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13968 Ai'PiICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER • —BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT 13968 BVL 1,G - 40oRES 5 �t , -n BUILDING—ELECTRICAL—PLUMBING—ME CHANICAL l PLAN CHECK VALIDATION 4sr'•6-w+'w OWNERNAIM�A - OTY. ELECTRIC PERMIT FEE CONTRACTOR'S OUTLETS-SWITCHES-RECEP 10.00/1.00 id NAME10.00/1.00 n �� kAIL 10.NO3iLt—Jr'( LIGHTING FIXTURES If% L CONTRACTOR a II ,fys�i L�/GJ- APPLIANCES-RESIDENTIAL 4.00 AD R SS r\ lit 10,00 DATE OF APPLICATION PHONE 5 -7k� PANELS 20.00 - PLAN CHECK FEE P.C.NO. ARCHITECT ' PANELS (OVER 200 AMP) ��➢ OR 4 b .3.00 n ENGINEER LIC.NO. SIGNS TRANS. PERMIT VAI-ILA I ION ARCH.OR ENG. SPECIAL CIRCUIT 5,00 rT ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPucANTsSMOTORS SEE FEE SCH. 1 '� 9f P ADDRES 20.00 L 18 s �L 'f, YZ_,G_p /C 2— SERVICE CHANGE w o a LICENSED CONTRACTORS DECLARATION ISSUANCE DATE at u�i 1 hereby affirm that I am licensed under provisions of Cha P[er 9 BLDG. ELECT. PLG. MECH. (commencing with Section 7000)of Division 3 of the Business ad ❑ ❑ F D z Professions Co n y ILeense is in fell for II�e1feL'LG, ❑- z o ow — License Clas Lie,Number II I! o y H w Date 10-10Contractor BUILDING PERMIT a yINFORMATION OWNER-BUILDER DECLARATION REFER TO ORD u u MISC.— VALUATION $/FT. X f I hereby affirm that I am exempt from the ContBusiness nd Professions License PERMIT ISSUANCE 10.00 LL o a Law for the following reason.(Sec.7031.5,Business and Professions I QO — M � Cade:Any city or County whichrequiresapermitloconstrucl,alter, LIC:NO. w E improve,demolish,Or repair any slmcture,prior to its issuance,also ELEC.CONTR. TOTAL 2 M<0 TOTAL PERMIT TO ea o u requires[he applicam for such permit to file a signed statement that wB an he is licensed pursuant to the provisions of the Contractor's License iLZ Law(Chapter9(commencingwith$ection]000)Of Uivision7otthn PLUMBING PERMIT FEE f < Business and Professions Code)or That he is exempt therefrom and DTY. STORIES TYPE CONSTR. S s D the basis far the alleged exemption.Any violation of Section]031.5 v';$ by any applicant forapermil sdbjecis the applicannoacivil penalty ALTER-DRAIN&VENT-WATER IEA.) 5,00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.OR UP. RES.UNITS (heir sole compenwfion,will d0 the work,and the structure is not intended or offered for sale(Sec. 7044, Business end Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 . �� Code:The Contractor's License Law does not apP1Y to an owner of FIXTURES-PER TRAP 5.0011 SO.FT.FLOOR AREA TOTAL ACREAGE property who builds or improves thereon,and who does such work himself or through his own employees,provided thalsuchjmprove - GAS-EA.SVSTEM•11NC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 RES IND BUILD,— builder usEPB Other builder will have the burden of proving that he did not build or im- ❑ ❑ ❑ ❑ ❑ prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 O L as owner of the Property,am exclusively contracting with ASSESSORS PARCEL NO. licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 I 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 contraclor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO, the Contractor's License Law. ,EE&P.C.for this ❑ Iamexemptunder Sec. WATER HEATER W/VENT 6.00 reason OwnerWATER SYSTEM 5.00 ACC.DATE ACO.FILE NO. Owner WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-Insum. ZONING ENG.SITE NO. or a certificate of Workeri Compensation Insurance,or a certified copy thereof(Sec.3800, Immy.1,�_--�, Policy ere Company sly— s�Ep FIRE SPRINK ENERGY T34 O ❑ sfsed copy is hereby form X'� Z Z Certif�acpy is a wR the nI division. MISC.- REFER TO ORD. Y ❑ N v ❑ NO Applicant�y.e.IL a 10,00 FLOOD ZONE A.L.U.C. 1- y, TI I- SEM VV PERMIT ISSUANCE — CERTIFICATE.PE EXEMPTION FROM WORKERS' Y❑ N❑ Y ❑ N❑ LU > COMPENSATION INSURANCIi PLG,CONTE. LIC.NO. TOTAL 1 0 (This section need not be completed if the permit is for one :3Z hundred dollars(S 100)or less.) FEE FEE SUMMARY U O I certify that in the perlbrmance of the work for which this per- QTY. MECHANICAL PERMIT I— mil is issued,1 shall not employ any Person in any manner so is to BUILDING U' Q become subject to the Workeri Compensation Laws of California. ALTER OR ADD TO MECH. 5.00 O W Date Applicant } tail NOTICE TO APPLICANT: If,after making this Certi(iate of liz- 5 00 PLAN CHEC F,• Z emptron,you should become subject to the Workers'Compensation APPLIANCE FEE r provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO IOMC.F.M-) 4.00 (� such Provisions or this permit shall be deemed revoked. e Jh AIR HANDLING UNIT(OVER 10,000 C.F.M.) 6.00 SEISMIC FE CONSTRUCTION LENDING AGENCY Cl I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 MICROFILM the performance of the work;or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 3097,Civ.CJ. Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)B,50 ELECTRIC Lenders Address 1 certiy that 1 havread this application and state that the above VENTILATION FAN (SINGLE) 4'00 fe PLUMBING information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ordinances and state lawsMatingto building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.I MECHANICAL above-mentioned property for inspection purposes. REFER TO ORD. (We) agree to save, indemnify and keep harmless the City of MISC.• 10 00 CONST.TAX Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE Mul. y way accrue against said City in consequence of the LIC.NO. MECH. this p I. r_ /� / _�/� MECH.CONT. TOTAL TOTAL Cj 37 f 'ant ontractor Data (' OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING reRNnr NUMBER CITY OF CUPERTINO 1396$ ' T INSPECTION DIVISION J_ µ JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS 10745 N DEANZA uNIT# Lor# EPERMIT EXPIRES IF WORK OWNER SPORTS CITY CAFE CONTRACTOR ARROW SIGN IS.NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION IASTCALLED INSPECTION. UFER PREGUNITE r� PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- UNDERGROUND /SLAB e/ N•S,A•' PLUMBING O``,a " _eh1TE ELECTRICAL - � Iss ANI:^ ArE MECHANICAL - BLDG. �LECr- PLD. NECK❑� ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION s/FT. PLUMBING MECHANICAL PERMIT TO SELECTRICAL - FRAMING - I STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS I` DACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FLOOR AREA TOTAL ACREAGE 1 _ ROOF DIAPHRAGM BUILDING USE RES IND CON PB Other El 0 N APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1 El PARCEL NO. ROUGH PLUMBING 1-07- o 13 TRACT NO. PARCEL NO. GAS TEST MECHANICAL - ACC.DATE ACC.FILE NO. • ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T.24 MECHANICAL Y ❑ N❑ YE] N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE LATH—INTERIOR ELECTRICAL aL:u.c. LATH—EXTERIOR FIRE DEPT. - v N� v ❑ <:] SHEETROCK GRADE - FEESUMMARY SHEARINTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING ,•j�) - FIREWALLS ELECTRIC - PLAN CHECK ! GAS - FEE II / aNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occUPANCY SEISMIC FEEr OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC fir. ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z' MECHANICAL TX ANICAL CO — SEE PERMIT FOR EXPIRATION DATE — NS . A IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL j '� 3 CALLING,FOR FINAL INSPECTION. OFFICECOPY