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11977P UILDNG TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI FICATION APPLICATION & PERMIT BUILDING -ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUM.- ' / \� 1 1 977 am�olNG - AD Rs I I �f OWNERS PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE •� PHONE pl . CONTRACTORS NAME N UTLETS-SWITCHES-RECEP 10.00/1.00 FIXTURES 10.00/1.00 ^r. tLIGHTING TRACTORS s APPLIANCES -RESIDENTIAL 4.00 ORESS w yt7�RDrvE �� S DATE OF APPLICATION PANELS 10.00 ARCHITECTPANELS(OV OR ENGINEER • LIC. No. ER 200 AMP). 20,00 - PLANCHECK FEE. P.C. NO. - SIGNS TRANS. 3.00 ARCH. OR ING.' - .l ADDRESS SPECIAL CIRCUIT 5.0.0 'P LIDATION A'l/p��tlNj� EMP. METER OR POLE INS. 20.00 ZIP OCT 7 21 APPLICANTS MOTORS SEE FEE SCH. ADDRESS 1f1ap. JV A SERVICE CHANGE 20.00 ' City pp �� C LICENSED CONTRACTORS DECLARATION - �1 .y UpQjt�nO . I hereby dffrm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect Li¢nse CCla Lia Number _ BA . ELECT. PLG. MECH. Date O'er Contractor BUILDING PERMIT " OWNER -BUILDER DECLARATION' 1 herebyaffirm that I am exempt from the Contractor's License pVALUATION 'Law forlyefollowing reason.(Seauireso, Business tornd Professions Code: Any city or county which myuires a permit 10 wnstmet; nap, improve, demolish, or repair any Strt¢ture, prim to its issuance, a1s0 INFORMATION MISC. - REFER TO ORD S/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. Eck. requires the applicant for such permit to He v signed statement that he is licensed pursuant to the provisions of the Contractors License TOTAL PE MIT GTY. PLUMBING PERMIT Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and basis forthe'alleged exemption.'Any violation ofSeclion7031.5 RIES YP ONby any applicant fore' permit subjects the applicant to a civil penalty more than rive hundred dollars (S500).): ALTER-DRAIN&VENT-WATER (EA.)ofnot ❑ I, as owner of the property, or my employees with wages asBACK their solecompensation, will do the work, end the structure is not intended"or offered for sale (Sec. 7044, Business and Professions ].FEEthe FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS "DRAINS -FLOOR, ROOF, AREA,COND. 5.00Code: The Contractor's License Law does not apply to an owner ofproperty whobuilds or improves thereon, and who docs such work• FIXTURES - PER TRAP5.00se,. Fr: FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building - GAS- EA. SYSTEM - 1 INCA OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- pruveforpurposeofsalc). 0 - 1, as owner of the property, am exclusively contracting with licensed contractors to embomet the project (Sec. 7044, Business GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE IND CON PB Omer ❑ ❑ • E) ❑ INDUSTRIAL WASTE INTER. 30.00 - LAWN SPRINKLERS - 1 INC 5 V.B. - 6.00 . AssessoRB PARCEL NO. and Professions Code: The 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 contractoRs) licensed pursuant to the Contractors License Law. SEWER -SANITARY -STORM EA. 200ft110.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. .B.&P.C. for this reason WATER HEATER W/VENT 6.00 OwnerDate WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. • WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby af0rm that Ihave a certif care of consent to svlf;insure. or a certificate of Workers' Compensation In sumnce, or a certified ZONING ENG. SITE N0. copy thereof (Sec. 3800, Lab.C.). Policy No. Company ❑ C'rti H dcopy is hereby furnished. FIRE SPRINK ENERGY T24 ea, espy is C d w' the city inspection division Applicant Y❑oN❑ Y❑ No MISC.- REFER TO ORD. CERTIFICATE EXEMPTION FROM WORKERS' PERMIT.ISSUANCE 10.00 FLOOD ZONE AL.UC. PLG. CONTR. LIC, No. PLG. TOTAL COM ENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ , N ❑ Y ❑ N ❑ OTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars IS 100) or Icss) - 1 certify that in the performance of the work for which this per- mit is issued, 1 sha11 not employ any person in any manner so as to BUILDING become subject to the Workeri Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE 1'0 APPLICANT'. If, after making this Certificate of Ex- APPLIANCE 5.00 'PLAN CHECK emption, you should become subject to the Workm Compensation provisions of. the lzbor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. FEE ' AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10p0011F.M.) 6.00 SEISMIC FEE , CONSTRUCTION LE NDING AGENCY 1 hereby affirm that there is a consiruclion lending agency for the performance of the work for which this pemtit is issued (Sec. 3097, CIv.C.). - EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Add 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING r , BOILER (3 H.P.'o4100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon.the above-mentioned property for inspection mrpnsev, MISC. - REFER TO ORD. ' (We) agree to save, indemnify -and kccp harmless the City of Cupertino against liabilities, judipricau, costs and expenses which may in any way ecerue,against said City in consequence of the CONST. TAX PERMIT ISSUANCE • . 10.00 MECH. CONT. LIC. NO. MECH. - gran ug of this permit. ' V _ TOTAL I I I I I TOTAL ` ✓ Signature of licant/Contractor Date OFFICE COPY 9 ki POST THIS CARD NEAR FRONT CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION per` f /J�� (///A;;; �{ JOB ADDRESS o1�"'I ` �I V l MLI rAML o INER. CO, NT OF BUILDING•; RECORD' �o UNIT# _ LOT# - PERMIT NUMBER 11977 PERMIT EXPIRATION pERM1T EXPIRES IF WORK IS NOT STARTED. WI THIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM - LASTCALLED INSPECTION:1 INSPECTION DATE INSPECTOR I SPECTI NRECORD FOUNDATION - UFER PREGUNITE - PERMIT -'VALIDATION OCT 211000 City 0f CURCrtIDO ISSUANCE DATE j POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED • - 'UNDERGROUND/SLAB PLUMBING - ELECTRICAL MECHANICAL. _ ELECT. ❑ PLG. El-oL MECH ^ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - UII,.ING PERMIT FORMATION WOOD FLOOR VALUATION - SIFT. ' PLUMBING � ' MECHANICAL ELECTRICAL PER IT TO '1 ui ' FRAMING INSULATION STORIES T E CfNSTR. OCG GROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF, 50,FT. FLOOR AREA .TOTALACREAGE DIAPHRAGM _81ILDMG USE D CON PB 0W11 CON APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH .. SES ORS PARCELN 1 0. PLUMBING GAS TEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACC. FILE NO. FRAMING (� SAN # INSULATION PLUMBING ZONING- ENG. SITE NO. - GAS MECHANICAL ' FIRE SPRINK Y El -• NE] ENERGY T'YA ` [] N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING � LATH -INTERIOR. ELECTRICAL FLOOD ZONE .Y 1:1 N 0.LU.C. Y C] .N❑ LATH -EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - BUILDING SHEAR EXTERIOR.TEMPORARY APPROVALS - FIREWALLS ELECTRIC PLAN CHECK FEE.. GAS, NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY' SEISMIC FEE t UCC UPANCY OF BUILDING S NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BU ILDING INSPECTOR'. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F ONE WORKING DAY BEFORE REQUIRED INSPECTION.." 0� PLEASE, GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE'-_ ELECTRIC PLUMBING MECHANICAL CONST. TAX - - - '- IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY.