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17142I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNET WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL "FRAMING INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEI ROOF DIAPHRAGM - ROOF SHEATHING (.t APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING gf. TUBS &'SHOWER PAN' MECHANICAL alz 4 ok-� e4�e r SAN.H BUILDING PERMIT INFORMATION ,LIIATION $TFT. .D 00 PE HMMIIT TO UCC GHOL SO FT FLOOR ALL BE MADE BEFORE ;IS PAID Rl IurS IND DATE INSP. ❑ ASSES E =JH A -CT NO i P '"IDR ELECTRICAL - POST THIS CARD NEAR FRONT OF BUILDING FRAMING 1 CITY 0P CUPERTINO-' PERMITNUMBER GAS TEST IGAS I- 1712 1 MECHANICAL INSPECTION DIVISION HEATING - JOB INSPECTION RECORD` ; PLUMBING !{�� • �l /lRNf1T P)))E]JRMII.T EXtP.Ily�iATION JOB ADDRESS V_LOT# OWNER ' 1_UNIT# W�j CONTRACTOR EXPIRES IF WORK IS. NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- AN CE OR 180 DAYS FROM ,LASTCALLEDINSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND'CITY OF UFER PREGUNITE - PEHNIIT VALIDATION CUPERTINO STANDARDS. M;�- �•! - ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Fbv1a�D$St16U AND�itTz to C -s =7-- Qe.i'!ii UNDERGROUND/SLAB -C\• PLUMBING - ve. Gaoul✓l 7e 11-PS=sy � . ELECTRICAL " - MFCHANICAI - BLDG I ELECT M PLG. MECH I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNET WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL "FRAMING INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNEI ROOF DIAPHRAGM - ROOF SHEATHING (.t APPLY NO ROOFING'UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING gf. TUBS &'SHOWER PAN' MECHANICAL alz 4 ok-� e4�e r SAN.H BUILDING PERMIT INFORMATION ,LIIATION $TFT. .D 00 PE HMMIIT TO UCC GHOL SO FT FLOOR ALL BE MADE BEFORE ;IS PAID Rl IurS IND DATE INSP. ❑ ASSES E =JH A -CT NO i P '"IDR ELECTRICAL - "I BUILDING ENERGY t FRAMING I ELECT. FINAL TEST INSULATION PLUMBING'. - �n GAS TEST IGAS I- �.•. MECHANICAL ',COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - INTERIOR SHEAR SHEETROCK EXTERIOR LATH INTERIOR LATH • IF I'E DEPT. GRADE BUILDING • _ ..TEMPORARY I_1 NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY OCCUPANCYOF BUILDING IS NOTPERMITTEO UNTIL BUILDING FINALISSIGNEO BY BUILDING I LU ARRANGE FOR INSPECTION BY PHONING 252-4505, F- ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT!.SI PLEASE: REAP REVERSE SE SIDE BEFORE CALLING FOR FINAL INSPECTION. . v. • we wr � FIRE SPRINK p N❑ ENERGY T 24 Y ❑ N❑ FLOOD LONE .Y❑ NE] A�. I. U C. Y I—I N❑ FEESUMMARY BUILDING PLAN CHECK' - FEE �.•. SEISMIC FEE MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX TOTAL ,✓� I �✓ O Z_ z LD LU — W > D. o 7 z Uo LL U Ow } N F" z db APPLICANT TO FILL IN INFORMATION WITHIN RED LINES _ USE BALL POINT PEN ONLY �" jIY LDI NG PROJECT I DEN FICATION APPLICATION&PERMIT •. BUILDING — ELECTRICAL— PLUMBING — MECHANICAL QTY. ELECTRIC PERMIT FEE .PERMIT NUMBER - - q 7� ^ rj I f 42 PLAN CHECK VALIDATION / r 0. PJ ' - ; HULONG ADDRESS was -5 . SIEu ING D OWNER'S NAME. .\ �r : E RL V N. yIFONE `196 3'122 corvrRAcroRs ,• NAME K 6�a P.OU.iN 5 (LIC. ND 3S 2(7Y� _ OUTLETS -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1,00 ' CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00 ADDRESS ^j 'J `L1?Zl 6kka VC PHONEgg637t2 ARCHITECT OR ENGINEER ' I - uc.ND. DATEOF KAPPLICATION PLAN CHECK FEE ecJNo. PANELS 0,00 PANELS (OVER 200 AMPI 20.00' SIGNS TRANS. 3.00 ARCH OR ENG. ADDRESS - zIF_ SPECIAL'CIRCUIT 5,00 PERMIT VALIDATION `CJI - a/1 1 1, , EMP. METER OR POLE INS. , 20.00 APPLICANTS - ADOREsS ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that Iam licensed under provisions o'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. PLG, MECH. Professions Code;' 1 my license Ls ht full (oryy3sOd dli9.'P License s Lia Nuirdat, ff(j'F-Ltl' `der Dated .$- Contractor ' ❑ ❑ ❑ - BUILDING PERMIT OWNER-BUILDPR DECLARA rION I herebyof Erm that I am exem t Froin the Contractor's License ' P Law for the following arson. f5ec. 7031.5, Business and Professions Code: Any city or coumy which requires a permit to construct, alter, improve, demolish, o repair any structure, prior to its issuance, also - INFORMATION MISC. — REFER TO ORD VALUATION 'S/FT. 100 'PERMIT ISSUANCE 10.00 ELEC. CONTE. LIC, NO. ELEC. requires the applicant for such permit to filen signed sbdnnenl that lie is licensed pursuant to the provisions of the Contractor's License Law (Chafer 9 (commencing with Section 7000) of Division 3 of tl e Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant toa civil penalty of not more than five hundred dollars (S5001.). - TOTAL PERMIT TO -- --C, / DTV. PLUMBING PERMIT FEE STORIES TYPE CONSTR. gLTER-DRAIN-WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES, UNITS ❑ 1, as owner of the property, or my employees with wages as their sole compensation,- will do the work, and the structure isnot intended or offered for sale (Sec. 7044, Business and Professions DRAINS -FLOOR, ROOF, AREA, 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 himself or through his own employees, provided that such improve- menta are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden o1' proving [hal be did not huild or imp prove for purpose of sale.)." O I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Ciro, INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 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 - OVER 5 (EA.) 1.00 contracts forsuch projects with u contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ftI10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ lam exempt under Sec.., B.&P.C. for this reason Owner Dade WATER SYSTEM 5.00 ACG DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I herchy affirm that I have a certificate of consent to self -insure, or o certificate of Workers' Compensation Insurance, or a certified ...+ ZONING ENG. SITE NO. My copy tbmLof(Sec. 3800. Lab.0 Policy No. Company FIRE SPRINK V [] NE] FLOOD ZONE ENERGY T-24 V ❑ N❑ A. L. U.C. ❑ Certified copy is hereby furnished. ❑ Certify 1, c�pyyy s gI wit t e e' h Iv¢mn. licam.(.£1(N�0-W 6 1�HTAY W }}}rrrgyy QIjb-1 6�1 —0 CIiRTIF CA'r1;OPE EMP'I'ION PROM WORKERS' MISC. - REFER T D. PERMIT ISSUANCE 1 Pe PLG. CONTR. LIQ NO. PLC. TOTAL COMPENSATION INSURANCE - (This Section need not be completed if the permit is for one V� N� V� NC] MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per -QTY. mit is issued I shall not employ any person in any manner so as to become subject to the Workers'Compereation laws of California' Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of fix- emption, you should become subject to the Workers' Conlpensmion provisions of the. Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY BUILDING (�^ ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK FEE - AIR HANDLING UNIT (TO 1000 C.F.M.) 4.00 AIR HANDLING UNIT(OVER 10,000C.F.M.) 6,00 SEISMIC FEE T^ .JO EXHAUST HOOD (WITH DUCT) 5.00 HEATING UNIT (TO 100,000 B.T.U.) 8.00 MICROFILM I hereby affirm that there is a construction'lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. HEATING UNIT (OVER 100,000 B.T.U.) 9,50 ELECTRIC Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING I certify that I have read this application and state (hut the above information is correct. I agree to comply with all city and county ordinances and stat, laws relating to building construction, and BOILER -cUMP I3 H.P. or 100,0008.T.U.) 6,00 BOILER -COMP (Over 100,000BTUISEE FEESCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to Nov., indemnify and keep harmless the City of upertino against liabilities, judgments, costs and expenses which ma in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECHCONT. LIC. NO, MECH. TOTAL TOTAL 1`Z�� / Thting us cant ` ))) � L /7 Signature of Applicant/Contractor Date OFFICE COPY