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14090 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY RUI L_OING PROJECT IDENTIFICATION PERMIT NUMBER eu rvG APPLICATION & PERMIT A-7 sn BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14090 OWNER'a T PLAN CHECK VALIDATION "aME ELECTRIC PERMIT FEE Q R✓I ONE V!- I CONT croRs NAME UTLETS-SWITCHES-RECEP 10.00/1.00 .ZS NAME LIC.NO. D LIGHTING FIXTURES 10,00/1.00 CONTRACTORS ADDRESS PPLIANCES-RESIDENTIAL 4.00 .� ADDRESS PHONE PANELS 10.00 - DATE OF APPLICATION ARCHITECTPLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIc.NO, SIGNS TRANS. 3.00 ARCH 009 ENO SPECIALCIRCUIT 5,00 PERMIT VALIDATION ZIP FEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS U ' SERVICE CHANGE 6 qArZ20.00 3P,2- a DOD LICENSED CONTRACTORS DECLARATION / �/,.rS/�7 ¢v v I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE 0A E LA a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. " PLG. MECH. F w i Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ z 0 o - License Class Lic.Number w- Date Cmuructor a m BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLARATION S, a ° MISC.- REFER TO ORD INFORMATION _W ¢H I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT. FLL0j Law for the following reason(Sec.7031.5,Business Professions PERMIT ISSUANCE 10.00 0• Code:Anycity Orcounty which requires a permit to construct,alter, n� �j '7 Q ¢ ¢ o improve,demolish,or repair any structure,prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. h.l 3 /,f/Ei V O IF requires lire applicant for such permit to file a signed statement(list TOTAL A.1 PERMIT TO whe is licensed pursuant to the provisions of the Contractor's License F z i Law(Chapter 9(commencing with Section 7000)of Division of the ¢ Business and Professions Code)or that he isexempl therefrom and DTV. PLUMBING PERMIT FEE 1 VVV ¢ r$ the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN 5.00 - of not more than five hundred dollars($500).): �S ❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 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 FIXTURES-PER TRAP 5.00 _ So.IT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6,00 . menta are not intended or offered for sale.If,however,the building 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 purpose of sale.). INDUSTRIAL WASTE INTER3000 REB IND CON PB Othar CI . . 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors t0 construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B, 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply l0 an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO, PARCEL NO. ❑ lumexemptut r . ,B.&P.C-forthis WATER HEATER W/VENT 6.00 reason_ Alli A Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of, [o self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.CJ. . Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. O Applicant Y ❑ N❑ Y ❑ N❑ N CERTIFICATE OF EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 0 ^ FLOOD ZONE A.L.U.C. LU LU O COMPENSATION INSURANCE PLG.CONTE. LIC.NO. TLG. 4OTAL Q__ Y F] N❑ Y❑ N❑ CL z (This section need not be completed if the permit is for one hundred dollars($100)or Tess.) - U 0 1 certify that in the performance of the work for which this per. DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,1 shall not employ any person in any manner so as to O uu become subject to the Workers'Compensation Laws of California. ' a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING >_ W NOTICE. TO APPLICANT. 1f,after making this Certificate of Fx- ? 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 V 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 10=C.F.M.) 6.00 SEISMIC FEE 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name H EATI N G U N IT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 'l(� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 o information is correct.I agree to comply with all city and county PLUMBING r60 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 of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection 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.w,'�x' seer.. against said City in consequence of the gra got 0/fs�e 'L MECH.CONT. LIC.NO. MECH. /Vj� TOTAL TOTAL 3& I ture of Applicant/Contractor Uale FFICE COPY � ; POST THIS CARD NEAR FRONT OF BUILDING 136'V (y PFRMITNUMPER CITY ,OF CUPERTINO 14090 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 20587 RODRIGUES UNIT# - LOT# - - PERMIT EXPIRES IF WORK OWNER PEKUROVSKAYA CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION , (O ..70 a IrX444/s�L ADDrlia ANCE OR 180 DAYS FROM UFER" 1ufu�n# d-�i7CNy rpiWMbpPG 66 LASTCALLED INSPECTION. PREGUNITE PERMIT VA00ATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL "ISSUANCE DATE MECHANICAL - BLDC. ELECT. PLG. MECH. ❑ ❑ ❑ I� a DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION y .WOOD FLOOR VALUATION S/FT. PLUMBING _Iw_ff 40 MECHANICAL PERMIT TO ELECTRICAL h !/ J, - ,✓ FRAMING ,— INSULATION RAMING ,INSULATION STORIES TYPE CONSTR, OCCGROUPRES.UNITS _ IiP,LFACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Olney 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH _ PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL b i i . ELECTRICAL v ACCDATE ACC.FILE NO. FINALS DATE. INSP. . FRAMING Ijr SAN # ZONING ENG.SITE No, IN ULATIONPLUMBING _. '�• AS MECHANICAL ,./ FIRE SPRINK ENERGY T2 "COVER NO WORK UNTILABOVEHAS BEEN SIGNED j HEATING Y [D N� Y ❑ N� LATH-INTERIOR ELECTRICAL bf FLOOD ZONE A.L.uc. LATH-EXTERIOR FIRE DEPT. Yo N[] Yo N❑ SHEETROCK _ GRADE j ,FEE SUMMARY SHEAR INTERIOR BUILDING 1/ SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS. ELECTRIC PLAN CHECK GAS FEE LO TAPE OR PLASTER UNTIL ABOVE HAS B IGNED JOCCUPANCY 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 INSPECTIPLUMBING ON. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX d PLEASE-READ REVERSE SIDE BEFORE TOTAL ` CALLING FOR FINAL INSPECTION." OFFICECOPY