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15686 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . BUILDING PROJECT IDENTIFICATION .PERMIT NUMBER - P D,NG APPLICATION & PERMIT 16 �� AflESS J Q £ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 568 I rvAME S bORK.9/y1�-1 PLAN CHECK VALIDATION (� QTY. ELECTRIC PERMIT - FEE PHONE 5 NAMERAcroRs OUTLETS,-SWITCHES-RECEP_�IO;OOt .00 VJ`-• . LIC NO. LIGHTING FIXTURES 10:60MOO 7 `_ nooeEss Tons PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10,00 DATE OF APPLICATION ARCHITECT /CG PLAN CHECK FEE D.C.NO. -� oR ��q�JDW1q� PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.NO. SIGNS TRANS. 3.00 ADDRESS,,/ SPECIAL CIRCUIT 5.00 PERMIT VALIDATION yob 266-33078 ZIP TEMP.METER OR POLE INS. 20.00 APPLICANT'S ADDREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 �0 0 LICENSED CONTRACTORS DECLARATION'- - - - ` q a .u I hereby affru thatI am licensed under pros_isions of Chapter 9 H a w (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE m i Professions Code,and my license is in full force and effect, - ELECT. PLG. MECH. ' z O m - License Class ' Lie.Number w Date Contractor si y E J ¢ Ix w a OWNFR-BUILDER DECLARATION V ILDING PERMIT o a U INFORMATION X g w I hereby affirm that I am exempt from the Convactor's License MISC.- REFER TO ORD a_ u. Law for the following reason.(Sec.7031.5,Brldnessand Professions PERMIT ISSUANCE VALUATION $/FT. Code:Any city or colmly w hich requiresu permit to cnnslruch alter, le Q Q 0 improve,demolish,or repair any structure,prior to its Issuance,alio ELEC.CONTR. LIC.NO. O" K re requires the applicant for such permit to file a signed statement that TOTAL /7 u w he is licensed pursuant to the provisions of the Contractor's License PERMIT riQLaw(Chapter 9(commencingwith Section 7000)of Division 3 of the - l E 4 O Business and Professions Code)or that he is exempt therefrom and QTV. PLUMBING PERMIT FEE t ce H es the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE CONSTR. ate _ by any applicant for a permit subjects the applicanno a civil penalty gLTER-DRAIN&VENT-WATER (EA-1_5,09 of not more than five hundred dollars dollars(55001.): c�- ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not into or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA;COND. 5.00 Code:The Contractor's License Law does not apply to an owner of properly who builds or improve,thereon,and who doe,Such work FIXTURES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve- mentsare not intended oruttered for sale.It,however,the building GAS-EA.SYSTEM-1INC.4OUTLETS Sa,00. a-- or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE Ilk for purpose ofshep INDUSTRIAL WASTE INTER. 30.00 RES IND '.CON Pe Omer 7.as d as owner rs the property,he exclusively contactBusine s ❑ 11' ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The who builds License Law deon not apply to an owner of property s wi builds tr improvesensed p,and who LAWN SPRINKLERS OVER 6 (EA.) 1.00 contracts for such projects with a contmetor(s)licenced pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. t exempt under Sec. ,B.kP.C.tie N,ix r`a❑ I am WATER HEATER W/VENT 6.00 Owner r Date WATER SYSTEM 5.00 -ACC.DATE ACC.FILE NO. 1VORrm th t I have a A1'ION DECe.11-ARATIO WATER TREATING EQUIP. 5.00 I hereby ate of that 1 have a ce ns tion lelimo ,ce,loself-insure, or a certificate of Workers'Compensation Insurance,or a cert il'ied - ZONING ENG.SITE N0. copy lhereol Bee 3800, Cco PnNpany _ 1 0 Certified copy is hereby furnished. Z Z ❑ Ceril ied copy is filed with the city inspection division. FIRE SPRINK ENERGY TQ4 Fp Applicant MISC.- REFER TO ORD. v� NE] y ❑ ry� _mow CERTIFICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 4O_ FLOODZONE LU > COMPENSATION INSURANCE PLG.CMMECHAN;ICAL PLG. (L O ('Phis seodma need not be completed it the permit is for one TOTAL V N V ry Z) 2 hundred dollars IS 100)or less.) U O I certify that in the preloneance of the work for which this per OTVERMIT FEE' FEE SUMMARY LL H mit is issued,1 shall not employ any person in any nanner so as to O Ubecome subject to the Workers'Compensation Laws ofCalifornia. Dau npphc°m H. BUILDINGN NOT'ICI' TO APPLICANT: If,after making this Cerilicate of fix- -- emption,you should becmne subject to the Workeri Compensation 5.00 PLAN CHECK provisions of tiro Labor Code, you must forthwith comply with FEE U such provisions or this permit Shan be deemed revoked. AIR HANDLING UNIT(TO 10=41F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE �e 06 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 ICV ER 100,000 B.T.U.19.50 ELECTRIC ,S� I certify flat I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING oRlimnce, and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authoriic rePmsennalives of this city to Calc, upon the n.r.�... above mentioned property for inspection purposes. BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep hanNess tire City of MISC.- REFER TO ORD. . Cupertino against liabilities,judgments, costs :Rid cx Ferries which may in any way accrue against said City in consequence of the PERMIT ISSUANCE .10.00 - CONST.TAX rattingofthispermit MECH.CONT. LIC.NO. MECH. 3TOTAL _/OY TOTAL p0� Sign e o plus t/Contractor D / OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING .. PERMIT NUMBER _ CITY OF CUPERTINO 5686 INSPECTION DIVISION JOB INSPECTION RECORD S • - - - PERMIT EXPIRATION JOB ADDRESS ��O�U h/%.Q ipU� UNIT# -_LOT# PERMIT EXPIRES IF WORK OWNER /LT � 'CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION FI180 DAYS OF PERMIT ISSU- FOUNDATION — — R ` NOTE: ANCE OR 180 DAYS FROM '/ LAST CALLED INSPECTION. UFER ALL GRADING AND I NAGE S 8 INSTALLED PREGUNITE r TO COMPLY WITH THE OPRO PLANS AND CITY OF PEHMIT VALIDATION; CUPERTINO STANDA S. GARAGE SLABS - i I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING r ' ELECTRICAL - IssuANCE DA I MECHANICAL; BI-oc. eLEcr. - PLr,. MECH ❑ o I ❑ ' DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED pQ BUILDING PERMIT WOOD FLOOR 1w0 INFORMATION PLUMBING VALUATION -5/FT, - ' MECHANICAL - ELECTRICAL PevMn FRAMING Al /L6'� •/L/0 EL INSULATION �B; G _ ..r O�s�s_ STORIES_ TYPE CONSTR OCC GROUP RES.UNITS 1 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE. sa`r `Looe AREA TOTAL ACREAGE �. DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING - _ - BUILDING USE - RES IND CON PB 0II- APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N - 1 ASSESSORS PARCEL NO � ' PLUMBING k ELECT.ENERGY TUBS&SHOWER PAN ELUMBING ENERGY TRACI NO. PARCELNO MECHANICAL - MECR ENERGY ELECTRICAL a. BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT.FINAL TEST INSULATION PLUMBING zON1NG ENG.SITE NO. GAS TEST rEj 'NICAL FIRE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNG - Y ❑ N'❑ ° ❑ "❑EXTERIOR SHEAR ICAL RELEASE FLUGOLONE ALU CINTERIOR SHEAR PT. Y ❑ N❑ ° ❑ N❑SHEETROCK - FEESUMMARY EXTERIOR LATH GINTERIOR LATH TEMPORARY APPROVALS -BUILDING SCRATCH COAT IC PLAN CHECKFEE NO TAPE OR PLASTER UNTIL ABOVEHAS BEEN SIGNCY SEISMIC FEE A;7CQAD— OCCUPANCY OF BUILD'ING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. - MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ELI ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING pp' Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL Bp IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 06 CALLING FOR FINAL INSPECTION. OFFICE COPY