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17520 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .• BUI LDING PROJECT I DENT[FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ii, 17520 ADD E BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OwN PLAN CHECK VALIDATION Nnrne QTY. ELECTRIC PERMIT 'FEE • t NaNER^AcioRS UTLETS-SWITCHES-RECEP 10.00/1.00 .,T �" 1 TO _IC No. LIGHTING FIXTURES 10.00/1.00 if 1 OF A DEREADioirs PPLIANCES-RESIDENTIAL 4.00 L N9+k }' L] _ PHONE C-"EP PANELS 10.00 DATE OF APPLICATION ONCHITECi PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER uc.NO. SIGNS TRANS. 3.00 ARCH,OR ADDRESS ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 `� ADDRESS TS MOTORS SEE FEE SCH. - J O- SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION a o LI hereby afllnn that 1 am licensed under proviaiou of Chaptar 9 _ ISSUANCE DATE „<m (commenting with Section 7000)0!Division 3 0l the Basin•ss end I U J BLDG. ELECT. PLG. MECH. F m z Professions CoJ nJ my 'cunsc is in full fore• d. ❑ ❑ ❑ z o w - License Class - Lic.Number ,. e c 4 o Dote - Contractor a x BUILDING PERMIT ic ¢ i OWNER-BUILDER DI.CLARAT'ION INFORMATION w E- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD in 4o Law for the following rcastm(Sri.7031.5.Businessand ProfessionVALUATION SIFT. Cade:Any city.,county which requiresapermitmnmstn¢t,almq PERMIT ISSUANCE 10.00 10 ce R ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. /"]` ¢ requires the applicant for such permit to the u signed statement that - TOTAL r SP w ° he u licensed Pursuant en the with Sects of the Contractor's License -( PERMir TO ' F z i Law(Chapter 9(commeneing with Section 7000)of Uivision3of ilia �p✓M 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢H the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR. d ; _ by any applicant for a permit subjects the applicant to a civil Penalty gLTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dull,,(55001.1: ❑ I,as owner of the property,or my cmPloyce,with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROup RES.UNITS Ilncir wle compensation,will do the work,and the structure Is not intended or offered for sale(Sec. 7044, Busilless unit 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 mnployces,Provided that Such innprove- mentsarenolimendedorofferedforsak.IL however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvmnent is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the bu dcn of proving that he did not build or stn- BUILDING USE prove for purpose of sale.). RES IND CON PS Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 1:1 El El ❑ 11licensed contractors to construct the project (Sec. 7044,BusinessLAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No. and Professions Code:1'he 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 coniraetims)lieunsed mouunt m SEWER-SANITARY-STORM EA.2008/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,B.&PC.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSAf1ON DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a c.nificam ofcument to wif-insi m. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3ROO.Lub.C.). Policy No. Company Q ❑ Certs y is hereby furnished FIRE SPRINK ENERGY T 24 Z 2 1�/ Certs u• it fled rith the city inspection division. H O A�,}gtrant MISC.- REFER TO ORD. - Y C] NE] v [:] N[:] CC rn G1iRTl1'ICnI'Ii OP li .MP"PION PROM WO RKIiRS' PERMIT ISSUANCE 10.00 FLOOD zo NF A.L.u.c. L COMPE.NS TION INSURANCE PLG.CONTR. LIC.No. PLG. CL O ('Phis section Mrm Med not be completed if the peit is for one TOTAL Y Elhundred do11m1S100)o,loss.) N❑ Y ❑ N❑ Z U O 1 certify that in the p;rtllmmnce of the work for which hiss per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued 1 shall not employ any person in any manner o as to O w become subject to the Workers Compensation Laws of Calilomia. ED Date Applicant BUILDING } m NOTICE TO APPLICANT: If,after making this Ccrtifcatc of Ex- ALTER OR ADD TO MECH. 5.00 F. ? cmption,you should become subject to the Workers'Compensxlion APPLIANCE - 5.00 PLAN CHECK provisions of the Labor Code, you muss forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=QF.M.) 4.00 CONSTRUCTION LI'NDING AGENCY AIR HANDLING UNITiOVER 10MC.F.M.) 6.00 SEISMIC FEE I hereby afford that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 i0 ,CC.), um e lorof work for which ilii permit is issued(See, HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC � I certify that l have read this application and stale that the above VENTILATION FAN (6INGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING .Niummes and slate laws relating to building can tm,ti.n. and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. above n.coloo ed property for inspection purposes. MECHANICAL (We) godd to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. 'upertino against liabilities,judgments, costs and expenses which CONST.TAX ay a accrue against said City in consequence of the PERMIT ISSUANCE 10.00 (anti g o 11 I Iit L MECH.CONT. LIC.NO. MECH. _ TOTAL TOTAL (7 f� ignatu o P tint, 4.r Date OFFICE COPY POSTTHIS CARD NEAR FRONT OF BUILDING rERm1T NumeER CITY OF CUPERTINO 17520 INSPECTION DIVISION • JOB INSPECTION RECORD " PERMIT EXPIRATION - JOBADDRESS-I ��T��Tx�vGe UNIT#{ . LOT# owNER -e .� � CECONrancroR ( `� PERMIT EXPIRES IF WORK �L( e C' 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 PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. - ., �� C; POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ UNDERGROUND /SLAB MAR 3 u I�J4- PLUMBING ELECTRICAL city Of Qpdm LLEC CI:DALE MECHANICAL nLOc- XT' PLC" mecH o ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. �.� MECHANICAL ' ELECTRICAL Jrb�PERR.M TT�To FRAMING INSULATION STORIES TYPE CDNSTR. - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . " ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SOFT FLOOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID " oUILOwG USE ROOF SHEATHING HES IND CON PR 0', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ - ❑ ❑ ASSESSORS PARCEL ROUGH SAN.q NO PLUMBING - ELECT.ENERGY - TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL VECH.ENERGY- ELECTRICAL BUILDING ENERGY ACC DATE ACC.FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING' ZONING ENG,SI TE NO. GAS TEST GAS FIRE SPRINK ENERGY r•za MECHANICAL v ❑ N❑ v ❑ • N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE O' ' FLOOD ZONE A,L U C. INTERIOR SHEAR FIRE DEPT. Y❑ NQ v ❑ N❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT. IELECTRIC.. PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM LuARRANGE 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 CALLING FOR FINAL INSPECTION. OFFICE COPY