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16837 * . APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES.- USE BALL POINT PEN ONLY 13UI LD1 NO PROJECT I DENTI FICATION - PERMIT NUMBER. BUILDING APPLICATION & PERMIT t- 6837 ADDRESS / - Q - • ' v - �0,5<e 'kiyk/ir[ L9n� /' ('iin UILDING-ELECTRICAL-PLUMBING-MECHANICAL �' OWNER'S - f PLAN CHECK VALIDATION NAMEa OTY. 'ELECTRIC PERMIT • FEE A.CZI PHONE - 10 I • CONTRACTOR'S - NAMEJ•/ _ UTLETS-SWITCHES-RECEP' 110.00/1.00 tQ jJ .uc.so.' LIGHTING FIXTURES 10.00/1.00roNTRACTons �' 2.ADDRESS '/ �V1y .S' ,`, PPLIANCES=.RESIDENT.IAL - . 4.00 �t pp�PIioNE PANELS ;: 10.00 2. q G�A r6i CATION •, ARCHITECT - PANELS (OVER 200 AMP) 20.00 PLA ECK FEE P.C.'NO. OR ENGINEER - u L,_ uC.NO: SIGNSTRANS. - 3,00 ARCH.OR ENG. PERMIT VALIDATION ADORESS SPECIAL CIRCUIT - •5.00 .1 AZIP EMP.METER OR POLE INS. 20.00 / AP LIC Ta i - MOTORS - SEE FEE SCH. SERVICE CHANGE 20.00 ItJ/�11I,� ui o o LICENSED CONTRACTORS DECLARATION au I hereby affirmthat 1 am licensed under provisions of Chapter 9 i ISSUANCE DATE a a (commencing with Section 7000)of Division 3 of the Business and OG. ELECT. PLG.' MECH. H w i Professions Code,EV d my license is in full force c I'E E Z,Z w 0 License Class_-,�_-yj�qJ Lic.Number I��y - IN. /�QE_ConlrucLLu y[.i_0,x_s- 1`-' (NE BUILDING PERMIT ¢ 0.0- OWNER-BUILDER DECLARA'T'ION E o a u - .INFORMATION X S LL H 1 herehy alfirin Ilial I am exempt from the Conlmetor's License MISC.- - - VALUATION $/FT. LL o-a - Law for the following reason.(Sec.7031.5,Buvinessand Professions d0 H _ -PERMIT ISSUANCE 10.00 ,00 SE COde:Anycolish Cor reparnty any strreClucture,iresa prior to ¢ ¢ 4 O improve,demolish,or repair any structure,prior In its issuance,also ELEC.CONTR. LIC.N0.- ELEC. Q / p� ( - w w ¢ requires the applicant for such permit to file a signed statement that - TOTAL J O r PERMIT TO $ he is licensed pursuant In the provisions of the Contractor's License Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 offhe a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE V Ce $ the basis for the alleged exemption.Any violation of Section 7031.5 ' - STORIES TYPE CONSTR. n3 � by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN WATER ( ) 5100 of not more than five hundred dollars($5001.1: t' VENT- EA. ❑ 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 life work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:'I'hw Contractor's Licease Law does not apply to in owner of - property who builds or improves thereon,and who does such work FIXTURES PER.TRAP 5.00 fVV SO.FT.FLOOR AREA TOTAL ACREAGE ppm, hiplaW or through his own employees,provided that such improve- - menuare not intended or offered for sale.If,however,the building GAS-EA.'SYSTEM-11NC.40UTLETS 6.00 s /dE or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 ^N builder will have the burden of proving that be did not build or inr T D B ILDING USE , prove for Purpose ofsale.). - _ RES IND, CON PB Other Cl} I;as owner of the Property ani exclusive) INDUSTRIAL WASTE INTER. 30.00 licensed <oions ors to construct the project La does of apply LAWN SPRINKLERS- 1-INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Crop:The who buildsContractor'sI-:corse s th does not apply ' to an ownenrf h projects who ba tour r improves nand t to LAWN'SPRINKLERS=OVER 51EA.) 1.00 contracts ctor'shceneLwitha contramortsl licensed pursuant to SEWER-SANITARY-STORM EAr 200tt/10.00 ` t. the Contractor's License Law. TRACT NO. PARCEL NO. ' ❑ lam exempt under Sec. ,B.SP.C.litr this WATER HEATER,W/VENT 6.00 - reason t Owner Uate WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO. • WORKERS'COMPENSAI'ION DECLARATION WATER TREATING EQUIP, 5.00 - Thereby at ftiat I have a'certificate ofconsent to selfminsua. ZONING - ENG.SITE NO. kor a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec. 00,Lab.C.). POLICY No/��,QQnmpany Q 1 Certif- ieJcopy is heiriby furnished. FIRE SPRINK , ENERGY TZe Z Z - O Certified copy is filed with the city inspection division. 'O- A}tplicxnt- MISC.- REFERTOORD. - Y ❑ N❑ Y,❑ N❑ CC = CERTIFICATE 01'EXEMPTION FROM WORKERS' - PERMIT ISSUANCE-, 10.00 z dU FLOOD ZONE A.L.U.C. Ill > { COMPHNSATION INSURANCE. PLG.CONTR. - LIC NO. - PCG. 0..0 t'I'I'In, section nccd not he completed If the pant it is for one TOTAL .06' Y❑ N❑ , Y ❑ N❑ ::) Z - [fund red dollars IS 100)(ir less.) U O 1 certify'thaPm tete Performance of the work for which this per QTY MECHANICAL PERMIT FEE FEE SUMMARY LL F. mit is issued,I shall.not employ any person in any manner so as to U become subject to Ole Workers*Compensation Laws of California. C. Umc Applicaul ALTER OR ADD TO MECH. 5.00 1 Q BUILDING 3 y?IS`0 } w NOTICE TO APPLICANT: it,after making this Certificate of L'x- F,-, Z entption,you should become subject to the Workers''Compensation APPLIANCE - 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE ' .. C..1 suchprovisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,0000F.M.) 4.00 CONSTRUCTION LENDING AGENCY - AIR HANDLING UNIT(OVER IQOOOC.F.M.) 6.00 SEISMIC FEE aA 6 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 HEATING UNIT(OVER 100,000 BJ.U.)9.50 61,0 '- Lender's Address - 'ELECTRIC I certify that,)have read this applicutionand state that the above VENTI LATION FAN (SINGLE) "4.00 information is correct. I agree to comply with.1I city and county 'PLUMBING D(� dth,un ces and state laws totaling to building construction, and 'BOILER .a H.P.Or 1001000 B.T.U.) 6.00 U d hereby authorize representatives of this eity'to enter upon IhC BOILER-COMP (Ovor 100,000 BTU)SEE'FEE SCH. MECHANICAL above-mentioned property for inspection purposes. 1 4 D o (WeT agree to ave, indemnify and keep harmless the City of MISC.' REFERTO.ORD. - Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 (2-00CONST.TAX may in any way-accrue against said City in consequence of lire ranting oft is mit. MECH.CONT. .111 No. - MECH. Syl/ /F� TOTAL .�- u TOTAL yLj U k' a opplicat/CotactorSpnalurf n OFFICE COP') POST THIS CARD NEAR-FRONT OF BUILDING • PERMIT'NUMBER CITY' OF CUPERTINO 1 6837 ' . INSPECTION DIVISION' JOB INSPECTION RECORD Q" c f PER{MIT X�RATIP�N� M JOB ADDRESS•—�U 1�� f� 'V �,��� A s`�UNIT# _LOT#, p�MITEIR�S^a�1�F WORK OWNER' -A4 i 6- W CONTRACTOR S•D Ils�,}{yq,T,'�ySi.A„Rm£D�IVITHIN .' INSPECTION DATE INSPECTOR INSPECTION RECORD SEA; OFiPERM1T•ISSU� FOUNDATION NOTE: ANCE OR 180 DAYS FROM - - !' •• "' LASTCAL'LEDINSPECTION. UFER i �' .(� , � ALL GRADING AND DRAINAGE SHALL BE INSTALLED •' PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF .r PERMIT VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING - - ;�.AN 19R9 ) ELECTRICAL 'NIS , ,II ISSUANCE DATE, MECHANICAL LOc. ELECT. .PLO. . Mec-yca AJ '2tT90:Y DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDING PERMIT I' . `INFORMATION ., 'WOOD FLOOR '" ' ' '' '� + ' VALUATION � .s,ET. PLUMBING -�• �/ - • � MECHANICAL -� PE MIT TO ELECTRICAL FRAMING ,- INSULATION ' - - STORIES `TYPE CONSTR. OCC.CROUP RES.UNITS . ;;'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED F II' ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn ET FLOOR AFWA rornL ACREAGE '1 DIAPHRAGM �,-, - - ' THE CONSTRUCTION TAX IS PAID 1: -' "BUILUI NG USE, ROOF SHEATHING• - �c1.00A� ['- HLs' IND CON PB o , —' "APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED FINALS DATE INSP. © 1:3 El ' GE "J", - SAN.M ASSESSORSPARCEL NU. PLUMBING ELECT.ENERGY.,- TRACT NO. PARCEL NO, TUBS BSRiONIE&•PAt.! -- PLUMBING ENERGY - MECHANICAL La- MECH.ENERGY ELECTRICAL BUILDING ENERGY - Acc.oarE ACC.PILE No. , FRAMING e�' e °"• c�(}$Q ELECT:FINAL TEST '• I INSULATION q PLUMBING ZONING, 'ENc SITE NO. - � � ' GAS TEST - - GAS + .. + 'E MECHANICAL IRE SPRINK. . ,ENERcv r.2a . 'COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING >•... Y ❑." D' ,r,YgO "Ell ELECTRICAL RELEASE FLOOD 'EXTERIOR SHEAR 'INTERIOR SHEAR FIRE DEPT. ' Y❑ "❑ v ❑ "❑ SHEETROCK GRADE - FEE SUMMARY EXTERIOR LATH BUILDING " INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT - ELECTRIC PLAN CHECK •,r,,. GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANcY + '. SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY.BUICDINGINSPECTOR. MICROFILM -. ARRANGE F.OR�INSPECTION BY PHONING 252-4505 ELECTRIC=; , 6,,b© - „`n IHwi ONEXORK'ING DAY BEFORE REOUIRED;INSPECTION. ,' PLUMBING o0. PLEASE GIVE JOB ADDRESS WHEN PHONING. "s,OV . y. ZI ° MECHANICAL —'SEE PERMIT,FOR EXPIRATION DATE — Ob IMPORTANT! "' CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL 2 • �� CALLING FOR FINAL INSPECTION. OFFICE COPY