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180730 z_z 1 0 LU CL - Q. Q UO LL U 0 W } a Z 'a APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY_-• •'•- BUI LDI NG PROJECT I DENTI FICATION APPLICATION & PERMIT - BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER o O r� �j '�{- 1. O I t� s Mb -DING 0 aooREss ©. 06 OWNER'S �boQ xaME O OTY.. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION A CONTRACTOR'S NAME Q uc.xo OUTLETS -SWITCHES - RECEP- 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 !-o NTRACTOR's 4-16,4411jEss APPLIANCES - RESIDENTIAL 4.00 7,E PHON PANELS '10,00 DATE OF APPLICATION' 1' O v 1 50"3 NGINEER Ic. No PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARC R. OR END ADOREss SPECIALCIRCUIT 5.00 PERMIT VALIDATION , / v'-_.� (�'C� _�S EMP. METER OR POLE INS. 20.00 - ADOflCA ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE JaAlln 20.00 ... A�'�Q �Nf LCI ' LICENSED CON'TRACT'ORS DECLARATION/�(�j,,J(�1'/� (� - ._ I hereby uITirm that I am licensed under provisions of Chapter!) (commencing with Sec(ion 70,a)I of Division 3 of the Business and Prol'essians Coda, d my license is in full fo iV 1 Cla l.ic. Number. _ Date'-3�- _Cnntmetnr_ ISSUANCE DATP+ BIL�D'IG. ELECT. PLG. M1 CH. rs� 3 - City City of Cupertino BUILDING PERMIT INFORMATION OWNED -BUILDER DECLARA'T'ION I hereby, affirm that I am exempt from the inessmctoi x I -.cense oach c. reg03sa permit tocnd Professions Code: Any city or coo rep which requirese permit to construct,, alter, Code:Law Any cityl Guaranty improve, demolish, or repair any structure, prior no its issuance, also he uires isictheapplicantfo[ tine Permit to fileaaClantictco'',Li...a statement Hart he is licensed 9 (c oaml en the with Som of the Contractors License Law (Chapter 9 (commencingwith Section 7000) of Division 3 Him Business and Professions Code) or hot In, is exempt therefrom and .,,it MISC.- REFER TO ORD PERMIT ISSUANCE - 10.00 ,L O� VALUATION [ / �7 71 Q P 06 i S/FT. ELEC. CONTR. LIC. N0. ELEC. �G TOTAL1 •'a6 QTY. PLUMBING PERMIT FEE PERMIT TO S' the basis for [he alleged exemption. Any violation of Section 7011.5 i by any applicant far a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500).): STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 ❑ I, as owner of the ProPerty, or my employees with wages as.BACK their sole compensation, will do the work, and the structure is not FLOW PROTECT. DEVICE 4.00 OCCGROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered far sale (Sec. 7044, Business and Professions Code: "The Con[mctor's License Law does not apply to an owner of 'property who builds or improves thereon, and who does such work himself a, through his own employees, provided that such mimprove- plants inesareno[ intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 So. FT. FLOOR AREA � � TOTAL ACREAGE 7(8' (d is sold within one year of completion, the owner- builder will hhve the burden of proving that he did not build or int- Prove for purpose of sale.). ❑ as owner of the property, exclusively contracting with GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 d he licensed contractors to construct the project, La 71344, Business tonProfessions at Code: The Contractor's Licenu Law does not apply to an owner of property who builds t r improves thereon. and who contractsonctor'or shcense Lswithueomractor(sl licensed pursuant to the Contractor's License Law, LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS -OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO, ry �s^ •xS l_ , 3 / r 6D(p , WxP SEWER -SANITARY -STORM EA. 200f1/10.00 TRACT N0. PARCEL N0. ❑ I am exempt under Sec. 0.&P.C. for Iltis reason WATER HEATER W/VENT - 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5,00 WORK Ii RS'COMPENSA'IION DECLARATION I hereby affirm that I have a certificate of consent to sel6innuc. or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab.C.). Policy No. Company ❑ Certified copy is h ereby f urn.shd ]( Ccrti i[I yl��/��,(j�"a�le7}I(��wyt}r���1)ve��.^_aa I coon Alv6ian. AppTa:unt.Tf,�1�1ML .{LNIYI �•- Cf: i 4 0'' E ON FI O, vO R K ERS' FIRE SPRINK Y ❑ N ❑ ENERGY T 24 Y ❑ N❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 70.00 1�. O l9 FLOOO ZONE A.LU.C. COMPENSATION INSURANCE (This section meed not be completed *if the pe nn it is for one PLG. CONTR. LIC. NO, PLG. �y TOTAL - Qa Y ❑ N[] Y ❑' N❑ hundred dollars IS 100) or less.) I certify that in the performance of tie work for which this per- nit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE SUMMARY BUILDING g�7F become subject to the Workers Compensation Laws of California. D,RL Applicant ALTER OR ADD TO MECH. Q NOTICE TO APPLICANT': If, after making this Certificate of Es- emption, you shndd become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith COMPly with such provisions or this permit shall he deemed revoked. 'APPLIANCE .00 AIR HANDLING UNIT (TO 10,0000. F.M.) 4. 0 PLAN CHECK, FEE AIR HANDLING UNIT(OVERIQOOOC.EM.) 6A SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm That there is a construction ]ending agency for EXHAUST HOOD (WIT U T) 5.00 the performance of file work for which this permit is issued (Sea 3097, Cie.C.), MICROFILM HEATING UNIT (TO B. 0 Lender's Name Lender's AddressELECTRIC HEATING UNIT 100,0009.T.U.)9. '7 C� dD VENTILATION FAN (SINGLE) 4.00 I certify that lhave read this application and store that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING O� BOILER- CDMP(3 H.P. or 100,000 B.T.U.) 6.0 BOILER -COMP (Over 100,000 BTU) SEE FEE H. MECHANICAL hereby authorize representatives of this city to anter upon the above-mentioned property for inspection purposes. MISC. - REFER TO RD. PERMIT ISSUANCE 0.00 (We) agree to save, indemnify and keep harmless the City of upertino against liabilities judgments, costs mW expenses which may In any way accrue a 'list said City in consequence of the rant of [his perm A L 104 /0 Si f pelican ntra I 1e DL CONST. TAX Au p MECH. CONT. LIC. NO. MEC TOTAL! 'TOTAL - 4x6 � ?1V19P •OFFICE COPY .T; POST THIS CARD NEAR FRONT OF BUILDING • CITY OF CUPERTINO .A INSPECTION DIVISION ! JOB INSPECTION RECORD ' ''7 / ��% {� JOB ADDRESS '�I ( 1 �V�" �D•• I�� UNIT# - _LOT#' ' _/ 'y ''j'' �+ OWNER Vv ,DO �` CONTRACTOR GV —4, SLO ,IL CD PERMITNUMBEF 18073 PfERc I. EXPIR TION /f -1 ' � PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR SPECTION RECORD . FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED O COMPLY WITH THE APPROYDAICS AND CITY OF. CUPERTINO STANDARDS. UFER PREGUNITET ' M PErIrT VALIDAnoN � '� J. T L� � • I Y; �-�+.��`Lv - ISSUANCE DArE/ GARAGE SLABS ` �-� POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,n�ngq U C SDC' UNDERGROUND-/ SL'AB. PLUMBING Ll.,.� r6136- � I LI' � `1P�� V ELECTRICAL - - MECHANICAL - �.,, .,6.19 DG. eLeeT. I rvi Pu;. I MecN. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED " BUILDING PERMIT INFORMATION ' WOOD FLOOR VA ILLATION Pm.OO $IFT. PLUMBING _ MECHANICAL ELECTRICAL PEEERRMII TO FRAMING INSULATION sroRl Es rYPECONSTRIN. c ® lmp OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF - I' NO IN D FORE TH 10 TAX ISP ID D FT „a AREA LACHEAGE �I '. I r DIAPHRAGM ROOF SHEATHING BUILDING USE Res IND CON PB umh­ - 0 L ❑ L O APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. R1OUGH SAN.H IP 6F. - ASSESSORS PARCEL NO (� 3q- 1p PLUMBING ELECT: ENERGY - TUBS SHOWER PAN PLUMBING ENERGY TRACT NO., PARCEL NO - MECHANICAL MECH.ENERGY ELECTRICAL � � BUILDING ENERGY ACC , DATE . ACCFILE NO FRAMING : ELECT. FINAL TEST INSULATION � � PLUMBING ' ZONING •, ENG. SITE NO! _ GAS TEST GAS. ' - MECHANICAL FIRE SPRINK Y C] NL ENERGY Lon I Y L NL COVER NO WORK UNTIL'ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE - FLOOD ZONE Y L NL. A.L.0 C. Y L NL INTERIOR SHEAR FIRE DEPT. SHEETROCK _ GRADE •r_ 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 OCCUPANCY SEISMIC FEE 3 OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM, • ARRANGE FOR INSPECTION BY PHONING 252-4505, I--� ONE WORKING DAY BEFORE REQUIRED INSPECTION.' PLEASE GIVE JOB ADDRESS WHEN PHONING. Z " -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC Is PLUMBING MECHANICAL �1 " o? CONST. TAX 3 0"st IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL f 6 7 OFFICE COPY Ohl a Ls Citl of CWrertiro FINANCE DEPARTMENT • CUPERTINO, CALIFORNIA 15709 BUSINESS LICENSE TAX CERTIFICATE iooi9 EXPIRATION DATE