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14066APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY •BUILDING PROJECT.I DENTI FICATI ON APPLICATION & PERMIT ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 406 BUILDING AODREss S- 1iUILDING- OWNER'S O�,//�V �S NAME `� t ICO - P-DNE QTY- ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION ONTRAcro s NAal_ 10 (�� -e SAA Aic.ao. g s UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 nooeess TORS 6S I V Ce la -ONE `a l -J APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER LIC, NO. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 nooe'ESS R ENG. ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION %C / D/� 9! d', - /s . ISSUANCE DATE BLDG. ELECT. PLG. MECH. n• [1( R❑ ❑ ❑ TEMP. METER OR POLE INS. 20.00 APPLICANT $ ADDRESSDDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod • and I icense is in full fo( • a f LZ License Class Lic. Number Date IV---/ 4_��._R`-1 Contractor _ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Professions Lawfor Anycity orco rl.tywhch reg03sa permit to permit to consuanc alter, Codeimprove, improve, happicant repair any structure. prior to its issuance, also e, demolish, county my wh icy structure, for such permit to file a signed statement that requires the dp pursuant he is licensed pursuanten the provisions of 700 )ofDivision License ofDivision 3 of the Law (Chapter 9 (commencing with Section is exempt Business and Professions Code) or that si is exempt therefrom and by basis for the allegedexemption.Anyviolation of Section en L5 by any applicant fora permit subjects the applicant los civil penalty of not more than five hundred dollars (S500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. meets are not intended or offered for sale. If, however, the building 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- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Coda The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such projects with a contractor(,) licensed pursuant to the Contractor's License Law. reawnl am exempt under Sea ,e.&P.C. lilt this 1 sJ• ( �s "BUILDING PERMIT INFORMATION MISC.- REFERTO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT T �! (TN QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -11NC.4 OUTLETS 6.00. SO. FT. FLOOR AREA TOTALACREAGE GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Omer INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B.600 . ASSESSORSPARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACTNO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dam WATER SYSTEM 5.00 WORK ERS'COMPENSAT'ION DECLARATION 1 hereby affirm that I have a certificate of consent to self- insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800. Lab.C.).�T�-_&ted Policy No. Company_.7L ACL. -DATE ACG FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. ❑ Certified copy is hereby furnished. Certifiy��. py is �Ied with the cit n eetion ivision pplicanL61B,YGia-s/+� A?_� CIi RTIPICATE OI'EXEMPTION FROM WORKERS'PERMIT COMPENSATION IN'SURANC17 (This section need not be completed if the permis for one it hundred dollars IS 100) of less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate sa ion emvisionon, you should become subject to the Workers'Compensation with provisions io the Labor Code, you muss forthwith comply with such provisions or this permit shall he deemed revoked. LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. Lender's .C.). 30')7,,', Na ). I me FIRE SPRINK Y [:]N ENERGY T-24 Y C] N� MISC. - REFER TO ORD. ISSUANCE 10.00 FLoOO ZONEA. Y N� L. u.c. Y ❑ NE] PLG. COI LIC. NO. PLG. TOTAL OTV PERMIT FEE FEE SUMMARY BUILDING ALTER OH. 5.00 qpp LIAN5.00 &(TO PLAN CHECK FEE / l (/ 3 7 AIR HAND10,000QF.M.1 4.00CONSTRUCTION AIR HANDR 10400C. F.M.16.00 SEISMIC FEEI EXHAUSDUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Address I certify that I have read this application and state that the above information is state l 1 agree to comply with all oily and county ordinances and stain laws relating to building construction, and 'hereby authorize representatives ladies of this city to emer upon the above-mentioned property for inspection purposes. (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may In way accrue against sml City in consequence of the grand this permit. '// n pp �� / �/A Jlgnature of Appineem,umnioclor Uate HEATING UN IT (OVER 100,000 B.T.U.)9.50 ELECTRIC VENTILATION FAN (SINGLE) 4,00 BOILER-COMP(3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER-COMP (Over t00,000BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL e1 9 OFFICE COPY m POST THIS CARD NEAR FRONT OF BUILDING • CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD 20590 HOMESTEAD JOB ADDRESS UNIT# LOT# MOSKATEL' S ACTIVE SIGN OWNER CONTRACTOR PERMIT NUMBER 14066 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION UFER PREGUNITE - PERMIT VALIDATION -- 1nPll ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING C " ELECTRICALr MECHANICAL - �II\1,13 r ELECT. �� ❑ PLC. MECH. ,❑, ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT. INFORMATION WOOD FLOOR PLUMBING VALUATION $/FT. MECHANICAL ELECTRICAL PERMIT TO ' FRAMING INSULATION STORIES TYPE CONSTR. - OCC. CROUP RES. UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -ROOF SOFT FLOORAREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Oil— ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PARCEL NO. PLUMBING - GAS TEST TRACT NO. ' PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACG FILE NO. FRAMING - SAN # INSULATION PLUMBING zoNwc. ENC. SITE NO. GAS• MECHANICAL FIRE SPRINK ,❑ N❑ ENERGY TQQ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL S FLOOD ZONE Y ❑ N❑ aL.u.c. Y ❑ N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK IGRADE - -- FEESUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ✓ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. i MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL IMPORTANTI PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL OFFIGE COPY