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09785 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT lDENTIFICATION PERMIT NUMBER gppLICATION & PERMIT X eunowr 09785 ADDRESS 462(6 /ffl/n ES'7�A 4ze BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S 1=r,1-,uI-0 ,sex,T-o �..yt,�ly PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE PHONE /✓1 )- CONTRACTOR'S 7406 )-O NAME B-( UTLETS-SWITCHES-RECEP 10.00/1.00 13LACH Ce 1J5M CO, uc,No„'1,90 tQ� LIGHTING FIXTURES 10.00/1.00 ADD.'AcroR's �N a�� PPLIANCES-RESIDENTIAL 4.00 NTR 30o Suri Bu/b gtuf>1 PHONE y - /Qp PANELS 10.00 GATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR /¢SSoC- - ENGINEER LIc.NO.0/e�o'l/O JSIGNS TRANS. 3.00 AENG. - - ADDRESS .irw./.A ,ST SPECIAL CIRCUIT 5,00 PERMIT VALIDATION SS.S-i9,f7U^-r�rF- *IIJCIS� G/1• zip EMP.METER OR POLE INS. 20.00 /PAID APPLICANT'S/yd �! I 1 ADDRESS 6L,*-C# CeN;PY.CD MOTORS SEE FEE SCH. Seo Sce� /3c�b• 5,}Un1 Chf29 4SoS'� SERVICE CHANGE 20.00 �, r o 2 LICENSED CONI RACTORS DECLARATION TEMP.POLE 30.00 ./ -'/f,F�/ a u u 1 hereby affirm that I am licensed under provisions of Chapter 9 CITy Ol LrN e'-' 0 N ¢u (commencing with Section 7000)of Division 3 of the Business and ISs(IANCE DATE F o i Professions Cod- and my license is in full fore•a it of ed BLDG. ELECL PLG. MECH. o,z_ C License Class _Lie.Number ❑ ❑ F n J Datu�/ Contractor M M w 4 OWNER-BUILDER D: nR N BUILDING PERMIT o d D INFORMATION a-y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL O 4 Law for the following reason.(Sec.703 L5,Businessund Professions 7VAUTATION $/FT. Code:An cit or count PERMIT ISSUANCE 10.00ne U�'t7 Any y county any structure, permit its issuance, 4 FO improve,demolish,or repair any structure,prior l0 its issuance,also ELEG CONTR. LIC.N0. / ELEC. u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO a w m he is licensed pursuant to the provisions of the Contractor's License n/ H Z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 7 A �f� q O Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE l.� is I- m the basis for the alleged exemption.Any violation of Section 7031.5 n S,; by any applicant for a permit subjects the applicant to a civil penally STORIES TYPE CONSTR, ofnot more than five hundred dollars(35001.): ALTER-DRAIN& VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself le through his own employees,provided that such improve- mcntsaovement not tended or within rone OT year o complevee lhe the owner, GAS-EA.SVSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING-USE prove for 1,aso neeose of sale.). INDUSTRIAL WASTE INTER. 30.00 O lO CON Other ❑ L as owner of the property,he exclusively.7044,Business licensed contractors : construct the project(Sec.7044,Business LAWN SPRINKLER$- t INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to anowner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractoKs)licensed pursuant to the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 in exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5,00I ACC.DATE ACG FILE NO. WORK ERS'COM PENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby dfftrm that I have a certificate of consent to self-insure. or a certificate of Workers'Compensation Insurtnee,or a evil il'icd ZONING -NG.SITE NO. copy thereof(Sec.3800,Lab.CJ. Policy No. Company R/RD17A'A3 O ❑citified copy is hereby furnished. Z 2 CeDiOcd copy is Bled with [he city inspection division. FIRE SPR IPK ENERGY T24 Applicant/� �.��- o MISC.- REFER TO ORD, V � NF] V [] NE] CC LO CH RTI FICn'h: P IiXhn P71ON FROM WORKERS' PERMIT ISSUANCE 10.00 _ FLOOD ONE A.L.U.C. L13 COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG. d O (This section need nut he completed if tire permit is for one TOTAL v❑ N� V ry� � Z hundred doll...IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE F mit is issued,I shall not employ an FEE SUMMARY LL U p Y y person in any manner so as to 0 w become subject to the Workers'Compensation Laws of California. y Date.Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emption,you should become subject to the Workers'Compensation qpp LI 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 1Q000GF.M.) 4.00 CONSTRUCTION LENDING ACF-NCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 1 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. 3097,Civ.C.). HEATING UNIT(TO 100000 BTU ) 800 MICROFILM Lender's Name , . . . . Lander'.Address HEATING UNIT(OVER 100,000 B.T.U.)B.50 ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 Information is correct. I agree to with uIcity and county PLUMBING ordinances and slate laws relatingg to to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the abovcmenlioned property for inspection purposes. BOILER-COMP(Own 100,000 B!n- OFFICE MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way .ecrue against said ty in c (sequence of the PEflM1T ISSUANCE granting of this pennil � 4M-ECHCONT. LIG NO. G'eN Ca Signature of Applicant/CoNractor U [e TOTAL � COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY- OF CUPERTINO ' Q7�5 or-" Ol�5� INSPECTION DIVISION r / JOB INSPECTION RECORD PERMIT EXPIRATION., _ JOB AD E55 N !# LOT# (.1�� Z , PERMIT EXPIRES IF WORK OWNER (�{/ CONTRACTOR IS NOT,STARTED WITHIN INSPECTION DATE •INSPECTOR IN PE TION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION -ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING • . I ELECTRICAL - ISSUANCE DATE MECHANICAL a ELECT. . PLG. MECH. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR + - INFORMATION PLUMBING VALUATION $/FT. MECHANICAL ELECTRICAL f l'vER TO FRAMING - INSULATION' _ STORAIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF SO,FT.FLOOR AREA TOTAL PCREA(:E DIAPHRAGM BUILDING USE RES INOCON PS Ov,.•r APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ '❑ • ❑ ❑ ROUGH ASSESSORS PARCEL NO. . � � - PLUMBING GAS TEST - TRACT NO. PARCEL N0. MECHANICAL ELECTRICAL - !ER INALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING Q �D—],). INSULATION ING - ZONING ENO.SITE NO. NICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED G Y ❑ "❑ v ❑ "❑ LATH—INTERIOR ' ICAL FLOOD ZONE A.L.U.C, LATH—EXTERIOR PT. - Y❑ N❑ Y ❑ NSHEETROCK SHEAR INTERIOR, FEE SUMMARY NGSHEAR EXTERIOR TEMPORARY APPROVALS BUILDINGFIREWALLS IC PLAN CHECK FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED NCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� -ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX , PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY.