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15403e O Z z F0 CC W - D_ 0 D z Uo LL U O w y H � A ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY : — BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT '- G BUILDING ELECTRICAL— PLUMBING —MECHANICAL PERMIT NUMBER q /I O� P. 15 4 BUILDING AooR ss '•/ I9NER'$ PLAN CHECK VALIOA�(I ON NAME % ^OTY• HONE p ELECTRIC PERMIT FEE y�p'1 CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ' LIC. No, _ CONTRACTOR AD ADDRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 10,00 PHONE DATE OF APPLICATION ogcHITECT - ENGINEER' LIC. No. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION - ZIP TEMP. METER OR POLE INS. 20.00 �•v ^�-' APPLICANTS ADDRESS MOTORS SEE FEE SCH.Q SERVICE CHANGE 20,00 tV ' LICENSED CONTRACTORS DECLARATION I hereby afli6n that 1 am licensed under provisions of Chapter 9 (emnmencing with Sectlmt 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lie. Number Date Contmclor ISSUANCE DATE LOG. ELECT. PLG. MECH. �t ❑ ^D rl BUILDING PERMIT FORMATION - A-/ ALUATION $/FT. / 0-" Q OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License haw for the following reason. (Sec. 7031.5, Husinessand Professions Code: Any city or county which requires a pto construct, alter, ermit improve, demolish, orrepWr any structure, prior to its issuance, also ret{uires file applicant for such permit to file a signed ,latement Ihal he is licensed pursuant to the provisions of lite Contractor's License r 1� •� MISC. — REFER TO ORD PERMIT ISSUANCE 10'00 ELEC. CONTR. LIC. ND. ELEG TOTAL �� -� PERMIT T OTY. PLUMBING PERMIT FEE Law (Chapter 9 (commencing with Section 700()of Division 3 ofthe Business and Professions Code) or that he is exempt therefrom and the basis for ttic alleged exemption. Any violation of Sect ion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.): STORIES TYPE CONSTR. ALTER -DRAIN -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (he work, and the OCCUR, 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 Snell improve- mmlts are not intended or.ifered forsale. If, however, the building 50. FT. FLOOR AREA TOTALACREAGE ,L , 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- GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE p, act.. purpose cut ,, e.). ,act.. as owner of the property, am exclusively contracting with RES IND CON PB Other ❑ F-1 El ❑ El INDUSTRIAL WASTE INTER. 30.00 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 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO., . LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projecn with II contractor(s) licensed pursuant un theContraclor'sLicenseLaw. ❑ IanI exempt under Sec. ,B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 - TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner I Dam WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 - WORKERS'COMP SATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a cerlifieA ZONING ENG. SITE N0. copy thereof (Sec. 3800, Lab.C.). Policy Nu.Company ❑ Certified copy is hereby furnished. ❑ Certified copy is fled with the city inspection division. Applicant MISC,- REFER TO ORD. FIRE SPRINK V N ❑ ❑ ENERGY TY4 V N C]❑ CER1'IFICA'1'I70FEMiMPT1ON FROM WORKERS' COMPENSATION INSURANC17 (This section need not be completed it the permit is for one PERMIT ISSUANCE 10.00Ni—I FLOOD ZONE V ❑ N❑ A.L.U.C. Y ❑ N❑ PLG. CONTR. LIC. NO. PLG. TOTAL hundmd dollars IS 100) or less.) I certify that in the performance of the work I'or which this per- Hill is issued, I shall not employ any person in any manner so as to DTV. MECHANICAL PERMIT FEE FEE SUMMARY . become subject to the Workers' Compensation Laws of California. Mite—Applicant BUILDING �� -�_ ALTER OR ADD TO MECH. 5.00 NOTIC17 TO APPLICANT': If, after making this Certificate of 17 APPLIANCE 5.00 - AIR HANDLING UNIT (TO 10=CF.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 this permit shall be deemed revoked. - AIR HANDLING UNIT (OVER 10=C.F.M,) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affitm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.), Lender's EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lenders Address ddr HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC a0 �- VENTILATION FAN (SINGLE) 4.00 I certify that 1 have read this application and state that the above Intonation is correct. I agree to comply withmll city and county ordinances and state laws relating to building construction, and PLUMBING 3 �^ BOILER- COMP (3 H.P. Or 100,000 B.T.U.I 6,00 Hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER -COMP (Over 100,000 BTU) SEE FEE SCM. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC. - REFER TO ORD. upertino against ran les, judgments, costs anA expenses which Y, in any way accrue against said City in consequence of the III f this permit, PERMIT ISSUANCE '10,00 CONST. TAX MECH. CONT. LIC. NO. MECH. [ran Stgn u Applicant/Con lr r Date TOTAL TOTAL OFFICE COPY J POST THIS CARD NEAR FRONT OF BUILDING CITY "OF CUPERTINO { INSPECTION DIVISION JOB INSPECTION -RECORD - 19654 Stevens Creek Blvd. JOB ADDRESS UNIT# _LOT# DwNER Sue Ta lOr • CONTRACTOR PCRMITNUMBER 15403 t PERMIT EXPIRATION" PERMIT.EXPIRES IF WORK IS NOT .STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR I80 DAYS FROM LASTCA C LLED INSPECTION. INSPECTION DATE INSPECTOR INSPECTION RECORD .FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. ' LEER PR EGUNITE PERIOD VALIDATION . "'.i ' GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING "`fie •.... '., C NS "S'LANCE DATE ELECTRICAL MECHANICAL - - CeT, I EI T, PLG. MECR, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING -2�. MECHANICAL ELECTRICAL PERMIT TO - FRAMING - INSULATION STHIF.S - TYPE CnNSTTi. - OCC GROUP RES UNITS OPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF. NOTE: NO FINAL INSP. SHALL BE MADE BEFORE. THE CONSTRUCTION TAX IS PAID 1 SO, IT 1_0 . OR AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING UPS colo ILoCON USE Om.' ❑ ❑ El "`APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SANA ASSESSORS PARCE L NO PLUMBING - ELECT..ENERGY 1/7;' op TUBS 8 SHOWER PAN PLUMBING ENERGY _ TRACT NO PARCEL NO MECHANICAL '. MECH.ENERGY ELECTRICAL 41-;7X BUILDING ENERGY ACC DATE ACC. FILE NO FRAMING -;x2.• - ELECT. FINAL TEST INSULATION PLUMBING ZONNNG ENG. SITE NO. GAS TEST_, - GAS MECHANICAL ` FIRE SPRINK Y [] NE] ENERGY T"20 Y 0 N � COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOD ZONE Y E N A L TO C. ❑ N❑ INTERIOR SHEARFIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING ',� �•' INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDINGIS NOTP-ERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM • ARRANGE FOR INSPECTION BY PHONING 252-4505, z � ONE WORKING DAY BEFORE REQUIRED.INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — ELECTRIC'= - PLUMBING — MECHANICAL CONST. TAX IMPORTANT! PLEASE READ' REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL r' / OFFICE COPY