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18378.O Z2 F 0 CC LU _ C 0 Uo LL U Ow >a .F Z. L+. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY UI LDI NO PROJECT I DENTI FICATIO BUNG=I— APPLICATION.& PERMIT PERMIT NUMBER n 1�8 A Clt11IE > BUILDING — ELECTRICAL— PLUMBING — MECHANICAL r OWN`ER'S NAVE - QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' PHONE vu : DATE OF APPLICATION'' CONN CTOR'S Ap h VI✓ ilko 1 •, � 'urc. No J 5 V UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S po& AOf1O''''tRtE55 PHONE -IZSD APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 ARCHITECTPANELS(OVER OR ENGINEER - LIC. NO. 200 AMPI 20.00 PLAN CNECK FEE P.C. NO. SIGNS TRANS, 3.00 AR H,eNG. ,ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION O EMP. METER OR POLE INS. I p .7Bt0V I0 UJ1� APPLICANT ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 \v LICENSED CONTRACTORS DECLARATION I hereby oIfirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and PIUI'C59I n11a Code, and my license 11 In I lull fllrCqq++ll�Ipf{vct�♦ LLie. N,in ber_J `-l_r7 ! Dulcl� Citalm,tnrj l ISSUANCE DATE BLDG. ELE PLG. CN. '� 1 BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the hm's Contractor's License Law forthel'lyoremledson.ISee.uires a permit torous Prnfessioos Code: Any city or coo my which sequiture permit toconst Rlnc sacs, M150.= REFER TO ORD PERMIT ISSUANCE Z1� ZrXF VALUATION $/FT. ELEC. GDNTR, LIC. NO. ELEC. •/� G TOTAL `u to f, prior n its issuance, also inquires demolish, of repair any permit requires the d, applicant for such permit is of t a signed statement that he is licensed, pursuant to the provisions of the Contractor's License H,sinland Pnicevoons Code) or Section is 00) exempt therefion oofthe Business and Professions Code) or that he is exempt and ' PERMIT TO t--� Grb •, t—t QTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR, echo 70 lire basis for the alleged exemption. Any violation otoncfion for a livepermitl dollar, the applicant ton civil penalty malty by any more live Ile Of not mare ALTER-DRAIN-WATER(EA.) 5.00 ❑ I, as owner at the property, army employees with wages as woe prop sty, or my emp their sole compensation, will Jo the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (See. .7044, Business and Professions Cndc: 'file Cantractoi s License Law does not apply to an owner of FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, fire building GAS - EA. SYSTEM- 1 INC. 4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did net build o r im- pmve for purpose of sale.). ❑ I. as owner of the properly, um excllnively contracting with - . -.. GAS EASYSTEM OVER 4 (EA.) 200 BUILDING USE RLEY IND CON PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project ISec. 7044, Business and Professions Code: 1'he 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 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORSPARCEL NO. ' contracts for such projects with a cont sudor(,) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200tt/10.00 TRACT NO. PARCEL NO. I ❑ 1 and exempt under Sec. , 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 WORK ERS'COMPENSATION DECLARATION I hereby affirm that I have a eertillcafe of consent to self-inwre, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof (See. 3800, Lab.C.). Policy No. Company _ FIRE SPRINK y ❑ N ❑ ENERGY T�24 v ❑ N❑ ❑ Certified copy is hereby bursted, ❑ Certified copy is filed with the city inspection division. Applicant MISC, - REFER TO ORD, CER3'IFICATE OF EXEMPTION FROM WORKERS' 'PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. - COMPENSATION INSURANCE (This section need not be completed if the permit is for Due V ❑ N❑ V ❑ No PLG. CONTR. LIC. NO, PLG. TOTAL handled dollars IS 100) or tell.) 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 CITY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compansation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making fills Certificate o1 Ex- APPLIANCE 5.00 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 this permit shall be declined revoked. AIR HANDLING UNIT (TO 10,00DC.F.M.) . 4.00 AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCT ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of Ihu work for which this permit ix issued ISec. 3097, Civ.C.L MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Nddr Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC " I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby authbncm representatives fatties of this city 10 enter upon the hereby enllmriz property tot vespo inspection purposes, to. PLUMBING BOILER -COMP Q H.P. Of 100,000 B.T.U.) 6.00 BOILER -COMP love, 100,000 BTU) SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of Upertime against liabilities, ju meals, costs and expenses which y ay eters a est said City in consequence of the MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 ru ng 1 s pcnnil. 7 7 H. CONT. LIC. NO. MECH. /Lf TOTAL, TOTAL ignalure of Applicant/:0)5PIrct., Data OFFICE COPY T POST THIS CARD NEAR FRONT OF BUILDING CITY -OF CUPERTINO INSPECTION DIVISION 1 ' JOB INSPECTION RECORD JOB ADDR ESS �� / UNIT# _LOT# OWNERNr1PACTOR PERXiIT i UMBER 1 Vat U PERMIT EXPIRATION PERMIT &XPIqAIWORK IS NOT, STARTED WITHIN -180 DAYS.OF PERMIT ISSU- OR 180 DAYS FROM LASTCALLEO INSPECTION. - • ,INSPECTION DATE INSPECTOR INSPECTION RECORD- FOUNDATIONANCE NOTE: ..ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. UFER PREGUNITE _ PEHNm VAI.1LATION �! 1 •./� �J IN ISSU NCH LATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .UNDERGROUND/SLAB PLUMBING - ELECTRICAL MECHANICAL BLDG I ELECT I PLG. MECH. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED _ BUILDrWG PERMIT INFORMATION WOOD FLOOR VALUATION $TFT. PLUMBING MECHANICAL - ELECTRICAL _ ERN IT TO FRAMING INSULATION - STORIES Tv CONSTR. LCC GHOUP R+:S UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID ' - sa. Er n.00la n++Ln rnTn� ncBI:nGE DIAPHRAGM ROOF SHEATHINGHE' BUILDING USE IND CON PB -DO,.v ❑ ❑ ❑ ❑ - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN,# ASSESSORSPARCELNO > 'I PLUMBING - ELECT. ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY RACi NO. PARCEL NO. MECHANICAL - MECH.ENERGY- ELECTRICALBUILDING'ENERGY ACC. DATE ACC, , FILE NO -FRAMING ELECT: FINAL TEST INSULATION PLUMBING ZONING ENG. Sl E NO. GAS TEST GAS - '• - MECHANICAL FIRE SPRINK r O N E] ENERGY T 2 v 0 NF] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR - ELECTRICAL RELEASE 0 FLouD ZONE N� aL u.G. L ry� INTERIOR SHEAR FIRE DEPT: SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR.LATH - TEMPORARY APPROVALS SCRATCH COAT ELECTRIC 'Z Z— PLAN CHECK GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE /'✓. OCCUPANCYOF BUILDING ISNOTPERMITTED UNTIL BUILDI NG FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM 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 - ELECTRIC PLUMBING. MECHANICAL CONST. TAX r IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION, TOTAL . OFFICE COPY