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15049 APP,.LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT IDENTIFICATION PERMIT NUMBER - BUILDING } / / APPLICATION & PERMIT 15049 AOUT 7 V/y b ,ro f'I Y BUILDING-ELECTRICAL-PLUMBING -MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME' I C l ITV. ELECTRIC PERMIT FEE o PHDNE 2 7-4781 CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 NAME r -'L F UC.mU LIGHTING FIXTURES 10.00/1.00 ADDTRADTDR's DRESS APPLIANCES-RESIDENTIAL 4.00 sFIm -,(- PHONE )/'+/� t' PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No. ISIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP.METER OR POLE INS. 20.00 /s APPLICANTS MOTORS SEE FEE SCH. ZIP T ADDDRESSDRESS SERVICECHANGE 20.00 woo LICENSED CONTRACTORS DECLARATION a U u I hereby alfinm that 1 am licensed under provisions of Chapter`) ISSUANCE DATE - h <w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F m z Professions Code,and my license is in full force and effect. _ z o m - License Class Lia Number El 11 ❑ 9 w in Data Contractor " - E \ B�1J�ING PERMIT rc re w¢ OWNER-RUILDIiR DECLARATION '(lh►1E 0A " MISC.- REFER TO ORD ORMATION w3 LL H I hereby affirm that I am exempt from the Contractor's License u o a Law I'of the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. r WCode:Any city or county which requires a permit to construct,alter, ¢4 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ¢ requires the applicant for such permit to tile a signed statement that TOTAL PERMITTO ��g1.(/ a w m ol he is licensed pursuant to the provisions of the Contractor's License , AA''� FZQ Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe �L,L7(r'• E.Qie(/7 .ckZa�P i/ Businessand Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ f O the basis far the allcgcd exemption.Any violation of Section 7031.$ STORI S TYPE ONSTR. i; by any applicant for a pemlit subjects the applicant toa civil penalty of not more than live hundred dollars($500t): ALTER-DRAIN III VENT-WATER (EA.) 5.00 ❑ 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 intended or offered for sale(Seo. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 { Code:The Cmmmvtur's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SO.ET FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such in,prove- mous are not intended or offered for sale.It,however,the build ing GAS-EA.SVSTEM-11NC.40UTLETS 6.00 of 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 int- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to aonstrud the project IS,,. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of property MS.builds or improves Ihemun,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts orsuch projects with a crair.c or(s)licensed purxuont of the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I an,exempt under Sec.-.B.&P.C.nor this WATER HEATER W/VENT 6.00 remora Owner r-eN WATER SYSTEM 5.00 ACC.GATE ACG FILE NO. WORK ERS'CONIPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby aIflrm that I have a certificate ol'consent if,w1Gineure ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy IhereotISce.3800,Lab.C.). Policy No. Company Q ❑ Certificdcopyishcrehyfurnishcd. FIRE SPRINK ENERGY T 24 Z Z ❑ Cerliticd copy is fled will, em city inspection division. MtSC.- REFER TO ORD. O Applicant Y ❑ N❑ Y ❑ N❑ M y CER'I'IFICA'I'F OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W �_ CO.MPI NSATION INSURANCE PLG.GONER. LIC.NO. PLG. CL 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑ Z) Z hundred dollars($100)or Ica.) U O 1 certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY W H mit is issued, 1 dull not employ any person in any manner so as to U become sublcd to the Workers'Compensation Lows of California. U) BUILDINGDam TPPlicant ALTER OR ADD TO MECH. 5.00 >_ N s C� NOT ICE APPLICANT. If.alter making this Certificate of Ex- f" ? emption,you should become subject to the Worker Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit slid]be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE I hereby atfirnn that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work liar which this permit is issued(Sec. MICROFILM 3097,Civ CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I testily that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct, I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordiisances and state laws relating In building construction,and hereby authorise representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for lnspeclion purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino against liabilities,judgments, costs and cxpens'es which CONST.TAX ay in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 ran ng of is pyrmn. t MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of ApplicantlContractor Date -� OFFICE COPY - POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15049 INSPECTION DIVISION JOB INSPECTION RECORD 00 ,I ,, PERMIT EXPIRATION JOB ADDRESS /0(0 S UNIT# LOT# PERMIT EXPIRES IF WORK OWNER c- 'a CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD .180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF - PERMIT VALIDATION P R EG UN I TE CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED -do-88 uTSm UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE FLOG ELECT PLG. MEC. MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT mo INFORMATION WOOD FLOOR [[''dVALU4TIlIN - SIFT. PLUMBING v c - MECHANICAL Al a - ee ELECTRICAL PERMI* TUB- ,L FRAMING •S�y 01 (a`ty Of cups iRO. STORIESI ` TYPE CONSTR INSULATION OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE sn.I t FLooR nmPA TorAL ncRPnee �`- DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING use ROOF SHEATHING Res IrvO CON PR Om., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDFINALS DATE INSP. ❑ ❑ El El ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TNACI NO, PARC[L NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY AC DATE ACG FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST F7_iNc eNc SITE No. INSULATION PLUMBING GAS TEST - GAS IRE SVHINK ENERGY T,24 MECHANICAL Y COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N r ❑ N� O UALNE AUC EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR - FIRE DEPT ❑ NE:l ❑ N❑ SHEET-ROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING PDN INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY