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18718 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL''POINT PEN ONLY a EU01 LDI NG PROJECT I DENTI FICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT Y 871 �: ADORp6 �1 ST RD BUILDING-ELECTRICAL-PLUMBING-MECHANICAL O E (pooNER'S `w u/ PLAN CHECK VALIDATION NAME klN�T/'0 /�.'1RI# /��Q OTY. ELECTRIC PERMIT FEE MW cuss luau DNG.as9 OzJ`y NA"MERAc.oRs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 AcroRs DDRUSAPPLIANCES 4.00 DOREss PHONE PANELS 10.00 DATE OF APPLICATION , ARCHITECT PANELS (OVER 200 AMP) 20.00, PLAN CHECK FEE P.C.NO. ENGINEER _IC No. SIGNS TRANS. 3.00 Doo ESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS REMOTORS SEE FEE SCH. AP $ SERVICE CHANGE 20.00 a ¢ z Foo LICENSED CONTRACTORS DECLARATIONPAID c i p 1 hereby affirm that 1 um licensed tinder provisions of Chapter 9 ISSUANCE DATE w a H (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F w z P...fcssions Ccde,�and my Recuse is in full force and effect ncT 9 ❑ ❑ ❑ go T W License Class Lia.Number y A,F Uate Contractor - a yBUILDING PERMIT a OWNER-BUILDER DECLARATION A ° " MISC.- E TO ORD INFORMATION w ;` w 1 hereby off nn that I am exempt from the Contractor's License to Oj Law for the following reason(Sec.7031.5.Bisinessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. i Code:Any city or county which renuires a permit construct,alter, ¢.a0 improve,demolish,Or repair any structure,prior to its Issuance,also ELEC.CONTE, LIC.NO. ELEG /0 adolo LL c"Gires the applicant for such permit to file a signed statement that TOTAL I w m he is licensed pursuant to Ole provisions of the Contractor's License „ 46PERMITTO I Uzi Law(Chapter 9(commencingwith Section 7000)of Division 3ofthe 4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ H es the basis for the alleged exemption.Any violation of Section 7031.5 1 STORIES TYPE CONSTR, a „- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 6.00 of not more than Ove hundred dollars(8500)): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 DCC.GROUP RIES.UNITS their sole compensation,will do the work,and the structure is not into med or offered for sole(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 improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.ET FLOOR AREA TOTALACREAGE /• himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If.Imowevec the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or impr vement is sold witllin one year of completion,the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove-for purpose of solo). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orhe, c Lae owner of the proPerry,am exclusively contracting with El E El El Q IiC�em4 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 docs not apply to un 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 the Cmutuctor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I out exempt under Sec.-,B.&P.C.for this non WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSA I ION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to xlfror,ure, _ or it certificate of Workers'Campunsation Insurance,or it certified ZONING ENG,SITE NO. copy thereof(Sec,3800,Lab.C.). Policy No. Company O Cl Certified copy is hereby furnished. RE SPRINK ENERGYT]4 Z Z O Certified copy is fled with the city inspection division. ♦-- O Applicant MISC.- - REFER TO ORO. Y ❑' N(] Y [:J N� CC CERTIFICATEOF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE AT.uc. LU > CONTENSA'hON INSURANCE PLG.CONTR. LIC.NO. PLG CL O (This section neednoI be completed if the permit is for one TOTAL Y❑ N❑ Y [:] N EI � Z hundred dnllm,(SIOO)nr less,I V O 1 certify that in the performance of[lie work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any nmanncr.lrax to V W be,,mic subject to the Workers'Compensation Laws of California. D- Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } rn NOTICE TO APPLICANT: If,a0cr looking this Certificate of H.- ? emption,you should become subject to the Workeri CompensationApp APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL1 4.00 FEE CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE fv 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 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 �• infonnatimm is correct. I agree to comply with all city and county orPLUMBING dinances and state laws relating to building construction, and BOILER-COMPOH.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOI LEO-COMP IOver 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and kiep harmless the City of MISC.- - REFER TO ORD. upertino against I'abiI tics,judgments, costs and ixpenscs which CONST.TAX ay t an se true ag test City in co e9ue ce of the PERMIT ISSUANCE 10.00 rant mit MECH.CONT. LIC.NO. MECH. /p TOTAL TOTAL �/ Ignature o App i t/Contractor I is ��A N OFFICE COPY l POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER' CITY OF CUPERTINO 18?18 ' INSPECTION DIVISION JOB INSPECTION RECORD �• - ////'''n�ly'- /ryI [_� �/�J PERMIT EXPIRATION JOB ADDRESS_ -��Al /d��/�«/•+4� UNIT#: LOT# PERMIT EXPIRES IF WORK OWNER ��d ./ � A ��"�— CONTRACTOR ` /IS NKT.ST.-REED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATIONANCE OR 180 DAYS FROM NOTE:' LASTCALLED INSPECTION. UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUPJITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vnuunnoN CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB " PLUMBING . ELECTRICAL - ISSUANCE LATE (f MECHANICAL v f BLDG ELECT PLc. MECH. �' ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. � '7 MECHANICAL ELECTRICAL - //-1 PERMIT TO FRAMING /✓ �/I INSULATION vSTOHIES - TYPE CONSTR. oci OCC GHOLP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I rift, p;,me,{;,,n \ \,� ROOF $O Gi FLOORAREA TOTAL ACREAGE Il NOTE'NO FINAL INSP. PMADE BEFORE DIAPHRAGM I THE CONSTRUCTION TAXAX IS IS PAID BUCON USE ROOF SHEATHING Hes INDCON Pe o1nr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑• •-� A55E5SOHSPARCEL NO. ROUGH SAN.# PLUMBING ELECT.ENERGY - T TUBS&SHOWER PAN PLUMBING ENERGY FACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.LATE ACC ERE NO. FRAMING - ELECT.FINAL TEST INSULATION PLUMBING ZONING ENG.SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T,)A COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° ❑ N❑ EXTERIOR SHEAR ELECTRICAL RELEASE - GUTo11 IONE 7.LUC INTERIOR SHEAR FIRE DEPT. Y❑ IN ` ❑' N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH _ - BUILLOING t� INTERIOR LATH - TEMPORARY APPROVALS BUILDING I / SCRATCH COAT - ELECTRIC .PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - - SEISMIC FEE �. OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC � ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING If Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE ' CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY