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13110 . '& .APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN 0RLY •• BUILDING PROJECT IDENTIFICATION PERMIT NUMBER lAou"';z" DILGI-, �S M ,( 0. APPLICATION & PERMIT 13110 v(7 i TiNo CI;- 1BUILDING - ELECTRICAL-PLUMBING-MECHANICALWNER'$ sli PLAN CHELK VALIDATION AME r.' CITY. ELECTRIC PERMIT FEE (N(�,tM/Ls- PHONE 7 CONTRACTOR s l NAME .�.�,f l OUTLETS 10.00/1.00 a ell _ T_ GI-L ./�". 5 LIGHTING FIXTURES 10.00/1.00 3 Ob LIC.NO. CONTRACTOR'S ',;gpPLIANCES-RESIDENTIAL 4.00 - 160 /Z S,f/!A(aG4 Y PHONE - PANELS 10.00 (� - DATE OF APPLICATION ARRCHITECT{♦.�/�"✓/� yry, pANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER/ � �LU �, LL Le No. SIGNS TRANS. 3.00 ., ARCH.OR EN 5.00 PERMIT VALIDATION $Gfn// q� ODRESs g/a6-12,0. Lal RCUIT SPECIAL CI �.� �218d ZIPEMP.METER OR POLE INS. 20.00 APPLICANT'BL� AOOR ss MOTORS SEE FEE SCH. (Q� /.�1F/lJUMn✓G3`L flK/HI SERVICE L'HANGE 20.00 woo , LICENSED CONTRACTORS DECLARATION /�- CUped{u a a w I hereby affirm that I am licensed under provisions at Chapter 9 y�" ISSUANCE DATE N a w (commencing with Section 7000)of Division 3 ofBusiness and BLDG. ELECT, PLG. MECH. H N z Professions Code,f�8 my license is in full force d1J1 tq Z O O e License Cpss�(/ Lin.Contractor ®- 9 T H °w_. Dale-�(�'y(�-o¢�(_Contmctor x� � < , 2 a - ' ` BUILDING PERMIT ce m w 4 WNER-BUILDER DECLARATION INFORMATION F. ;u N I hereby affirm that I am exempt from lire Contractor's License MISC.- REFER TO ORD iu .. 0 4 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION SIFT. � -0 Code:Any city orcounty which requires a permit to construct,alter, J �� . - 1 Q ia a M improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. !/ I/ds� ELEC. q9 H -a a, requires the applicant for such permit to file a signed statement that TOTAL X117 -' PERMIT TO wOy he is licensed pursuant to the provisions of the Contractor's License F z Q Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe s 4 O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE re H $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. T ; by any applicant for a permit subjects lite applicant to a civil penallyALTER-DRAIN&VENT-WATER (EA.) 5.00 V N� of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not Q intended or offered for sale(Sec. 7044, Business and Professions I DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 3 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 6Z O.- SFT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mre fi mes anot intended or offered for sale.If,however,the building -7--GAS-EA.SVSTEM-11NC.40UTLETS 6.00 O or 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 am- RES IND CON PB Other / prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am explusively contracting with licensed contractors to construct the project(Sec.7044,Business I LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply L / p to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 3 Lf� /N _621191 contracts for such projects with a contractors)licensed pursuant to 1 SEWER-SANITARY V.STORM EA.200ft/10.00 the Contractors License Law. t] ^ TRACT NO. PARCEL NO. ❑ lam exempt under Seo-,B&P.C.for this I IWATER HEATER W/VENT 6.00 reason Owner Dare WATER SYSTEM 5.00 S� ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, 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 [1 Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. YE] NE] Y E) NE] H � Applicant PERMIT ISSUANCE 10.00 ll FLOODZONE A.LU.C. � � CIiRTI FICCObPE EXEMPTION FROM WORKERS' 11J COMPfiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG. pf Q-Q d0 TOTAL D Y� N� YC] N� (This section need not be completed if the permit is for one D Z hundred dollars(YI00)or less.) U O 1 certify hat in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F- mil is is..55��ii I hall not employ any perwn in any manner so as to V becomeJf Workers'Cir en'lio L cos of I'fo ia. w Date- Applicam_ ALTER OR ADD TO MECH. 5.00 BUILDING } h NOTICE 0 I'1' ICANT: If,after making this Certificate of E.- l.- Z onfuu n,you should become subject to the Workeri Compensation APPLIANCE 5.00 PLAN CHECK �ht provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT IT 10,000 C.F.M.) 4.00 FEE such provisions of this permit shall be deemed revoked. �[ CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10SMC.F.M.) 6.00 SEISMIC FEE �( f I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 0fy the perlormance of the work for which t^his_p�er nnil is issued(Sec. MICROFILM 3097,Civ.C.). �'8�'� HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name - HEATING UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address -,, I certify lhatl havercadthisap catiol an state that thea ove VENTILATION FAN (SINGLE) 4.00 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 ordinances and Slate laws rotating to building construction, and hereby stithorize representatives of this city to enter upon the BOILER-COMP 10ver 100,000BTUI SEE FEESCH. MECHANICAL above mentioned properly for inspection purpows. (We) agAamerue . indemnify and keep harmless the City of MISC.- REFER TO ORD. Oa Cupertino es,ju gments, costs and expenses which CONST.TAX may in anagai st said City in cons luence of the PERMIT ISSUANCE 1000 O- manling ofMECH.CONT. LIG NO. MECH. (� TOTAL .3/' 0 TOTAL /3 3,Z )�\ Signa re o Applicant/Contractor Date OFFICE COPY - _ POST THIS CARD NEAR FRONT OF BUILDING PFRM1LT NUMBER CITY OF CUPERTINO 13110 1' * INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 10695 MERRIMAN ROAD UNIT# Lor# PERMIT EXPIRES IF WORK OWNER REED SPARKS CONTRACTOR IC&C INC. IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION p-2.0' LAST CALLED INSPECTION. UFER —j�D-�C PERMIT VALIDATION PREGUNITE �l-vu✓ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ( _ % �1 y Of CUgeIT<Ido / /f ELECTRICAL — ISSUANCE DATE BLDG. ELECT. I PLG. MECH, MECHANICAL Dq DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 6—� BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION siFT. PLUMBINGQvoro - p MECHANICAL O •�%- PERMIT TO ELECTRICAL SSWL FRAMING -J�7 444 TYPE CONSTR. INSULATION to I- 8 OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - • 50.FT,FLUOR AREA TOTAL ACREAGE ROOF 3330/ DIAPHRAGM BUILDING USE RES IND CON PS 011- APPLY NO ROOFING UNTIL'ABOVE HAS BEEN SIGNED - El El ❑ 0 ASSESSORS PARCEL NO, ROUGH PLUMBING TRACT NO. PANCEL NO GAS TEST MECHANICAL FILE NO. - ACC DATE ACC. ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION 1- _ PLUMBING GAS FIRE SPR INK ENERGY L]< MECHANICAL v [D NE] r ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. LATH-INTERIOR 11_ ELECTRICAL LATH-EXTERIOR FIRE DEPT. F] N� ❑ N❑ SHEETROCK C ccpf }L '• GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR Z TEMPORARY APPROVALS l FIREWALLS ELECTRIC 0_ _-5 PLAN CHECK GAS FLEE -a�- .,� NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM N- E ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 11 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL ' 2 - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. - OFFICE COPY �r