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13316 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT 13316 q RE55 D BUILDING-ELECTRICAL-PLUMBING-MECHANICAL NFR'S PLAN CHECK VALIDATION unME _ QTY. ELECTRIC PERMIT FEE h&. 7I PX-NF CONTRACTOR s NAMEUTLETS-SWITCHES-RECEP 10.00/1.00 • . 4-_ IC.NOi G (N LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'5PPLIANCES-RESIDENTIAL 4.00 ADDRESS ✓y�� {� NONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No, SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS SEE FEE SCH. a,r•d..r�J ADDDRESSDRESS SERVICE CHANGE 20.00 �J '02 LICENSED CONTRACTORS Df:CLARATION /��r /� M Z, I hereby affirm that I am licensed under provisions of Chapter 9 IgSU NCE BATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. zProfessions Co� spfl license is in full fuer/2fnQ.if W License Cla s to Lic.Number ([$ ❑ ❑ ❑ 9 m Date Contructor�_y ¢ xs / BUILDING PERMIT 2 tc w OWN:R-BUILDIiR DECLARATION o A MISC.- REFER TO ORD INFORMATION w !.. u I hereby afttnn that I am exempt from the Contractor's License LLOG Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT. _ 10.00 Code:Any city or county which requirese permit to construct,alter, aaR ¢ improve,demolish,Or repair any shuctme,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. , 0 LL requires the applicant for such permit to file a signed statement that .TOTAL PERMIT TO w he is licensed pursuant to the provisions of the Contractor's License r z i Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe ¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r $ the basis for the alleged exemption.Any violation of SecUon7031.5 STORIES TYPE CONSTR. a ; by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500).): O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 400 their sole compensation,will do the work,and the st Rmture 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 properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees.provided that such improve. menta are not intended or offered for sale.If,however,the buildingGAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM OVER 4 (EA.) 2.00 builder will have the burden of proving that h . - . e did not build or im- BUILDING USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner Of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon•and who LAWN SPRINKLERS-OV R 5L A.) 1.00 contracts for such projects with a contractors)licensed pursuant to gEWER-SANITAR V-STORM .200ft X0.00 the Contractors License Law. / TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VBNT%. 6.00 reason Owner Data WATER SYSTEM s ACC.OATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQLfI �j ids 5.00 1 hereby affirm that I have a certificate of consent to seIf-i sure, or a Certificate of Workers Co ation Insurance,nr a C hued ZONING ENG.SITE NO. copy thereq1 iE��e•��1p� kA.0 ��--y�L Policy No.{�R[GL•ItanYlw!� 0 ❑ Cert1 jed Copy is hereby furnished. FIRE SPRINK ENERGY T-24 z z4, O Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. H O Applicant - Y ❑ N❑ Y ❑ NE]N cc CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L,U.C. LU COMPENSATION INSURANCE PLG.CONTH, LIC.NO. PLG. 0 (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F• mit is issued, I shall not employ any person in any manner so as to 0 W become subject to the Workers'Compensation Laws of California. CL Date Applicant ALTER OR ADD TO MECH. 5.001 BUILDING } N NOTICE TO APPLICANT: If,after making this Certificate of Ex F ? emption,you should become subject In the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions 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)OODCF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=1 .RM.) 6.00 SEISMIC FEE I hereby affirm that 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,CIv.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 _ Lender's Address ELECTRIC 1 Certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information is correct. I agree to comply with all city,and county g01LER-CUMP13 H.P.Or 100,000 B.T.U.) 6.001PLUMBING ordinances and state laws relating to building construelion, and hereby authorize representatives of this city tD enter upon the BOILER-COMP (Over 100,000 BTU)$EE FEE SCH, MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep Imrmless the City of MISC.- REFER TO ORD. Cupertin Inst Iiabilitin dgme s, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in accrue nst r City in con the the t $ P�y! MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Signature of Applicant ontractor Date OFFICE COPY • a POST THIS CARD NEAR FRONT OF BUILDING PFRN11T NUMBER CITY OF CUPERTINO, �� 6 INSPECTION DIVISION JOB INSPECTION RECORD 19340 PHIL LANE PERMIT EXPIRATION JOB ADDR ESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER ANDERSON CONTRACTOR CONSUMERS PLUMBING IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- 'ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL {'qY� ISSUANCE DATE ECR. MECHANICAL BLoc. ELECT. PLc. M „l1 ❑� - ❑ . �' ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w BU�Iqp LNG PERMIT WOOD FLOOR - 4 �u117�1�'IyI�MATION '� ) VAWATION $SFT. PLUMBING ' MECHANICAL " PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO,FT,FLOOR AREA TOTAL ACREAGE • ROOF DIAPHRAGM BUILDINGUSE RES IND CON PR Olne. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ 0 ROUGH ASSESSORS PARCEL NO. � ' PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL . ELECTRICAL FINALS DATE INSP. ACC DATE ACCFILE Na. FRAMING SAN # ZONING T ENO.SITE NO. INSULATION PLUMBING GAS MECHANICAL FIRESPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NEINE] LATH—INTERIOR ELECTRICAL - FLOOD ZONE A.L.U.C. LATH—EXTERIOR FIRE DEPT. - Y[:] NC] Y �] N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL$ BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED liOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BYBUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC H - .ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING o PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL • - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPV