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16685A'?PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY OCT IDENTIFICATION - PERMT NUMBER,BUILDING BUIDING APPLICATION J BUILDING - ELECTRICAL- PLUMBING - MECHANICAL SR ENGINEER LICENSED C RACTORS DECLARATION I hereby ul'Erm tlmt at,, licensed under pm vwronsol'Chapter 9 nmmencing with Section 7000) of Division 3 of the Business and ofessions Code, and my license is in full force and effect. - . —i OWNER -BUILDER DECLARATION 10.00/1.00 _IGHTING FIXTURES I hereby affirm that I am exempt from the Contractor's License aw for the following reason. (Sec. 7031.5, Buslnessand Professions 4.00 ode: Any city or county which requires a permit to construct, alter, ELEC. rprove, demolish, or repair any structure, prior to its issuance, also 20.00 quires the applicant for such permit to file a signed statement that n is licensed pursuant to lite provisions of the Contractor's License SPECIALCIRCUIT aw (Chapter 9 (commencing with Section 7000) of Division 3 of the TEMP. METER OR POLE INS. usiness and Profesiions Code) or that he is exempt therefrom and OTY ie basis for [lie alleged exemption. Any violation of Section 7031.5 20.00 i any applicant for a permit subjects the applicant boa civil penalty 6.00 not mom than five hundred dollars($500).)', ❑ I, as owner of the property, or my employees with wages as eir sole compensation, will do the work, and the structure is not tendedor offered for sale (See. 7044, Business and Professions adv: The Contmetor'sLicense Law dos not apply to an owner of operty who builds or improves thereon, and who does such work of or through his own employees, provided that such improve- ents are not intended or offered for sale. If, however, the building 11� improvement is said within one year of oonspletion, the owner - ;i Wer will have the burden of proving it,., he did not build or im- eye'for purpose ofside.). ❑ I, as owner of the property, am exclusively contracting with eased contractors to construct the project (Sec. 7044, Business id Professions Code: The Contractor's License Law dues not apply _ an owner of property who holds or improves thereon. and who mtracts for such projects with a contractor(s) licensed pursuant to e Contractor's License Law. ❑ 1 a exempt under Sec. ,B.&1'.C. for this ,son xner Date WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell' -insure, a certificate of Workers' Compensation Insurance, or a certified CERFk0CA'I'E OF EXF-MPTION PROM WORKERS' COMPANSATION INSURANCE ' (This section need not be completed if the permit is fur one hundred dollars ($100) or ILoJ 1 certify that in the performance of the work ]or which this per- mit is issued, I shall not employ anyperson fit any manner so as to beconm subject to the Workers' Compensation Laws of California. Date Applicant NOTICE '10 APPLICANT: If, after making this Certificate of Ex- emption, you should beconm 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 LANDING AGENCY 1 hereby affirm that there is a construction lending agency for the perfornmace,ol' Ille walk far which this permit is issued (Sec. 3097, Civ.C.). Lender's Name _ Lender's Address I certify that I 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 property for inspection purposes. (We), agree to save, indemnify and keep harmless the City of .uperlino against liabilities, judgments, costs and expenses which in any way accrue against ad City in consequence of the n ti ng of this penni}rs // - ELECTRIC PERMIT OUTLETS -SWITCHES -RECEP 10.00/1.00 _IGHTING FIXTURES 10.00/1.00 4PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 PANELS (OVER 200 AMP) 20.00 SIGNS TRANS. 3.00 SPECIALCIRCUIT 5.00 TEMP. METER OR POLE INS. 20.00 MOTORS SEE FEE SCH: SERVICE CHANGE 20.00 MISC. - PERMIT ISSUANCE PLUMBING PERMIT LTER-DRAIN & VENT -WATER IEA.) 5.00 ACK FLOW PROTECT. DEVICE 4.00 RAINS -FLOOR, ROOF, AREA, COND. 5.00 IXTURES - PER TRAP - 5.00 AS-EA.SYSTEM-1 INC.4OUTLETS 600 AS - EA. SYSTEM - OVER 4 (EA.) 2.00 JDUSTRIAL WASTE INTER. 30.00 AWN SPRIN ERS - 1 INC 5 V.B. 6.00 AWN SPRINKLERS- OVER 5 (EA.) 1.00 EWER -SANITARY -STORM EA. 200ft/10.00 'ALTER OR ADD TO MECH. 5.00 IATER HEATER W/VENT 6.00 WATER TREATING EQUIP. FEE FEE I r -L RES MISC. - - REFER TO ORD. I FIRESPR INK Y ❑ N ❑ ENERGY T 24 Y ❑ N❑ PERMIT ISSUANCE rf 'too LZIA ISSUANCE DATE BLDG. ELECT. PLG. MEI ❑ ' ❑ Y ❑ . N ❑ BUILDING PERMIT OTY. MECHANICAL PERMIT INFORMATION VALUATION S/FT. FEE I r -L RES MISC. - - REFER TO ORD. I FIRESPR INK Y ❑ N ❑ ENERGY T 24 Y ❑ N❑ PERMIT ISSUANCE rf 'too LZIA PLUMBING FLOOD ZONE A.C.O.C. PLG. CONTR. LIC. NO. TOTAL I Y ❑ . N ❑ Y ❑ N ❑ OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING , 'ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10,000C.F.M.) 6.00 EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) •8410 HEATING UNIT (OVER 100,0008.T.U.)9.50 VENTILATION FAN (SINGLE) 4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP love, 100,000 BTU) SEE FEE SCH. MISC.-' REFER TO ORD. I1 PERMIT ISSUANCE 19-.66 4(� ;ONT. LIC. NO. MECH. '1/� TOTAL pa SQLFICE COPY FEE SEISMIC FEE MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX 0 TOTAL IOF POST THIS CARD NEAR FRONT OF BUILDING' - CITY OF CUPERTINO :. INSPECTION DIVISION JOB INSPECTION RECORD - JOB ADDR E55 '_3 k N IT# _LOT# OWNER C)(- • ft- CONTRACTOR , 'PERMIT NUMBER � 16685 PERMIT EXPIRATION � pMlT•"EXPIRES rF WORK j IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISS. 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 - PERMIT VALIDATION + GIUCCG I SSUANCE DATE GARAGE SLABS_, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL MECHANICAL BLDG ELECT I PLG. MECR. DO NOT POUR FLOOR UNTIL ABGVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR �. VALUATION F SIFT. PLUMBING - MECHANICAL ELECTRICALPAID, PAID PERMIT To }� y �`ch 4 FRAMING INSULATION Nov. 1.1[100 1 IJVN SL TIES TYPE CONST City Of Cupertino OCC GROUP RES UNITS - PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID sa. FT. Fulmv Anen TOTAL ncvLncu DIAPHRAGM ROOF SHEATHING -r BUILDING USE RES IND EON PB om., ❑ - 1:10 11{ ❑ APPLY NO,ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATEINSP. '. ROUGH SAN.# ASSESSORS PARCEL NO PLUMBING - ELECT. ENERGY - TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCELNO- MECHANICAL MECH.ENERGY ELECTRICAL - BUILDING ENERGY Acc DATE ACC. Pl�e rvo. FRAMING ELECT. FINAL TEST INSULATION PLUMBING'O-A _z ZONING ENG, SITE NO, GAS TEST GAS - MECHANICAL . FIRE SPRINK Y E] "❑ ENERGY T 24 ° ❑ "❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING XTERIOR SHEAR ELECTRICAL RELEASE 'F LOOD ZONE Y ❑ "❑ . ALU C. Y ❑ 'N❑ INTERIOR SHEAR .• FIRE DEPT. SIHEETROCK GRADE FEE SUMMARY E TERIOR LATH- BUILDING BUILDING IN'tERIOR•LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE ' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM '; ARRANGE FOR, INSPECTION BY PHONING 252-4505, FW-� ''ONE WORKING -DAY BEFORE REQUIRED INSPECTION: z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING ,OR.; MECHANICAL ; p! iA CONST. TAX IMPORTANT!, PLEASE REAID.REVERSE SIDEtBEFORE CALLING FOR FINAL INSPECTION. TOTAL, I OFFICE COPY