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11847 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER BU LDI NG PROJECT I DENT[FICATI ON BOLLDINc ADDAPPLICATION & PERMIT ��� ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S I PLAN CHECK VALIDATION NAME CITY. ELECTRIC PERMIT FEE • i I` PHONE DDNTBAT.R's OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME ?. J UC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADORE ss / J Z� �,7 IAQ1+.ONE � / - PANELS 10.00 DATE OF APPLICATION OR C- PAN ELS IOV ER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER VU N L LIC.NO. SIGNS TR ANS. 3.00 ADENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDDRESSRESS zIP TEMP.METER OR POLE INS. 20.00 � APPLICANT'S MOTORS SEE FEE SCH. ADDRESS AYv1 SERVICE CHANGE 20.00 0 0 o LICENSED CONTRACTORS DECLARATION F i W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000)of Division 3 al the Business end BLDG. ELECT, PLG. MECH. SII F H i Professions Code. my license is in full force and effect z o m - License CIS s Lie.Number L.d� IAC , z F D Date Contract., y f a Y I BUILDING PERMIT ar 2 w 4 OWNER-BUILDER DECLARATION s INFORMATION REFER TO ORD wa n I hereby affirm that I am exempt from the Contractor's License MISC.- VALUATION 5/FT. Fuoes Law for the following reason (Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Code Any6ivorcounty which requires a permit to construct,alter, S x<G improve.demolish,or repair an structure,prior to its issuance,also SLED.CONTR. LIC.NO. I i p y ELEC. - DLL requires Ne applicant forsuch permit to file a signed statement that TOTAL%.l� PERMIT TO ' w m he is licensed pursuant to the provisions of the Contractor's License a Law(Chapter 9(commencing with Section 7000)of Division 3 of the ic Business and Professions Code)or that he is exempt therefrom and QTY: PLUMBING PERMIT FEE RH the basis for the alleged exemption.Any violation of Section 703 1.5 1 STORIES TYPECONSTR. byanyapplicant for a permit subjects the applicant to a civil penalty 00 of not more than five hundred dollars(S500i): gLTER-DRAIN&VENT-WATER (EA.) 5. •�/���/� pf��" ❑ 1,as owner of the property,or my employees with wages as ggCK F LOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not CC.GROU RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The 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 Gl 50.FT,FLOOR AREA TOTAL ACREAGE • himself or through his own employees.provided that such improve ments are not intended or offered for sale.If,however.the building GAS-EA.SYSTEM-I1NC.40UTLETS 6.00 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 im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RESI IND CON PS Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors t0 construct the project(Sec.7044.Business LAWN SPRINKLERS-1 INC 5 V.S. 6.00 ASSESSORS PARCEL N O. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who I LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contmcicrls)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 ARCEL NO, the Contractor's License Law. TRACT NO. PContractor's ❑ lam exempt under Ser.-.B&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure. ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof f Sec.3800,Lab.C.l. Policy No. Company (] ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z ZCertified copy is filed with the city inspection division. O A' tc t MISC.- REFER TO ORD. Y❑ N❑ Y ❑ No ~ w a PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. CL - CERTI FI NI F SAI IOTINS FROM WORKERS' UJ > COMPENSATION INSURANCE PLO.CONTR. LIC.NO. I.G.P d O (This section need not be completed if the permit is for one TOTAL �(� Y❑ N❑ Y ❑ N❑ Z hundred dollar,IS 100)or less.) U O I certify that in the performance of the work for which this per- QTY. I MECHANICAL PERMIT FEE FEE SUMMARY, -,.' 1L F mit is issued,I shall not employ any person in any manner so as to - U become subject to the Workers Compensation Laws of California. U w Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } m NOTICE TO APPLICANT: If,after making this Certificate of Ex FZ emption,you should become subject to the Workers'Compensation I APPLIANCE 5.00 PLAN CHECK provisions of the Labs Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOWCflM.) 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.). �/_ rv�' ( HEATING UNIT(TO 100,000 B.T.U.) 8.00 =i ^ Lender's Name /7 HEATING UNIT(OVER 100,000B.T.U.)9.50 ELECTRIC Lender's Addm% I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING BOILER-COMP(3 H.P.or t00,0008.T.U.) 6.00 0. ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon (lie BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL , above-mentioned property for inspection purposes. (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 n� may in away accrue against said City in consequence of the gmyrtp prmil. MECH.CONT. LIC.NO. TOTAL reo pplicantl n actor ale? i�'n, TOTAL INSPECTOR COPY POST THIS CARD,NEAR FRONT OF BUILDING PERMIT NUMBER_ y' CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTITI�ONN..�yRJECORD JOB ADDRESS �1� i� GMVU LN- I[!L UNIT# LOT# PERMIT EXPIRATION - - PERMIT EXPIRES IF WORK OWNER CONTRACTOR b IS NOT STARTED WITMIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM . LASTCALLED INSPECTION. UFER PREGUNITE' + ' PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ' i' PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLDG, ELECT. PLG. MEC . DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 6 BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL ELECTRICAL - PERMIT To FRAMING '' / G " eo% 'STORIES TYPE CONSTR. INSULATION + OCO.GROUP RES,UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF 50.FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON P8 Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ Q El I] ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRACT NO.'' PARCEL No. 2-2(-87 ' MECHANICAL ELECTRICAL ,Q FINALS DATE INSP. ACC.DATE ACC.PILE No. , FRAMING - SAN # ZONING ENG.SITE NO. INSULATION- - PLUMBING .. GAS MECHANICAL FIRE SPRINK ENERGY T ZE COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 N Y [] N� FLOODZONE A.L.U.C. LATH—INTERIOR I'L I- ELECTRICAL Y Y D • N❑ - LATH—EXTERIOR J� (� FIRE DEPT. - SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR - .BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS . ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I SEISMIC FEE OCCUPANCY OF,BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNEO BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Imo '• _- I Z PLEASE GIVE JOB ADDRESS WHEN PHONING. i 1 - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! coNsr.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION.. OFFICE COPY -