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13132_, , , APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFICATI ON APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 13132 911ILD1NG ADORE T- OWNER' �j NAME y/ �S Cj OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION .� DATE OF APPLICATION CONTRACTOR'S NAmE uc. ND. OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS A DDREss C' �C� / j Yy1, jqPHONE�E3SO / PPLIANCES-RESIDENTIAL 4.00 PANELS 10.00 on ENGINEER LIC. no. PANELS(OVER 200 AMP) 20.00 PANELS PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 nooniss E.G. ZIP SPECIAL CIRCUIT 5.00 PER LT Vquy TION 1� / `J ISSUANCE DATE BLDG. ELECT. PLG. J;7 I vel �tfl EMP. METER OR POLE INS. 20.00 ADDRESSr$ ADREss MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affrin that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus" ess nd r Professions Code my license is in full for a f ect. License Class Lic. Number Date Contractor OWNI?R-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law forthe followingreason.(Sec. 7031.5, Business and Professions Code: Any city or munty which requires a permit to construct, alter, improve, demolish, or repair any structure, prior its issuance, also requires the applicant for such permit to file a signed ed statement that he is licensed pursuant m the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of5ection 7031.5 by.mry applicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars (b50O.): ❑ 1, 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 an owner of property who builds or improves thereon• and who does such work himself or through his own employees, provided that such improve- mentsarenot intended or offered 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 am. Prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 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 contractors) licensed pursuant to the Contractor's License Law. ❑ 1 um exempt under Sec. R&CC. for this reason BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10 .00 7 VALUATION 3 $/FT. ELEC. CONTR. LIC. NO. TOTAELEC. L PERMIT TO / Ad�) //7-/ / CITY. PLUMBING PERMIT FEE ) STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 . BACK FLOW PROTECTDEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 n FIXTURES - PER TRAP 5.00 -- GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 SO. FT. FLOOR AREA TOTALACREAGE BUILDING USE RES IrvD CON PB orher INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATERHEATER W •VENT 6.00 Owner Date WATER SYSTEM _ 5.00 WORKERS'COMPF.NSATION DECLARATION I hereby affirm (flat I have a certificate Of consent to sell' -insure. or a certificate of Workers' Compensatio Insurance, or y eerI,F, copy the,v,oIii). \ Policy NoyO ❑ Ce lifed co y 1s here y fu ed ❑ Certif he y ins eetioA di cion. Applicant9-/y��i �B I ACC. GATE ACC. FILE NO. WATER TREATI G EQUIP. 1jV s 5.00 N) ZONING ENG. SITE NO. IB MISC. - REFER TO ORD. FIRE SPRINK v N ENERGY T-24 v N� CERTIFICA'T'E OF EXEMP'T'ION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if tile e permit is for One hundred dollars (5100) or less.) I certify that in the performance of the work for which this per- mil is issued 1 shall not employ any person in any manner w as to become subject to (he Workeri Compensation Laws of California. DateNOT Applicant PERMIT ISSUANCE CE 10.00/0 '- FLOOD ZONE Y [] NF] A.L.U.C. Y No PLG. CONTR. LIC. NO. PLG. / '' TOTAL T� CITY MECHANICAL PERMIT FEE FEE SUMMARY BUILDING O Ufa / ALTER OR ADD ,MECH. a .. 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 most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that (here is a construction landing agency forEXHAUST the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). - Lender's Name APPLIANCE 5.00 AIR HANDLING UNIT (TO,I0000C.F.M.) 4.00 PLAN CHECK FEE AIRHANDLING_UNIT-(OVER 10=C.F.M.) 6,00 SEISMIC FEE MICROFILM HOOD (WITH DUCT)tU 5.00 s'� '- HEATING UNIT -(TO 100,000 B.T.U.) 8.00 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 Cupertino against liabilities, jgd lents, cAsts and expenses which may in a way a9 ue ag tut said Cily m consequence of the la tin his per I . _ HEAT[ NG UN IT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN (SINGLE)4.00 BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 PLUMBING BOILER -COMP (Over 10.000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. ISSUANCE 10.00 6 CONST. TAX fPERMIT MECH. LIC. NO. MECH. TOTAL r/it, TOTAL �� 7 lgoa ucorAppl ant/Cont Dale E V POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOBADDRESS 1182 STAFFORD . UNIT# _LOT# OWNER MR & MRS HENRY CONTRACTOR LOU PIRNICK INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION ,J PERMIT EXPIRES IF WORK LIFER PREGUNITE ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED J UNDERGROUND/SLAB PLUMBING I11� n ELECTRICAL MECHANICAL City Ct 1'j"_ IPD 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING _ _ INFORMATION MECHANICAL ELECTRICAL / FRAMING J^ y,) INSULATION /W/7-Mim STORIES PLACE NO SUBFL00 DIAPHRAGM APPLY NO ROOFIN( PLUMBING GAS TEST MECHANICAL ELECTRICAL FRAMING INSULATION UNTIL ABOVE HAS BEEN COVER NO WORK UNTIL LATH—INTERIOR LATH—EXTERIOR SHEETROCK SHEAR INTERIOR SHEAR EXTERIOR FINALS SAN * PLUMBING GAS MECHANICAL HEATING ELECTRICAL FIRE DEPT. 3RADE MIZE INSP 'I I'tCVVH LIJ ELECTRIC GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY )CCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ARRANGE FOR INSPECTION BY PHONING 252-4505, luj — ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. o - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! i . PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY ' PFRM1IIT NUM13ER 13132 PERMIT -EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PERMIT VALIDATION J -71:3 7 I l ISSUANCE DATE BLDG. ELECT. PLG. MECH, 1'j"_ IPD BUILDING PERMIT INFORMATION VALUATION SIFT. / PERMIT TO /W/7-Mim STORIES TYPECONSTR. OCC. GROUP RES. UNITS SO.FT,FLOOR AREA TOTAL ACREAGE BUILDING USE RES IND CON PB O,n,, ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. TRACT NO. PARCEL NO, ACC. DATE ACG FILE NO. ZONING ENG. SITE NO. FIRE SPRINK ENERGY T 2 Y ❑ NE] Y ❑ N ❑ FLOODZONE A.L.U.C. YE] N❑ Yo No FEE SUMMARY BUILDING PLAN CHECK FEE SEISMIC FEE MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX TOTAL