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14858Z Z— Fv00 cc W _ CL 0 D Z UO LL U Ow } a a APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT PERMITNUMBER A 1 4 8 U I V aWLDM _r- ADDRESR /+ 76 77B�ILDING—ELECTRICAL—PLUMBING—MECHANICAL OWNER'S, NAME PHarvE GTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION •<` '; DATE OF APPLICATION, CONTRACTOR'S NAME Bit H/ � �, JUGOP JOUTLETS - SWITCHES -RECEP 10,00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDDDC yOF 2tPJ RE., � Br /- 0�PHONE7r7-J'e-� PPLIANCES- RESIDENTIAL ' 4.00 PANELS 10.00 - ARC/ O� T�.f fi 3 OR T ENGINEER- uc.No. PANELS (OVER 200 AMP) 20.00 r" PLAN CHECK FEE P.C. NO. ' SIGNS TRANS. 3.00 ARCH. OR ENG.PERMIT ADDRESS. TIP SPECIAL CIRCUIT '- 5.00 VALIDATION - TEMP. METER OR POLE INS. -20.00 ' AS ADDRESS MOTORS - SEE FEE SCH. SERVICE CHANGE 20.00 - _ S 7� 4 - LICENSED CONTRACTORS DECLARATION - . I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Co}y{r�y_ndmyIa�case is in full fa rt' a4J yffY3`AQ License Class /` f Ef Lia Nmnber .i e eC7 Dale Contractor ISSUANCE DATE lk-D—G.-I ELECT. PLG. MECH. . 0 ILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION ION I hemby affirm that -I am exempttfromrom the Contractor's License Law for the following reason. (Sec.7031-.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter9(commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and MISC. - REFER TO ORIM" TION S/FT. PERMIT ISSUANCE +1$00 FLED. CONTR. LIC. NO' FLED.. TOTAL t0 `- PERMIT TO " DTV. PLUMBING PERMIT FEE .STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Sec[ian 703 T.5 - by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN -WATER SEA.) 5.00 ❑ F,'as owner of rhe property: or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECTDEVICE - 400 . . . , occGRouP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (See. 7044, Business and Professions - - Code: The Contractor's License Law does or apply to an owner of propertywhobuildsorimproveslhereon, and who docs such work himself or through his own employees, provided that such improve- mends are not intended or offered for sale. If, however, the building - - FIXTURES - PER TRAP 5.00 SO, FT. FLOOR AREA - ' TOTAL ACREAGE GAS-EA.SVSTEM-11NC.4,OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that Ire did not build or inn prove for purpose of sale.). ❑ ` I, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 - BUILDING USE RES IND `CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER: 30.00 licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. - - - LAWN SPRINKLERS - OVER 5 (EA.). 1.00 contracts for such projects with a conlracumo licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. '❑ lamexempt,under Sec. ,B.&P.C. ]or this - WATER HEATER W/VENT 6.00 reason Owner Date WATER.SYSTEM 5.00 ACC.OATE ACC. FILE NO., WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or o certified - -ZONING ENG. SITE NO. copy themof(SeC. 3800, Lab.C.). L Policy No. - Company ❑ Certified copy is hereby furnished. - ❑ Certified copy is pled with the City inspaetlan division. Applicant FIRE SPRINK Y E]N ❑1 - "ENERGY T 2 Y ❑ N❑ MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE •H)000 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. Qd TOTAL /. `. COMPENSATION INSURANCE - IThis sec ion need not be completed if the permit is for one V E] N ❑ V ❑ N ❑ QTY. MECHANICAL PERMIT FEE - FEE SUMMARY hundred dollars IS 100) or less I terrify that in the performance of the work for which this per, mit is issued, I shall not employ an person in any manner so a o beta I Workers' enmtirm La 'for a Date ppli' erti mate- Ex- NOTIC TO PPLI ung this Certificate/Ex- BUILDING ALTER OR ADD TO MECH. .5,00 - APPLIANCE 5.00 PLAN CHECK FEE i emption, you should become subject to the Workers' Comps sution tion, provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Alfl HANDLING UNIT (TO 10 =C.F.M.) 4.00 AIR HANDLING UNIT(OVERIdj=C.EM.) 6.00 SEISMIC'FEE S'0 CONSTRUCTION LENDING AGENCY I hereby affirm that abets is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, s Na . Name Lender's Na EXHAUST'HOOD (WITH DUCT) 5.00 MICROFILM . r HEATING UNIT (TO 100,000 B.T.U.) 6.00 HEATING UNIT (OVER 100,000B.T.U.)9.50 '' ELECTRIC / —� Lender's Address - _ I certify that I have read this application and stale ihat the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) - 4.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER-COMP•(Over 100,0.00 BTU) SEE FEE SCH. - MECHANICAL ' hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. _ MISC.- ' : - REFER TO ORD.' CONST. TAX - - (We) agree to save, Indemnify and keep harmless the City of upertino against liabilities, judgments,` Costs. and expenses which in, any way accrue against said. City in consequence of the PERMIT ISSUANCE - 10.00 MECH. CONT. LIC. NO. MECH. NOTAL rant' is permit. ' / PTOTAL E! ppiicand/Contractor Date OFFICE COPY ►., POST THIS CARD NEAR FRONT OF BUILDING CITY OF .CUPERTINO s ; INSPECTION DIVISION ' JOB iNSPECTION RECORD - JOB ADDRESS 7Y"7 -7i UNIT# -_LOT# „ - - - OWNER CONTRACTOR PERMITNDMBER 1485$ - PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION.' 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. LIFER PREGUNITE_ PERMIT VALIDATION _ ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL 1p - - BLDG I ELECT ❑ '❑ PLG- MECH 1❑ '. ❑ ' - DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,`AV • BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING � � ^`yO WV VALUATION' SIFT. � (�,� MECHANICAL-,- ELECTRICALPERMIT - TO" 4' FRAMING INSULATION STORIES TYPE CONSTR. OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE: NO FINAL'INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - $O11.FI.00H AREA . TOTALALREAGE . DIAPHRAGM. .. ROOF SHEATHING BUILDING USE RES IND CON PB Orli. El ❑ El ElASSESSORS APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ' ROUGH SAN.# PARCEL NO. PLUMBING ELECT. ENERGY TUBS &SHOWER PAN PLUMBING ENERGY . TRACT NO. PARCEL NO MECHANICAL - MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC.DATE ACC FILE NO. FRAMING ELECT, FINAL TEST INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST,, . GAS MECHANICAL FIRE S ENEOv. TNa ❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - .HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE v ❑ NE] .A.L UC. 'v ❑ " N❑ INTERIOR SHEAR y FIRE DEPT. SHEETROCK GRADE 'FEE SUMMARY EXTERIOR* LATH - BUILDING BUILDING..s, - INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - PLAN CHECK FEE - GAS NQTAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE y OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM, ARRANGE FOR INSPECTION'BY PHONING 252-4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING.. Z - SEE PERMIT FOR EXPIRATION'DATE -' ELECTRIC I PLUMBING MECHANICAL CONST. TAX IMPORTANT'! PLEASE READ REVERSE SIDE BEFORE x,°• `' .CALLING FOR FINAL INSPECTION. TOTAL 7: OFFICE COPY