 1 .: . •' - ' WgTER,HEATER W/VENT- ,'6.00 O no.. ..1i 7171' WATER SYSTEM •5.00 -ACC. DATE a, ACC. FILE N0. WATERTREATING'EQUIP."', '• 5.00 _ WORKERS:COMPEry SATIONDFCLARA'rION I hereby affirm Thant have ,tifwelcOf consent t .elf -i re or a certificate of Workers' Compensation, nsurance, or a certflicd - - ZONING' ENG SITE NO. wpy thereof(Sce. 3800, Lab.CJ. Policy No. - Company ,- FIRE SPRINK -. • Y ❑ N �' ENERGY T,-24 ' 'Y ❑ NO -O Certified copy is hereby fu r,i,h,d. ❑ Certifiedcopyis Cded'.wflh the eity'inspecticn..divisionL' Applicant - `< MISC. - '- REFER TO ORD. 'CFRTIfICATIi OF EXEMPTION FROM WORKERS' COMPENSATION INSU_RANCh, '. This section completed if [he pnrmit is for one PERMIT ISSUANCE Y .. .10,00 _ FLOOD ZONE Y ❑; N'❑ _ '. A. L. U.C. ' t' ' Y ❑ N ❑ - PLG. CONTR. LIC. N0: PLG. A,(\ TOTAL ' � •%- '• QTY. •MECHANICAL PERMIT " FEE' - - - - -FEE SUMMARY , -" Snordloot,be es, hundred dollars ($1001 onlessJ. -R, '. .. I certify , I h the performance of the work for which this per- manner so as m is issued, I shall not rkers' any person m anyLaws andbecome b came subject to the Workers C 'mpensaton Lawsrof Celiforn8 Dam - - am - BUILDING •,PLANCHE ' „FEE 13 _ d 'ALTER OR ADD TO-MECH. "' 5.00 APPLIANCE ,'.. )'' 500 's � AAppliPPLICANT NOTICE T., APPLICANT'. L, after making the ps' Certificate ,r Ex- cmptwns of th,Cbor,Codc,iubject Workers'Ccoply with you must, provisions ns' of theLabogCode you must, forthwith comply will, si s.h provisions or this Pamir shall he deemed revoked'. 'AIR HANDLING UNIT (TO 10,000 C. F. M.) '4.00 i ', s , AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 S FE '- l ..'CONSTRUCTION I.ENDWC AGENCY r EXHAUST HOOD (WITH DUCT).'' 5.00 '- - - -- - I hereby, affirm'thatthere Is" construction lending'agency for the performance of the work -for which:this, permit is Issued (Sec. 3097, Civ.C.) . ',•, - Lender's Name „- FIL HEATING UNIT (TO 100,000 B.T.U.) 8.00 " HEATING UNIT T U 0 )9 T(OVER 10;000 B....5 HEA -_ 0 ELECTRIC L'ender's Address' I certify th t I Imve read this application and state that the above _ VENTILATION FAN (SINGLE)" --'. 4.00 ._• + - information's correct -1 agree to comply.with all city and county ordinances and state,laws'relating todbuilding construction, and hereby authorize representatives of this, city to enter upon the abovmdmmioned property for in purposes. PLUMBING - 'BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 - BOILER -COMP IOvei100,006 BTUI'SeCFEE SCR: ''c - - MECHANICA - - _ MISC.-"r. aI REFER'TOORD. - r - , ,(We,agree,tosale,. Indemnify uad keep.harnless'the City' of Cupertino against liabilities; judgments, costs and icxpensos which mayinany way accrue against said City in consequence of the ranyygof It permit - s'; 'CONST. TAX ' _ IRERMIT ISSUANCE - 10.00 MECH.CONT LIC NO, MECH rDTATOTAL. v " _. llII 11 Signature of Ap scan[/Con[raUor-,' "OFFICE COPY"