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14872 PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY •- BUILDING PROJECT IDENTIFICATION PERMIr NumeER IN APPLICATION & PERMIT A n r� IL (J I 'AOOREss /..� ••• tt Uhbb BUILDING -ELECTRICAL-PLUMBING-`GIECHARICAL LM OWNER'S - J - PLAN CHECK VALIDATION NAME OTY..I ELECTRIC PERMIT FEE r PRONE I CoNTA ORS- . NaME � / UTLETS,-SWITCHES-RECEP 10.00/1.00 .R Q LIGHTING FIXTURES 10.00/1.00 ...NIT.Re AOR'$ �� APPLIANCES-RESIDENTIAL - 4.00 aOs J1Up _ PHONi - PANELS IOAO DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. on ENGINEER - ' uc.No. SIGNS TRANS. 3.00 ' ADDRESS ENG. SPECIAL CIRCUIT' 5,00 PERMIT VALIDATION ZIP TEMP..METER OR POLE INS. 20.00 - APPLICANT'S MOTORS' SEE FEE SCH. - ADDRESS a - (1 /N'/V�, SERVICE CHANGE 20.00 Q'— �[, woo LICENSED,COM'RACTORS DECLARATION /1 M O " c u- I hereby affirm that I am licensed under provisions of Cha 11019 i SSUANCE DATE ' H <a (commencing with Section 7000)of Division 3 n Busi and BLDG. ELECT. PLG. MECH. HOZ Professions Cod ,a I y 'cense is in full fort n e e - zON - License Cl us Lic.Number- '� O - O Datc Contractor Q a V s t • � BUILDING PERMIT rc rc w OWNER-BUILDER DECLARATION ' INFORMATION w ;'y 1 hereby off rm that I am exempt from he Contractor's License MISC.- D VALUATION $/FT. H u D v, Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 . 01 '-' Code'.Any city or county which requiresa permit to construct aheq 2 ¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also E .CONT LIC. ELEC. �""' w O'. requires the applicant for such permit to file a signed statement that �" TOTAL Q PERMIT TO v 'w m he is licensed pursuant to the provisions of the Contractor's License F i at Law(Chapter and Professions Code)or Section is 00)exempt Division o and E tlic < Business and Professions Code)or[hal he is exempt therefrom and DTV. PLUMBING PERMIT FEE / siO a; $ by basis for the alleged exemption.Any violation of Section malty STORIES TYPE CONSTR. a3 � by any applicant fora permit subjectstire(S500plicanl toacivil penally ALTER-ORAIN&VENT-WATER (EA.) 5.00 of not more than five hundred Jailors(5500).):' ❑ 1;as owner of the property,or my employees with.wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not ' 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 mems re not hrough or offend forSle.I ided that however,the improve GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 meats are not intended or offered for sale.II',however,the improve. building or improvement 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 that be did not build or int- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with I❑ ❑ ❑ ❑ ❑ licensed contractors to construct tire project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 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-OVER 5(EA.) 1.00 ' contracts for such projects with a contraetous)licensed pursuant to I he Contractor's Licese l-aw. SEWER-SANITARY-STORM EA.200k/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sec. .B.&P.C.Ibr this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. Ora certificate of Workers'Comps ion In ce,u a certified copy te Lab.C). Policyd�IpanY i Qperlilied Copy is hereby furnished. FIRE SPRINK ENERGY T20 Z Z citified copy is filed with the city inspection sivisiom MISC.- REFER TO ORD. O Applicant v ❑ N❑ V ❑ N❑ X to CF-RTIFICA1'801:17XEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. LU 7 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. 1 O (This section need not be completed if the permit is for one TOTAL .Y❑ N❑ Y❑ N❑ 0 Z hundred dollars(S 100)or less) U O 1 certily that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE- FEE SUMMARY LL I- mil is issued,1 shall not employ any person in any manner was to U become subject to the Workers'Compensation Laws of California. i Dao—Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } So NOTICE TO APPLICANT: If,after making this Certificate of Ex.. F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF-NL) 4,00 _ - CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IQ=GF.M.) 6.00 SEISMIC FEE 1 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that l have read this application and stale 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-CONTO H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino a t et liabilities,judgments, costs and expenses which !,CONST.TAX ay in an y ace a against s d City in.consequ nee f the PERMIT ISSUANCE 10.00 ranting of h' MECH.CONT. LIC.NO. MECH. �) TOTAL TOTAL Signature pplicant/ nU'ALI&L Un e I� OFFICE COPY POST S CARD NEAR FRONT OF BUILDIN' `j PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION L1o3'• 24 '/Sos. �� l 4872 JOB INSPECTION RECORD PERMIT EXPIRATION B ADDRESS I L"` -' r ; .�jJl> l-C.' U N I T# _LOTl. # PERMIT EXPIRES IF WORK OWNOTE: OWNER �L.� �•l-I �L- CONTRACTOR , '� ,�• ���� �,L(, �,� IS:NOT STARTED WITHIN INSPECT C DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDNATION ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE C PERT*IST NDARDS. GARAGE SLABS -Ia I ,�,✓KL POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -17•" Aaf/94 ry,, UNDERGROUND /SLAB el"uT. PLUMBING 0•27 - to /y !N4 A = ELECTRICAL ISSUANCE DATE BLOC; ELECT PLG.El ME MECHANICAL %art"lnl-- -y 1�, ❑ 11 V)hdit Cv v . . .�"o( E R BUILDING PERMIT 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIG ' �,�,/� ,� ie3 r�i9 �(� pf CO O INFORMATION WOOD FLOOR VALUATION sIPT. PLUMBING ._ �.,QGkCf•Q �'1 /'L2 MECHANICAL Arf owl PERMIT ro ELECTRICAL dtijf� Z. //./lL/l.ti /'f•/— _ FRAMING /b2L ✓ - STORIES ' TYPE CONSTR. INSULATION 4t et R 161- lo7-- td, 4- o • ¢ 6lTt c r/00 OCC.GROUP RES UNITSSD �Kke`p w PLACE:NO SUBFLOOR UNTiL ABOVE HAS BEEN SIGNED': - ++4G SU.FT.FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SiIALL BE MAD ORE 71UA PHRAGM THE CONSTRUCTION TAX IS PAID - BUILDING USE RES SND CON PB Oen., PPL ,NO.ROOFIN UNTICABOVE HAS BE IGNED ' :'rMkiFINALS.= vg's a 'DATEWV. 4014SP:; � ELASSESORSPARCELNO. ROUGH SAN.# MBING ELECT.ENERGYTRACT NO. PARCEL NO S 8 SHOWER PAN PLUMBING ENERGY CHANICAL MECH.ENERGY ACC,DATE ACC,FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST - d - Izorvlrvc ENG.SITE No. INSULATION PLUMBING GAS TEST GAS i FIRE SPRINK ENERGY L?< MECHANICAL y C] NO v N[j COVER NO WORK UNTPL ABOVE HAS BEE NEO . - HEATING FLDoO zarvE A.L.u.c. EXTERIOR SHEAR ELECTRICAL RELEASE - INTERIOR SHEAR FIRE DEPT. -I `' NE] LJ rv❑ SHEETROCK GRADE EXTERIOR LATH BUILDING -a BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE V OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILOING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM h n w ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ul ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '1 PLEASE GIVE JOB ADDRESS WHEN PHONING. 3• - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Y - IMPORTANT! CONST.TAX pv PLEASE READ REVERSE SIDE BEFORE TOTAL `l CALLING FOR FINAL INSPECTION. APPLICANTS POSTING COPY POST THIS CARD NEAR FRONT OF BUILDING eRMiT NUMBER CITY OF CUPERTINO 14872 INSPECTION DIVISION JOB INSPECTION RECORD •� \ PERMIT EXPIRATION JOB ADDRESS .'�0a 6 �• ?LI ,B A .JP� UNIT4; LOT 4t PERMIT.EXPIRES IF WORK , OWNER Dav CoH v E - CONTRACTOR , (-t/T�y¢ IS NOT STARTED WITHIN INSOYCTION DATE I INSPECTOR INSPECTION RECORD 180'DAYSOFPERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM 3 NOTE: LAST CALLED INSPECTION. - UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAI.iDATION CUPERTINO STANDARDS. . GARAGESCABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ 7 b b r - i UNDERGROUND /SLAB erS' - cT t (� . PLUMBING V•.1t.9-s•"N-VEx , 4L 1:tT. . '•.�y./ {i 0 . ELECTRICALIssUANCE DATET MECHANICALb - T%GiZ G7-' ao••-rq BLDG. ELECT rL, MECR V8 El El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED S 1z- g It V 2dp p�UILDING PERMIT WOOD FLOOR 11`�Y INFORMATION PLUMBING Y.s 'VALUATION SIFT. . it-U- C A;A; 't d MECHANICAL - - •'j(F•j'p �1F ,t� • ' ELECTRICAL - - �� PERMIT To tc7 FRAMING ' INSULATION - - STORIES TYPE CONSTR 'OCC CROU, RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO,FT FLOOR AREA TOTAL ACREACE _ ,ROOF NOTE:NO FINAL.INSP.SHALL BE MADE BEFORE DIAPHRAGM - THE CONSTRUCTION TAX IS PAID. _ BUILDING USE ROOF SHEATHING RES IND . CON PB 00- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 1:1 I] 11 ASSESSORS PARCEL NO ROUGH SAN.k PLUMBING ELECT.ENERGY . TUBS&SHOWER PAN � PLUMBING ENERGY TRACT NOPARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL ACC.DATF ACC,FILE NO BUILDING ENERGY FRAMING ELECT.FINAL TEST i zoNlNc- G.SITE No. INSULATION PLUMBING GAS TEST GAS ' FIRE SPRINK ENERGY T.]J ' MECHANICAL L I YO N❑ T,❑ .N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATINGI(4" EXTERIOR SHEAR ELECTRICAL RELEASE `� FLOOD ZONE aLD.c. INTERIOR SHEAR FIRE DEPT. Y ❑ NQ v ❑ N� I SHEETROCK GRADE - - FEE SUMMARY EXTERIOR LATH - BUILDING - INTERIOR LATH - TEMPORARY APPROVALS - BUILDING SCRATCH COAT - - ELECTRICIf . V• PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN;SIGN k0fil OCCUPANCY - 'SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU PLUMBING' S fw, FONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE -' E ECHANICAL ' IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE. TOTAL', CALLING FOR FINAL INSPECTION. .,,OFFICE COPY