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16732APPLICANT TO FILL-IN INFORMATION WITHIN RED LINES - USE BALL POINT. PEN ONLY• • UILG PROJECT IDENTI FICA_TION APPLICATION &,PERMIT P. BUILDING-ELECTRICAL-LUMBING,-MECHANICAL LLPERMIT1 NUMBER C . I rl J 2 �% 3'2 Sm,oOlN�HI ADDRESS �?� OWNER'S QTY. ELECTRIC PERMIT FEE " PLAN CHECK VALIDATION - /t PHONE DATE OF APPLICATION. V;. CONTRq TOR'S NAmEr�UTLETS LIC.NO. 7/ -SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS`77' /J �•a /�r�' V.' PHDNE �a '6-72' APPLIANCES -RESIDENTIAL ''- 4.00 PANELS 10.00 ARC HITFCT - OR ENGINEER uc. NO. PANELS (OVER 200 AMP) 20.00 PLAN CNECK FEE P.C.AO. " - SIGNS TRANS. 3.00 ADDREOR SS ENG. ' ZIP SPECIAL CIRCUIT '5.00 PERMIT VALIDATION '' 1 EMP. METER OR POLE INS. 20.00 ADDIR r$ r gDR ESS MOTORS SEE FEE SCH. ' SERVICE CHANGE 20.00 t LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business andL Professions Cod} aA6y license is in full to '' 1 License ClassSC:d'Z_ Lic. Number ISSUANCE DATE- .. DG. ELECT. ❑ EJ PLG. -'MECH. El Data - Contractor ' BUILDING PERMIT . INFORMATION OWNER -BUILDER DECLARATION ' I hereby affirm that 1 am exempt from the Contractor s Licens0 Law for [he 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 'F •MISC. - ' � REFE TO ORD VALUATION $/FT. _ PERMIT ISSUANCE - - 10.00 '- ELEC. CONTE. LIC. NO. ELEC. TOTAL PERMIT TO QTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000)of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and ' Li STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any, applicant for a permitsubjects the applicant to a civil penalty. of not more than five hundred dollars ($500).)'. - ALTER -DRAIN -WATER (EA.) 5.00 ❑ US - a owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not _ BACK FLOW PROTECT. DEVICE 4.00 Occ. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale -(Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work' himself or through his own employees, provided that such improve marts 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.40UTLETS 6.00 or improvement is sold within oneyear of completion, the owner- builder will have the burden of proving that he did not build or int: provefor purpose of sale.).,- • ❑ 'L as owner of the property, am exclusively contracting with .GAS - EA. SYSTEM -,OVEfl 4 IEA.) 2.00 ` BUILDING USE RES IND CON.. PB Other' ❑ ❑ ❑❑, E1, INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS- 1 INC 5 V.B.' ' 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. , licensed contractors to construct the project (Sec. 7044, BusinessLAWN and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with o contraetons) licensed pursuant to the Contractors License Law. - SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,, B &P.C. for this reason - WATER HEATER W/VENT" 6.00 Owner - Date - WATER SYSTEM .5.00 PCC. DATE ACL. FILE NO. WORKF.RS'COMPENSATION DECLARATION ,• WATER TREATINGEQUIP. 5.00 - hereby affirm that I have a certificate of consent o a certified or,5 certificate of Compensation Insurance, or a certil led - ` - ZONING ENG. SITE NO. 3800,Workers' Copy [hereof fSec. 3800, Lab.CJ. Policy No. '� Company - ❑ Certified 'opy is hereby famished! C,Wt,Certificd ei Iled, with' the city inspection division. APPlicant - " FIRE SPRINK , Y ❑. NE] ENERGY T-24 Y ❑ N❑. - MISC. REFER•TO ORD. CERTIFICATEOF EXEMPTION FROM WORKERS'` PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C. PLG. CONTE. - LIC. NO. PLG. TOTAL COMPENSATION INSURANCE. (This section need not be completed if the permit Is for one Y E] N❑ Y E] N❑ QTY MECHANICAL PERMIT FEE ' FEE SUMMARY hundred dollars 1$100) or less.) I certify that in the performance of ate work for which this perry mit is issued, 1 shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ' ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- c.ption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked APPLIANCE' 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10. =C.F.M.), 4.00 - AIR HANDLING UNIT (OVER 10=C.EM.) 6.00 SEISMIC FEE CONSTRUCTIONLENDINGAGENCY - 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: 3097,CueC.). MICROFILM - - HEATING UNIT (TO.100,000 B.T.U.) " 8.009, J HEATING UNIT (OVER 100,000 B.T.U.0.50- 'ELECTRIC ` _Lender's Name- Conifer's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING I ce,rtify that l have read this application and state that the above information is correct. 1 agree to comply with all city and county GNinances and state laws relating to building construction, and BOILER- COMP (3 H.P:Or 100,000 B.T.U.) 6.00 BOILER -COMP Waa1100;000 BTU) SEE' FEE SCH. I• - MECHANICAL q� r (/ hereby authorize representatives of this city to enter .upon the above-mentioned property for inspection purposes. - MISC. - REFER T_O ORD. 'CONST. TAX .,. • �.. LW AI-alil ree to save, indemnify and keep harmless the City of ertin a l cost 'abilities, judgments, casts and expenses which may .I come against said City in consequence of the PERMIT ISSUANCE ' 10.00 Z.op MECH. CONT. LIC. NO. MECH TOTAL- r D TOTAL' ran g o it, Signature of Applicant/Contractor Date OFFICE COPY wr POST THIS CARD NEAR FRONT OF BUILDING CITY OF. CUPERTINO •INSPECTION DIVISION JOB INSPECTION RECORD JOBfA `' '] 77 -}�� (�1I UNIT# ILOT# DDR ESS '"/ � ` �� "'- + -PERMIT owNea . coNrRAcroR eng-7- PERMIT NUMBER 16732 1 'PERMIT EXPIRATION r , EXPIRES IF WORK IS NOT STARTED WITHIN .I 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. UF ER PR EGUNITE `sr'PERMIT VALIDATION - _ ' +. `. "GARAGE SLABS ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ; • I QRCI UNDERGROUND -/SLAB PLUMBING •• v ELECTRICAL MECHANICAL - - - oG. ELECT. PLG. •MECH.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOORINFORMATION VALUATION > $IFT. PLUMBING • ' MECHANICAL ELECTRICAL PERMIT TU FRAMING INSULATION - STO IES TY PE CONSTR. . OOc. GROUP RES. UNI TS , PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP.'SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID .. 'SO'FT FLOOR AREA TOTAL PCR EAGE DIAPHRAGM - - - ROOF SHEATHING BUILDING USE •RES ,ND* CON. PB '09- El 0 N 11 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ": ASSESSORS PARCEL NO _ ROUGH SAN.# PLUMBING ELECT. ENERGY TRACT NO. .PARCEL NO TUBS & SHOWER PAN. PLUMBING ENERGY •.' - MECHANICAL "MECH. ENERGY - ELECTRICAL - - BUILDING ENERGY Acc..OATE ACC FILE No FRAMING - ELECT. FINAL TEST' 'INSULATION PLUMBING, '. " ZONIN. 'G ENGSITE NO, GAS TEST: _ GAS FIRE SPRINK Y ❑ " ENERGY 1 2 ,. `'E] "E� ' MECHANICAL + COVER NO WORK UNTIL ABO E HAS BEEN SIGNED HEATING FLOOD20NE . 'Y n NE]v"�' A. L, U+6,' "� E XTE R IO R'SH EAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. ... SHEETROCK'• GRADE FEE SUMMARY EXTERI OR,LATH1. BUILDING. "- - BUILDING INTERIOR LATH - TEMPORARY "APPROVALS ' .SCRATCH COATELECTRIC - PLAN CHECK.- FEE 1 •i "GAS SEISMIC FEE I. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED - OCCUPANCY ..' OCCUPANCYOF BUILDING IS NOTPEAMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. "T MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, LU F ; ' ONE WORKING DAY BEFORE REQUIREDIINSPECTION.• , o PLEASE GIVE JOB ADDRESS WHEN PHONING. z — SEE PERMIT FOR EXPIRATIONDATE -' k"• t " #�. y a w E, BLEcrRlc PLUMBING MECHANICAL ; , CONST. TAX " IMPORTANT!' .'. PLEASE READ REVERSE SIDE BEFORE .. CALLING -FOR FINAL INSPECTION., " TOTAL E. , :.r OFFICE COPY.