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162540 O ZZ 0 L CL 0 0 z U O LL U Ow �_Z a } Z u APPLICANT TO FILL: IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY _*BU I LDING PROJECT I DENTIFICATI ON APPLICATION & PERMIT ' BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER / r� C A G J 4 BURRING, ADDRESS tt �\\ U S -JkA µll/ R•D, OWNER'S �/p'j{P-p .� JN b ME �/'�r 1 )Amts c DO &O� SHONE / l - O71, _ TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' rcacrORs AME I,U-TL-YLIS- OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS - �p ADDRESS/wob`)O�QFs-�L,Iy APPLIANCES - RESIDENTIAL 4.00 /y �y� 2�I�Cq / i/LUl�/ r�.\PHOfNEp� S2Y1 DATE OF APPLICATION PANELS 0,00 ARCHITECT S-. 747 ENGINEER LIC. No. PANELS IDV ER 200 AMP) 20.00 .PLAN CHECK FEE .C. N0. SIGNS TRANS.'. 3.00 moo Ess END ' ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 A ADDRESS MOTORS SEE FEE SCH. ��/Q AI/ a u SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisionsof Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod nd my license is in full fort- .f . Licenseff��iiss� Llc. Number _ ISSUANCE DATE BLDG. ELECT. PLG. MECH. � .� - Dutc1L 5Vn- Conhactor - BUILDING PERMIT INFORMATION �/ /OWN Eli -BUILDER DECLARATION I hereby affirm that I am exempt from tab metra d Pr License BusProfessions Law: forthefollowingreason.whihec.7ires a permitIo construct, Code: Any city or mtmty which requirese p toconstant,, MISC.- REFER TO ORD PERMIT ISSUANCE VALUATION $/FT. prior also improve, demolish, or repair Any Shia ane, prior n its statement requires the applicant for such permit to file a signed statement )hut that pursuant en the provisions of the Contractor's Litems ha is (Chapter Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and ELEC. CONTR. LIC. N0. ELEO, TOTAL �.� QTY. PLUMBING PERMITe. it R PERMIT TO \til t J L,8 - V4 - tile the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for o permit subjects the applicant to a civil penally ofoot more than live hundred dollars(8500).): ALTER -DRAIN -WATER IEA.) 5.00 ac ES TYPE CONSTR. V ❑ I, as owner of the properly, or my col with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA,CON D. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code The Contractor's License Law does not apply to an owner of FIXTURES - PER TRAP �- GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 SQ FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work likewlf or through his own employees, provided that such inlpro e- mintsarenotintendedoroffered for sale. If, however, the building or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did not build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES IND CON PB Other. 11 Cl ❑ 1:1licensed INDUSTRIAL WASTE INTER. 30.00 contractors to construct the project (See 7044, Business and 1'rofcssions Cnde: The Contractor's License Law does not Imply to an owner of property who builds or improves thereon. and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractors) licensed punumtt to the Contractor's License Law. ❑ tum exempt under Sec. ,B.&P.C. for this on SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO, PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACD. FILE NO. WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSATION DECLARATION 1 hereby affirm that I have it certificate of consent to self -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or o certified copy thereof(Sec 3800, Lab.CJ. Policy No. Company MISC. - REFER TO ORD. FIRE SPRINK Y ❑ N ❑ ENERGY T-24 -Y ❑ IN ❑ Certified copy is hereby punished. ❑ Certified copy is filed with the city inspection division. Applicant CERTWICA'1'17 OF IiXEMPFION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one PERMIT ISSUANCE FLOOD ZONE Y ❑ N❑ A.L.U, C. V ❑ N❑ PLG.CONTR. LIC. NO. PLG. to TOTAL � hundred dollars IS 100) or less.) I certify that in the performance of the work for which this per- mil is iss ted, I shall not employyI perso,� ilyaJt tmannelx s lU ante tpsAmWorkers'G�f Ions"�OW"nt '(f ia� Dat• J_Applicanl ` - N01' CE AI'1'LICANT: ,Biter aking thi+Cerlificate of fix- QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10)M"11F.M.) 4.00 PLAN CHECK FEE e option, you should become suhjecl to the Workns'Compensm ion provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10p00QEM.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for fire performance of the work for which this permit is issued fSec. 3097, Civ.C). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 I.endar's Name Lender's Address H EATI N G UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE)' 4.00 BOILER-COMP(3 H.P. Or 100,000B.T.U.) 6.00 that have mad this application and slide that the above 'd iCertifynformation ordinmetion nneared. 1agree In comply with all city and county ordinances and state Taws relating m building construction, and above'- authorize representatives ins of this city es emir upon the above-mentioned property for inspection purposes. - PLUMBING / BOILER -COMP )Over 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harndess the City of MISC. - REFER TO ORD. Cupertino against liabilities, judgments, costs and expenses wbidt may in any way accrue against s id City in consequence of the •r tl goflhispe it � ci! % PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL TOTAL a�� Signator 'f Applicant/Conlrxc[or Date OFFICE COPY POST THIS CARD NEAR FRONT:OF BUILDING ..CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD (� - JOB ADDRESS %�'Q JQ�•% 7E/9'V RD UNIT# -LOT# 'OWNER /Q...a6- CONTRACTOR V L-C/L_. (2'OM '7 PERMIT NUMHEH 16254 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER -- � PREGUNITE ' PI:IWIT VAI.IOATION • "" ' ISSUANCE. HATH - GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL- MECHANICAL RLUG ELECT. .PLG. MECH, 00 NOTPOURFLOOR UNTIL ABOVE HAS BEEN SIGNED - .. BUILDING PERMIT INFORMATION ' WOOD FLOOR - ' PLUMBING VALUATION $ITT. I MECHANICAL ELECTRICAL PERMIT TO FRAMING INSULATION - STORIES .TvV CONSTR. , • IIPLACE NO SUBFLOOR UNTIL ABOVE -HAS SIGNED OCC GROUP RES UNITS ROOFSO. NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID � FT FLOOR AH EA TOTAL ACHEAGE DIAPHRAGM - ROOF SHEATHING �� HUILOI OUSE rl INN Hs. IND N Pe om.,. ❑ ❑ El 11 El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. .ROUGH - SAN.tr ASSLSSORSPAHCELNO PLUMBING. -/9-Ao .OAi ELECT. ENERGY TUBS & SHOWER PAN - PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECR ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING - ELECT. FINAL TEST INSULATION _ PLUMBING ZONING ENG, SITE NO. GAS TEST. GAS ' MECHANICAL FIRE STRINK Y E]"❑ ENERGY T 14 Y E]"❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOOZONF. Y ❑ N❑ ALUC, ' Y ❑ "❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDIN BUILDING INTERIOR LATH TEMPORARY APPROVAL SCRATCH COAT. ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDINGINSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, F-0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC-- •' PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY