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17114 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION I .PERMIT NUMBER BUILDING a L • Sfat'S APPLICATION & PERMIT AD DRESS -ELECTRICAL-PLUMBING-MECHANICAL • 17114 qqA BUILDING OWNER'S C PLAN CHECK VALIDATION rvnmE 1 CITY. ELECTRIC PERMIT FEE I er PRorvE -�7) NAMERAcroR _ '/ U ETS-SWITCHES-RECEP 10.00/1.00 }LUC.NO 1/40 rv1(e LIGHT G'FIXTURES A 10.00/1.00 ADDRESS TORS /1 ..,c' APPLIAN S-RESIDENTIAL 4.00 ' '11T r'Cisl PHGNE 0,Y/(0 PANELS 10.00 'DATE Of APPLICATION ARCHITECT (PLAN CHECK FEE P.C.N0. OR - PANELS (OVER 0 AMP) 20.00 .- ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADORCEs ENG. SPECIAL CIRCUIT $,QQ PERMIT VVALIDATION ZIP EMP.METER OR POLE I S. 20.00 Z 1,�TJg APPLICANT ssTs MOTORS EE FEE SCH. SERVICE CHANGE 20:00 F00 O o LICIiNSEU CONTRACTORS DECLARATION a v v 1 hereby affirm that I am licensed under provisions of Chapter 9 y a$ (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE H N z Professions Code.and my license is in full force and effect. - BDOG. ELECT. PLG. MECH. p 0 w o License Class a-.a p Lic.Number Y&( :T lb(' _ ❑ ❑ �` ,2 H w Datc-A-��Contractor {1c.S - tFY wa OWNER-BUILDER DECLARA'T'ION BUILDING PERMIT K o a " I INFORMATION X g LL w 1 hereby affirm that I am exempt from the Contractor's License MISC.-' REFER TO OR u 0 j Low for the following reason.(Seo 7031.5,Business and Professions VALUATION $/FT. - .PERMIT ISSUANCE 10.00 ,,4 Code:Any molish coo ntywhiny structure,prior alteq Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC,NO. ELEG 0 at requires the applicant for such permit to(ilea signed stutemmnt that TOTAL a ce m he is licensed pursuant to the provisions of the Contractor License I PERMIT TO z i Law(Chapter 9(commencing with Section 7000)oflAvision 3 often _ 4 a Business and Professions Code)or that he is exempt therefrom and G PLUMBING PERMIT FEE r m the basis for the alleged exemption.Any violation of Section 7031.5 (STORIES Tv E CONSTR. d ; _ by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars(S500).): TER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as gq FLOW PROTECTDEVICE 4.00 their sole compensation,will do.the work,and lite structure is not . OCC.GROUP RES.UNITS intended or offered 10, sale(Sec. 7044, Business and Professions .DRAI -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 docs such work FIXTUR -PER TRAP 5.00 SO.PT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meritsare not intended oroffered for sole.If however.the building GAS-EA.S TEM-1 INC.4 OUTLETS_6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SV EM-OVER 4 IEA.) 2.00 builder will have the burden ofproving that he did not build or in* BUILDING USE prove for purpose of Salc.). INDUSTRIAL TE INTER. 30.00 RES IND CON PB Other ❑ I,as owner of life property,am exclusively contracting with O f-1 Code,licensed contractors to construct the project(See 7044,Business LAWN SPRINKLER - I INC 5 V.B. 6.00 I ASSESSORS PARCEL NO. 1:1 El and Professions CodI'lie Contractor's License Law docs not apply V-- to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS- VER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to I the Contractor's License Law. SEWER-SANITARY-STO MEA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Ser..,B.hPC.for this WATER HEATER W/V EN T reason 6.00 O. Owner Date WATER SV STEM 5.00 AIC.OATE ACG FILE NO. l WORK IiRS'COMPIiNSA'I'[ON DEWATER TREATING EQUIP. 5.00 u 1 hereby afit rmI that I I.ave ave,tific.ty oFconsent toself-insure. no a certificate of Workers'Compensation Insurance,or a certified NTNG ENG.SITE NO. copy there 1 �c 3 OQ F,ocy ) I Policy No. / + Company :SupL'ri Or A),,+/ O O Certified copy is hrechy furnished. Z Z Q Certif,,•�1 coy is filed with the city inspection division. FIRESPRINK ENERGYT24 ' f- O APPlicant-/t-fl�,S MISC.- REFO'9RD. PERMIT ISSUANCE Y ❑ N� v N� ir Ln CER'I'I 19C\TE OP EXEMPTION FROM WORKERS' 10.00 FLOODZONE A.L.U.C. LU Q COMPlzlxS TION INSURANCE PLG.CONTR.' LIC. PL �� (This welkin need not be completed if the permit is for one V N� y N� Z hundred dollars($100)or less.) V U O 1 certify that m life performance of lite work for which this per- CITY MECHANICAL(PERMIT FEE I FEE SUMMARY L U mit is issued,I shall not employ any person in any manner so as m become subject to the Workers'Compensat ion Laws of Calil'onlia. W Daze Applicant ALTER OR ADD TO MECH. 5.00PSEIS6CFEE BUILDING } W NOTICE TO AITCICANT: If,after making this Certificate of Ex- F ? emplion,you should become subject to the Workers'Compensation APPLIANCE provisions of the labor Code, you must forthwith comply with 5.00 U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0=C.6M.) 6.00I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00the performance of the work 1or which this permit is issued(Sec.3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.)9� 8:00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9,50 I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information n correct.1 agree to comply with all city and musty BOILER-LX)MP PLUMBING ordinances and state laws relating m building construction, and 13 H.P.or 100,000 B.T.U.) 6.00 I hereby enthorim representatives for of this city Wen ler upon [he BOILER-COMP above-mentioned properly for inspection purposes. (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree less to save, indemnify and keep harmthe City of MISC.- REFER TO ORD. operon. against liabilities,judgments, costs and expenses which CONST.TAX may t any way accrue against said City in mnsequence of the PERMIT ISSUANCE. /Z. }gOQ (4,'.Op rank hi/spermit. // MECH.CONT, LIC.NO. MECH. (' 1•CC�hI�Y ISS / TOTAL ` Signature A pplman"Cantramor ate 1 /66d �'cQ TOTAL al t {AN\ OFFICE COPY C 1 POST THIS CARD NEAR FRONT OF BUILDING SER CITY OF CUPERTINO R,<.1N7114 INSPECTION DIVISION JOB INSPECTION RECORD ^� PERMIT EXPIRATION JOB ADDRESS_'j(�Lo J rte+ \�ylib UNIT# _LOT# . , PERMIT EXPIRES IF WORK OWNER wl CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE - INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. 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 7 - vt_Rwl 1AUDATTON GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLA.B - I :,�ip PLUMBING ELECTRICAL ' ISSUANCE UAIE MECHANICAL ' - BLDG I ELECT,I PEG. n+ECH ❑ ❑ ❑ l�t 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUAI uiq 5/E T. ' MECHANICAL - ELECTRICAL- PERnln TO FRAMING INSULATION STORIES �E CONSTR ,UCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF III IT cLouRARE,T TOTALACREAGE NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDI NO USE ROOFSHEATHING RES IND coN PB Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ El 1:1 El SAN.q ROUGH _ ASSESSORSPAHCELNO PLUMBING ELECT.ENERGY �� TUBS&SHOWER PAN PLUMBING ENERGY UAtTRACT ND. PARCEL No MECHANICAL MECH. ENERGY •� ' ELECTRICAL BUILDING ENERGY vm u ACC DATE ACC.LILE NO FRAMING - ELECT.FINAL TEST INSULATION - PLUMBING ZONING ENG.SITE NO. GAS TEST NFIREDEPT. Z FIRESPRINK ENERG�T2G COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED Z425 ° ❑ IN ❑ N❑ EXTERIOR SHEAR lHASBEEN RELEASE EEdou ZONE a.Luc. INTERIOR SHEAR `'❑ N❑ t ❑ N❑SHEETROCK - - EXTERIOR LATH FEE SUMMARY BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTFER MITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. - MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, O� ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL 2 �� I IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE I CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY