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10898APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING i1ROJECT IDENTIFICATION . APPLICATION & PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL PERMIT NUMBER 10898 BUILDING Boo ss.7n?i�S^ ' `'xI,I (� /-I(�/ fel �'V�/ OWNER'SG-CS NAM m^ llms WE J�'Jrn[� PHO E ` QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION caNTRACTORS Llc. o. OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS A RESa X51 j� WDU PHONE I (Q APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER uc. NO PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG, - AOOREss ' ZIP SPECIAL CIRCUIT S.OQ PERMITVALIDATION ISSUANCE AT EMP. METER OR POLE INS. 20.00 AvvL Aurs _ A. \ C 'i S 2 MOTORS SEE FEE SCH. SERVICE CHANGE 20.0 LII'10ENSED CONTRACTORS DECLARATION I hereby affirm that I um licensed under provisions of Chapter 9- (commencing with Section 7000) of Division 3 of the Business and Professions Co - icense is in full fur •' d t License CI ss Lic. Number Date 'V 'VIN R-BmLnIiR DECL rl I hereby affirm that I am exempt from the Contractor's License Professions Law for the ity owcolontng reason. (S requires Code: Any city or county which requirese permit to construct, alter, a permit to improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and thebasisand Pr sessionslleged Code)orthatn. he iolation 703nd by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (1500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or Offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to ua owner of property who builds or improves(hereon, and who does such work imself or through his own employees, provided that such improve- ments are nor intended oroffered 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 h e did not build or im- prove for purpose of sale.). O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon. and who contracts for such projects with a contractorts) licensed pursuant to conthe tractsf for License Law. ❑ lamexeMptlmder Sec ,B.&I'.C.forthis reason BLDG. ELECT, El PLG, I MECH. ❑ Lg BUILDIRMATIONG IT INFORMATION MISC.— REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO M QTY. • PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN VENT -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCG GROUP RES. UNITS - DRAINS -FLOOR, ROOF, AREA, COND. 5.00 FIXTURES - PER TRAP 5.06 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 . .. GAS - EASYSTEM -OVER 4 IEA) 200 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. SEWER -SAN ITARY•STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ^` Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WORKERS'COMPENSATION DECLARATION I hereby affirm (I I I have u cu it to of consent to self -insure, or a certificate of Workers' Comp cation Ino •Ince, orrlified co t r 1 £. ab.C. �_/Y PY hq Policy any ertified copy s rereIt rnished. A cantCe,tll c fle with the city inspection division. CERTIFICATE OF F- -M ION FROM WORKIIRS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars IS] 00) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any mannerso as to become subject to the Workers' Co npensalion Laws of California. Date ' Applicant WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. FIRE SPRINK yN ❑ ❑ ENERGY T-24 V N ❑ ❑ MISC.- REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ N ❑ A.L.U.C. Y ❑ No PLG. CONTR. - LIC. NO. PLG. TOTAL OTV. ECHANI AL PE MI FEE FEE SUMMARY BUILDING AUTEYOR ADD TO.MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby of rin that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Leader's Name APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT ( C.F.M.1 4.00 AI 3H NDLING UNIT(OVER 10 ,,,M.) 6.00 SEISMIC FEE EXHAUST HOOD IW T D ) .QO MICROFILM HEATING UNIT (T 0,000 g,QQ H EATI NG UN IT (OV ERl B.T.U.)9.50 ELECTRIC Leader's Address I certify that 1 have read this application and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned pro Pen for inspection purposes. (We) agree to save, i demnify and keep harmless the City of Cupertino against liabilit es, judgments, costs and expoes which may ,a any we ac'ru aga' said City in co'_•sp.�-yue a of the gmnlin Of this m �J _I„�I VENTILATION FAN IS GLE) 4.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL a QG MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 M CH. CONT. LIC. NO. MECH. �/�/r TOTAL �I dl f /'V TOTAL Sign ureof4ppluant/Clintract., Date OFFICE COPY CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ry �^ C� JOB ADDRESS '2 A ��1 V�^I cTiJ.Y-i✓ UNIT# LOT# OWNER A- CONTHACTOR 0898 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1BIJ DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD ' FOUNDATION UFER PREGUNITE PERMIT VALIOAT ION PAID ISSUANCE DATE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL IL c. i PEG I mECH. El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I y 0 OW G PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION S/FT. MECHANICAL ELECTRICAL - PERMIT TO FRAMING INSULATION STORRrs TYPE CONST14 PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC. GROUP RES UNITS ROOF 50 FT, FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE Hes Irvu CON Pn ❑ Q Q Q Q APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH ASSESSORS PAHCEL NO. PLUMBING GAS TEST fHACT D. PARCEL NO, MECHANICAL y ELECTRICAL17 FINALS DATE INSP. ACC. DATE ACC. FILE NO. FRAMING SAN it INSULATION PLUMBING ZONING ENO. SITE NO. GAS MECHANICAL _�-� FIRE SPHINK Y N� ENERGY T 14 Y N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING :( T LATH—INTERIOR ELECTRICAL FLOOD ZONE Y ❑ N[:] A.L.u.C. Y 0 N❑ LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDINGINSPECTOR. T; I ' ��I #, 1 ` MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT!r ,�; ,. ,I, PLEASE READ REVERSE SIDE BEFORE �T� �ti E4`:.� CALLING FOR FINAL INSPECTION. TOTAL ?OUC :NTS POSTING COPY