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17491 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY r US LDI NG PROJECT I IDENTIFICATION PERMIT NUMBER pp,LDNG�I�D 491214Z411 n/A�11 APPLICATION PERMIT 17491 7 A n 1 91f�1Y BUILDING-ELECTRICAL-PLUMBING-MECHANICAL � �# J S OwNER'S ' PLAN CHECK VALIDATION NAME �j'(/QDTV. �N 1 Rr ELECTRIC PERMIT FEE W= ONE IQ2 CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 U-`J N S Ic.No. LIGHTING FIXTURES 10.00/1.00 roNTRgcTOR's PPLIANCES-RESIDENTIAL 4.00 - E /JxC-4L��TA7 t PANELS 10.00 DATE OF APPLICATION .h. ARCHITECT / ©� PLAN CHECK FEE P.C.NO. {4��EC \O'' PANELS (OVER 200 AMP) 20.00 LIC.NO. ( SIGNS TRANS. 3.00 ARCH OR ENG. ( Q SPECIAL CIRCUIT S.QQ PERMIT VALIDATION AODR �� / �L Cir( )(C� EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDNl/ 1 �� .�/ Z.` SERVICE CHANGE 20.00 1-2 0 o LICENSED CONTRACTORS DECLARATIO <v U I hereby uflirm thin 1 any licens'e'd under provisions of Chapter 9 ISSUANCE DATE E. (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. P, m z Proles ions Cnd� my license is in full fore C WdISI z Out - LiccnaC I's Cm Numhcs`% F--r r-I CIL 0 0 F_w DJtc Contractor ��1,y{� a E , Clh!Of C a,w a OWNER-BUILDER DECLARA'l'1ON "W�w� BUILDING PERMIT A o A D MISC.- REFER TO OR INFORMATION A. g; LL w 1 hereby affirm that 1 am exempt from the Contractor's License LLoj Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 L,L9D VALUATION S/FT. ❑ - Code:Any city or county which requiresuperntil I.CoDalmCLatte" p h Ci ^/1/1 2 a,0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. I /t�V `7WD Iu O LL requires the applicant for such permit to file a signed statement that TOTAL / a V PERMIT TO a w$ he is licensed pursuant to the provisions ol'thu Contractor's License 1 H z a Law(Chapler 9 fcommereing with Section 1000)of Division 3 ofthe Business and Professions Code)or that he is exempt therefrom and OTY, PLUMBING PERMIT FEE K f o the basis for tic alleged exemption.Any violation of Section 7031.5 STORIES I TYPE CONSTR. ate _ by anyapplicant torn permit subjectslhc applicant to a civil penalty / ALTER-DRAIN& VENT-WATER (EA.) 5.00 00 of not modr re than live bombed do11ars(E500).): ❑ I,as owner of the property,or nhy 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 (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Cade:The Contractor's License Law docs not apply to nn owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through Itis own employees,provided that such improve- mintsorC not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 r OD or improve ment is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IN. CON PB Omer ❑ 1,as owner at the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed Contractors to construct the project(Sec. 7044,Business ILAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Poo essinna Code I'he Contractors Liec ur,Law docs not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contractor's Liecise Law, SEWER-SANITARY-STORM EA.2001t/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec,-,B.&P.C.for this WATER HEATER W/VENT 6.00 rcusnn Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK I'RS'COMPENSATION DECLARATION ' WATER TREATING EQUIP. 5.00 ,OD 1 hereby al0nn that I have a certificate of consent to setfminsCre' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.L Policy No. Company O ❑ C ilied copy., let famish ed FIRE SPRINK ENERGY T-24 Z Z ertifhe opy ed try t C 'ity inspection division. O Appli,any (�` REFER TO ORD. Y ❑ N❑ Y ❑ N❑ ~ va PERMIT ISSUANCE 10.00 L rO PLooD ZUNE a.L.u.c. � C I-.R'rl F I CATH 01'I:X Ii M PTIO FROM WORKERS' W > COMPF-NSAI']ON INSURANCE PLG.CONTR. LIC.NO. PLG. ( , 0 D Y❑ N❑ Y❑ N❑ CL O 1'I'his section need not he completed if tam PCrn it is for one TOTAL 1 =) Z hmNred dollars(8100)or less.) U O I certify that in the performance(it tile work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL - all is issued, I shall not employ any person in any manner so as to U become subject to the Workers'Compensation laws of California. p ING m Dam Applicant ALTER OR ADD TO MECH. 5.00 BUILDO } m NOTICE'10 APPLICANT': If,after making this Certificate of Ex- F ? a..fohn,you should bccmme odoce t to the Workers'Compensntfon APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must Rhrthwith comply with FEE U such provisions or this permit still[[be deemed revoked. AIR HANDLING UNIT(TO I0=CF.NL) 4.00 CONST RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOODCFM.) 6.00 SEISMIC FEE 1 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. HEATING UNIT(TO 100,000 B.T.U.)- 8.00 MICROFILM �• 3097,Civ.CJ. Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC / S� ,lam Lender's Address 1 I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 1._ information is correct. I agree to comply with all city and county BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 PLUMBING OY QQ ordinances and state laws relating to building construction, and _ hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEESCH. 2,IM1r�B MECHANICAL S U above-mentioned property for inspection purposes. t _.` (We) agree to save, Indery if]Iy and keep hurnless lire City of MISC.- REFER TO ORD. Cupertino against rr��bildre{judgments, costs and expenses which CONST.TAX may in any w .Ecru .gains a' City in consequence of/e PERMIT ISSUANCE 10.00 OD rantingothi pfmit MECH.CONT. LIGNO. MECH. OTAL7ffrn TOTAL c J 1 V Signature PAPP cant/C ntmclot ate OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING NI IAmEI� CITY OF G-OPERTINO 17491 INSPECTION DIVISION JOB INSPECTION RECORD • q1 PERMIT EXPIRATION •IUB ADDRESS 16 ` O V �A"K y� __ vy e UNIT LOT it _/ PERMIT EXPIRES IF WORK OWNEN -s U CT CONTHACTOT D L&Q IS NOT STARTED WITHIN INSPE TION DATE INSPECTOR INSPECTION RECORD IOU DAYS OF PERMIT ISSU ANCE OR 180 DAYS FROM FOUNDATION NOTE: LAST CALLED INSPECTION. UFFR ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF I'111'alt VAI OA I ION PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB 1 1 + ( ap PLUMBING ELECTRICAL bbISSUANCE NAIL NLI1G f1�.�f-C11 1'LG rq lJl MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR vnIUAnVN sm PLUMBING ,•I MECHANICAL l V oOt ELECTRICAL r•nmmOl FRAMINGC,� ti111111Iti lvlf CIIN$111 INSULATION / "cc 6111111I" "I'S UNITS � 7/...!✓✓l OAS(. � �i7iG��/l> PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 3 i Sn I I I1 111111 AIIIA IIn AI Aua Al.•t ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '• DIAPHRAGM THE CONSTRUCTION TAX IS PAID BNIL IIIN(:IIS', ROOF SHEAT RING If S wu CON vu n)It . APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ 0 0 ASGLS5011.11`AIiC'I.NII ROUGH SAN.n PLUMBING ELECT.ENERGY 14 Af,1 NU AAIIILI-NU I UBS R SHOWER PAN PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ncc unit ACC ilLe NO ELECTRICAL .7 BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENGSITENO - INSULATION PLUMBING GAS TEST GAS i cu+E sr1aNK ,ENt'n(Iv 1 an MECHANICAL D—.3 -V v ❑ N v E) No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 1 L(lun roNe A C u e EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. °❑ N� L• rv� SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING D�'Q... INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRA t CH COAT ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ,3 OCCUPANCY OF BUILDING IS NOT PERMITT ED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM _..,. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC UT ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING _00 O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL S(J - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY