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13557APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY OFFICE COPY PERMIr NUMBER BUI LDIHJG PROJECT 1 DENTI FICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL 35 7 euaowG ADDRESS 10716 S. Stelling Rd. OWNER'S - NAME Christopher Olsory„°NE 255-3217. QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS: NAME l' OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 -LIC. No. ? CONTRACTOR'S ADDRESS APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 PHONE DATE OF APPLICATION ARCHITECT OR ENGINEER Melvin R. HilkNo. 19704 PANELS (OVER 200 AMP[ 20.00 PLANCHECKFEE P.O. NO. SIGNS TRANS. 3.00 "PC"°RE"° 410 Sunnyoaks, Ave. AGGRESS Campbell, CA 95009 SPECIAL CIRCUIT 5.00 PERMIT VALIDATION P4(i///^jjj 1` I t TEMP. METER OR POLE INS. 20.00 APPLICANT - ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed tinder provisions of Chapter (,I yELECT. - (commencing with Section 700e)i of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lin. Number BLDG ELECT.' ❑ P`DATE r'uPLG! MECH. ❑ ❑ Date Contractor. BUILDING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law lot the followingreason(Sec. 7031.5. Businessand Professions Code: Any city or county which requires permit to construct, alter, 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 INFORMATION MISC. - REFER TO ORO VALUATION 4 q/FT. PERMIT ISSUANCE 10.00 "Q+ ELEC. CONTH. LIC. NO, ELEC. 2 TOTAL �-� PERMIT TO , CITY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofnot more than five hundred doilars(5500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or any employees with wages as their sole compensation, will do the work, and the structure Is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS I DRAINS -FLOOR, ROOF, AREA, COND. 5.00 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- meals are not intended or offered farsxle. 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 mi -RES prove for purpose of sale.). I, as owner of the property, am exclusively cocting with ntra FIXTURES - PER TRAP 5.00 sD. FT. PLooR AREA TorAL ACREAGE l GAS-EA.SVSTEM-11NC.40UTLETS 6.00 GAS - EA. SYSTEM -OVER 4 IEA.1 2.00 BUILDING USE IND . CON PB -' Omer ❑ El El ElO INDUSTRIALWASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSE5SORS PARCEL NO. t licensed contractors to construct the project (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 contracts for such projects with a contmctor(s) licensed phiisuanl to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ la Ipt cadet B,&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 -- KER.' MP'N DECLARATION - I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy Otereof (Sea. 3800, Lab.C.). Policy No. Company ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPANK Y E]N❑ ENERGY T-24 Y [3N❑ MISC.- REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 10 FLOODZONE A.LU.C. PLG. CONTE. LIC. NO. PLG. _� TOTAL COMPENSATION INSURANCE section need not be crnmlete l if the penail is for one Y E] N ❑ Y [:] N E]([']its CITY. MECHANICAL PERMIT FEE - FEE SUMMARY hundred dollars IS 100) or less.)' I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to BUILDING become subject to the Workers' Compensation Laws of California. Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Ex- OR ADD TO MECH. 5.00' -- APPLIANCE 5.00 PLAN CHECK emption, you Should become subject to the Workers' Conhpensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10PMC.F.M.) 4.00 AIR HANDLING UNIT(OVER10,000QF.M.) 6.00 SEISMIC FEE i lo CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency lot EXHAUST HOOD (WITH DUCT) 5.00 the performance oI' the work for which this permit is issued (Sec. 3097, CIv.C.), MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC SO5E.00I Lender's Nome Lender's Address certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and County ordinances and state laws relating to building mnstructi0n, and VENTILATION FAN (SINGLE) 4.00 PLUMBING O� BOILER-CQMPI3H.P.Or100,0006.T.U.) 6.00 BOILER -COMP (Over 100.000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ' MISC. - REFER TO ORD. (We) a - to save, indemnify and keep harmless the City Of Cuperf trial liabilities, judgment. costs and expenses which may i an ay ac rue agains ti .ity im consequence of the grant goth peon 1. li-ITOTAL CONST. TAX PERMIT ISSUANCE 10.00 O MECH. CONT., LIC. NO. MECH. j / TOTAL igna re o' pelican[ Con[m Data OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING ��' — io_- CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD ' •' 10716 S. STELLING JOB ADDRESS—UNIT,*--LOT# OWNER CHRISTOPHER .OLSON CONTRACTOR RnuT"GHRF 1•��V. 356 - PERMIT EXPIRATION PERMIT EXPIRES IF WOR IS NOT STARTED WITHI 160 DAYS OF PERMIT ISSU ANCE OR 160 DAYS'FROM LAST CALLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION b - bo .. UFER PREGUNITE - PERM.TWALI-DATION V tity Ci w11!1CaL1O ISSUANCE DATE 'JPOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL BLOC ELECT. PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR - VALUATION $IFT. - ' �•� - PLUMBING � � MECHANICAL - ELECTRICAL � � PERMITIU .v ��F,, ✓..i..ij. .,r%.a..;••✓ FRAMING INSULATION � - STORIES TYPE,_COa$TR. OCC. GROUP', HES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO. FT. FLOOR AREA TOTAL ACREAGE Y DIAPHRAGM ' BUILDING USE NES NO CON PB OV�m ❑ ❑ ❑ ❑ ❑ ®APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED _ ROUGH ASSESSORS PARCELNO. ' I PLUMBING' GAS TEST TRACT NO. PARCEL N0. MECHANICAL i.+�Z ELECTRICAL �:f FINALS DATE INSP. ACC.DATE ACC. FILA " 'FRAMING SAN # INSULATION PLUMBING ZONING ENG. SITE No. GAS FIRE SPRINK v El NEI ENERGY T-24 v ❑ INC] MECHANICAL, - �.�� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING —1? _ LATH—INTERIOR ELECTRICAL - FLOOD ZONE Y❑ "❑ A.L.D.C. °❑ N[_SHEETROCK LATH—EXTERIORU`CO !-�CL-B ! FIRE DEPT. —12� GRADE • FEE SUMMARY SHEAR INTERIOR BUILDIN -i„'%. i - BUILDING �, . - - SHEAR EXTERIOR TEMPORA Y APPROVALS - FIREWALLS - ELECTRIC PLAN CHECK FEE GAS (NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE' n OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. Z —SEE PERMIT FOR EXPIRATION DATE.- MICROFILM ELECTRIC -yl PLUMBING5 Ol > MECHANICAL ' coNsr. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL �✓ �� OFFICE COPY