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18892 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY t/ BUILDING PRPERMIT NUMBERbJECTTDENTI FICATION APPLICATION & PERMIT . AUaolrvc AooREss - ., 18 8 9 2 JJ BUILDING—ELECTRICAL—PLUMBING—MECHANICAL NArqoB PLAN CHECK VALIDATION OWNER 5 JA) TJv _ re- j3z QTY. ELECTRIC PERMIT FEE /1 O LIIL PHONE NONTRAcrofls NAME C-360A OUTLETS-SWITCHES-RECEP' 10.00/1.00 �pp�� yy..,� T J. O ,C.N0,46 10 LIGHTINGFIXTURES 10.00/1.00 ADDRESS APPLIANCES-''^p PPLIANCES-RESIDENTIAL 4.00 ADDRE/SS� ,(��[/��/�� /VY /� - 517 /OL�i4l&AVM PHONE��?J/ PANELS 10.00 DATE OF APPLICATION 0Rcmrrcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. eN SIGNS TRANS. r '3.00 ADDRESS esa SPECIAL CIRCUIT 5.00 PERMIT VALIDATION AEMP.METER OR POLE INS. 20.00 V ADDDRESSDRESS MOTORS SEE FEE SCH. I V / o '02 .S As I`•rN.✓A SERVICE CHANGE 20.00 O O LICENSED CONTRACTORS DECLARATION a z w 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE ATE rt a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. LG. MECH. H n i I'rafesMca s Code n y license is in full fore��spp j� ❑ zO z w a License Class ti Lic.Number W 4 ly� _ 4 H w Date�/� Contract.,_ZAM - ¢ m ¢ ¢ OWNER-BUILDER DECLARATION BUILDING PERMIT ¢ w u INFORMATION EC ., ; LL w I hereby affirm that I am exempt from the Contractor's License MISC.— Q-1ur imEFER TO ORD u o j Law for the following reason.(Sec.7031.5,Businessand Professions VALUATION PERMIT ISSUANCE 10.00 - Code:Any city or county which requires a permit to construct,alter, Q,IF c 0._ improve,demolish,or repair any strtmture,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. y wO u requires the applicant for suclh permit to file a signed statement that TOTAL PERMIT 7;0 7� he is licensed pursuant to the provisions of the Contractor's License r'z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe _ 11�_ 1 f i so Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE re $ the basis for the alleged exenhption.Any violation of Sect ion 7031.5 STORIES TYPEAONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT- ATER (EA.)of not more than five hundred dollars($5001): - ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.!—DEVIC Oce,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale (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 Rproperty who builds or improves thereon,and who does such work FIXTURES-PER TRAP 2 / 511C so.FT.FLOOR AREA TOTAL ACREAGE imsclf or thrnot intended de own roffered lot ,provided.I .ho ever,hat t h improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 .. . mems are not intended or o(fereJ I'or sale.If,however,the building or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 huilder will have the burden of proving that he did not build or inh. BUILDING USE prove for purpose of sale.). RES IND CON PB Omer' 1 ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ 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 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 contmmots)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200tt/10.00" TRACT NO. PARCEL No. O lam exempt under Sec.—.BAP.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEMZ 2 ACC.DATE ACC.FILE NO. WORK ERS'CO.M 11FNSATION DECLARATION WATER TREATING EQUIP, 5.00 I hereby affirm that I have a certificate ofconacnt to sdl'-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy Nn. Company _ O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFE TO ORD.' F O Applicant Y ❑ N❑ Y ❑ IN LU to CERTIFICATE OF EXEMPTION FROM WORKCRS• PERMIT ISSUANCE —$Q-0G FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LC.NO. PLG. � Z (This section need not he completed if the permit is for one e 3 — 7/d TOTAL .Y❑ N❑ Y ❑ N❑ hundred dollars($1000 or Jr..) L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY .LL I— mit is issued I s all not employ any p rsnn any,manner so as to O ED become ytj t he Workers' sa' uw fCAIM —� y Date- f_/'7 Applicum_ ! r ALTER OR ADD TO MECH. 5.00 BUILDING } tn_ NOTICE O APPLICANT: If,afIE ma ing this Certificate of Es- F. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCT ION 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 is issued(Sec. MICROFILM 3097,Civ C.) HEATING UNIT(TO 100,000 B.T.U.) 8.00 L'ender's Name HEATING UN IT ER 100,000 B.T.U.)9.50 Lender's Addd ress ELECTRIC I certify that I have read this application and that the above VENTILATION FAN (SINGLE) 4.00 Z— information all c correct.I agree to comply with all city and county BOILER.COKW(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and slate laws relating to building construction, and 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 (he City of MISC.- REFER TO ORD. uper.Win against liabilities,judgments, costs and expenses which CONST.TAX ay in any way accrue against said City in cooseque ce of the PERMIT ISSUANCE 10.00 ranting oftpl MECH.CONT, LIC.NO. MECH. / � -;g `��0 TOTAL TOTAL U Signature ofA ican Contractor ate ell 01/Z 7_0Z OFFICE COPY POST THIS CARD NEAR.FRONT OF BUILDING PERMIT NUMBEvv J CITY OF CUPERTINO . 18892 2. INSPECTION DIVISION ' ' PAID It JOB INSPECTION RECORD . n'I IIY1vUU •� PERMIT EXPIRATION JOB ADDRESS 755 - •DY�dL�pr'C-t16Z)� UNIT#11 Sj ' ^� ^4,03 PERMIT*EXPIRES IF WORK OWNER �UG CONTRACTOR Tc.J L O � L 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 CIN OF PERNIIT VALIDATION CUPERTINO STANDARDS. - .,, GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB h ' PLUMBING ELECTRICAL /v ISSUANCLUATE / MECHANICAL - BLDG ELECT LG.- MECH, 0 0 . . ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - - - BUILDING PERMIT WOOD FLOOR INFORMATION • PLUMBING VAW=� $IFT. . - - , MECHANICAL - �� PERMIT TU ELECTRICAL FRAMING INSULATION '.,' STORIES TYPECONSTR. Ire-1&��-e OCC-GROUP RES.UNITS GLACE NO SUBIFLOOR UNTIL ABOVE HAS BEEN SIGNED pG ,may ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO,IT FL DOR ARIA TOTAL ACREACE IPHRAGM THE CONSTRUCTION TAX IS PAID. I 11 BUILDING USE � JOF SHEATHING RES IND CON PB o om., APPLYAO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ '❑ El [D ROUGH SAN# ASSESSORS PARCEL NO ` ¢� PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN. PLUMBING ENERGY TRACT No. .PARCEL NO MECHANICAL MECH:ENERGv . ELECTRICALBUILDING ENERGY ACC.DATE ACC.FI LE NO ' ' FRAMING ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST GAS - - MECHANICAL - FIRE SPR INK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ No I ❑ IN • EXTERIOR SHEAR IELECTRICAL RELEASE FLOOD ZONE A.L U.C. INTERIOR SHEARFIRE DEPT. Y'❑ NO - Y ❑ No SHEETROCK GRADE - - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS, BUILDING SCRATCH COAT. ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL B UI LDING FINAL ISSIGNED BY BUILDING'INSPECTOR. MICROFILM �. 4. ARRANGE FOR INSPECTION BY PHONING 252-4505, . ELECTRIC- `i' -ONE WORKING DAY BEFORE REQUIRED INSPECTION. . L 10 PLUMBING Y PLEASE GIVE JOB ADDRESS WHEN PHONING. - ? -- SEE PERMIT FO,R EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE �/�/ ` �•G 5 CALLING'FOR FINAL INSPECTION. TOTAL. (/ OFFICE COPY