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13201 �')1i'PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING - APPLICATION & PERMIT- ^ O tME BUILDING-ELECTRICAL-PLUMBING-MECHANICAL G r PLAN CHECK VALIDATION OTY. .ELECTRIC PERMIT FEE PNONE TOR'2S NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 �• Llc.No. LIGHTING FIXTURES 10.00/1.00 CONTRAS ADDRESS APPLIANCES- PPLIANCES-RESIDENTIAL 4.00 10,V6 4Wr,,r- PANELS 10.00 GATE OF APPLICATION ARCHITECT OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C.NO, O ENGINEER ' uc.No. ISIGNS TRANS. 3.00 ' AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 PLICA ADDREs ADRESNrs MOTORS SEE FEE SCH. s SERVICE CHANGE 20.00 wo o - LICENSED CONTRACTORS DECLARATION u v I hereby affirm that I um licensed under provisions of Chapter 9 ISSUANCE DATE N <n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H 0 i Professions Code, cd m 'cense is in full fo fyyp}�e( t. ,� ❑ ❑ ❑ z 0 as License Class le Number-�'7JLya u w Date_4LZS!5P! Contmctor4ILL-/_4 a sa s s o a ° OWNER-BUILDER DECLARATION BUILDING PERMIT INFORMATION w0 LL y 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u 0 ¢ Law for the following reason.(Sec.703 L5,Business and Professions pERM1T ISSUANCE 10.00 VALUATION SIFT. fwvaCode:Any city orcounty which requires a permit to construct,Star, IC Q 0 Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONT. LIC.NO. ELE w0 IC requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO ea" he is licensed pursuant to the provisions of the Contractor's License •� , ,S Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE r o the basis for the alleged exemption.Any violation of Section 703L5 STORIES TYPE CONSTR. e ; f' by any applicant for a permit subjects the applicant In a civil penalty 00) 5. p of not more than five hundred dollars($5001.): ALTER-DRAIN&VENT-WATER (EA. s� 0 O ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 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:The Contractor's License Law does not apply to an owner of 0 property who builds is improves thereon and who docs such work �' FIXTURES-PER TRAP 6.00 0 SO.FT.FLOOR AREA TOTAL ACREAGE himself or not hrough ownemployees,for Sale. If,eJ(bat such improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 OC . improvement 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 inn. BUILDING USE Prove for purpose of salol. RES IND El El El PB Ome D r as owner of the property, exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 licensedd contractors construct thehe project(Sec. 7044,Business LAWN SPR IN KL Efls- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code::The Contractor's License Law docs non apply to antr owner of property who builds to improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contractsctor'shceneLwithacontractor(sl licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL N0. ❑ tum exempt under Sec.-,BAP.C.for this WATER HEATER W/VENT 6.00 reason i Owner Dade WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have u certificate of consent tosell-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ. Policy No. Company 0 ❑ Certified copy is hereby Intnished. FIRE SPRINK ENERGY T@4 � Cer' d_c� witsyple ItY inspection division. ❑ ❑ Z 0 Appllcan 99�F '' y r v` MISC.- REFER TO ORD. Y F] N v ❑ N CC CE RTI F I CATE OI IiXF.M PTION FROM WO R K E RS' PERMIT ISSUANCE 10.00 (D•- FLOOD ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONNTR. LIC.N . PLO ("O (This section need not be completed if the permit is for one lL/� d� TOTAL 0Y❑ NC] Y[ N1:1 D Z hundred dollars(S 100)or less.) U O 1 certify that in the ped'ormance of the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. IL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT': If,after making this Certificate of Fix- 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 V such provisions ar this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCYAIR 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. MICROFILM 3097,Civ.C.L HEATING UNIT(TO 100,000'B.T.U.) 8.00 Lender's Name HEATING UNIT(OV ER 100,000 B.T.U.)9.50 1 Lender's Address ELECTRIC I certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to Comply with all city and county PLUMBING t 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 above-mentioned property for inspection purposes. BOILER-COMP IDVBr 100,000 BTU)SEE FEE SCH. MECHANICAL (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 way accrue against said City in consequence of the gra ng of is elmiL MECH.CONT, LIC.NO. MECH. 41 TOTAL TOTAL Signature ant Contrac Uaro OFFICE COPY POST THIS CARD NEAR FRONT'OF BUILDING - . CITY OF CUPERTINO 13201 INSPECTION DIVISION JOB INSPECTION RECORD f.. JOBADDRESS PERMIT EXPIRATION 1601. Sunnyvale Saratoga _ UNIT# LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN ` INSPECTION DATE INSPECTOR INSPECTION ECORD 180DAYS OFPERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. P.R EGUNITE UFER - - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB- PLUMBING LD z i 0-7 ELECTRICAL - ISSUANCE DATE . MECHANICAL - PEGG, ELECT. PLG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - INFORMATION VALUATION $/FT. PLUMBING - - MECHANICAL - ELECTRICAL FRAMING INSULATION - sTORI ES TYPE CONSTR. OCC.GROUP RES.UNITS JP.UACE NO SUBFLOOR UNTIL ABOVE,HAS BEEN SIGNED ROOF $0,FT,FLOOR AREA TOTAL ACREAGE r.� DIAPHRAGM ' �el��eell NUIL USE CON HES IND CON PB Olney NAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED El D El 0 1:1 ROUGH ASSESSORS PARCEL NO. . PLUMBING ' GAS TEST TRACT NO. PARCEL NO. MECHANICAL ACG DALE ACC.FILE NO. ELECTRICAL - " FINALS DATE INSP. FRAMING SAN # - INSULATION - PLUMBING ZONING , ENG.SITE NO. GAS MECHANICAL FIR E$PRINK ENERGY MA COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° "� NE] LATH-INTERIOR ELECTRICAL FLOOD ZONE A.L.uc. LATH-EXTERIOR - = FIRE DEPT: Y NEj Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING p SHEAR EXTERIOR TEMPORARY APFIROVALS BUILDING ' FIREWALLS - ELECTRIC - PLAN CHECK GAS FEE LNO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BYBUI LDINGINSPECTOR. MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING t 00 z0 PLEASE'GIVE JOB ADDRESS WHEN PHONING. ' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL00 CALLING FOR FINAL INSPECTION. �� OFFICE COPY .