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10794 A LICANT-TO)FILL IN INFORi ATION WITHIN RED LINES - USE BALL POINT PEN ONLY '112UILDING PROJECT IDENTI FIC N PERMIT NUMBER nDLLOmG _ - APPLICATION & PE IT 10794 / [ADDRESS OSt�AJ �� ���- p BUILDING - ELECTRICAL-PLUMBING-MECHANICAL Y\ OAsN R'5 T • , p5� PLAN CHECK VALIDATION ,` RC1 "p4 J, SFf p�ffQppDEass-6o(f(>�FV. ELECTRIC PERMIT FEE a97 �� CONTRACTORS NAMED e6ya� eL� c'l-. -\ UTLETS-SWITCHES-RECEP 10.00/1.00 �� } c� C� t J LIC.NO. . LIGHTING FIXTURES 10.00/1.00 / ` ArORs VADDRESS APPLIANCES-RESIDENTIAL 4.00 ADDRESS ,\ PHONE PANELS 10.00 GATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMPI 20.00 ENGINEER uc,No. SIGNS TRANS. 3.00 ga ARCH.OR ENG. O�PERMIT' I ATION ADDRESS SPECIALCIRCUIT 5.00 T ZIP EMP.METER OR POLE INS. 20.00 ( 1 t_, ADDRESS S-_ MOTORS SEE FEE SCH. city 1� t 1A ADDRESS 4� �V� JFyq$'E4/66Eu/ane b J e0. SERVICE CHANGE 20.00 yof woo LICENSED CONTRACTORS DECLARATION < i w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE a e (commencing with Section 7000)of Division 3 of the Business and BL ELECT, PLG. MECH. H y Professions Code,and my license is in full force and effect. ❑ a ❑ z O w License Class Lic.Number 2. r [)ate Contractor a m - BUILDING PERMIT It , M a OWNER-BUILD17R DECLARATION A0 ne u INFORMATION X ;a. N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD �. o j Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. L' - Code:Any city or county which requires a permit to construct,a let, - Q Q ¢Q Improve,demolish,or repair any structure,prior to Its Issuance',also ELEC.CONTR. LIC.NO. ELEC. - DLL requires the applicant for such permit to file a signed statement that TOTAL PERMIT T P. w m he is licensed pursuant to the provisions of the Contractor's License Fz > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢gym the basis for the alleged exemption.Any violation ofSection 7031.5 - STORIES TYPE CONSTR. A. by any applicant for a permit subjects the applicant to a civil penalty 00 ) 5. of not more than five hundred dollars($5001.): ALTER-DRAIN&VENT-WATER (EA. ❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not } intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:'rite Contractor's License Law does not apply to an owner of • - property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 5D,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS 6.00 .1 i=are not intended or offered for sale.If,however,the building �7 Q or Improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4 IEA) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im - . - . RE IND CON PB 011ier 4 prove 1.aso mer of the INDUSTRIALWASTE INTER. 30.00 O d as owner of the property,he exclusively contracting with licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 A ESSORS PARCEL NO. and Professions Code:The Contractor's License Lawdoes eonoat apply a - O/ to tr owner of property who builds tr improves thereon and who LAWN SPRINKLER$-OVER 5IEA.1 1.00 x3 7-'- .3 contracts for such projects with a amtracWr(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt and xc. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason / I -� Owner jay, a _ `W WATER SYSTEM 5.00 v ACC.DATE ACC.FILE NO. WORK 17 RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO. . copy thereof(Sec.3800,Lab.0 L Policy No. Company (] ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY TZ4 Z 2 ❑ Certified copy is fled with the city inspection division. MISC. REFER TO ORD. F 0 Applicant Y[] N[3 Y E3 NE3 cc y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.96 FLOOD ZONE A.L.U.C. LU - COMPENSATION INSURANCE PLG.CONTR. LIC.NO, PLG, CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N� Y [] N� hundred dollars(S 100)or less.) L) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL - mil is issued,I shall not employ any person in any mannerso as to become subject to the Workers Compensation Laws of California. LU Date Applicant ALTER OR ADD TO MECH. 5,00 BUILDING /O s } rn NOTICE TO APPLICAN'P If,after making this Certificate of Ex. - F Z 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 1Q000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00SEISMIC FEE 92 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the pertormance of the work for which this permit is issued(Sec. MICROFILM 3097,Cie.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 S.T.U.)9.50 Lenders Address ELECTRIC 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 Is correct. I agree to comply with all city and county _ PLUMBING ;and state laws relating to building Construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.1 6.00 I here Ahorize representatives of this city. to enter upon the 4 'above mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL \ (We) We. to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, casts and expenses which' CONST.TAX may in any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00 �.176 grantingoftht permit. MECH.CONT. LIC.NO. MECH. `� Ln/�� � �- S�/� TOTAL TOTAL Signature of Applicant/Contractor Date/ OFFIM& ST THIS CAP,DINEAR FRONT OF BUI.LDING CITOFCUPERTINO 14794 PERMIT NUMBER r -.INSPECTION DIVISION - RD JOB INSPECTION RECO I _ , PERMIT EXPIRATION JOB ADDRESS '^^ '• UNIT#' _LOT# pERM1T EXPIRES IF,WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTI N DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ►'1(�i�( Li�ebe.T ?p I k, - ANCE OR 180 DAYS FROM UFER [� p LAST CAL4E09METION. PREGUNITE 3.2��7 If I ©�04� k PERMIT VALIDATION POU 0 CCRETE UNTIL ABOVE MAS E SIGNED UNDERGROUND /SLAB City Of CuDert' Q PLUMBING ' ELECTRICAL J ' ISSUANCE GATE MECHANICAL - BLDG! ELECT, PLG. MECR,• r ww rl!>s !i I ❑ ❑ ❑ . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION PLUMBING VALUATION . $/FT. � � , MECHANICAL s - ELECTRICAL PERMIT TO FRAMING INSULATION , STORIES TYPE CONSTR, . OCC.GROUP RES,UNITS UVA'CE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO,FT.FLOOR AREA TOTAL ACREAGE PAPHRAGM/ IL USE RAS INORUCON CON, PB OMrr 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ' ROUGH ASSESSORS PARCEL NO. ' 7LLLL PLUMBING N —:274—';1'�4—0/3 TRACT NO. PARCEL NO, ' GAS TEST � � � �� cK f/.ow R VC /Nsrar.�eD ' MECHANICAL N7- ELECTRICAL FINALS DATE INSP. ACG DATE ACC,FILE NO. FRAMING y SANtk • p' i ENG.SITE NO. INSULATION � �B" PLUMBING . � ZONING ' GAS• '• MECHANICAL FIRE SPRINK EN — COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ ° ❑ N❑ LATH-INTERIOR ELECTRICAL =APPRnVAI � FLOOD ZONE L,U C. _ LATH-EXTERIOR _I,( ] FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK - (d ' GRADEFEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR ,TEMP.ORARY . � BUILDING fr FIREWALLS ELECTRIC - i �f� 7' PLAN CHECK ' GAS �p FEE - N'O'TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY 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 " I :1 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL I CALLING FOR FINAL INSPECTION. OFFICE COPY 1" '