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17503 . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,P 1WILDING PROJECT IDENTIFICATION PERMIT NUMBER ,a•4 eu,LDINc- Q. APPLICATION & PERMIT ADORE •ZZ � BUILDING1 7- ELECTRICAL-PLUMBING-MECHANICAL I� 1 1 O I- OWNERS PLAN CHECK VALIDATION NAME - C� CITY. ELECTRIC PERMIT FEE -- BONE AE -s UTLETS-SWITCHES-RECEP 10.00/1.00 ND 2 A-CAiQ 1 CA Z 3 ? LNo. LIGHTING FIXTURES 10.00/1.00 1ADOREINTRAcroRs PPLIANCES-RESIDENTIAL _ 4.00 (aC' WIs1'I C/(j, -E -7Z,0-11,57 IPANELS 10.00 DATE OF APPLICATION - ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.O. 3I SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 L{7r.r�1P1Q,Y[-I(� IP EMP.METER OR POLE INS. 20.00 APPLICAJP ADDDRESSDRESS MOTORS SEE FEE SCH. _ G Q SERVICE CHANGE 20.00 00 LICENSED CONTRACTORS DECLARATION Q u e~j I.hereby alfmn that l urn lic wird under provisions of Chapter 0 ISSUANCE DATE r2 w (commencing with Section 7000)of Division 3 of the Rosiness and WOO. ELECT I PLG. MECH. N i Professions Codnand my license a in full fore f x O m - License C ss Lie.Nu tuber 11 1 ❑ ❑ ❑ 0 r O Date Contractor�i_�_I .• APR / I VV rVV 19C':- , a m s = BUILDING PERMIT a s a owNERR ILDER DECLARATION - MISC.- O ORD INFORMATION w , 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. Fac Law for(be following reason.(Sea 7031.5.Businessand Professions PERMIT ISSUANCE 10.00 as I Code:Any city or county which rryuiresa permit to construct,alleq O 2G 2 improve,demolish,or repair any structure,prior to its issuance,nlw ELEC.CONTE. LIC.NO. ELEC. . 0001 O an requires the applicant for such permit to file a Lgncd statement that TOT auAL PERMIT TO u w$ he is licensed Fauvism to the provisions of the Contractor's License A T Hii Law(Chapter 9(commencingwith Section 7000)ofDivisiou 3 ofthe 4 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE IF I $ the but for the alleged exemption.Any violmion of Section 7031.5 Y a. byanyapplieunt forapcnnit subjcc(v tlm upplicros(toucivilpcnully ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 UNITS- their sole compensation,will do the work,and the stnatom n not DCC.GROUP REB.UrvITs intended or offered for sole (Sec. 7044„1husiness and Professions DRAINS.FLOOR,ROOF,AR EA,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 50.n.FLOOR AREA TOTAL ACREAGE himself or of rote his own employees,provided(hal such ire building mems up,not his or offered employees, or provided that r.such building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- proveforpurpose ofsole.). INDUSTRIAL WASTE TER. 30.00 'RES IND CON .PB omar I LA ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ Iicenred contractors to construct the project(See. 7044.Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves themon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts fur such projects with a contoctods)licensed purvlum to SEWER-SANITARY-STORM EA.200tt/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under See.-,B&P,C.for this WATER HEATER W/VENT 6.00 reason Owner [)ateWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKFRS'COMPIiNSAT1ON DECLARATION WATER TREATING EQUIP. 5.00 - I hereby affirm that I have a cen ilicate ofconsent to self-insure. _.� ZONING ENG.SITE NO. or a certificate of Worker:Compensation Insurance,or a verified copy thereof(Sec.3800.Lab.C.). I'Nicy N..-C.,hpany ur - O Q Ccrf pyt herebyf h FIRE SPRINK ENERGY T 24 Z Z erli- d is Ned wish Ile 'y-'t c' n div' MISC.- REFER TO ORD. 0 AFPIt ;," a Y ❑ N❑ Y ❑ N❑ � N C17R'I'IFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOOD ZONE A.L.U.O. UJ > COMPFNSATION INSURANCE PLG.CONTR. LIC.NO. 'PLG. - CL O Cfhis section need not he completed if the permit Is for one TOTAL Y❑ N❑ Y N❑ Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I shall not employ any person in any manner so as to U beconm subject to the Workeri Compensation Laws of Culiformu. U a Ua(c APPIic°nIALTER OR ADD TO MECH. 5.00 BUILDING x' A NOTICE '10 APPLICANT: It,utter making this Certificate of El ? emption.you should become subject to the Workeri Compenution APPLIANCE 5.00 PLAN CHECK provisiom 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 . CONSTRUCr10N LFNDING ACENCY AIR HANDLING UNIT(OVER 10pWCF.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for hich this permit is issued(Sec. MICROFILM ]097.civ.c.l. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lcndcr4 Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC - Afy that 1 ve read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ion is c e t.1 agree to comply with all city and county PLUMBING s and sem lows rclming Io building comtruclion, and BOILER-COfaP13 H.P.Dr 100,000 B.T.U.1 6.00 uthor ro rc resentalives of "I- city to enter upon thentio d pro erly for inspection purposesBOILER-COMP,IOse(100,000BTU)BEE FEESCH. MECHANICAL gue In sa indemnify and keep harmless the City of MISC.- - REFER TO ORD. ag ns[ G allies,judgments, tons and epenses w CONST.TAX ny Y a rue against said City in cousequen thePERMIT ISSUANCE 10.00 f th pem L MECH.CONT. LIC.NO. MECH,TOTAL TOTAL ofA t/Contracmr Uam ' OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING . PERMIT NUM9EH CITY OFCUPERTINO INSPEC7TION DIVISION ' 1 " 503 JOB INSPECTION RECORD .`� PE/POE RM IT EX`IR I J�• JOB ADDRESS Q—l-^ •J UNIT# LOT# R /_ , MIT EXPIRES IF W RK OWNER \ N(A CrY, C0rr\,0uAef5 CONTRACTOR IS NOT STARTED-WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR'180 DAYS FROM NOTE: - LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE •+ CUPERTINO STANDARDS. I ' ' - GARAGE SLABS • 4 ' L� �� 1 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING � J / ELECTRICAL - ISSUANCE DATE - 7171ELECt. PEC. MECH. MECHANICAL ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED f BUILDING PERMIT WOOD FLOOR Nr��S INFORMATION �"•.�VALUATION 5/FT. PLUMBING JQ1 Doo ' MECHANICAL PERMIT 10 ELECTRICAL FRAMING APR JpD [ •.1�jGIJUj � �f'�i[,e�t R�,.dr5•, f.-I IL I 1-•-' r I • STORIES TYPE CONSTR. INSULATION City of Qwrw OCC.GROUP RES UNITS I, - go-chi- o-c.. 2��r', izov,.� w •� . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED S' SD,IT,TIME AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE / DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID• BUILDING USE ROOFSHEATHING its IND CON PB Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. - 0 ❑ ❑ ❑ ❑ ASSESSORS PARCEL N_O ' ROUGH SAN.N PLUMBING ELECT.-ENERGY - - IHACTND, PAHCCL NO TUBS 6 SHOWER PAN PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ACC DATE ACC,FILE NO ELECTRICAL ' BUILDING ENERGY ' FRAMING LC2, ELECT.FINAL TEST - ZONING ENG.SrtE NO, .INSULATION PLUMBING GAS TEST GAS FIRE SPRINA ENERGY TQA MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOO u mNE A.L.D,c. INTERIOR SHEAR FIRE DEPT. r ❑ No r ❑ N❑ SHEETROCKGRADE FEE SUMMARY EXTERIOR LATH BUILDING - .INTERIOR LATH TEMPORARY APPROVALS su1LDlryG f , j SCRATCH COAT ELECTRIC PLAN CHECK_ GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE I U OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, 1ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z 'I, SEE PERMIT FOR EXPIMECHANICAL — RATION DATE — IMPORTANT! CONST.TAX PLEASE,REAREVERSE SIDE BEFORE TOTAL t,}� D I 1 ' CALLING FOR FINAL INSPECTION. OFFICE COPY