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11322 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ADSG APPLICATION & PERMIT 11322 ADDREORESS 7 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION xAME GTV. ELECTRIC PERMIT FEE p 1 EL PHDNE NAME CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME /��l 3 V LIC.NO � LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDR PPLIANCES-RESIDENTIAL 4.00 C u PHONE O PANELS 10.00 DATE OF APPLICATION AR HIjECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR _I♦ia ENGINEER Llc.No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIALCIRCUIT 5.00 PER MIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 oO LICENSED CONTRACTORS DECLARATION (D T I[ ewi I I hereby affirm that I am licensed under provisions of Chapter 9 g ISSUANC Of CU O.'y`I O ¢ z w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. I MECH. G w i Professions C e y license is in full for J e Z O w- License�Jass .l,�.n��, Lic.Numher 1 1 U ❑ ❑ ❑ ❑ o , H O Date_(�- ,E U: Commctor LJJ L / �U a Y s BUILDING PERMIT ¢ rz w OWNER-BUILDER UFECLARATI N INFORMATION K ;u w 1 hereby affirm that 1 am exempt from the Contractor's License M TSC.- p1u. o ¢ Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. J Co :Any city or county which requires a permit to construct,alter, ¢ 2 ¢Q impr demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. EIEC, w y O¢ requires a applicant for such permit to lite a sighed statement that TOTAL�' PERMIT TO rrr�� X$ he is Been pursuant to the provisions of the Contractor's License px�/��/ a /fid Fii Law(Chapte (commencing with Section 7000)of Division 3 of the J / Ez ¢ Business and fessions Code)or that lie is exempt therefrom and GTY. PLUMBING PERMIT FEE ¢ r the basis for the eged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u;� by any epplicmdfo upemtil subjects the applicant toucivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 �(f'\/J of not more Ihnn five unfired dollars($S00).): ❑ L us owner of t property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS theirsolu compensation, ill do the work,mId the structure is not intended or offered for sa (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's Lice a Law does not apply to an owner of properly who builds or impro Thereon,and who docs such work FIXTURES-PER TRAP 5.00 SG.FT.FLOOR AREA TOTALACREAGE himself or through his own empl ces,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 menta arc not intended or offered sale.IL however,the building or improvement is sold within one r of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.1 2.00 builder will have the burden of provin that he did not build or int- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pe ower ❑ 1,as owner of the property,ren ex, lively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the prole (Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's Licen Law does not apply to an owner of property who builds or improve. thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts for such projects with a contructor(s)lie sed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL No. ❑ lam exempt under Sec. ,B. '.Cforthis WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE N0, WORKERS'COMPENSATION DECLARAI'ION WATER TR EATING EG I hereby affirm that I have a certificate of consent to sell'-insure, - ZONING or a certificate of Workers'Compensation Insurance.or a certified ENG.SITE NO. copy thereof(Sec.3600,Lab.C.)�.- 'p z� � ,±�� V O 1 Policy No. Compasry-T:19 _4&AWIG4ELCA O ❑ Certified copy is hereby furnished, FIRE SPRINK ENERGY T-24 _z 2 fij/ferlified copy is filed with the city inspection division. MC.- REFER TO ORD. O Applicant - V E] N❑ V ❑ NE] ~ y PRMIT ISSUANCE 10.00 � - CERTIFICATF:OP EXEMPTION PROM WORKERS' FLOOD ZONE A.L.U.c. LCOMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y N❑ Y ❑ N[ - (This Z (This tion need net be completed if the permit is for one TOTA hundred do �10_� O I certify that ice of the work for which this per- QTY. MECHANICAL PERMIT FEEFEE SUMMARY LL F- - mit is issudR,1 su n in anymanner so as toU become subject tompensulion lifornia.yDate ALTER OR ADD TO MECH. 5.00 BUILDING �f } N NOTICE:'1'O APPLICANT', IL mice making this Certificate of Ex. Z eniplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10M C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMICFEE , 77 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH D 5.00 the performance of the work for which this payout is issued(SCC. - MICROFILM 3097,Civ.C.). �_ �� E HEATING UNIT(TO 100,000 B.T.U.) 6.00 Lender's Name N I EATNG UIT(OVER1 0,- .If.tJ, :5 Lender's Address H ELECTRIC 3 .i I certify that I have read this application and state that the above VENTILATION FAN (SIh1GLE) 4;00 in is correct. I agree to comply with all city and county 81.WPLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or 10 440 hereby authorize representatives of this city to enter upon the BOILE MP to.,100 0 B UI SEE FEE SCR. ECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MI .- EFER TO ORD. ` Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in we ac-rue against said City in consequence of the gm ing f 1s e m L� MECH,CONT. LIC.NO. MECH. �,� TOTAL„ TOTAL Tgnelure o Applicant/Contractor Date OFFICE COPY f POST THIS CARD NEAR FRONT OF BUILDING PFRM1IR NUMBER CITY OF CUPERTINO 11322 INSPECTION DIVISION JOB INSPECTION RECORD �j�j ``1 PERMIT EXPIRATION JOB ADDRESS �� ` " �Vos�e Ct A UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER A CONTRACTOR �lue aV�h Y IS NOT STARTEDWITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION $ Lov4 r; iL.- ANCE OR 180 DAYS FROM LIFER Q �YT LASTCALLED INSPECTION. PERMIT VALIDATION PREGUNITE OUR NO CONCRETE UNTIL ABOVE HAS BE GNED f\ UNDERGROUND /SLAB PLUMBING • I ! ELECTRICAL — S�'b' ISSUANCE DATE DG. ELECT. PLG. WCH. 'MECHANICAL ❑ 11 1110 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL veRMlr ro > ELECTRICAL S(UIMtirI,Jlr��ld� FRAMING sroRles ,TYP INSULATION E ONSTR. OCC.GROUP ___RES UNITS T 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.-FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM RUILowc usE RES IND CON PB Olner APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING ACT NO, PARCEL NO. GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL .� FINALS ffDAT.EINSP. FRAMING SAN # ZONING ENG.SITE NO, INSULATION PLUMBING ' GAS - FIRE$PRINK ENERGY RT< MECHANICAL Y ❑ NE r 0 N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.LU.C. LATH—INTERIOR ELECTRICAL LATH—EERIOR FIRE DEPT. Y❑ N[3 Yo NQ SHEETROCXTK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING OO //- -r6 11 SHEAR EXTERIOR - TEMPORARY APPROVALVV BUILDING i FIREWALLS ELECTRICPLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY I I SEISMIC FEE /. OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. �. PLUMBING o� PLEASE GIVE JOB ADDRESS WHEN PHONING. 2 MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX T IMPORTANTI PLEASE READ REVERSE SIDE BEFORE g»4: .. TOTAL CALLING FOR FINAL INSPECTION. OFFICIE COPY