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15918 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -,USE BALL POINT PEN ONLY .PERMIT NUMBER BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT a°"°'N° 15 918 ADDREss �J�p/) M��-I— BUILDING - ELECTRICAL—PLUMBING—MECHANICAL OWNER'S �A�v �, PLAN CHECK VALIDATION Is NAME W QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS - LETS-SWI ES-RECEP 10.00/1.00 (y LIC.-.4,54WIGHTING FIXTUR S 10.00/1.00 CONTRACTOR'S - P ADDRESS �%///aatL//'�Qp APPLIANCES 4.00 UYJI� H°NEFW-Roof PANELS 10.00 DATE OFAPPLICATION ARCHITECT PLAN CHECK FEE P.C..NO. Sy{N J'YSO PANELS (OVER 200 AMP) 20.00 ENGINEER UC.N0 � SIGNS TRANS. - 3.00 - ADDRESS ENG _r SPECIAL CIRCUIT ; 5.00 .PERMIT VALIDATION \� nP TEMP.METER OR POLE INS. 20.00 J APPLICANT'SMOTORS ' SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION a i w I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE ¢ A (commencing with Section 7000)of Division 3 of the Business and ,BLDG. ELECT. - PLG. MECH. L,Ol i Professions Code,a y license iv'in full fore•ayd f ❑ ❑ Z O m w License Class_ Liu.Number 0 m H w Date .O Contractor _ �- F - - J 77 �q a M s J too— A N BUILDING PERMIT ¢ a a OWNIiR;B UILDF:R UECLA RATION o d u INFORMATION F. iL N I hereby affirm that 1 um exempt from the Contractor's License MISC.— REFER TO OR w0< Law for the following reason, 7031.5,Businessand Professions PERMIT ISSUANCE \ LUATION S/FT. F w 0 Y Code:Any city or county which requiresa permit to construct,alter, ' �^ rt a ¢ O improve,demolish,or repair any structure,prior to its issuance,also, ELEC.CONTR. LIC.N0. ELEC. N� /J V V o iL m LL requires the applicant for such permit to file a signed statement that TOTAL W PERMIT TO he is licensed pursuant to the provisions of the Contractor's License _ H i Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe ic Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 'S (C r$ the basis for the alleged'exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n3 � by any applicant for a permit subjects the applicant o a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): - ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of _ Property who builds or improves thereon,and who doessuch work FIXTURES-PER TRAP 5,00 SO.FT.FLOOR AREA TOTAL ACREAGE ' . himself or through his own employees,provided that such improve- ments are not intended or offered for sile.l(.however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the Owner- builder (EA.)will have the burden of proving that he did not build or im. BUILDING USE prove for purpou Of sale.). RES IND CON PB Orbe, INDUSTRIAL WASTE INTER00 ❑ 1,as owner of the properly,am exclusively contracting with . 30. ❑ ❑ n licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does 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 conlraclor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,HAPC.for this reason WATER HEATER W/VENT 6.00 Owtie rut/'_1A��j A Pum WATER SYSTEM 5,00 ACC,DATE ACC.FILE NO, WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 Il ht eby of firm that I have a cc if if cafe of consent to self-insure, or a cc ificale of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy the of(Sec.3800,Lab.C.). �y^�s/� Policy No. Company_AG./_/_V O ❑ CertifiC copy is hereby or Ishod .iFIRE SPRINK ENERGYT24 Z Z ❑ Certif J copy Is e t .inspection division. Applicant_ _ _ � MISC.- REFER TO ORD. Y ❑ N[3 Y 0 No N CERTIPICATE Op EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLO.CONTR. LIC.NO. PLG, CLa( This section need not be completed if the permit is for One TOTAL U O hundred dollars 1$100)or]caa.) 1 certify that in the performance Of the work for which this per- GTY. MECHANICAL PERMIT FEE FEE SUMMARY LL l- mit is issued,I shall not employ any person in any manner so as to .Li become subject to the Workers'Compensation Laws of California, U-i. Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 63 } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- F.. ? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provOions,of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.I 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER IOADOC.RM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 file performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ,C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county BOILER•OJMP13 H.P.Dr 100,000 B.T.U.) 6,00 PLUMBING I ordinances and state laws relating to building construction, find - hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless Ilse City of MISC.- REFER TO ORD. upertino against liabilities,judgliwnts, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay i ny way aceme ag St said 'ILin cons nonce of tire rant fthis per i MECH.CONT, LIC.NO. MECH. TOTAL mTOTAL 76 5� gnalure Of Applicant Contractor Dat OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO X5918 INSPECTION'DIVISION JOB INSPECTION RECORD t r • I' ' /j - .PERMIT EXPIRATION ' JOB ADDRESS �0:^Z.00 •/"C///L��.(-c�Z- 0416e UNIT# LOT# PERMIT EXPIRES IF WORK ,' OWNER C 74'/ '87r0'U CONTRACTOR �f V, f� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD ISO DAYS OF PERMIT ISSU- 5 'FOUNDATION , ANCE'OR 180 DAYS FROM NOTE:. LAST CALLED INSPECTION. . LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTI NO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - ' ...- UNDERGROUND /SLAB PLUMBING ELECTRICAL - r J " ISSUANCE DATE, .r EILDG - ELECT PLG- MECH, MECHANICAL - 00 NOT,POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - t1{.BUILDING PERMIT WOOD FLOOR INFORMATION 41 Y7?' VALUATION SIFT. PLUMBING MECHANICAL - ELECTRICAL PERM-IS�T To - FRAMING ` E.9'F'`' r/!Z� , STORIES TYPE CONSTR. INSULATION - , OCC GROUP RES.UNI TS ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE so,FT,FLooR AREA .TOTAL ACRsnce DIAPHRAGM THE CONSTRUCTION TAX IS PAID. 6 - BUILDING USE ROOF SHEATHING 1' - HEs IND CON PB, Go- 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ - ❑ ❑ ❑ ASSES50R5 PARCEL NO. ROUGH SAN.N PLUMBING ELECT.ENERGYTRACT NO, PARCEL No TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC.DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY - FRAMING UwI}r IL 7 - $ ELECT,FINALTEST / -f-k ZONING ENG:SITE NO. INSULATION - PLUMBING GAS TEST GAS FIRE SPRINR ENERGY TSE MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED - HEATING` Y ❑ "❑ Y.❑ N❑; FLOOD ZONE A,L U,C EXTERIOR SHEAR. - � ELECTRICAL RELEASE ./Lf -� - ❑ N❑ Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCKGRADE - ' FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR 'LATH TEMPORARY APPROVALS BUILDING 63:lla,_. ' SCRATCH COAT ELECTRIC PLAN CHECK GAS- . . FEE NO TAPE OR PLASTER,UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE S-pi OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED,BY BUILDING INSPECTOR. MICROFILM - U.1 ARRANGE FOR INSPECTION BY PHONING 252-4505, -ELECTRIC r ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING ° PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE HEAD REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY