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12467 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LOING PROJECT IDENTIFICATION - PERMIT NUMBER a noING. APPLICATION & PERMIT ` / n�iDREss I^4DO f� . UM1 ; G� BUILDING-ELECTRICAL-PWMBING-MECHANICAL 12467 O NER'S e - PLAN CHECK VALIDATION NAME__ tt C_)w OTY. ELECTRIC`PERMIT FEE 7 ./��p�//��__ �\ N W"\ ONE ��l l CONTRACTOR'S NAME � OUTLETS-SWITCHES 10.00/1.00 LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADORES e40? APPLIANCES-RESIDENTIAL 4.00 1210 o , NE - q' PANELS 10.00 DATE OF APPLICATION ogcHlrecT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.No. ENGINE S V%.J f M- e V%. AO�+.�+o. SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SkPOIJ✓ , SPECIAL CIRCUIT 5.00 t✓11`I.3 ZIPEMP.METER OR POLE INS. 20.00 n I APPLICANT s ADDRESSMOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 ] - '02 LICENSED CONTRACTORS DECLARATION CC�j/ � r i w 1 hereby affirm that I am licensed under provisions of Chapter 9 1 SUANC DATE rn rt u (commencing with Section 7000)of Division 3 of the Business and - BLDG. ELECT. PLG. MECH. H o i Professions Co and my license is in full force and effect ❑ ❑ ❑ z o. - :cense ass Lia Number - O m H Dale Contract. F - J w u OWNER.BUILDER DECLARATION BUILDING PERMIT La ;LL H I hembyaffirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION H u o J Law for the fallowing reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit to construct,alter, rc ¢ ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. O M requires the applicant for such permit to file a signed slatement that TOTAL PERMIT E 8 he is licensed pursuant to the provisions of the Contractor's License HiQ Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe �N're�LAJ2 oA 2 o Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE //`` H c� the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CDNSTR. by any ih.re tha for a permit subjects 55000.he licmdtnacivil Penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 oC not more than five hundred dollars(5500).1: .❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds Or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.06 50.FT,FLOOR AREA TOTAL ACREAGE himself ohis own employees,provided that such improve- _ menfs arere notof intended nded or offered for sale.If,however,the budding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 or improvement is sold 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 purposo of sale.). RES IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 f_1 ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who iLAWN SPRINKLERS-OVER 5(EA.) 1,00 contracts for such projects with it contractods)licensed pursuant t0 SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER.W/VENT 6.00 reason Awner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have u certificate of consent to self-Insure, or a certificate of Worker:Compensation Insurance,or a certified ZONING ENG.SITE NO. -�/ copy thercol'(Sec.3800,Lah.C.). �� Policy No. Company ❑ Ccrtilied 'opy is hereby urns he d. FIRESPRINK ENERGYT-24�pf Certili�(,.J� A�o�� I��ded wIl the cit insttctian division. Z rtfillpcanl VV\2:•�Yf a- .- 4. 1 MISC.- - REFER TO ORD. YC] IN E] I Y ❑ N� ~ va PERMIT ISSUANCE 10.00 Ud - CIiR'1'IEICAMPOF ENFWION INS FROM IVORKERS' FLOOD ZONE A.L.U.C. W > COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. Z( This .Section need not be completed if the pernit is for one TOTAL Y❑ N Y [:] N hundred do1WrS($100)or less.) U O 1 certify that in the performance of the work"or which this per- CITY MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to O Ubecome subject to the Workers'Compensation Laws of California. _ a Date Applicant BUILDING } W NOTICE:TO APPLICANT: IF,after making this Certificate of Ex- J ALTER OR ADD TO MECH. 5.00 A 3 F 2 emption,you should become subject to 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=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.RM.) 6.00 SEISMIC FEE � - 04 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI N G LIN IT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC . I certify that I 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 PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives inspection this city es enter upon theabove 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby authorize ned properly representatives of purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- 'REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against I City in consequence of the I raf�lh It 'it, MECH.CONT. LIC.NO. MECH. 3 gj TOTAL TOTAL Signature of Applmant/ tractor ate OFFICE COPY r POST THIS CARD NEAR FRONT OF BUI'L`DINGO `= ,I CITY OF CUPERTINO�. PEH 'Ir�D ,RER ` INSPECTION DIVISION 42467: JOB INSPECTION RECORD, •PERM IT•EXPIRATION , JOB ADDRESS /0 5-a l I2/jd,-6-�//L'•-l-v ✓ /�— '•UNIT'# LOT# �� PERMIT EXPIRES IF WORK OWNER ; /y11 G—_J-/ CO/:I ✓%G�� CONTRACTOR p ( - GrIV't IS NOT STARTED WITHIN. INSPECTION DATE INSPECTOR INSPECTION-RECOR 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION _g O LASTCALLED INSPECTION. UFER. p .7AZ +-q PREGUNITE .9&- C2r / i L'c PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /0 / 0'1;wD / Arwloc*7 2 " f1. UNDERGROUND /SL B m sK 4110#7 'sw PLUMBING ,r� /o ff7 NYS/De ELECTRICAL o2""d` S/{e y-Ufa/� �'r 6//e/B% ISSUANCE DATE MECHANICAL - -/ un. C lC,�X G. ELECT. PLG. MECH. . �•/S'"tf/� flt r/�Lf( piMA7$/( � f'� Ii ❑ ❑ . .d ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED A CIAC, BUILDING PERMIT '?;; INFORMATION+� WOOD FLOOR 'VALUATION S/FT. PLUMBING - IST' RT({Rea'HS4M6�j9�J'77� J ''''L " •.1 MECHANICAL ' ELECTRICAL. / n PEHMrt ro r FRAMING INSULATION a' 44101 , p ;g-/,y16•1STORIES TYPE CONSTR. �S�ur/ S ST 40o eK OCC.CHOUP HES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 4eSV-We,FE cK ROOF SO.Fr FLOOR AREA TOTAL ACREAGE 7-30 7 �e(J.SIn a..0 DIAPHRAGM � ^U- GS IND II DCON USE B' 0IM1PI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED y �IST�2 !PO ❑ ❑ ❑ ❑ ASSESSORS PARCEL No. ROUGH c s. � PLUMBING ur I ' GAS TEST e-c1*7 Oji- ra4 rPh b rr 3�. PARCEL No. MECHANICAL ' S DCw-e.wa< iaax-7 D ACC.DATE ACC.FILE N0, ELECTRICAL FINALS DATE INSP. FRAMING _ -& SAN # TONING ENG.SITE N0. INSU LATION� � PLUMBING • owT wN FLO AMF w« 'p As �s u1S 'i ECHANICAL FIRESPRINK ENERGYTPC COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v ❑ "❑ v ❑ "❑ LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.uc. LATH-EXTERIOR FIRE DEPT. W3 Y�r Ll( v❑ N❑ Y ❑ N❑ SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVAL$ BUILDING — FIREWALLS . . ELECTRIC - 'PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL'BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC � o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEAS; E GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE . TOTAL p CALLING FOR FINAL.INSPECTION. OFFICE COPY (:2) �77Y1t7/'l/� W4GL x CA It •cam , f r J n {1:.y11•:ti fir, � y''.'l-•S+�yJT,,. .VO:` �,.<t , .' 7{, 1. �. �. , 1, �. '• jw� , Itd f t7.a ., 1.a.Lia 'd`1`• r. r` t ,; 1 - c — - ..r_ •: :'��N4vGi'� j.. -i r, }�,..r r ' �:,l.c. Fnn.e n..o'sl .. :. a•,+� - _ _ '_" t! •q'ta •c^•,,..y t' hwe;�t N,�lltick ik 'Tr-,R�'K xP�': ,