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14525APPI-ICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PERMITNUMBER PROJECT I DENTIFICATION APPLICATION & PERMIT . BUILDING -ELECTRICAL- PLUMBING -MECHANICAL 14525 BUILDING ADD HE35 Q C ( P( OWN R' p NAME ULr �,�R.TI W O S - PHONE Oe TV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION = CONTRACTORS i NV)-OUTLETS L LIC.NO. 5 I /O -SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 noo ee TORS� p ` �J 3�`I2 Lav 1Y11vn PHONE I��V�O PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 ARCHITECTQ1 ID OR lJe-�' ' 'j l,(.)/}i>�f/ ENGINEER UC. NO PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS.. 3.00 ADDRREOR SS ENG.SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. - 20.00 ZIP - kx `"�r""•""� AOFESNr$ A.OREss / MOTORS. SEE, FEE SCH. SERVICE CHANGE 20.00 - LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sech n 7000) of Division 3 of the Business and Professions Cod a i Li is in full (orpe aBsk ,[jAi' - `e'1 Lia Number I SUANCE DATE ELECT. E PLG. MECH. ❑ DaenuClass Date Contractor - L11 OWNER -BUILDER DECLARATION I hereby collo that I oro exempt from the contness ractor's is License CodLawe: Any citylowtng monly whichauiresapero7031.5, ut town Professions Code: Any city or county which requirespermit to construct, alter, DING PERMIT INFORMATION MISC. - REFEfl TO ORD . VA ION Al, $/F T. PERMIT ISSUANCE 10.00 Improve, demolish. Or for such to ILS issuance. talsohat any structure, prior signed re is tic the applicant for such permit to file a sCont statement that he is licensed pursuant to the provisions of the Contractor's License ELEQ CONTR. LIC NO. ELEC. - TOTAL V V PERMIT TO DTV. PLUMBING PERMIT FEE the Law (Chard Pl.co ions,Codeng ) lit Section I, 00) exempt Business and Professions Code) or that he is exempt therefrom and I // % STORIES TYPE CONSTR. CONST the basis for the alleged exemption. Any caofSection malty permit dollars theapplicam toacivil penalty applicant by any more than of not more than fivC hundred Dollars (45001.): ALTER-DRAIN-WATER'(EA.) 5.00 ❑ I, as owner of the property, or my employees with wagesas their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 5.00 . intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mprove me menta are not intended or offered for sale. If, however, the building - FIXTURES - PER TRAP 5.00 -GAS•EA.SVSTEM-11NC.40UTLETS 6.00 so. PT. FLOOR AREA TOTAL ACREAGE , or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or am. prove for purpose of sale.). [1. I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4'(EA.) 2.00 BUILDING USE 'RES IND CON PB Omer ❑ ❑ ' ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 3000 . licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Conra tctor's License Law does not apply to an owner of property who builds or improves thereon, and. who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractons) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 1 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C. for this reason WATER HEATER WIVENT .6.00 Owner Data WATER SYSTEM 5.00 ACL. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sel&insure, ar a cetlil'icam of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. Copy Ihcr y?fa X00, Lab.C. Policy No,• n+CompanyC0r"f(-_W.TWT.0f '• ' , FIRE SPRINK - V ❑ IS[] -ENERGYT]4 V ❑ N❑ ❑ Certified copy ishereby furnished. 7YN/9P41C4 P000 ❑ Certified copy is riled with lite city inspection division. Applicant MISC. - REFER TO ORD. CERTIFICAI'1: OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG.CONTR. LIC. NO. - PLG. TOTAL - COMPENSATION INSURANCE. IThis section need not be completed if the permit is for one Y ❑ N❑ Y ❑ N❑ QTY. MECHANICAL PERMIT - . FEE FEE SUMMARY hundred dollars IS 100) or less.) I certify that in the performance of lite work for which this per- mit is issued, I shall not employ any person in any manner so as to BUILDING td ✓ Sa become subject to the Workers' Compensation Laws of California. Date Applicant- '10 ALTER OR ADD TO MECH. 5.00 NOTICE APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT ITO lo=r-F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE s'fJ CONSTRUCTION LENDING AGENCY I 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. 3097, Civ,C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lenders Name - Lender's Address I certify that l have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) .. 4.00 PLUMBING BOILER -COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon lite above-mentioned property for inspection purposes. MISC. • REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which ay i y way ac rue a ,lips said City in consequence of the mat- grof thispe L / I� ��88 PERMIT ISSUANCE 10.00 MECH. CONT LIC. NO. MECH. TOTAL TOTAL J7 Signa ore ofA licant/Contractor ate OFFICE COPY POSTTHIS CARD NEAR FRONT OF BUILDING CITY ,OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS GRAVIES UNIT# LOT#.' - OWNER WINDOW DOCTOR CONTRACTOR - ' PERMIT NUMBER 14525 . PERMIT EXPIRATION - PERMIT EXPIRES IF WORK ' IS NOT. STARTED WITHIN 180 DAYS OF PERMIT ISSu,- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. ' INSPECTION DATE . INSPECTOR INSPECTION RECORD FOUNDATION' - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED COMPLY WITH THE APPROVED PLANS AND CITY OF. CUPERTINO STANDARDS. UFER - PREGUNITETO . I 1 PERMIT VALIDATION GARAGE SLABS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED cE UATO! UNDERGROUND/SLAB PLUMBING , ELECTRICAL MECHANICAL - ., LECT ❑ ❑ PLG.• MECH ❑ ❑, . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - - BUILDING PERMIT INFORMATION _ " WOOD FLOOR VALUATION S/FT:' PLUMBING MECHANICAL ELECTRICAL. - PERMIT TO ^ T •'�,�. ::_ C i•/ y. r . FRAMING'. INSULATION STORIES TYPE CONSTR. OCC, GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF- - NOTE: NO FINAL INSP. SHALL BE MADE BEFORE' THE CONSTRUCTION TAX IS PAID ' SO, FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM - ROOFSHEATHING BUILDING USE RES' IND CON PB OMe, ❑ ❑' ❑ ❑ APPLY NO ROOFING UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN* PLUMBING ELECT. ENERGY - TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO , MECHANICAL - MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE ACC: FILE N0. FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST GAS FIRE SPRINK v ❑ N ❑ ENERGY T-24 v ❑ "❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING •. EXTERIOR SHEAR - - ELECTRICAL RELEASE FLOOD zoNE Y ❑ ".❑ ALuc. ° ❑ "❑' INTERIOR SHEAR` .' FIRE DEPT, SNEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING'- BUILDING . . J INTERIOR' LATH - TEMPORARY APPROVALS SCRATCH COAT ELECTRIC ' PLAN CHECK FEE - - G' v AS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR.INSPECTION BY PHONING 252-4505, 1- ONE WORKING DAY BEFORE REQUIRED INSPECTION. F - PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY