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13094 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION $( PERMIT' aooREss O/C B 1fT BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 13094 i OWry R'a PLAN CHECK VALIDATION Na OTV. ELECTRIC PERMIT FEE P f �d?R oAy 36 7�. Vrf=�/ N Nr oRs �L OUTLETS-SWITCHES-RECEP 10.00/1,00 E r uG.ry LIGHTING FIXTURES 10.00/1.00 CIN TRACTOR . ' aoOTRE RAC / , APPLIANCES-RESIDENTIAL -4.00 /p �/�',E!✓l1�p N `'y{t S }' PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER UC.NO. SIGNS TRANS. - 3.00 ADDRESS END. SPECIALCIRCUIT 5.00 PERMIL4f4\ID$TyoN ZIP EMP.METER OR POLE INS. 20.00 TPYIL ADDRESrvrs - p4�1n'1 AD DRESS MOTORS SEVMGH. SERVICE CHANGE 20.00LY� QOP Foo LICENSED CONTRACTORS DECLARATION � G_f/(lily ¢ i w 1 hereby affirm that I am licensed under provisions of Chapter 9 . -L at.' dd IS$UA CE GATE H (commencing with Section 7000)of Division 3 of the Business and ¢ w . BLDG, ELECT. PLG. MECH. H a Professions C ny license iS in full f o uMi- Licemi las Lia Numbs C 2 w r w Dafe Contractor ¢ x BUILDING PERMIT tc a OWNER-BUILDER DECLARATION o a INFORMATION I hereby affirm that I am exempt from the Contractor's License MISC,- REFER TO OR Fey J Law for the following reason.(Sec.7031.5,B usiness and Professions' PERMIT ISSUANCE 10.00 p VALUATION $/FT. m0 Code:Any city or county which requiresa permit to construct,alter, 2 R ¢ FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. �r i w m LL requires the applicant for such permit to file a signed statement that TOTAL J PERMIT TO he is licensed pursuant to the provisions of the Contractor's License r ¢Q Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe //V��Qp� i D Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ 1- $ the basis for the alleged exemption,Any violation of Section 703 LS STORIES TYPE CONSTR. i3 � by any applicant fora permit subjects $5000.licannoacivil penalty ALTER-DRAIN 5.00 /--/ .too(more than five hundred dollars(8500).): /" se ct�4� 4 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP REB.UNITS their sole compensation,will do the work,and the structure is not intended cur offered for sale (Sec. 7044, Business and Professions Code: 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 F IXTUR ES-PER TRAP 5.00 se.FT.FLOOR AREA TOTAL acREaGE himself or through his own employees,provided that such improve- mentsarenotintended or offered for sale,If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the Owner- t builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Other / ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ 0 O ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 IN 6, 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-OVE 5(EA.) 1.00 contracts for such projects with a conlmctor(s)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STO M1HA1200 10.00 TRACT NO, PARCEL NO. ❑, I am exempt under Sec.-,BAP.C.for this WATER HEATER W/VENTV t 6.00 reason Owner Date WATER SYSTEM -x of Vned ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUI 5.00 1 hereby affirm that 1 have a certificate of consent to selhinsure, or a certificate of Workers'Compensation Insurance,or a certified _ ZONING ENG.SITE NO. copy thef��f�Sec.3800,Lab.C,]]��r, ''�t L 6 6r G C Policy N ompanywci 4gy�/ 6yp 14-55 0 ❑ Certifiedc is hereby furnished %% FIRE SPRINK ENERGY T-24 Z-Z ❑ -Cert�rq,�•copy Is led with the city ns�,t ctiyn division. F Applicant-bSGL a �q�tPf/(j{- MISC.- REFER TO ORD. V N Y N� � w CEIKYTIIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE. 10.00 CJ - FLOOOZONE A.L.uc. W - COMPENSATION INSURANCE. PLG.CONTR. LIC.No. PLG, ❑ ❑ ❑ ❑ CL 0 (This section need no[ be completed if the permit is for one TOTAL V N V N � Z hundred dollar,IS 100)or less.) U 0 1 certify that in the performance of the work for which this per- GTV. MECHANICAL PERMIT FEE FEE SUMMARY LL mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. y Date ApplicantBUILDING >- 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you nmst forthwith comply with FEE C„) 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 1W.CMMJ6.00 SEISMIC FEE V 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH T) ,5.00 the performance of the work for which this permit is issued(Sec, MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,OOP B,T!U. ; 8.00 Lender's Name HEATI NG UNIT OO;OOOB.T.U.)95 Lenders Address .- ELECTRIC l9V -� ['certify that I have read this application and state that the above VENTILATION FAN (SINGLE) V Q CA" information is correct. 1 agree to comply with all city and county PLUMBING d ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.Or 1061 O'9.T.U.) 6.00 hereby authorize representatives of this,city to enter upon the BOILER-COMP (Over 100,000BTUI SEE FEE SCH. MECHANICAL above-mentioned property for representatives inspection ofth purposes.ts. (We),agree to save, indemnify and keep harmless the City of MISC.- ...�� REFER TO ORD. ..t- Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in way accrue a I st said City in consequ ce of the PERMIT ISSUANCE 10.00 (,-� gran[ o Is permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL . rgn nt/ nlractor D e OFFICECOPY POST THIS CARD NEAR FRONT OF BUILDING " CITY, OF CUPERTINO PERMIT NUMBER INSPECTION DIVISION 13094 JOB INSPECTION RECORD. J - PEBUIT EXPIRATION ` JOB ADDR ESS 943 BY001(.gTOVe Lane UNIT# LOT# :' • PERMIT EXPIRES IF WORK OWNER'- Norman BreslaVer CONTRACTOR San Juan Pools IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD I80 DAYS OF PERMIT ISSU- FOUNDATION - 40-5r Q pV ANCE OR 180 DAYS FROM LIFER , - JOIJIVd•, )c,G " LAST CALLED INSPECTION " PREGUNITE - - .1�py d F,O, PERMIT VAuonnoN POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ,, . ( PLUMBING - - - ,/ •// • l ELECTRICAL ISSUANCE DATE MECHANICAL - - - BLUc ELEICT. PLG. MECH, DO NOT POUR FLOOR UNTIL ABDVE'HAS BEEN SIGNED + fPERMI T• WOOD FLOOR ot eUuIpQNMATION PLUMBING VALUATION S/ET. MECHANICAL ELECTRICAL . - PERMITTD .-.J, FRAMING . - f :.�+' d r, r•I. I1.(,.. INSULATION STORIES TYPE CONSTH. OCC.GROUP: RES:UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED .ROOF SOFT.FLOORAR EA TOTAL ACREAGE--- DIAPHRAGM' CREAGEDIAPHRAGM• - BUILDING USE HES IND CONI PB• O+ner - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ,• ❑ ❑ ROUGH _ ASSESSO RS PARCELNO. PLUMBING ' GAS TEST TRACT NO. •PARCEL NO. MECHANICAL ELECTRICAL _ ACC.DATE- ACC.FILE No FINALS DATE INSP. . FRAMING SAN # INSULATION . PLUMBING . ZONINO ENc.SITE No. �- ,7 GAS , . MECHANICAL FIRE SPRINK ENERGY T24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ✓❑ N❑ Y ❑ 'N❑ LATH-INTERIOR ELECTRICAL r� FLOOD ZONE A.L.uc. e LATH-EXTERIOR FIRE DEPT. - Y,❑ " N❑ - 10 N❑. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR _ BUILDING T O` - fr BUILDING r ' SHEAR EXTERIOR TE PORARY PPROVALS u^ FIREWALLS ELECTRIC 'PLAN CHECK GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE O OCCUPANCY OF BUILDING IS NOTPERMITTE D UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFiLM�.` ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC x o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING µ Z PLEASE.GIVE JOB ADDRESS WHEN PHONING. , SEE'PERMIT FOR EXPIRATION DATE — MECHANICAL .,3 IMPORTANT! co NST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - - --