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18273APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER q O q II: I 0 1 euILDIrvG ADOREu-//O�'..D' TELL �c Nfs DwNER'9••D HI$\1Jp�-���` NAME 1/ ROSERT IHoB)�y�_7YT� SLHWgRTys PHGrvE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION 6 l �♦ �� DATE OF APPLICATION - CONTRACTOR'S rvaME -{ ' ' y - VE_ V G08 Ct uarvo5ISp 11 OUTLETS - SWITCHES -RECEP 10.00/1:00 LIGHTING FIXTURES 10.00/1.00 AG DRESS (HOB) RE(HOB) aDNRIA 1C4E 'PHONE 250 APPLIANCES - RESIDENTIAL 4.00 PANELS 10,00 OR L=LR - OR ��TT L ENGINEER LIC. No, - PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C. 0. ISIGNS TRANS. 3.00 ARCH. OR ENG. ADDREssp[� L Y ciP95o) SPECIALCIRCUIT 5.00 PERMIT VALIDATION D EMP. METER OR POLE INS. 20:00 APPLICANT'S APgLO LTO DDRESS MOTORS SEE FEE SCH. 00 W3 - 1- SERVICE CHANGE 20.00 LICENSED CONI 'RACTORSDECLARATION PAIDFi ♦ I hereby affirm that l am licensed tinder prnvivmHS of Chupler 9 (Commencing with Section 7000) of Division 3 of the Business and IT to CO d•ZImyIICI`n Li IYmmb f0 5!1110 Livenxvu.n s Lie. Number 1 ISSUANCE DATE BLDG. ELECT. PLG. MECH. t , (- {^ Dntc-/G.(^�Cnntroutor(vA.w OWNER -BUILDER DECLARATION I hereby affirm That 1 am exempt from the Contractor'sMISC. ctor's License Law forthe followingreason.(Sec. 7031.5, Bessand Professions win Code: Any city or county which requires a 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 Li that he is licensed to the provisions of the Contractor's License - v .{ Cupertino BUILDING PERMIT INFORMATION - REFER TO ORD PERMIT ISSUANCE 10.00 (.)..0d t) VALUATION ! o D -� ELEC, CONTR. LIC. NO. ELEC. TOTAL PERMIT TO 9(coPursuant Law (Chapter 9(commencingwith Section If and Professions Code) or tAnl he is that therefrom and is exemfDtheren3 and GTY. PLUMBING PERMIT FEE a basis tion of the basis for the alleged exemption. Any violation of Section malty by any applicant fora permit subjects 500R.licum toacivil penalty, of not more than five hundred ($5 STORIES TYPE CONSTR. ALTER-DRAIN-WATER(EA.) 5.00 o amp ❑ I, as owner of the property, or my employees with wages as property, their Sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS 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 ' FIXTURES - PER TRAP 5.00 GAS -EA. SYSTEM -1 INC.4 OUTLETS 6.00 property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- meats are not intended or offered for i0e. If, Imwavcr, the building` or improvement is sold within one year of comptetion, the owner- builder will have the burden of proving tliat,hc did not build or int- prove for purpose ofsalc.). ❑ I, as owner of the property, am exclusively contracting with SO. FT. FLOOR A / ^ �� S TOTAL ACREAGE GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Onor ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, fiusiness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contructoD U licensed pursuant to the Contractor's License Law. ❑ lam cxempYunder Sec.-B.&I'.C. for Ibis reason SEWER -SAN V -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Dale WATER SYSTEM 5.00 - ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby infirm that I have a certificate of consent to sell -insure, ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.CJ. Policy No. Company '❑ R•rtilieJ copy is hereby furnished. X Certi •d co II•d Ith theity inspection division. Applicant_ , � 7c=_'na, � FIRESPRINK Y ❑ N ❑ ENERGYT-24 Y ER N❑ MISC. - REFER TO ORD. CE RI' ll' [CAT 1. O E 17 E M PTI ON 17 ROM WO RK Ii RS CONIPE.NSATION INSURANCE This section need not be completed if .tire permit is 1'or one PERMIT ISSUANCE 10.00 .0/) FLOOD ZONE Y ❑ N❑ A.L.U.C. Y ❑ N❑ PLG. CONTR. LIC. NO. TOTAL •� hundred dollars(S 100) or less.) - I cranny that in the psnournanco of the work for which this per- HIT is issued, I shall not employ any person in any manner so as to DTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING •!� become subject to the Workers' Compensul ion Laws of California. Dote Applicant NOTICE 'TO APPLICANT': If, after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 1g000C.F.M.) 4.00 PLAN CHECK FEE emption, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or Inds permit shall be deemed revoked. AIR HANDLING UNIT(OVER 10MC.F.M.)6.00 SEISMIC FEE l.i�JD •, CONSTRUCTION LENDING AGENCY • I hereby affirm that there is a constnmtion lending agency for the performance of the work ]or which this pe nn it is issued (Sce. 3097, Cie.C.). Name EXHAUST HOOD (WITH DUCT) 5.00 - MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Lender's Address HEATING UNIT 100,000 B.T.U.)9.50 ELECTRIC I C 1 certify tlmt have read Ibis application and state that the above information is correct. I agree to comply with all city and county nc ordinaes and stale laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING 3 BOILER •COMP13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL 3y9) above-herebymentioned representatives of this city es enter upon the above-mentioned properly for inspection purposes. ' ' (We) agree to save, indemnify and keep harnlleas the City of Cupertino against liabilities, judgments, costs and expenses which may in any way aceru taint said City in consequence of the ant f this panni --zfi .MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 ]� CONST. TAX MECH. CONT. LIC. NO. MECH. TOTAL ��'� TOTAL t y�q /L f ' A signature pp m /Contractor Dote .v OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING ' + PERMIT NUMBER _ CITY OF CUPERTINO .. 18273 INSPECTION DIVISION JOB,INSPECTION RECORD �I ` �(/I—UNIT# PERMIT EXPIRATION JOB ADDRESS _LOT# -'SI pERM1T EXPIRES IF WORK OWNER k_9 SL VVrk Ty CONTRACTOR d„1r�, �• ,C,d $ d IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM INSPECTIONDA E I PECTOR INSPECTION RECORD FOUNDATION NOTE: `� ' LIFER -19A was lw_ ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF LASTCALLED INSPECTION. - 'PREGUNITE • PERMIT VALIDATION ' CUPERTINQ$,7$1"/ DS. ` GARAGE SCARS - ('+h/{J J., 0 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED p[# OCT UNDERGROUND/SLAB - PLUMBING /. p City of. CUp@ItIDO ISSUANCE DATE ELECTRICAL MECHANICAL ►Ni Di�,WjT-G�UI�U•N�1��OC7� I/ nEOG. V/..Lcr. / XPLG.rcR. !� 4 u sl o s . 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNE _'S RNRCL3 PIVX6r 1-4-'90 iG BUILDING PERMIT , INFORMATION WOOD FLOOR VALUATION -FT. V PLUMBING MECHANICAL ELECTRICAL _ I . PERMI ro -e'�iDWc FRAMING INSULATION 00 Q sroR�BS TYPE CONSTR. OCC. GROUP RES UNITS -PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED " - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAXIS PAID s IT FIBER A TOT AL ACREAGE DIAPHRAGM ROOF SHEATHING - x�Es 1� RUI4DING USE 6 O oQ� - -APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. " ROUGH - SAN.# " ASsessoRS PARCEL NO PLUMBING - ELECT. ENERGY - TUBS 8 SHOWER PAN PLUMBING ENERGY THACT NO. PARCEL NO MECHANICALMECH.ENERGY - ELECTRICAL U BUILDING ENERGY ACC DATE " Acc, FILE No FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG, SITE N0, GAS TEST GAS - MECHANICAL FIRE SPRINK Y NL LNERGYL24~ Y L NL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE ZONE F l,oD N L A,LI NL INTERIOR SHEAR Q FIRE DEPT. SHEETROCK- GRADE _ FEE SUMMARY EXTERIOR LATH BUILDING- BUILDING «/ INTERIOR LATH - .' TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - PLAN CHECK FEE CNS GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' / 3 .3v OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY. BUILDING INSPECTOR: MICROFILM ELECTRIC ARRANGE FOR INSPECTION BY PHONING M-4505, F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 3 " Z PLEASE GIVE JOB ADDRESS WHEN PHONING. _ —SEE PERMIT FOR EXPIRATION DATE -... MECHANICAL 72 CONST. TAX " IMPORTANT! TOTAL PLEASE.READ REVERSE SIDE BEFORE CALLING. FOR FINAL INSPECTION. OFFICE COPY "