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15655 APPLICANT TO FILL IN INFORMATION WITH IN'RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT 1 DENTI FICATION - - PERMIT NUMBER BUILDING , APPLICATION & PERMIT � 15655[C [ ` _ L LA( ( BUILDING-ELECTRICAL-PLUMBING-MECHANICAL J U�J�J OWNER/' / NAMEU 7, V. ELECTRIC PERMIT FEE PLAIN CHECK VALIDATION cDATRIA rolls UTLETS=SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 - IC. r,ONTRA oRs APPLIANCES - 4.00 .RE A9G PHONE�7 /- PANELS 10.00 GATE OF APPLICATION ARRCH ITECT PANELS (OVER 200 AMP) 20,60 PLAN CHECK FEE P.C:NO. O ENGINEER L. No. SIGNS TRANS. ,3.00 - ADDRESS eNa. - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ziP EMP.METER OR POLE INS. 20.00 ASNr'$ ' MOTORS SEE FEE SCH. ADDRESS / SERVICE CHANGE - 20.00 woo LICENSED CONTRACTORS DECLARATION U w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ,o a N (commencing with Section 7000)of Division 3 of the Rusirc s and BLDG. ELECT. PLG, MECH. F w z Professions C and ply license is in full for - M z Lie.Number IF y� 1 a m BUILDING PERMIT o n U OWNER-BUILDER DECLARAT ON FORMATION X g; LL H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER T27 ,OR Law for the following reason.(Sec.7031.5.Blninessand Professions PERMIT ISSUANCE -i6'0[f ATION $)FT. LIES Code:Any'city or county which requires a permit to construct,alter �� ELEC.CONTE. LIG NO. a O improve,demolish,or repair any structure,prior to its issuance,also ELEQ 1 _- 0 u requires the applicant for such penent to Elle a signed sIatcmerd that TAL Oe- PERMIT TO K $ he is licensed pursuant In the provisions of the Contractor's License �� ! � - Fii Law(Chapter 9(commencing with Section 7000)ofDivision 3 of the a Business and Professions Code)pr that he is exempt thurefrom and QTY. PLUMBING PERMIT FEE I i o ¢ H the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. e. _ by any applicant for a Permit subjects the applicant tox civil penalty of not more than Five handled dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ 1,as owner of the properly,or my employees with wages as 'BACK F LOW PROTECT. DEVICE 4.00 ore.GROUP RES.UNITS sole compensation,.will do the work,and the structure is not intended or offered for safe (Sec. 7044, Business and Professions ,DRAINS-FLOOR,ROOF,AREA,COND.- 5.00 Code:'The Contractors License Law dna not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 s¢FT.FLOOR AREA TOTAL ACREAGE himself or through his own employ Yom,provided that such improve- Partsare not intended oroffered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or ire- BUILDING USE prove for purpose of sale.). e INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer nra ❑ I,as owner of the property,and exclusively corcting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7014,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code I'he Contractor's License Use does not apply a an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts forSueh prujL,(,with a eoNmetor(s)licensed pursuant m SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I an,exempt under See---B&P.C.for this WATER HEATER W/VENT 6.00 ' reason Owner Date WATER SYSTEM, 5.00 ACC.DATE ACC.FILE NO. WORK E RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sclfminSUR, ZONING o a certificate of Workm Compensati Insu�e,or j ceHifwd ENG.SITE NO. ,opy thereyf((Sec JIM,Lab.C.jrs d ' Policy NnI&_J fRLa(:o1Lrcb ssOr ❑ Cc I e opy s hcrcby turn' d. z Z ❑ Certified c Py � EI•d I city inspection division. FIRE SVRINK ENERGY T�Yd O' Applicam . ,S�S MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ At ir Lo CI;RTI FICAT XEMPTION('ROM W'ORA ERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.0 c. LU > COMP17NSAIION INSURANCE; PLG.CONTE. LIC.NO. PLG. CL O (This Section need not he completed if the permil is for one TOTAL v❑ N❑ Y ❑ N❑ Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U (nit is issued.I shall not employ any Person in any manner so as to become subject to the Worker;Compensation Laws of California. 0 y . Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING ,F } m NOTICE; TO APPLICANT: If,after making this Certificate of Ex- F. Z emption,you should Ix-come subject to the Worken'Compensation APPLIANCE 5.00 PLAN CHECK prosisions of the labor Code, you must forthwith comply with FEE �S^ U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10X0C.F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1C.EM) 6.00 SEISMIC FEE lu I hereby affirm that men is a constmctian lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the PcUo..n,B of life work Ila which this permil is issued(See MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT.(OVER 100,000 B.T.U.)9.50 Lender',Address ELECTRIC h I certify that I have read this appli ention and state that the above VENTILATION FAN (SINGLE) 4.00 - information is correct. I agree to comply with all city and county PLUMBING ordinances and state laws chiiiag to building construction, and - BOILER-CONP(3 H.P.or100,000 B.T.U.) 6.00 hcrcby enthorire representatives forties of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL alreby antiooed property for inspection purposes. '(We) agree to save, indemnify and keep humdess the City of MISC.- ..REFER TO ORD. upertino a liabilities,judgments, coil andexpenses which PERMIT ISSUANCE 10.00 CONST.TAX ay i n}' ay attrue against i C' pence of the mg ,his permit. MECH.CONT. LIC.NO. MECH. TOTAL A3 re I'Applicant/Contractor Ua e _ TOTAL OFFICE COPY POST.THiS CARD NEAR FRONT OF BUILDING PERMIT NUMBER v GITY OF CUPERTINO 15655. INSPECTION DIVISION' '. JOB INSPECTION RECORD _ ]] PERMIT EXPIRATION' JOB ADDRE ''77SS_J & f ICZ-57 At- UNIT# LOT*t - Q(J 1 - PERMIT EXPIRES IF WORK . DINNER CONTRACTOR ®R IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RE RD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER - ALL GRADING AND DRAINAGE SHALL,BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND Cl TV OF. PERMIT VALIDATION CUPERTINO STANDARDS. , GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' PLUMBING ' ELECTRICAL - ISSUANCE DATE MECHANICAL BLDG ELECT I PLG. MECR. p.At Eg- to ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ( BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION ` S/R T. MECHANICAL ELECTRICAL FRAMING INSULATION - - / •�[ / INSULATION STORIES TYPE CONSTR, ' - � , OCC.GROUP RES:UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.IT.FLOOR AREA TOTAL ACREAGE ,• ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAXIS PAID . B ROOF SHEATHING UILDING USE RES IND CON- .PB O,n- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ,❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.N PLUMBING ELECT,ENERGY I PACT NO. PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL - MECH.ENERGY ACC.DATE - ACC,FILE 10. ELECTRICAL BUILDING ENERGY FRAMING' ELECTeFINAL TEST ZONING ENG.SITE NO: INSULATION - PLUMBING ' GAS TEST .. GAS MECHANICAL FIRE SPRINK ENERGY L24 • COVER NO WORK UNTIL ABOVE.HAS BEEN SIGNED HEATING Y ❑ N❑ ` ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD TONE AL.U.C. INTERIOR SHEAR FIRE DEPT. Y❑ N❑ ` ❑ N❑ SHEETROCK. - GRADE 'FEE SUMMARY EXTERIOR LATH - BUILDING - _y INTERIOR LATH TEMPORARY APPROVALS -BUILDING �' SCRATCH COAT - - ELECTRIC PLAN CHECK GAS FEE d NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE a OCCUPANCVOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY,BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC w as� U-I ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLUMewc , Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE -• MECHANICAL ` . IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL d>S ' OFFICE COPY i