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14812 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - - GUI LD1 NG PROJECT I DENT]FICATION '+ - PERMIT NUMBER BUILDING APPLICATION & PERMIT 4� �'Oo '� ADDRESS I G BUILDING-ELECTRICAL-PLUMBING-MECHANICAL v� OWNEn'. - PLAN CHECK VALIDATION NAIVE • . f OTY. ELECTRIC PERMIT FEE PHONE " NAME acrpfls UTLETS-SWITCHES_-RECEP 10.00/1.00 L LIc,NOS �� LIGHTING FIXTURES 10.00/1.00 - rorvrRA TOR's [APPLIANCES RESIDENTIAL 4.00 ' ADDRESS. PHONE PANELS 10.00 PATE APPLICATION ARCHITECT• PANELS (OVER 200 AMP) 20,00 PLAN CHECKK FEE P.C.N0. OR ENGINEER - uc.No. SIGNS TRANS. 3.00 ADDREOR SS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS _ MOTORS SEE FEE SCH. -�//J/A/ AOOflE53 4pkid SERVICE CHANGE 20.00 _- °w .0 LICENSED CONTRACTORS DECL RATION ��/�• ¢ v eHi I hereby affirm that I an licensed under provisions of Chapter 9 ISSUANCE DATE w<a, (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. o z Professions Cad�ynd y license is in full r fj ❑ ❑ ❑' Z 02- License Sl�ss_._6 Lic.Number 1 ❑ Cornruclor- _ s BUILDING PERMIT ¢.¢w 4 OWNER-BUILDER DECLARATION INFORMATION o a.0MISC.- REFER TO ORD w g LL VALUATION $/FT. N I hereby alfirm that 1 am exempt from the Contractor's License u o 4 Law for the following reason.(Sec.7031.5,Business and Profess ions PERMIT ISSUANCE' 10.00 -w-+ Code Any city or county which requires a permit toconstrucl,ah- 2 2 ¢ improve,demolish:or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. wD, requires the applicant for such permit to file a signed statement that TOTAL m, pER2 a- ry7 TO he Is licensed pursuant to the provisions of the Coutroetoi a License Fii Law(Chapter 9(commencing with Section 7000)of Division 3 of the Wgz( zQ 4 o Hisino.and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H the basis far the alleged exemption,Any violation of5ection 7031.5 STORIES TYPE CONSTR. by anyappliena fora permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EP.) 5.00 of not more than five hundred dollars($500).): ❑ [,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 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 himself or through his own employees,provided that such improve- mentsarenetintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6,00 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 he did not build or im- RES IND CON PB Omer prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 _ O I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the 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 contractor(s)licensed pursuant to. the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No. ❑ l am exempt under Sec. .BAP.C.for this WATER HEATER'W/VENT 6.00 reason Owner _ Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPGNSA'rION DECLARATION WATER TREATING EQUIP. 5,00 I hereby affirm Ihat'1 have a certificate of consent to selfusure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a cc tified. copy thereof(Sec 3800,Lab.C.I Policy No. Company O Certified D y hereby furnished. FIRE SPRINK ENERGY T-24 Z Z Certifine is f th city inspection division. MISC.- REFER TO ORD. LD Applicant _ r❑ N❑ Y ❑ N❑ - F' wPERMIT ISSUANCE .10.00 FLOOD ZONE A.L.U.C. CERTIFICAT OF f:XEMPTION FROM WORKERS' W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d O (This Section need not'be completed if the permnit is for one TOTAL Y❑ N❑ Y❑ N❑ Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers}Com easation Laws of California. O w p BUILDING /�.� n Date Applicant ALTER OR ADD TO MECH. 5.00 } m emplimNOTIC17 TO APPLICANT: If,after making this Certificate to Ex- F Z emvisionyou should Labor Code. to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,090C.F.1,10 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0DOOC.EM.) 6.00 SEISMIC FEE 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(See HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). . Lender's Name Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC _ I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ordina ccs n correct. I agree to comply with all nst and county and PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon Be BOILER-COMP(Over IDQ000 BTU)SEE FEE SCM. MECHANICAL above-mentioned property for inspection purposes. (We) agree 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 an a) 'ceras against said City in consequence of the anlingo lY MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature f Ali nt/Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER =` CITY OF CUPERTINQ 14812 INSPECTION DIVISION • JOB INSPECTION RECORD " PERMIT EXPIRATION j JOB ADDRESS 20387 Clifden Way UNIT# -LOT# PERMIT EXPIRES IF WORK OWNERWelnSOth - CONTRACTOR IS NOT STARTED WITHIN - INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OFPEAMITASSU- ' FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED . ' PREGUNITE TO COMPLY,WITH THE APPROVED PLANS AND CITY OF PERMIT.VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS ' r POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED !� •_ v t � UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL _ .IBLDG, ELECT.I PLG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � ' 'l. BUILDING PERMIT WOOD FLOOR .•+ INFORMATION PLUMBING T VALUATION SSIFT, MECHANICAL ~ I O ELECTRICAL PERMIT To -,� FRAMING rPJui;y�< k ' r INSULATION ' STORIES TYPE CONSTR. - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ` SO,FT.FLOOR AREA TOTAL ACREAGE ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING BUILDING L usE • RES IND CON PB om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑' El "❑ ID ASSESSORS PARCEL NO ROUGH SAN.# - - ' PLUMBING - ELECT.ENERGY - ' TRACT NO "PARCEL NO. . TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC.FILE NO. ELECTRICAL BUILDING ENERGY - r FRAMING J ELECT.FINAL TEST .2 DINING ENG.SIDE NO, , .INSULATION PLUMBING J GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T-24 I - - , COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v E] N[] v,❑ No EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC.- Y❑ 'N,❑ Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK . GRDE FEE SUMMARY • EXTERIOR LATH �/ BUIALDING ,INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC T FEEN CHECK GAS 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 ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING: — SEE PERMIT FOR EXPIRATION DATE — , MECHANICAL IMPORTANT! CONST.TAX, PLEASE READ REVERSE SIDE BEFORE TOTAL - r J CALLING FOR FINAL INSPECTION. OFFICE COPY