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15760i's 0- Zz O CC W _ (Lo =)z Uo LL U Ow } y ♦- z Z APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU I LPING PROJECT I DENTIFICATI ON -' - &PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL ,PERMITNUMBER - 5 r� C O J 1 U ADDREss � Sim trioAPPLICATION S OWNE(J RS qa/\ NAMED OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDAT I N \ (1yJe. K0090 HONE so� t CONTRACTORS rvAME OUTLETS - SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. NO - CONTRACTORS /OGRESS APPLIANCES - RESIDENTIAL 4.00 PANELS, - 10.00 PHONE DATE OF APPLICATION ARCHITECT OR /�.�� ENGINEER ,T ' /W6 LIE. NO. `' fV PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH.OR ENG. ADDRESS hu /�[S [y ' L !„ /'r /.S't .a �- S'M ZIP' q,72� SPECIAL CIRCUIT 5.00 PERMIT VALIDATION / �i(� ' EMP. METER OR POLE INS. 20.00 APPLI DDRESS rs . - ADDRESS ' MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 w �T+ - LICENSED CONTRACTORS DECLARATION I herebyaffirmthat I ion licensed under provisions of Chapter (commencing with Section 70001 of Division 3 of the Business and Pfofea,mars Cma, aml my license Is Ill fall once' and affect. License Class - Lic. Number ISSUANCE DATE BLDG. ELECT. PLG, MECH. � ❑. ❑ ❑ Dote Contractor ,.y City Of CU 6ffIBO OWNER -BUILDER DECLARATION I hereby affirm that 1 um exempt from the Contractor's License Law torthe followingreason.(Sec. 7031,5, Business and Professions Code: Anycity orcounty which requires a permit tocanstruct, alter, improve, demolish, Or repair any Structure, prior toils issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions Of the Contractor'sfffivision of trsc BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION L (! S/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL h&- of Division 3 of the 3 Law. (Chapter 9 Professions Business and Professions Codc) or that he is exempt Cod with Shauna is exempt ram and - OTY. PLUMBING PERMIT FEE �X4 �Q. ` actio the oasis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects Ilia applicant to a civil penalty of not more than five hundred dollars (5500).): STORIES ' TYPE CONSTR, gLTER-DRAIN-WATER (EA.) 5,00 ❑ 1, as owner of the property, or my 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 DRAINS -FLOOR, ROOF, AR EA,CON D. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: 'fire Contractor's License Law does not apply to an owner of ' FIXTURES - PER TRAP - 5.00 GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve. Hants are nor intended or offered for sole. IL however, the building, SO. FT, FLOOR AREA TOTAL ACREAGE or improvement is sold within one year of completion, the owner builder will have the burden of proving that he did Trot build or im-BUILDING GAS - EA. SYSTEM - OVER '4 IEA.1 2.00 USE prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with RES IND CON PB otne, 11 13 El ❑ 1:1licensed . INDUSTRIAL WASTE INTER30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 - LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contractors to constant the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who ASSESSORS PARCEL NO. contracts for such projects with a contraaoN sl licensed pursuant to the Contractor's License law. '❑ lam exempt lender Sec. ,li.&BC. for this on SEWER -SANITARY -STORM EA: 200ft/10.00 TRACT No. PARCEL NO. WATER HEATER WENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a CCITIfICtiN ofconsent to self -insure, - , ZONING ENG. SITE NO. or a certificate of Workers' Compensation Insurance, or a certilied ' copy Thereof(Sec. 3800, Lab.C.). Policy No. Company MISC- REFER TO ORD. " ❑ Cerlifiedcopyisherebyfumished. ❑ Certified copy is filed with the city inspection division. Applicant FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ CERTIFICATE OP 17XENIPTION FROM WORKERS' PERMIT ISSUANCE - 10.00 FLOODZONE A.LU.C. COMPENSATION INSURANCE (Phis section need not be completed if the permit is for one Y ❑ N ❑ V ❑ N ❑ PLG, CONTH. - LIC. NO. PLG. TOTAL lumdred dollars IS 100) or Ices.) I cerlity that in ilia performance of the work for which this per- alit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING e o O become subject to the Workers' Compensation Laws of California. Dula Applicant NOTICE TO APPLICANT: If, after making this Certificate or Ex- ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 AIR HANDLING UNIT (TO 10,000CF.M.) 4.00 PLAN CHECK FEE enrpllou, you should become subject to the Workers' Compensation provisions of The Labor Code, you must forthwith comply with Stich provisions Or this permit shall be deemed revoked AIR HANDLING UNIT(OVER O=C.FM.) 6.00 SEISMIC FEE !a 3 CONSTRUCT ION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 I hereby affirm Ilial there is a construction lending agency for file performance of the work for which this permit is issued (Sec.MICROFILM 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.)* 8.00 Lender Ndd Lender's Address H EATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC VENTILATION FAN'ISINGLE) 4.00 Icerlify that l haveread thisapplicatim, ,,it state lhanhe above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and PLUMBING BOILER - COMP (3H.P,Gr100,000B.LU.) 6.00 (erebyhove- authori<e roperty ladies of this city to enter upon the hbove-mentioned property I'or inspection purposes, I (We) agree to save, indemnify and keep harniless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the 'ranting of this permit BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 CONST. TAX MECH. CONT. L.D. NO. MECH:, ' TOTAL I ' TOTAL �r Signature of Applicant/Cmllractor Data OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO ~ INSPECTION DIVISION ' . / JOB INSPECTION RECORD �6 7 U - JOB ADDRESS 1 5 �Tc L11'" UNIT# _LOT.} ey@S� OWNER - f 0� JC.\\ 'e o TRACTOR 'e PERMIT NUMBER 15760 � PERMIT E%PIfiAT10N PERMIT EXPIRES IF WORK .IS NOT STARTED WITHIN 180 DAYS OF PERMIT IAU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTI N DATE I INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CIN OF CUPERTINO STANDARDS. UFER PR EGUNI TE PERmIF VALIDATION , -- ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL - BLDG .ELECT, Cti ❑ I PLG. MEC. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ' WOOD FLOOR PLUMBING VALUATION y (,VdO $TFT. MECHANICAL ELECTRICAL FERMI O t . I Q 1M�Q FRAMING INSULATION 6 1988 tity IID IES TYPE CONSTR. DCC. GROUP RES, UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SO, IT FLOOR ARFA .TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE HIS -IND CON PB _ om', ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.k ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY -23 SF Cf:C; TUBS 8 SHOWER PAN � PLUMBING ENERGY TRACT NO. PAHCELNO MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC, FILE NO , FRAMING ELECT. FINAL TEST - 3-8 ��- INSULATION PLUMBING ZONING ENG. SITE No. - GAS TEST GAS I MECHANICAL FIRE SPRINK Y ❑ NEIv ENERGY T.19 ' ❑ NE] NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE .J-� - � FLOOD ZONE - ❑ N❑ AL.0 C. , Y ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE ` FEE SUMMARY EXTERIOR LATH BUILDING- _Z-�_ BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC - PLAN CHECK FEE ,•r. ' GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv SEISMIC FEE , OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED 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 'IMPORTANT!' PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL r r"3 OFFICE COPY