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11196 ` . APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 5 BUILDING PROJECT IDENTIFICATION PERMIT NUMBER 1^ BUILDING ( APPLICATION & PERMIT � ADDRESS //S '{ BUILDING- ELECTRICAL-PLUMBING-MECHANICAL 11196 +N / ✓ OWNER'S PLAN CHE VALIDATH N NAMEOF, 6-J-3) , TY. ELECTRIC PERMIT FEE PNONE CONTRACTORS _ L� y UTLETS-SWITCHES-RECEP 10:00/1.00 NAME � LIGHTING FIXTURES 10.00/1.00 .- .� IC.NO. CONTRACTOR'5 APPLIANCES-RESIDENTIAL 4.00 •,yS AOOREaa / /� A- / x5 [/l,• /' pHO p � 37 PANELS 10.00 DATE OF APPLICATION / ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FE�A e-Vc.D.NO. / DR f ENGINEER I. . LIC.No, SIGNS TRANS. 3.00 ARCH,OR ENO SPECIAL CIRCUIT . ,00I PERM4T,yI�ID�TJON'I•V11."1 ADDRESS J4 r ZIP EMP.METER,OR POLE INS. 20.00 ADDRESSTs MOTORS S EF E,SC0 4- f;,(��Iy�I�RbL1f10 SERVICE CHANGE 20.00 kib 0 0 0 LICENSED CONTRACTORS DECLARATION 1S�e1' ¢ u 1 hereby affirm that 1 am licensed under provisions of Chapter ISSUANCE DATE hQ u ( mmencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. t H o Z fessions Code.at my license is in full forcfpis�l Vol W 6 z o= icen Class - Lie.Number �q-/-- L]� g w L w Uule�=� Contractor_yC_g;y�pn_Jf. - Q yEJ - - f!!/f " ¢ ¢ ¢ OWNER-BUILDER DECLARATIO BUILDING PERMIT o d U MISC.- REFER TO ORD INFORMATION X ; 'N 'I hereby affirm that I am exempt from the Contractor's License - VALUATION F- u_ a,j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 /0 -, Code:Any city or county which requires a permit to construct,alter, 0 PC ¢c improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. _ ELEC. 'j v v - - O In requires the applicant for such permit to file a signed statement that TOTAL 30 PERMITTO whe is licensed pursuant to the provisions of the Contractor's License - a A Fi > Low(Chapter 9(commencing with Section 7000)ofDivision3oftlm -L)-Dt1/7eJ-V-) . 4 o Rosiness and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE ¢t_$ the basis for the alleged exemption.Any violation of Section703L5 i STORIES TYPE CONSTR. by any applicant for.permit subjects the applicant too civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ - - of not more than-five huodmil dollars($500).): I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE' 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the strucDve is not - .. intended ...offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 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 TRAP S.00 SQ FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such impRwc- ."� i .mems are not intended or offered for Sale.If,however,the budding GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is Sold within one year of completion,the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PEE Other D I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does nm apply to an owner of property who builds or improves Wemon,and who LAWN SPRINKLERS-OVER 5(E 1.00 contracts for such projects with a contraetons)licensed pursuant to SEWER-SANITARY-STORM t/10.00 the Contractor's License Law. TRACT N0, PARCEL NO. O I am exempt under Sec. -,BAP.C.for this WATER HEATER W/VENT reason 14 Owner - Date WATER SYSTEM T.00- ACC.DATE ACC.FILE NO, WORKIiRS'COMPENSATION DECLARATION WATER TREATING EQUIR. ,5:Q6 1 hereby affirm that I have a certificate of consentto self-insure. x ZONING ENG.SITE NO. ur a certificate of Workers',Compensation Insurance,t or a cyrtifed cup,Thereof(Sec 3800,I-ab.0.). - Policy No. Company - Od coehy funlished. FIRE SPRINK ENERGY T.YA Z Elyfled with he cit iasp on division. MISC.- REFER TO ORD. .v ❑ N❑ v ❑ N❑ I"it (P:RT)17]CAT4.017FXI;MpriONFRO��wo - . I PERMIT ISSUANCE 10.00 MPTION PROM WO iR5• FLOOD mNE A.L.u.C: LUCOMPENSATION INSURANC17 PLG.CONTE. - LiC.NO. PLGd on need not be completed if the Permit is for one TOTAL IW v❑ N❑ Y❑ N❑ =) Z hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,.I shall not employ any person in any manner so m to1. L) become subjectto the Workers Compensation Laws of California. O w Datc Applicant ALTER OR ADD TO MECH. 5.00 BUILDINGG. } 0 NOTICE'1'O APPLICANT: If,after making this Certificate 0f fix. Z Cmplion,you should become subject to tile Workers'Compensulion APPLIANCE ' 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE C.1 such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10000 6.00 SEISMIC FEE 1 hereby affirm that'Ihere is B construction lending agency for EXHAUST HOOD(WITH DUCT s 5.09 the performance Of the work for which this permit is issued IS". 3097,Civ C.). HEATING UNIT(TO 100,000 B.TN .) 8.00 7x^� MICROFILM - _ Lender's Name - HEATING UNIT(OVER 100,OOD .U.19. Oyl s. ELECTRIC, 30 Lender's Address - I certify Out I have read this application and state that the above VENTILATION FAN (SINGLE) 0 _ - r :Of,roation,is correct. I agree to comply with all city and county '.PLUMBING �Q nNinances and state laws relating to building construclion. and 89ILER-00W(3H.P.or100,000B. 'V 6.00 .hereby xulhurim representatives of this city to enter upon the BOILER-COMP Over t00,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purp.scs. _ (We)'agree.to save, indemnify and keep harmless the City of M_ISE - REFER TO ORD. - Cupertino against liabilities,judgments,costs and expenses which - CONST.TAX may in any w y accrue against said City in consequence of thPERMIT ISSUANCE 10.00 Elie V got t of III permit �I MECH.CONT. LIC.N0. MECH. �ry � TOTAL Sig ature of plicant/Contracror Date O OFFICE COPY f' ' POST THIS CARD NEAR FRONT OF BUILDING. PF ' CITY OF CUPERTINO RMITNDN,BER INSPECTION DIVISION JOB INSPECTION RECORD _ PERMIT EXPIRATION JOB ADDRESS.` , / 5'•� -3 -6-YI Sbu rlG C�� UNIT# - LOT#t - - -'� _ PERMIT EXPIRES'IF WORK "OWNER �d�I�S�V� CONTRACTOR Q,r ale IS NOT..STARTED WITHIN INSPECTION DATE INSPECTOR 118PECTION RW'qRJ 180 DAYS OF PERMIT,ISSU- ' ANCE OR''160 DAYSFROM FOUNDATION w' LAST CALLED INSPECTION. LIFER ' G: ,PR EGUNITE• PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED d UNDERGROUND /SLAB PLUMBING - a ELECTRICAL- - IF SSUANCE'DATE MECHANICAL - , - BLDG. ELECT. --PLC. MECH. OO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR vALunnoN - slFr. PLUMBING• ' _ - - e MECHANICAL ELECTRICAL PERMIT TO_ .FRAMING . STORTORID IT-O� IES TYPE CONSTR. INSULATION 41 /' C. +T OC .CROUP" RES.UNITS 1PLsA'CE NO SUBELOOR UNTIL ABOVE HAS BEEN SIGNED s > n ROOF •. \,' FLOOR AREA TOTAL ACRE 'SO.4T,FL EA T PGE .. DIAPHRAGM •. ,. EDLOINGNSE RFS. IND CON PB DIM1m INAPPLY NOIROOFING,UNTIL ABOVE•HAS BEEN SIGNED - ❑ ❑' ❑- ❑ 1:1 ASSESSORS PARCEL NO, I! , ROUGH I PLUMBING ' - - Y-1 — - TRACT NO. PARCEL NO. GAS TEST •a .. 1 MECHANICAL I FINALS ACC.DATE ACC.FILE NO. ' ELECTRICAL � ���/� DATE INSP. s FRAMING iQ'_ SAN. ' _ INSULATION 8� _� PLU BIN iF ZONING' ENG.SITE NO. AzGAS MEC ANIDAL 0 FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEA ING Y ❑ A❑ ❑ N❑ ELEC -, ,,, FLOOD ZONE A.L.U.C. LATH—INTERIOR � " LATH—EXTERIOR 1, i FIRE DEPT, - - y❑ .N❑ Y ❑ ^+❑ SHEETROCK �/ GRADE FEE SUMMARY BUILDING SHEARINTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL FIREWALLS - ELECTRIC - PLAN CHECK " GAS - FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMICFEE / Wpt OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL SIGNED BY BUILDING INSPECTOR:, MICROFILM 1 ARRANGE' FOR-INSPECTION BY PHONING 252.4505, ELECTRIC } "' ONE WORKING DAY BEFORE REQ UIRED'INSPECTION. F PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. ' • " " Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE IMPORTANTI CONST.TAX. PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL 'OFFICE-COPY �' • ..» .