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17384 J/ APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY �e BUI.LDING PROJECT IDENTIFICATION gppUG:'-TSN & PERMIT PERMIT NUMBER awLDINc ADDRESS BUILDING-ELECTRIAL-�LUMBING-MECHANICAL 173 p n d OWNER'S PLAN CHECK VALIDATION NAME ZsS OTY. ELECTRIC PERMIT FEE d ONE ONTRACTOR's NAME UTLETS-SWITCHES-RECEP 10.00/1.00 sec.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'SPPL(ANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP( 2000 PLAN CHECK FEE P.C.NO. OH ENGINEER sec.NO. SIGNS TRANS. 3.00 - ARCH.oRENG' SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 -'3 APPLICANTS MOTORS SEE FEE SCH. / ADORES EE SERVICECHANGE 20.00 .� /� ,•�11,�r1 0 0 o LICENSED CONTRACTORS DECLARATION u L ¢ v v I hereby.,flim. Ihul I :un licensed under provisions of Chapter 9 MARTe V J ISSUANCE DATE Ha$ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. vI w z Professions Code.and my license is in full force and effect ❑ ❑ ❑ z 0. - License Class Lic.Nwnbe, City Of f6.re.{r�� 9 ,°u Date Contract., City WPwfNw a y 2 BUILDING PERMIT rc ¢w a OWNER-BUILDI:R DECLARATIONINFORMATION wLL 1 hereby affirm that I and exempt frond life Contractor's License MISC.- REFER TO ORD u o a Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. L- - v, Code Any city or county which requires a permit to construct,alter, ¢ 2¢ 0 ( improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. q O LL_ rtq vires lllc applicant for such permil to file a signed aLticnfcm that TOTAL '! 1 O 0 PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License x Fza Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe .e� 14 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CO STH. m by any applicant for a permit subjects the applicant to a civil penaltyALTER-DRAIN&VENT-WATER IEA.) 5.00 of nut more than five hundred dopm,($500)J'. 0 1,as owner of the properly.or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and life structure is not 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 �yM,."✓,+{y property who hands or improves thereon,and who does such work FIXTURES -PER TRAP 5.00 SO.Er.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such indprove- menlsarenmintendedorofferedforsale.Il',however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 or improve ancut 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 im- prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 KREs IND cOry PB Omer I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ C,"led em-toc ws to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 6 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contract,for such projects with a contractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractors License Law. ❑ lam apt under Scc. ,B.&P.C.for thla WATER HEATER W/VENT 6.00 reason11 Owner Uwe WATER SYSTEM 5.00 PCC.DATE ACC.FILE NO, WORK ERS'COMPENSATION DECLARA'T ION WATER TREATING EQUIP. 5.00 I herchy of firm that l have a certificate of consent to self-insure. or a certificate of Workers ZONING Compensation Insurance,or a certified ENG.SITE NO. copy Ihereof(Sec 3800.Lab.CJ. Policy No. Company 0 ❑ CeDitled copy is hereby furnished. FIRE SPRINK ENERGY T$4 Z 2 ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y❑ N❑ Y C] N❑ cc CERTIFICATE 01:EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE ALL.C. LET > COMPI,NSATION INSURANCE: PLG.CONTE. LIC.NO. PLG. d O ('Phis section need not be completed if the peon it is for one '\ TOTAL Y❑ N❑ Y❑ N❑ 2 It dd dollarsIS 100)or lcsv.l U O 1 certify that in the perl'urnfance of the work for which this per. CITY. MECHANICAL PERMIT FEE FEE SUMMARY IL P Clift is issued,I shall not employ any person in any nfanner so as to OL) secouy IIn II the Workers'Conl Cd tion-Laws of California. d DateL� APpficant //XX..GG..�i•• ALTER OR ADD TO MECH- 5.00 BUILDING } GO NO11CF O Al PLICAN'I': II',of cr making this Certificate of Ex- F'� nuption,you should bucmne subduct to Ilie Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Coda, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCT ION LENDING AGENCY AIRHANDLING UNIT(OVER 1Op00C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD,(WITH DUCT), 5.00 the perforianee of the work for which this permit is issued(Sec MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.f.U.) 8.00 Lender's Name HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC LendCr's Address I certify that I have read this application and state that the shove VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 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. '.t (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against Mobilities,judgment,, costs and expenses which CONST.TAX nWIT ay accrue agmnst 'd City in consequence of the PERMIT ISSUANCE 10.00 •ms permit MECH.CONE. LIC.NO, MECH. U TOTAL TOTAL r1 PPhcant/ .DDE"co Date r OFFICE COPY I POST THIS CARD NEAR FRONT OF BUILDING ' PERMIT NUMBER CITY OF CUPERTIfuN 17384 INSPECTION DIVISION * '• JOB INSPECTION RECORD PERMIT EXPIRATION �•. JOBADDRESS Jn 6 nIU V-PI�.t GP6-" D� UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER / e CONTRACTOR �� IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGESLABS C POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . 7 / UNDERGROUND /SLAB I' y - PLUMBING \A ,,i)VI ALL! ELECTRICAL ISSUANCE DATE BLDG ELECT PLG. MEG. MECHANICAL El ❑ E:] 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIG D BUILDING PERMIT INFORMATION WOOD FLOOR If VALUATION $/FT. PLUMBING MECHANICAL PERMIT IG ELECTRICAL FRAMING C STORIES iVPE CONSTR INSULATION UCC GROUP TIES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so FI .Loon AREA. TOTAL ACREAGE DIAPHRAGMTHE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING 'TEs IND CON PB On... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN,# PLUMBING ' ELECT. ENERGY nvncl No PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE$PRINK ENERGY LPn MECHANICAL N❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING F LOGO LONE ALU C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. ❑ NF] r --I N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS ° NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE 69 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM apv ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICTio w i r ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX F' PLEASE READ REVERSE SIDE BEFORE1 CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY