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12972 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER JW DING APPLICATION & PERMIT-2— rricmj AJ 12972 GDC EC L BUILDING-ELECTRICAL-PLUMBING-MECHANICAL EPLAN CHECK VALIDATION i NAMR'5 E HIS-3'{O-!dc TY. ELECTRIC PERMIT FEE P 1FS?1 2'(1 CONTRACTOR'S —Al NAME UTLETS-SWITCHES-RECEP 10.00/1.00 _ ."o. � LIGHTING FIXTURES 10.00/1.00 CONTBATORS ADDRESSd "Y1 — PPLIANCES-RESIDENTIAL 4.00 �PHONE PANELS 10.09 DATE OF APPLICATION ENGINEECT1�aw yuIlir/ PANELS (OVER 200 AMP) 20,99 PLAN CHECK FEE .G NO. oR U`n ✓—� ENGINEER __LIC.No. ISIGNS TRANS. 3.00 ARCH His ENG. SPECIAL CIRCUIT 5,99 PERMIT VALIDATION zIP EMP.METER OR POLE INS. 20.00 Q ADDRESS TS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �1-' f wo o LICENSED CONTRACTORS DECLARATION 1 �� f/��/ a i w I hereby affirm that I am licensed under provisions of Chapter 9 VY- tSSDANC DATE st a: (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r 2 z Professions Cod a my license is in lull force sed e f L ❑ ❑ ❑ z o,� - Licen Cla Liar.Number A7 o z F o Date Comracto It re F < N[.C� g o BUILDING PERMIT 6 U OWNER-BUILDER Deco I INFORMATION w ; LL H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD H a- o `� Law for the following reason.(Sec.7031.5,Busineuand ProfessionsPERMIT ISSUANCE 10.00 VALUATION O $/FT. Cade:Any city or county which requires a permit to construct.alter, re40 improve,< p improve,demolish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. T w- O ¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License F z rt Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 6-V4 4 Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r 0 the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. n ; _ by any applicant for a Permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER IEA.) 5.00 of not more than five hu n d red dollars IS 500).): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not DEC.GROUP RES.UNITS intended or offered for We(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 improve,thereon,and who does such work FIXTURES-PER TRAP 5.00 so.Pr.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.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 im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Orn., C1 1,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 don 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 SEWER-SANITARY-STORM EA.200h/10.00 the Contractors License Law. TRACT NO. PARCEL NO. 0 l am exempt under Soc..,B.AP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. wORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affrm that I have a certificate of consem to self-insure, or a cerlificate of Workers'Compensation Insurance,or a ccrtilied ZONING ENG.SITE NO. copy Ther f Sec.3 PolicYNo parry 11�y'At/AY f�/L Q ❑ Certified copy is hereby fumishc I FIRE SPRINK ENERGY T-24 Z Z1 ❑ CertifffW{�``opy. is filed cit Inspection division. F O � I' APPIIcanll�l�(, MISC.- REFER TO ORD. v N❑ v ❑ N❑ Q w CERNKK-ICATE OIr EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.LUC, L � COMPENSATION INSURANCE PLG.CONTR. uc.NO. PLD. � N� � ❑ Z (This section need not be Completed if the permit is for one TOTAL vYN hundred donees IS 100)or Icss.) U O 1 Certify that in the perfom oto of the work for which this per- QTM MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,1 shall not employ any person in any manner so as to become subject to Ore Workers'Compensation Laws of Culifomia. -jj y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3k , } res NOTICE TO APPLICANT: If,after making this Certificate of Ex- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK sq L provisions of the Labor Code, you most forthwith comply with FEE 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 10=C.F.M.) 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 L iuued(Sec. MICROFILM 3097,Cis.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI N G UN IT(OVER 100,000 B.T.U.)9.50 /3 Lender's Address ELECTRIC 1 certify that I have read this application and slate that the county VENTILATION FAN (SINGLE) 4,00 information n correct. I agree to comply with all city and county PLUMBING Jordinances and state laws relating to building construction, and BOILER-COfvP(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. 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 ISSUANCE70,00 CONST.TAX may in any way accrue against id City in consequence of the gun f this permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL 77 02- 7,,LS,JVM2 of Applicant/Contractor Date PEKE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PPRMFNUMBER INSPECTION DIVISION 12972 i JOB INSPECTION RECORD PERMIT EXPIRATION JOBADDRESS /OO/oZ /Vi �I %LL `.FV/J UNIT# LOT# PERMIT EXPIRES IF WORK OWNER U corvTRAcroR /`�/ /N LL JLsGCV%C-Ls? IS NOT STARTED WITHIN IN PECTION DATE INSPECTOR INSPECTION/RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - i ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -� UNDERGROUND /SLAB PAIR,_ ' / PLUMBING /9'�+"/ ELECTRICAL IAA 2 198r� ISSUANCE UA EE. MECHANICAL BLDG. E E T° PLG. MECR. Ci ° B El [ E5 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT ' WOOD FLOOR INFORMATION PLUMBING VALUATION ^` S/FT. MECHANICAL �' )' ELECTRICAL - G/PERMIr,To FRAMING - - INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED J SO.FT,FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE RES , IND CON PB' Olna APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 ❑ 11 ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. ' MECHANICAL . ELECTRICAL FINALS DATE INSP. ACC.DATE ACCFILE NO. FRAMING SAN * INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y O NO YO NO LATH—INTERIOR ELECTRICAL FLOOOZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. YO NO Y ❑ NO SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING TEMPORARY APPROVALS BUILDING SHEAR EXTERIOR -� ! FIREWALLS - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM 1 .` ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z lMECHANICAL� - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY -