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14907APPLICANT TO FILL IN INFORMATION WITHIN RED, LINES - USE BALL POINT PEN ONLY r UI LDI NG PROJECT I DENTI FIC TION "' APPLICATION &PERMIT BUILDING tELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER - 14907 BUILDING{ ADDRESS Q p IR, a / OWNER'S -II/ NAME ''1, 1^. I. -1q,t� ry(.1xRSj PHONE ITI SS OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' NAMERAcrORs UTLETS-SWITCHES-RECEP 10.00/1.00 '1 LIC. No. LIGHTING FIXTURES 10.00/1,00 ' r-DrvTRAcroR's ((Gp - C_^rLa TZ9 Urm. ADOREss APPLIANCES 4.00 PANELS 10.00 DATE OF APPLICATION.' ARCHITECT OR. e�l1l{a{�{LE ENGINEER �,,,puPc ^ �A r(� `/vwsrclM ET>NV� LIC. NO, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 1 ARCH. OR ENG. ADDRESS •3793 VO LAC12AA7-C VD SPECIALCIRCUIT 5.00 PERMIT VALIDATION' - TEMP. METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ' U G1/a qlL(�� ' ( /.+ LICENSED CON TRACTORS DECLARATION ? I hereby affirm that I am licensed under provisions of Chapter 9' PAJQUANCE DATE ' (commencing with.Sccti.D 7000) of Division 3 of the Business and PIOCeBaIO'a COIIC, afld Iny IIeIL-n9e Is Ill VIII Cnre nsI [y'e�1 Licensses� Clays Lic. Number I4'xg(Q Date v -I • G� Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec, 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and - B DG. ELECT. PLG. MECH. qq/'1I�v�A BUILDING PERMIT - �QkT10N L A ION S/FT. ,.,%Cl�r�) `"" -/ OOO MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 r0 ELEC. CONTR. LIC. 0. _ ELEC. �sp TOTAL" PERMIT TO /^ QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basisforthe alleged exemption. Anyviolation ofSeclion7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): ' ALTER -DRAIN -WATER (EA.) 5.00 ! ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND, 5.00 intended br offered for sale (Sec. 7044, Business and Professions Code.'The Contractors License Law does not apply to an owner at property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended orol Cared for sale. ll', however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA /.� A/ ( ro r TOTAL ACREAGE - GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6,00 or hnprovemenl is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im. prove for purpose of sale.).INDUSTRIAL ❑`' I, as owner of the properly, am.exclusively 'con Rucling with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES ,IND CON Pe Otha, & Cl ❑ ❑ ❑ WASTE INTER. - 30.00 licensed bommetors to construct the project (Sec. 7044, Business and Professmns Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. .- Q / contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA, 200ft/10.00 TRACT N0, PARCEL NO. ❑'l am exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPFNSAI'ION DECLARATION 1 hereby affirm that I have acertil'icate of consent to self-inslue, ora certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab.C. 1. Policy No. Company- FIRE SPR INK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ ❑ Certified copy is hereby ]or 1 tied. ,k.Ln ❑ Cur 'tied. c p 's Iled wi h the city inspecimn division pppBcant I MISC. - REFER TO ORD. PERMIT ISSUANCE d0{iO CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This .section need not be completed it the permit is for one PLG. CONTR. LIC. NO. I.G.P TOTAL - YC] ,''N❑- Y ❑ , N❑ hundred dollars (S 100) or less.) I certify that in the performance of the work for. which this per. mit is issued, 1 shall not employ any person in any manner so as In GTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING r V---.SAData a become subject to the Workers' Compensation Laws of California. Applicant ALTER OR ADD TO MECH. 5.00 NOTICE O APPLICANT: 11, after making this Certificate of rix- T APPLIANCE 5.00 AIR HANDLING UNIT (TO 10000C.F.M.) 4.00 PLAN CHECK FEE emplicn, you should become subject m the Workers'Compensalion provisions of the. Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE �0'd CONSTRUCTION LENDING AGENCY I hereby affirm that there iso construction Icuding agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec, 3097,Civ"C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 6.00 Lender's Name H EATI NG U N IT (OVER 100,000 B.T.U.) 9.50 - ELECTRIC Lender's Address I certify that I have read this application and saute that the above VENTILATION FAN (SINGLE) 4.00 information is correct. Lagree to comply with .I1 city and county - rdinances and state laws relating to building construction, and PLUMBING BOILER -COMP 13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH, MECHANICAL CONST. TAX 1'ereby authorize representatives of this city to enter upon the 9 -ave -mentioned petty for inspection purposes. (We), agree t c, indemnify and keep harmless the City of Cupertino agalns I' birdies, judgments, costs and expenses which in n a w Frac geinst said City in consequence of the r�Ig(of his It. l �JI A MISC. - REFER TO ORD. PERMIT ISSUANCE -10:00' -Oa MECH. CONT. LIC. NO. MECH. TOTAL wft TOTAL n/ IaCi Ignature of Applicant/Contractor Date _ OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING, CITY. OF MURTINO = INSPECTION DIVISION JOB INSPECTION RECORD q JOB ADDRESS N I-5OM UNIT# _LOT# OWNER 14-%J , ,r,/ 6- CONTRACTOR ls�M/N ,, denmlT NUMBER 14907 PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE, OR 180 DAYS FROM 'LASTCALLED INSPECTION. y;, INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND ORAINAGE'SHALL BE INSTALLED COMPLY WITH THEAPPROVEO PLANS AND CITY OF CUPERTINO STANDARDS. LIFER - PREGUNITETO ' PERMIT VALIDATION ✓ + ' "=• �' c'' �.`' ISSUANCE DATE GARAGE SLABS .'FOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB F ,ND({Z ,o U. Firs i -An EU on. 035-9111," c.paotin+15t�I-bF1aM_ PLUMBING _Z— w, 0 F 1 - — il p Y�i „p C ELECTRICAL - MECHANICAL' ' \-L. •- Gc t5'O �'b'Di'Uj ` �Haz�emtiQlWv QP' ELUc ELecr ❑ ❑ •PLG. MecR. m,❑ p DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;L�y �:_ �p�ppyu BUILDING P RMIT INFORMA ON' VALUATION SIFT. /�� WOOD FLOOR PLUMBING �' _ _/f �f �P�O,A�1 pgOh, e h 1.G,�- �� Q MECHANICAL `://- ELECTRICAL FRAMING- INSULATION STORIES "A TYPE CONSTR. b 'ND G►rf rA=N�wF< LyHFL y~p L•tL NOTE: NO FINAL INSP, SHALL BE MADE BE O V N�EQg2releWU¢k, 1�ial."jU S �is_�. OCC,GROUP RES. UNITS ; P.L'ACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED ' - ROOF SO, FT FLOOR ANSA TOrALACREAGE , ;DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB oRl.„, © ❑ ❑ ❑ 0 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED PINALS DATE INSP. ROUGH SANA ASSESSORS PARCEL NO PLUMBING1 ,T ELECT. ENERGYro TUBS 8 SHOWER AN /7 PLUMBING ENERGY TRACT NO! PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE- ACC. FILE NO. FRAMING ELECT. FINAL TEST .INSULATION � .� b PLUMBING D%2�FFi ZONING ENG, SITE NO. GAS TEST •' GAS WCC t 3 274 MECHANICAL FIRE sPRINK Y [:]N E] ENERGY T 2 IN COVER NO WORK UNTIL ABOVE HAS BEEN -SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ❑ N❑ ALUC Y ❑ Nq. INTERIOR SHEAR FIRE DEPT. .. SHEETROCK GRADE 1 FEE SUMMARY EXTERIOR LATH _ Q BUILDING BUILDING 0/ - INTERIOR LATH - tk3o TEMPORAR APP OV $ SCRATCH SCRATCH COAT' ELECTRIC PLAN CHECK. FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE �J OCCUPANCY OE.BIJILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY P=252-4505 w ONE WORKING DAY'BEFORE REQ PLEASE GIVE JOB ADDRESS WHE PERMIT FOR EXPIRAMECHANICAL ELECTRIC ,Z PLUMBING dSEE CONST. TAX % '�1 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY OFFICE CITY OF CUPERTINO _ COPY GAS SERVICE NOTICE ,19 To You are hereby authorized to.connect the GAS Iservice for Owner or Tenant f Y 1 C 1<i i� L4^C915J4 Ar New Service No. of Meters Reconnect + r No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR�j L 1 i CITY OF CUPERTINO INSPECTION DIVISION i d H H H z O z m Ll O D 9 0 p m N;r y y 2 2 y µ 1a 3 S2 O 2 2= m D m m v<i y Z 2 2 D[ rn T `GO D v O aD O D a t m O m g yy)� p w T y y O C CC p a O H m m D r r f y y m a Z m r C am O y m . K 2 m r V fi S D O y Z y y Z 3 n n m m D m m a O fA ; 2 O C y. a c y m O = m va 8 m p n 2 m m EQQ� Z o 2 0 tmi C i p 0 z< 2 v ti y Cf r _ m m m A LLnJl y n 9 s m m D 9 2 ~ m m n m m y ; D m m m C f rn W M m * 10m m ujl m - .' V o ; v m s Q Z m mr D A D mn O { r•� ❑ ] O O m Z O m m cc to' �fld y z m E < D r D r m m O m < rV I O \ 9 c Y S 1 I i d H H H z • CITY OF CUPERTINO INSPECTION DIVISION O m O m o G m S m S m m x y D a D r y m r rnn 2 ll O m D y i y (/1 y 1 r i d Gy ~ p. mN o n W 2 Z D O x ti D Oy 3 m O O O z v r 0 n C r 9 r Z 2 C D m m m m D y m m C r2 a < O N N m -xl r u. T c 2 Z Z 0 ZS ZS m D m m y D Z 2 Z r(n H y `2 D v 2 m 2 to T y �' 9 m .4>• v 9 b D O y Z Z D 2 3 D 9 m m D m 3 m m0 @ Z O C m m C C A ^ Q O in 9 F 4 3 j m Gy y y m O D O (m] Z 2 O O y 9 1 p$ n C m O O Z< Z y O r m m tmii O 1 a m g g 4 C o O 2 m v Z H a< 3 mD n m m 9 n a y 9 m D v 9 Z Z ti m o m O m♦ 9 a O m< 1 m~ y m'< m D$ r O m a m o y C m N D _ O D n m r � D rw n O m ❑ 3 c m m y m my m C 7rc mj z o ❑ y> 1 n L1 n m m m �� al n Cc 0 z 1 � ` z ❑ z