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14042APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY • •BUtEDING PROJECT IDENTIFICATION APPLICATION &,PERMIT BUILDING - ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 14042 BUILDING ADDRESS ��' .OWNER'S NAME�.,..�/ Q /� V/v 44 1Lf3 PHONE CITY. ELECTRIC PERMIT FEE PLAN CHECK VA ATION -DATE OF APPLICATION NAME CONTRACTOR - NAME ,E Si. (_S c.No.LS'34ZJo14 I UTLETS- SWITCHES -RECEP 10.00/1.00 10, IGHTING FIXTURES10.00/1.00 2170. CONTRACTOR'S5., ADDRESi 0/� t � q- /40r, PHONE V77�/ p/yw PPLIANCES- RESIDENTIAL 4.00 / PANELS 10.00 ,Q ARCHITECTPANELS OR ENGINEER LIC. Na. (OVER 200 AMP) 20.00 jPLAN CHECK FEE P.C. NO. SIGNS TRANS, 3.00 ARCH. OR ENG ADDRESS ZIP SPECIALCIRCUIT S.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 rN\•` ADDRESNrs ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 X11 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9. (commencing with Section 7000) of Division 3 of the Business and Professions Code!", license is in full a f 0I 4 License Class Lic. Numb ISSUANCE DATE 1 BLgG. ELECT. PLG. MECH. ale Contractor 9144W MfO BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I so exempt from the Contractor's License Professions Law for the ity or countng whichn. requirsa perminess t to Code: Any city or county which structure permit to construct, alter,ff improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he isexempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 INFORMATION MISC.- 'REFER TO ORD VALUATION -'' �/ �0. $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL CITY. PLUMBING PERMIT FEE PERMIT TO STORIES TYPE CONSTR. ALTER -DRAIN -WATER IEA.) 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).)r ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC: GROUP RES. UNITS ' DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work F IXTUR ES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale, If, however, the building GAS-EA.SYSTEM-111NC.40UTLETS 6.00. or improvement is sold within one year of completion, the owner- builder will have. the burden of proving that he did not build or m- Prove for purpose of sale.). ❑ I as owner of the property, am exclusively contracting with licensed contractors to constant the project (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 GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 GAS BUILDING USE IND eNry PB Omer • ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SAN ITAR V -STORM EA. 200ft/10.00 TRACT N0. PARCEL NO. WATER HEATER W/VENT 6.00.� ❑ l am exempt under Sec._, B.&P.C. for this reason Owner Date WATER SYSTEM 5.00 ACC. -DATE ALC. FILE NO. WORKERS'COMPENSATION DECLARATION ' L- WATER TREATING EQUIP. 5.00 y I hereby affirm that 1 have a Certificate of consent to self-Caure, a certificate of Workers' Compensation Insurance, or a certified - ZONING ENG. SITE NO. dor copy thereo Se Lab.C.). 1 Poli ompany ❑ Curti ledcop is hereby furnished. ❑ Certifie copy s fi a 't the city inspection division. pplicaut - CERTIFICATE OF EXEMPTION FROM WORKERS' , FIRESPRINK Y ❑ N ❑ ENERGY T 24 , Y ❑ No MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 O FLOOD ZOrvE A. L.u.c. PLG. CONTR. LIC. NO. PLG. / TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ CITY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars(S 100) or less.) I Certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to BUILDING become subject to the Workers'Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 I hereby affirm that there is a construction lending agency for the performance of the work for which.this permit is issued (Sec.MICROFILM 3097, CIv.CJ. HEATING UNIT (TO 100,000 B.T.U.)' 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRICd- Lender's Name Lender's'Address I VENTILATION FAN (SINGLE) 4.00 PLUMBING I I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building consVac"Imn, and BOILER-COMP13 H.P. or 100,000 B.T.U.) 8.00 1801 LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize, representatives of this city to enter upon the 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 may in any way accrue ago... Said Cit consequen a of the granting of this permit. - / b PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. roTAL TOTAL C;2/ 7l0 ig lure of Applicant Contractor put. OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING ' CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD • _ - JOBADDRESS 22047 CLEARCREEK' UNIT# 'LOT# - - - ,OWNER RON FAIRCHILD CONTRACTOR SWANI'POOLS Pf RAIIT NUMBER `u • 4042' (' PERMI,T�EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- OR 180 DAYS FROM ANCEFOUNDATION LAST CALLED INSPECTION. INSPECTION - DATE - INSPECTOR INSPECTION RECORD ODL _1 _ , UFER PREGUNITE PERMIT VALIDATION r 4eiUNDERGROUND/t �� ISSUANCE DATE "ApWAGPOUR NO CONCRE E UNTIL A8BOVE HAS BEEN SIGNED SLABO PLUMBING ELECTRICAL_3.8g MECHANICAL _ a�,LCrO--,c. b ELECT. e PLG. MECH, _ 0. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL pENMIT TO r ELECTRICAL FRAMING STORIES ' TYPE CONSTR. INSULATION Q OCG GROUP I ES. UNITS SP,L►ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - SO. FT, FLOOR AREA TOTAL ACREAGE :DIAPHRAGM BUILDING USE RES IND CON PB 00 - 0 0 ❑ ❑ 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. - ROUGH PLUMBING TRACT NO. PARCEL NO. GAS TEST - 3- $ 40 - MECHANICAL ACC -GATE ACG FILE NO. ELECTRICAL '`XF,INA'LS DATE INSP. FRAMING SAN # I - zomwG ENG. SITE NO. - - INSULATION PLUMBING p GAS FIRE SPRINK YLOON❑ ENERGY L]A Y F] NC] MECHANICAL d COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED;am HEATING FNE D ZO _ Y Ej N� Y A.L.U,C. 0 N❑ LATH—INTERIOR - ELECTRICAL o7 LATH—EXTERIOR FIRE DEPT. SUMMARY SHEETROCK - GRADEFEE SHEAR INTERIOR BUILDING p1L 6 °1 BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE =� NO TAPE OR PLASTER UNTIL -HAS ABOVE EEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM -� uJ + ARRANGE FOR INSPECTION BY PHONING 252-4505, F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE, GIVE JOB ADDRESS WHEN PHONING. I -SEE PERMIT FOR EXPIRATION_ DATE - ELECTRIC PLUMBING r MECHANICAL CONST. TAX - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY