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10124 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBERAPPLICATION & PERMIT 9 ILDING 1012 4 AooREsa BUILDING-ELECTRICAL-PLUMBING-MECHANICAL Z o l9 � c 0.NER'1 "U, sT'^- .: J:' !;,'+=':'$� �•e.�{ ,tt";; r PLAN CHECK VALIDATION ..� NAMEAlAii 0[TY' : BLED7IYOPEI�M1'i'�''•.�_�T PHONECON ••ae. "d.-vC? NAME ggTpR! ��''__�� UTLETS-SWITCHES•RECEP 10.00/1.00 /' f�P�AI.IC.NO. 7� LIGHTING FIXTURES 10.00/1.00 CONTRACTOR 5 PPLIANCES-RESIDENTIAL 4.00 AO E55 \/� l 0. J Z SLI PHGNE 46 -238 PANELS 10.00 � DATE onCARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK APPLICATION CF E . .NO. ENGINEER EIc.NO, SIGNS TRANS. 3,00 ARCHH'.OR ENG. SPECIAL CIRCUIT 5.00 PERMI JOAOON ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. DEC 2 2 G 1965 APPLICA SERVICE CHANGE 20,00 Woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 City of Cupertino a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE OATE N< "' (commencing with Section 7000)of Division 3 of the Business and BLD ELECT. PLG. I MECN. H o i Professions Code,and my license is in full force and effect. License ClaxzLic.Number o zN Dale Contractor n ~ J s ¢W OWNER-BUILDER DECLARATION I hereby affvm that I am exempt from the Contractor's License MISC.- REFER TO ORD W01 Law for the(Growing nason.(Sec.7031.5.Busineuand ProfessionsPERMIT ISSUANCE ~ VALUATION S/FT. in Code:Any city or county which mquimsa permit toconstruct,alter, 10'00 i e <p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. EL EC. 'N C 0 X requires the applicant for such permit to file a signed statement that TOTAL PE Mp IT TO w $H he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe . AF; 'i""'•"T z 0 Business;and Profession,Coder or that he is exempt therefrom and QtR ; PltlMOMf�/EIMIT;'^�•,';`;";I�. ;Aow Business; IF r $ the basis for the alleged exemption.Any violation of Section 7031.5 .^ r^'°=^' `•)a _ STORIES TYPE CON R. i3 � by any applicant fora permit subjects the applicant to a civil Penalty ALTER-DRAIN&VENT•WATER (EA.) 5.00 of not mon than five hundred down(5500).): ❑ 1,as owner of the property,or my employees with wages As BACK FLOW PROTECT.DEVICE 4.00 C. ROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 704x• Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law don not apply to an owner of property who builds or improves thereon,and who don such work FIXTURES•PER TRAP 5.00 M FT.FLOOR AREA TOTAL ACREAGE . himself or through his own employees,provided that such improve. marts an not intended or offered for sale.If,however,the budding GAS-EA.SYSTEM•1 INC.4 OUTLETS 8.00 or Improvement is told within one year of completion,the owner. GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 3000 E IND CON PB Omar ❑ 1,as owner of the property,am exclusively contracting with . 1:1 ❑ ❑ C]licensed contractors toBusinessconstruct the project(Sec.7044.Business LAWN SPRINKLER$•1 INC 5 V.B. 8.00 A PARCEL NO. and Professions Code:The Contrutor i License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS•OVER 5 IEA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEW ERSANITAflYSTORM EA.ZOOft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec..,S&P.C.for this WATER HEATER WNENT 8.00 mason Owner Date WATER SYSTEM 5.00 ACcc GATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self intum. or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.I. Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. O Applicant MISC.• REFER TO ORD. Y ❑ N❑ I v ❑ No H CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00Al FLOOD ZONE A.L.U.C. Lu ION NSURANCE CL O (This section need not,be com 1pYteal if the permit is for one PLO.CONTR. LIC.N0. TOTAL ( Y❑ N❑ Y❑ N❑ 0 Z hundred dollars IS 100)or less.) I , e sa + 2 v tir U 0 1 certify that in the performance of the work for which this per- 4 3 b r ly - mit is issued,I shall not as a f inns in any ma ern I to 1 ,7 V U w beco ! lee t the WerkelY sat) w aliform ' DateL.S=/EKG Appliont ALTER OR ADO TO MECH. 5.00 BUILDING } rglt NOTICE TO APPLICANT: it,after making that Certificate of E. emption.you should become subject to the Worken'Compenution 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 tOAWQF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVEfl 10=QF.M.) 8.00 SEISMIC FEE I hereby affirm that then is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,CN.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's NamAddress HEATING UNIT(OVER 100,000B.T.U.19.50 Lender's ss ELECTRIC . I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING r ordinances and state laws mlating to building construction, and BOILER•OObP(3 H.P.or 100,000 B.T.U.) 8.00 hereby authorize representativm of this city to enter upon the BOILER-0OMP (Ow,100,000 BTU)SEE FEE SCN. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmlen the City of MISC.• REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 granting of that permit. MECH.CONT. LIC.NO. MECR. / TOTAL ..MAL XSignature of Applicant/Contractor Date Y OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO INSPECTION DIVISION • JOB INSPECTION RECORD 1 J'An /�/��� /��L PERMIT EXPIRATION JOB ADDRESS/�{(/ LVd.. I fxu�U T,J#�/..�UA/�� LLOT# PERMIT EXPIRES IF WORK OWNER I, 11kid) CONTRACTOR udtt //J IS NOT STARTED WITHIN INSPECTION'. DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. LIFER PERMIT VALIDATION PREGUNITE PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB DEC 2 G 1985 PLUMBING fF ELECTRICAL city a wortino MECHANICAL BLo ELECT. PLO. mECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL PERM TO FRAMING INSULATION - STORIES T T EC N R. i OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,I ', ROOF -l'VJ J tl ( SO FC FLOOR AREA TOTAL ACREAGE DIAPHRAGM auILOIUSE RES IND CON PB O�nxr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ 13 ❑ ❑ ASSESSO RS PARCEL NO. PLUMBING ROUGH GAS TEST IfTRACT NO. PARCEL NO. MECHANICAL . ELECTRICAL FINALS DATE INSP. ACCDATE ACG FILE NO. FRAMING SAN INSULATION PLUMBING p ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRININ ENERGY TN COVER NO WORK UNTWABOVE•HASiBEEN SIGNED HEATING "� � . . LATH-INTERIOR ELECTRICAL FLOOD ZONE AL.0C. LATH-EXTERIOR - FIRE DEPT. r❑ "❑ ° ❑ N❑. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY POST'THIS CARD NEAR FRONT OF BUILDING' CITY OF CUPERTINO ,, PERMIT 1BZ INSPECTION DIVISION JOB INSPECTION RECORD .. *nwL. //// PERMIT EXPIRATION JOB ADDRESS I U T�#�Iy A� + LOT# PERMIT EXPIRES IF WORK OWNER ' CONTRACTOR UIN ll/vE�, IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAvS OF PERMIT ISSU. ' FOUNDATION - ANCE OR 180 DAYS FROM LIFER LAST CALLEDINSPECTION. PREGUNITE PERMIT VALIDATION PAID POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED rUNDERGROUND /SLAB DEC 2 G 1985 ' PLUMBING . - ELECTRICAL . City A'iuGll Glib MECHANICAL - BLD ELECT. PLG, MECH. It 1 ❑ ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED / BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. , � - � . MECHANICAL , ELECTRICAL - - PERM O FRAMING, INSULATION STORIES r PE c)N R. I�� ((�� ® p o ''p'' ® OCG GROUP RES,UNITS IL'RLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED c o m p V I E R ROOF n p / SO.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM + DATE '2 610 BUILDING USE Y RES IND CON PB 011l" -- - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - ❑ ❑' ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING. _GAS TEST - TRACT NO, PARCEL NO. MECHANICAL. . ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC.FILE NO, FRAMING SAN # ' ZONING ENG. NO. INSULATION - � PLUMBING SI T , GAS I MECHANICAL FIRE SPRINK ENERGVT-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING y ❑. N[] ° ❑ N❑ LATH-INTERIOR ELECTRICAL , FLOOD ZONE A.L.U.C. LATH-EXTERIOR - FIREDEPT. • r v❑ N❑ `" ❑ , N❑ SHEETROCK GRADE ;• FEE SUMMARY SHEAR INTERIOR BUILDING. - - �.: . SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING. i" FIREWALLS ELECTRIC - PLAN CHECK GAS - + FEE NO TAPE OR PLASTER UNTIL ABOVE HAS.BEEN SIGNED OCCUPANCY SEISMIC FEE �, OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL SIGNED BY BUILDING INSPECTOR. .MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o-- ONE WORKING'DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. , - SEE PERMIT.FOR EXPIRATION DATE - MECHANICAL -' IMPORTANT! CONST.rax PLEASE READ REVERSE SIDE BEFORE TOTAL '~ CALLING FOR FINAL INSPECTION. .OFFICE COPY '