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17345 APPCICAN-T TO FILL IN INFORMATION WITHIN RED,LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT T, dLC�D ygl BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ¢' 17345 I J e OWNER'S •r�✓ - PLAN CHECK VALIDATION "A E ✓/}�� V. ELECTRIC PERMIT FEE' P� PHONE • \ ��� `� CONTRACTORS NAME ''// AA UTLETS-SWITCHES-RECEP 10.00/1.00 CR `l L,C.Na, LIGHTING FIXTURES 10.00/1.00 CONTRACTORS roma (q15) PPLIANCES-RESIDENTIAL 4.00 - Qf}MolvA S . PHONE 322-6 -30)-PANELS 10.00 DATE OF APPLICATION :- - ARCHITECT - 'PLAN CHECK FEE P.C.NO. oR PANELS (OVER 200 AMP) 20.00 , 1 LIC.NO. SIGNS TRANS. 3.00 ARCH.OR E"D' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ()U1 V ii EMP.METER OR POLE INS. 20.00 L7' 2 APPLICANTS MOTORS 'SEE FEE SCH. 1 -v AooREss �I 7. " SERVICE CHANE i 20.00' O o LICENSED CONTRACTORS DECLARATION 1��' /-(- a s�j I hereby affirm that 1 am licensed under provisions of Chapter 9 H I'K f./ 198S ISSUANCE DATE ¢i (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r Z Professions Code,and my license is in full force and effect. (f1��a �{ .{ ❑ ❑ ❑ Z D= License Class Lie.Number Y�y y� CU�QryRO Q LI- Date Contractor - ¢ m s - BUILDING PERMIT ¢ S,i D OWNER-BUILDER DECLARATION INFORMATION w ;u w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION SIFT. LLD¢ Law for the following mason,(Sec.7031.5,Businessand Professions PERMIT ISSUANCE' 10.00 fwE0 Code:Any City orcounty which requires a permit to construct,alter, fD/' Q a, ¢Q Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. r" 1r)0, E//- r V �/0 O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO . w$m he is licensed pursuant to the provisions of the Contractor's License -f > Law(Chapter 9(commencing with Section 7000)of Division 3ofthe E i o Business and Professions Code)or that he is exempt therefrom and LUMBING PERMIT FEE OTV. P the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE 4ONSTR. by any applicant for apermit subjects the applicant to a civil penally ALTER-DRAIN -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 Occ-GROUP RES.UNITS their sole compensation.will do the work,and the structure is nor -- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00t - 2 Code:The Contractor's License Law does not apply to as owner of _ property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.Fr.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- - mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner . .) 2.00 BUILDING USE GAS-EASYSTEM-OVER 4 (EA builder will have the burden of proving that he did not build or im- RES IND CON PB DOW for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 EI .I,as owner of the property,am exclusively contracting with ❑ ❑ vr ❑ ❑ licensed contractors to Construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR PARCEL NO. and Professions Code:The Contractors 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 contractor(s)licensed pursuant to the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCELNO. ❑ lam a xempt under Sec.-,B.&P.C.for 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. or a certificate of Workers'Compensation Insurance,or a cerldied copy thereof(Sec.3000,Lub.CJ. Policy No. Compony 0 ❑ Olt ifed copy ish reby furnished. FIRE SPRINK ENERGY T-24 Z 2 t Ceruh• c p RI ith the city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑ O Applicants rL V N V N ~ va LU GIiRTII'IGOp E ION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. COI W � COMPENSATION INSURANCE PLG.CONTR. . LIC.NO, PLG. CL O (This section need not be completed if the permit is for one TOTAL Y❑ N❑ •'V❑ No D Z hundred dollars(E100)or less.) 'V O' 1 certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any mannerso as to V become subject to the Workers'Com ensation Laws of California. 0. Date-Applicant p ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F, Z emption,you should become subject to the Workers'Compensation APPLIANCE _ 5.00 PLAN CH provisions of the Labor Code, you must forthwith comply with FEE (D U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE h50 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 L the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.1: Lender's Name HEATING UNIT(OVER 100,000 B.T.U,)9,50 ELECTRIC - - Lender's Address i� information Ois correct. reaagree application and all c that and above VENTILATION FAN (SINGLE) 4.00 - information n cornet I agree to comply with all oily and county PLUMBING ordinances and stare laws relating to building construction, and BOILER-ODMP(3 H.P,Or 100,000 B.T.U.) 6.00 hereby outhmim representatives of this city to enter upon the BOI LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) Since to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - Cupertino against liabilities,judgments, costs•and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the ranting of this permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL J , Signature -AfTpplicaaDComftactor Date i OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO .• 17345 W , I INSPECTION DIVISION JOB INSPECTION RECORD a l / p �jO/ PERMITIEXPIRA1 ' 3 )TION JOB ADDRESS ( 4 L6 D f11) 1 !C_ UNIT# _LOT# t rtes' r - PERMIT EXPIRES IF WORK OWNER ' Q CONTRACTOR J G-(L CO e • IS NOT STARTED WITHIN- INS TON DATE INSPECTOR INSPECTION RECORD leo DAYS of PERMIT issu- FOUNDATION - ANCE OR 180 DAYSLFROM NOTE: • LIFER - � � ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION PR EGUNITE CUPERTINO STANDARDS. GARAGE SLABS �'�s�11.7 ' C/_ 2 7 `1' # ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 'nF'It 111989 UNDERGROUND /SLAB + JA V< PLUMBING • ELECTRICAL Cir. of CUmuno ISSUANCE DATE MECHANICAL BLDG ELECT PLG. .MECR. FINALED IN DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Cot\ /] BUILDING PERMIT v' OVI INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING 1r _ MECHANICAL - TCS ELECTRICAL ., PERMIT TOFRAMING r` .VA� t, ` INSULATION ., TYP ONSTR UP RES UNITS I PC PLACE NO SUBFLOORUNTIL ABOVE HAS BEENSIGNED . ROOF NOTE:AO FINAL INSP.SHALL BE MADE BEFORE SO.FT,FLOOR AREA TOTAL ACRLAGE DFAPHRAGM THE CONSTRUCTION TAX IS PAID ' ' .) •w - BUILDING USE - ROOF SHEATHING Res IND CON PR OII,-❑ ❑ ''© ❑ El1` -' APPLY NO ROOFING UNTIL ABOVE HAS BEENSIGNEDFINALS DATE INSP. ASSE SSORS PARCEL NO 'ROUGH SAN.# 'PLUMBING ELECT.ENERGY TNACT NO. PARCEL NO " TUBS 8 SHOWER PAN PLUMBING ENERGY , MECHANICAL MECH.ENERGY Acc.DATE ACC.PILE No. ELECTRICAL BUILDING ENERGY FRAMING - ELECT.FINAL TEST ZONING ENG'SIT E NO. INSULATION PLUMBING GAS TEST GAS - - FIRE SPR INK ENERGY MECHANICAL ❑ TN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING :N❑. ❑ .FL000 LONE A.LU C. EXTERIOR SHEAR ELECTRICAL RELEASE ❑ N❑ I NE INTERIOR SHEAR FIRE DEPT. SHEETROCKlq( + GRADE FEE SUMMARY EXTERIOR LATH BUILDING . INTERIOR LATH TEMPORARY APPROVALS " BUILDING ' SCRATCH COAT ELECTRIC PLAN CHECK,- . GAS FEE r _717 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY- SEISMIC FEE _ OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE-WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - a MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — _ IMPORTANT! coNsr.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 3 �' CALLING FOR FINAL INSPECTION. 1 OFFIC16COPV