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15680 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ~ BUILDING PROJECT IDENTIFICATION - .PERMIT NUMBER amLomruc I� APPLICATION U PERMIT q C68O AOOREaS ,/ / I J �,02$"� INN�l� VA/ BUILDING - ELECTRICAL-PLUMBING-MECHANICAL ,, OWNER'S PLAN CHECK VALIDATION NAME (may TV. ELECTRIC PERMIT FEE AMC50-y?) �' I S PHONE /t CONTRACTOR'S Q Nam IJ OUTLETS-SWITCHES-RECEP 10.0011.00 7, S'-U L LIGHTING IXTURES pp 1.000 CONTRACTOR'S ADDRESS Sy(�pG Qtc.l/,�W�S/��/ PPLIANCES-RESIDENTIAL 4.00 23e1'I I14)a/) /Iyl�LfynYTHONE/J/� >[» PANELS 10.00 DATE OF APPLICATION, OARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC. 1 ' c.No. SIGNS TRANS. 3.00 ADDDR'ESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 A DDRESSTS MOTORS - SEE FEE SCH. . SERVICE CHANGE s-, 20.00 0 o LICENSED CONTRACTORS DECLARATION <2 I hereby affirm that I atm licensed tinder provisions of Chaplet 9 ISSUANCE DATE r (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. -MECH. r N z Professions Code,'4R61 my license is in full fort tic ❑ ❑ Z.O w - Dae c Chls. . JS - Contractor Number E m t Date Convector a se f BUILDING PERMIT ¢ I= a OWNER-BUILDER DECLARATION ¢0 a u INFORMATION 'sa ; e-w 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LL 0¢ Law for the followin reason.(Sea]031.5,Business and Professions VALUATION S/FT. N N f g PERMIT ISSUANCE -M1&00- Code:Any city or cor rep which requirese permit to construct alter, ¢ ¢ a O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO'. ELEC. 0d ^� wD K requires the applicant for such permit to file if signed statement that TOTAL PERMIT TO $ he is licensed 9( opursuant to the provisions of 00 )ofDivision License r i 4 Law(Chapterand Professions Code)or Section 7000)rept therefrom o of the re i O Business and Professions Cade)or that he is exempt therefrom end DTV. PLUMBING PERMIT FEE ¢ r$ by basis for the cora exemption.Any violation o f Section malty TORIES TYPE CONSTR. a ; by any applicant fora hundred subjects the applicant roacivil penalty ALTER-DRAIN -WATER (EA',15.00 of not more owner five hundred dollars(Try em): ❑ o romper at theon,will do or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS ' their sole compensation,will do[he work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'fire Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does net,work FIXTURES,PER TRAP 5.00 aQFTFLOORAREA TOTALACREAGE himself re Through his own employees,provided that such improve- mentsarenotintended oroffered oyees,provided that s the building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GASEA.SYSTEM-OVER 4 (EA.) 2.00 ewtOWG USE builder will have the burden of proving[hal he did not build or im- prove for purpose of Nile.). INDUSTRIALWASTE INTER. 30.00 RES IND CDN PB Otho, O I,as owner of the property,am exclusively contracting With ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,BusinessLAWN 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 such projects with a contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200ftl10.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ Iumexemptunder Sec. ,BAP.C.for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COM PENSATION DECLARATION - WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a Certified Copy there-j(Se 3 O,Lah.CJ.,1lA* Q.,N1 I'oliyy No.T_104NiL-�Y]ompun �I ww - O /pl Certified�y is rcb fur FIRE SPRINK ENERGY T74 Z p ❑a'CinrIi(ied p f w' the city inspection division. MISC.- REFER TO ORD. Y A I' ❑ N❑ Y❑ N❑ ~ m 00 LU CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10. FLOOD ZONE A.L.u.C. W - COMPIiNSATION INSURANCE PLG.CONTR, LIC.N0. PLT, Y❑ -N Q Y E] N❑ CL 0 (1 his sectidn need not be completed if the permit Is for one TOTAL hundred dollars IS 100)or leas,) V 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 O Ed become subject to[he Workers'Compensation Laws of California. Date-Applicant BUILDING C. ALTER OR ADD TO MECH. 5.00 } W NOTICE TO APPLICANT: If,after making this rs'Coicme of F.x- F Z em vision you she L becomm,Co subject to the Workers'Ccomply will! APPLIANCE 5.00 PLAN CHECK such rove io the Labor Code, you duel forthwith comply whir - FEE U such provisions orchis permit shall be Deemed revoked AIR HANDLING UNIT TO 10,000GF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE P7 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH'DUCT) 5.00 lire performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lenders Name HEATI NG UNIT 100,000 B.T.U.18.50 ELECTRIC Q dU Lender's Address I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is correct I agree to comply with all city and county PLUMBING ordinances and stole lows relating to Building construction, and BOILER-OUMPI3H.P.m100,000BS.U.1 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mcntianed property for inspection purposes. (We) agree to save, 1 Imrnify keep harmless the City of MISC.- REFER TO ORD. - upertino against iabili s,jud a s, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in a way ce agains d City in conpequence of the dntin Ills mil Q MECH.CONT. LIC.NO. MECH. P TOTAL TOTAL �46 77 Signature of Applicant/Contractor Uut OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15680 INSPECTION DIVISION JOB INSPECTION RECORD' PERMIT EXPIRATION JOB ADDRESS '��T+�6e' PIC�C�y UNIT# _LOT# . PERMIT EXPIRES IF WORK OWNER A11,10 TRACTOR ;(�7- - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 160 DAYS OF PERMIT ISSU ,ANCE OR 180 DAYS FROM FOUNDATION, NOTE: LAST CALLED INSPECTION. ' s UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH•THE APPROVED PLANS AND CITY OF PERMIT VALIDATION - CUPERTINO STANDARDS. GARAGE SLABS . POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING • ELECTRICAL - ISSUANCE DATE' MECHANICAL - - BLDG PLEcr PLG. MECH: Ela El ❑ . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR. VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL 7 ,QPERMIT To FRAMING INSULATION - - STORIES TYPE CONSTR. - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP:SHALL BE MADE BEFORE SO.F,FLOOFAREA TOTALACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB om., 00 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING - - ELECT.ENERGY rRnri NO. PARCEL No TUBS&SHOWER PANPLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY ACC DATE. ACC.FILE NO FRAMING ELECT.FINAL TEST . . ZONING ENG.SITE NO, . INSULATION - PLUMBING GAS TEST GAS' FIRE SPRINK ENERGY T 24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLooD zarvE AL.uc - EXTERIOR SHEAR ELECTRICAL RELEAS � INTERIOR-SHEAR FIRE DEPT. Y ❑ NEl Y ❑ N❑ SHEET ROC K 1t% 1^t../ 7-1 - GRADEFEE SUMMARY EXTERIOR LATH BUILDING , INTERIOR LATH TEMPORARY APPROVALS BUILDING d0. SCRATCH COAT ELECTRIC :PLAN CHECK _ - GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I ISEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, I ELECTRIC a GU' ' ' `ONE-WORKING DAY BEFORE REQUIRED INSPECTION. ;, PLUMBING °z PLEASE GIVE JOB ADDRESS WHEN PHONING, ' — SEE PERMIT FOR EXPIRATION DATE - ECONST. IMPORTANT! *PLEASE READ REVERSE SIDE BEFORECALLING FOR FINAL INSPECTION. 6 OFFICE COPY•