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17264:..APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY it O z F O du — W a0 Z)z U_O LL Ow/ >_ WA ail H � A Wi,LDI NG PROJECT 1 DENT[ FICATI ON APPLICATION &PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL •PERMIT NUMBER ` T7264 �u,LoTNc aWILLIN �S RESS DDR 55 Name PHONE rJ OTY• ELECTRIC PERMIT FEE PLAN CHECK VALIDATION - DATE OF APPLICATION CONT ACTOR'S NAM �30 / LIC ua NO. OUTLETS -10.00/1.00 LIGHTING FIXTURES 10.00/1.00 roNTR croRs p CONR 5 �/_G�S�r ,Q• �O/L S PEONE -n APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 A ErECT OR ENGINEER - TIC No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. ] �,U�T\'b[ SIGNS TRANS.' 3.00 ADDRESS END.SPECIAL ZIP CIRCUIT 5.00 PERMIT VALIDATION / 1 _{ —) ISSUANCE DATE 7)�BL EMP. METER OR POLE INS. 20.00 nova Ess Ts MOTORS SEE FEE SCH. SERVICE CHANGE _ 20.00 LICHNSF.D NTRACTORS DECLARATION I hereby a1'1'inn that I um licensed ,miler provisions of Chaptcr 9 (commencing with $,eel n ]0007 of Division 3 of the business' A Professions Code, f I 'cense is in fall force an License Cl.s CLac.on Number tractor OWNI'R-B ILDER DECLARA'T'ION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 7031,5. Business and ProfessionsVALUATIOeN' Code: Any city or crony which renluiresa permit Incrnstruct,ahcr, mpr.ve, demolish, or repair any structure, prior to its issuance, also requires the applicant 1'or such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500).): ❑ 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 land Professions Code: The Contractors License Law does not apply I. an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsarenotintendedoroffered for sale. If. however, the building or improvement is sold within one year of complclion, the owner- builder ill hove the burden of proving that he did not build or im- p nv•or purpose off the.). I, as owner of the property, am exclusively . 7044,tBu with licensed contractors to construct the project (Sec. ]044, Business and Pro fessioro Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a cuntrlactur(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. , B.&P.C. for this reason q a - ;- T ,0 ^ �; I ELECT. PLG. MECH. ❑ ❑ ❑ .� _- _ . - P'Aa f Cune Inns BUILDING PERMIT INFORMATION MISC. — REFER TO ORD PERMIT IS UANCE 10.00 $/FT. ELEC. CON R LIC. NQ �, LEG06 TOTAL PERMIT TO OTY. PLUMBING PERMIT FEE ALTER -DRAIN (EA.) 5.00 STORIES - BACK FLOW PROTECTDEVICE 14.00 . OCC, GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, CON D. 5.00 FIXTURES -PER TRAP - 5.00 so. Fr. FLOOR AREA TOTALACREAGE GAS - EA. SYSTEM - I INC. 4 OUTLETS 6.00 - GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Orn., ❑ 0 ❑ 0 ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00TR ACT NO. -DATE PARCELNO. WATER HEATER W/VENT 6.00 Owner Date WORK 17 RS'COM PENSATION DECLARATION 1 hereby laf firm that I have a certificate of consent to self -insure. or a certificate of Werke Compensaf slnsur m, r ojertil icd Cher C. olicy PPolicy pa WATER SYSTEM 5.00 ACC. ACG FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. _ .�I ❑ Certifled copy is inis c Certified copy with the City ilio" Applicant CER ., PTION FROM WORKERS' iN$ATION INSURANCIi IT n need not he completed if the p' D I'or one bun Ims IS 100) or less) I I y that h the t crurmance of the for which this per- TO s issued, t I sh I not employ any f t many manner. col b' t he Workers'Co 'a L sof ornia. ,Oil Applicant FIRESPRINK Y 0 ryCJ ENERGY 24 Y Q NF MISC. - REFER TO ORD, PERMIT ISSUANCE 10.00 FLOOD ZONE v N� AL,U.C. Y ry� PLG. CONTE. LIC. NO. - PLG. TOTAL T,r MECHANICAL PERMIT FEE ' FEE SUMMARY BUILDING `moi7 ALTER OR ADD TO MECH. 5.0 ICE f e us rs'Cocne of fix- NO ICI. you 1' should bar mnption.vision you should bee oche Wrthwith comply with Provisions of the La SSI ,you must forthwith comply, wish such provisions or t - rout shall he deemed revoked. STRUCI'ION LENDING AG' 1 belch firm that there is r const n lending agency for the Per roncC of the wo for w Penn it ue3 (See 3097 v.C.). Len er's Namc Lender's Address I certify that 1 h lication and sta t at the above information is Pec to c nlply with all city and cru ordinance ws relating to building construe' of this city to t theahuvrnunY ed property for inspection pulp. agree m save, indemnify and ke ese City of upertino against liabilities, judgment ndexpenses whiX may in any way accrue against S, consequence .(the •rooting ofthis permiL i APPLIANCE 5.0 PLAN CHECK FEE ! -� AIR HANDLING UNIT (TO 10,000QF.M.) 4,0 AIR HANDLING UNITIOVER t0,000OF.M.16.0 SEISMIC FEE a EXHAUST HOOD (WITH T) 5.00 MICROFILM HEATING UNIT (TO 100, T.U.) 8.00 HEATING UNIT (OVER 1 ,0 .U.19. VENTILATION FAN (SIN LE) 4,00 BOILER -COMM H.P. or 100,000 B.T.U.) 6.00crcbypretcotutives BOILER -COMP (Over 100,000 BTU) SEE FEES ;ELECTRIC AL .(We) MISC. - REFERTOO D. PERMIT ISSUANCE 1 00 ECH, CONT. LIC. NO. MECH. OTAL L ��� Signature. Appan Date OFFICE COPY t POST THIS CARD NEAR FRONT OF BUILDING • CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD y� JOB ADDRESS `A�o b -7 r ='1 WL.Q-Sl"•Ct. k 7# _ LOT# OWNER V Y V V S U�� CONTRACTOR L 'K _ PERMIT NUMBER 17264 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN , 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM �,. uST��LI;E f1SPj CtT1(jN. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS: UFER PREGUNITE PERMIT VALIDAI ION I,I! 1• z(,(� �_ I r ISSUANCE DATE 1. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED li�lX1!IL'% j UNDERGROUND/SLAB PLUMBING • : :_ „ ,, i /l/ ELECTRICAL MECHANICAL y11 _- ;qpi 42 -: , BLDG CLCcr a PLG. MECH ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUAT5p G� .Y SIFT MECHANICAL ELECTRICAL .. PCI+MIT ro i FRAMING INSULATION STORIEN TYPE CONSTR. ®7 L OCCGHOUP HES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF NOTE: -NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so Fr. vLoor+AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING - BU ILDING USE HES IND CON PB Om", ❑❑ ❑ Ell, El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 'DATE INSP. - ROUGH SAN# ASSESSORSPAHCELNO, PLUMBING ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. ' PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING ENERGY . ACC. DATE ACC. cILE No FRAMING ELECT. FINAL TEST INSULATION - PLUMBING - zoNlrvG ENG, SITE NO. GAS TEST GAS MECHANICAL FIRESPRINK ❑ N'❑ ENERGY T.2a V ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE r ❑ N❑ . L�.•:'N❑ INTERIOR SHEAR FIRE DEPT, - SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH INTERIOR LATH' BUILDING y TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. SEISMIC FEE MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, �� ONE WORKING DAY BEFORE REQUIRED INSPECTION. o PLEASE GIVE JOB ADDRESS WHEN PHONING. z -SEE PERMIT FOR EXPIRATION DATE- ELECTRIC PLUMBING MECHANICAL IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. CONST. TAX TOTAL OFFICE COPY me-