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16790 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER APPLICATION & PERMIT AEss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL . 16790 0fp3i71641 1OWNER'S PLAN CHECK VALIDATION NAM �f yv aS -,1Z QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS NAME �y .f UTLETS'-SWITCHES-RECEP 10.00/1.00 ' M6 �' NG TQOss/ LIGHTING FIXTURES 10.00/1.00 - A DR ESSTOR'sPPLIANCES-RESIDENTIAL 4.00 U 1IUC/LPHONE 376295-5- PANELS 10.00 DATE OF APPLICATION ' ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIc.NO, ISIGNS TRANS. 3.00 moo Ess ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - zIP TEMP.METER OR POLE INS. 20.00 �^ Ars ADDDRESSDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20. '02 LICENSED CONTRACTORS DECLARATION pe ��/�J(,g� . a Z w I hereby affirm that I om licensed under provisions of Chapter 9 ISSU NCE GATE (cornnuncing with Section 7000)of Division 3 of the business and ¢ c BLOC. ' ELECT. PLG. MECH. H N Z Professions Code,atilt my license is N,full force and elle t. ❑ ❑ ❑ 2Om_ - License Cla Lie.Number BOOy-L O L m Date_/_ Contractor a y E BUILDING PERMIT ¢ ¢ a OWNER-BUILDER DECLARATION ¢ ur D INFORMATION I hereby amen Ill.[ I um exempt from the Contractor's License MISC.- REFER TO ORD F U 0 4 Law for the following reason.(Sec.7011.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. m Code:Any city or county which requires a permit to construct,alter. ¢ 0 f a O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. rP V i xCr¢ requires The applicant for such permit ill file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License Hi > Law(Chapter 9(commencingwith Section 7000)of Division 3 often i a Business.,,it Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500)): ❑ I•as owner of the propery,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their wit,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 f Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 bO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,fors Provided thin such improve himse are not through his or offered provided that such building GAS-EA.SVSTEM-l1NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that lie did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS Omer �Cl I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Seo. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:1'he 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 Snell projects with a contractor(s)licenard pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA,200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT' 6.00 reason Owner 11au: WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO, WORKE.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, or o certificate of Wotkers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). F Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGYTY4 Z Cl copy is filed with the city inspection division. MISC.- - -REFER TO ORD. ( APPlicunl Y❑ N❑ y ❑ N❑ ~ rn PERMIT ISSUANCE 10.00 = - CER-1'IPICA11:OI'EXEMI'1'ION FROM WORKERS' FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. LID.NO. PLG. - EL Z o CI his section need not be completed if the permit is for )he TOTAL Y❑ N❑ Y C] N❑ hundred dollars($100)or less.) U O 1 certify that in The performance of the work for which this per- OTY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner w as to O w hecnmy s the Workers' -Y Laws of California. Dam. Ah licunt BUILDING em n. - - I p ALTER OR ADD TO MECH. - 5.00 } to N01'IC e T API'LICAN'f: If,after nmking Ili Cerl il'icute of Ex- 2_F emption,you should become subject to lire Workers'Compensation APPLIANCE_ 5.00 PLAN CHECK provisions U the Labor Cole, you must forthwith comply with FEE such provisions or this permit shell be deemed revoked, AIR HANDLING UNIT(TO 10pODC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10A00C.RM.) 6.00 . SEISMIC FEE S� I hereby affirm Thal 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. MICROFILM 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 in iornmtion is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Of 100,000 B.T.U.) 6.00 PLUMBING a oidinuncus and state laws relating to building construction, and hereby authorize representatives of this city to enter upon Ore BAILER-COMP (Over 100,000 BTU)SEE FEE SCM. MECHANICAL above mentioned property for inspection purposes. T(We) agree to Save, indemnify and keep harmless the City of Misc.- REFER TO ORD. upertit o against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the tunli g of fl �mit. MECH.CONT. LIC.NO. MECH. sgn �f"npplt�ntr TOTAL TOTAL 5� OFFICE COPY POST THIS CARD NEAR, FRONT OF BUILDING PERM ITNUMBER =� ' CITY OF CUPERTINO 16790 INSPECTION DIVISION JOB INSPECTION RECORD L ,yy r PERMIT EXPIRATION JC/B ADDRESS �Q 3i `� /LLueg (/�J'T.Ch- f�'//�- UNIT# _LOT#J' PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTEDWITHIN INSPECTION DATE INSPECTOR I SPECTION REC R 180 DAYS OF PERMIT ISSU- ' FOUNDATION ANCE OR 180 DAYS FROM NOTE: UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PErORT VAI IMATTON CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB " PLUMBING ELECTRICAL - - P 'D ISSUANCE DATE MECHANICAL RLUG. ELECT PLG. MECH adv gS8 Elq ' E) DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDsUILDING PE IT WOOD FLOOR �� O{ tt10QFORMATION ti. VALUATION $IFTf' PLUMBING -7- �� ELECTRICAL P E H M TO FRAMING d INSULATION STORIES TYPEjtONSTR UCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLROR ARLA TOTAL ACREAati rt ROOF . - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE . n_ DIAPHRAGM THE'CONSTRUCTION TAX IS PAID k _ C BUILDING USE yL ROOF.SHEATHING Res IND CON PR om.t APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.N ASSESSORS PARCEL NO PLUMBING ELECT,ENERGY TUBS&SHOWER PAN - , PLUMBING ENERGY TRACTNO PARCEL No MECHANICAL - MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DAfE ACC,FILE NO FRAMINGLI— ELECT.FINAL TEST. ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS - MECHANICAL FIRE SPRINK ENERGY 1-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ I Y ❑ N❑ ELECTRICAL RELEASE PLOOD ZONE AL.U.0 EXTERIOR SHEAR 2--. 4r P INTERIOR SHEAR FIRE DEPT. Y❑ "❑ v ❑ N'❑ SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING .- INTERIOR LATH l ' -� Q TEMPORARY APPROVALS BUILDING (JY, SCRATCH COAT ELECTRIC PLANCHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM �" I LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC i.- ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. 'y z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE'SIDE'BEFORE TOTAL S� CALLING FOR FINAL INSPECTION. OFFICE COPY