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14088 - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 2a� 6a �a��s4�� 1408 NAME PLAN CHECK VALIDATION x NAME � 714- QTY. ELECTRIC PERMIT FEE E.<PHDNE77�/-57916 NAAMERncioRs OUTLETS-SWITCHES-RECEP 10.00/1.00 LIC.NO. LIGHTING FIXTURES 10.00/1.00 DHACroR's ADESS APPLIANCES-RESIDENTIAL 4.00 ADDRE PHONE PANELS 10.00 DATE OF APPLICATION OR ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.NO. JSIGNS TRANS. 3.00 ADDRESS ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zip TEMP. METER OR POLE INS. 20.00 ASMOTORS SEE FEE SCH. ADDREDDRESSS / /V'e"r /1/ �arb d�'� "qy hli�z�, SERVICE CHANGE - 20.00 woo LICENSED CONTRACTORS DECLARATION /aQC/7 U w I hereby affirm that I am licensed under provisions of Chapter 9 sUANJ DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r w i Professions Code,and my license is in full force and effect ❑ ❑ ❑ z o m- License Class Lie.Number o w w Date Contractor 4 - re y E J 6 w a OWNIi R-BUILDER DECLARATION - BUILDING PERMIT u`xl;LL p, I hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION F L O 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION w i Code:Any city or counly which requires permit to construct.alter, p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ca o LL requires the applicant for such permit to file a signed statement that TOTAL e w m he is licensed pursuant to the provisions of the Contractor's License PERMIT TO F z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s i o Business and Professions Code)or that he is exempt therefrom andQTY. PLUMBING PERMIT FEE a: H m the basis for the alleged exemption.Any violation of SSrtion703IS STORIES TYPE CONSTR. i by any applicant for a permit subjects the applicant to acted penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 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 ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 5.00 S 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 TRAP5.00 SO.FT FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended cur offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 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 purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer I as owner of the property,am exclusively contracting with El ❑ 1:1 1:1 IDli a d contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. .6.00 ASSESSORS PARCELNO. 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam Cx pt under 5 ,B.&P.C.for this WATER HEATER W/VENT son 6.00 Owreaner Dat WATER SYSTEM 5.00 �.,C%t•� ACC.GATE ACC.FILE N0. WORKERS'CI have a A OND LAR nt IONto s WATER TREATING EQUIP:_'� 5,00 I hereby affirm that I have a certificate of consent or self-insure, or a certificate of Workers'Compensation Insurance,or a certified - rT, ^\- ZONING ENG.SITE NO. copy thereof(Sec.3800 1. Policy Companyparry 1 U C1 Certified copy is hereby furnished. fps Z Z ❑ Certified Copy is filed with Bre city inspection division. L P11Ce FIRE SPRINK EN ERGV T-24 F O Applicant MISC.- RgrER TO ORD.' Y❑ N❑ Y ❑ N❑ DCN CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 O _ FLOOD ZONE A.L.u.C. LL > COMPENSATION INSURANCE PLG CONTR. LIC.NO. PLG. J��J - ❑ (This section need not be completed if the permit is for one TOTAL v Y❑ N❑ Y E] ry❑ Z hundred dollars($100)or less) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to U L) become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. } 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex. 5.00 BUILDING H ? pemption,you should become subject to the Workers'Compensation APPLIANCE 5,00 PLAN CHECK visions of the Labor Code, you must forthwith comply with U sucroh provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 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 Lender's Name Lender's Address HEATI NG UN IT(OV E R 100,000 B.T.U.)9.50 ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING �•� ordinances and state laws relating to building construction, and BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue gains) said City in consequence of the PERMIT ISSUANCE 10.00 gran g of[his per - MECH.CONT. LIC.NO. MECH. /o TOTAL TOTAL ignature of Applicant Con or ate OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER - C.ITY OF CUPERTINO 14088 . INSPECTION DIVISION ' JOB INSPECTION RECORD s - PERMIT EXPIRATION JOBADDRESS 20680 HOMESTEAD UNIT# Lor# PERMIT EXPIRES IF WORK OWNER CARL KARCHER' ENT CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ,y ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. I ELECT. PLG. MECH. _91 ❑ ❑ El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. MECHANICAL .,. ELECTRICAL PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED w ROOF SO FT,FLOOR AREA TOTAL ACREAGE �7 DIAPHRAGM RUILOI NG USE RES IND CON PB Otne, APPLY Ni ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ . ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT No. PARCEL No. MECHANICAL ELECTRICALFINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING SAN # INSULATION PLUMBING ,� zoNlNc ENG.SITE NO. GAS MECHANICAL 77 'T FIRE SPRINK ENERGY T2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING _ Y ❑ N❑ Y ❑ N❑ LATH—INTERIOR FLOOD ZONE A.L.u.C. ELECTRICAL [�.ev Of VU ��- LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE -- _ Y -- SHEAR INTERIOR FEE SUMMARY BUILDING � SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I SEISMIC FEE OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ELI 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. OFFICE COPY