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14704 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE,BALL POINT PEN ONLY BUILDING PROJECT 1 DENTI FICATI ON ' PERMIT NUMBER marDING ' APPLICATION & PERMIT '76 ADDAESs - BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 14704 26300 S TtaVr�� C` OWNER'S . / PLAN CHECK VALIDATION NAME �i MA�A6GMe.�� /cf QTY.. ELECTRICPERMIT FEE - Q R PHONE oNTR ACTans (9 OUTLETS 10.00/1.00 /MaE /J uc.No3yr72) Z. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESS APPLIANCES-RESIDENTIAL 4,00 20coo S eve-- Gee/(PHONE L.SS06ZD' PANELS - +,' 10.00 DATE OF APPLICATION . ARCHITECTPANELS (OVER 200 AMP) 20.00 -PLAN CHECK FEE P.C.No. OR . ENGINEEPG _ C-x7Uft uc.No. =SIGNS 3.00 I ARC H.OR ENG. PERMIT VALIDATION ADDRESS - r SPECIAL CIRCUIT 5.00 Z07 po 'S Gv6-J cree_,r=lZIP TEMP.METER OR POLE INS. 20.00 APPU CANTS MOTORS SEE FEE SCH: - - ADDREss L/ - ��-u � SERVICE CHANGE 20.00 > y," �•'I 0 0 o LICENSED CONTRACTORS DECLARATION/0 < v w 1'hereby affirm that I dm licensed under provisions of Chaplet 9 u ISS(((UANCE TATE " - H¢ N (commencing with Section 7000)of Division 3 of the Business and BLDG JE LECT. PLG. MECH. r z Professions Codeode, nnsc is in full ennf��r 1� i O m Liwnse Class Lie.Number - 4 � - G Date_'L12eJ- Comruclor t � .1^•^• rt lanix a y s,� C� BUILDING PERMIT ¢ ¢ w < OWNER-BUILDER DECLARATION - o W U - REFER TO ORD INFORMATION wS LL R 1 hereby affirm that I am exempt frons the Contractor's License MISE.- Ixoa Law for the following ,a (Sri.7031.5,Businessand Professions pERMIT.ISSUANCE 10.00 0.�< ,.VALUATION $/FL � - Code:Any city or county which requiona permit to construct,alter, OV-0 rt ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. �© "' "� - I K 0,S, - requires the applicant for suets permit to file a signed statement that TOTAL PERMIT TO. w m he is licensed pursuant to the provisions of tire Contractor's License - H z Law(Chapter 9( mmencing with Section 7000)of Division 3 ofthe a co i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a ;!2 by any applicantIcr u permit subjects the applicant ion civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ofnot more than five hundred dollars($500).): r _ ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure'is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 - - Code:The Contractor's License Law does not apply to an owner of -' property who builds or improves thereon',and who does such work FIXTURES-PER TRAP. 5.00 SO.FT.FLOOR AREA TOTALACREAGE himselforthrough his own employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTL ETS 6.00 ` meats etc no intended or offered for sale.If,however,the building - or.improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or int- REB IND - ION PR Omer Prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 - ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.8. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply, - to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts I'or such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Low. •TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 - reason Owner - Date WATER SYSTEM 5.00 ACC.DATE- ACC,FILE NO, WORKERS'COMPFNSATION DECLARATION WATERTREATING EQUIP, 5.00 -I hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy dtereof �a 3 Lab.CJ. s Policy NoNNCC npany Q/yb� � JNiNJL - 0 ❑ Certified copy is hereby fumished. FIRE$PRINK ENERGY T-24 Z ❑ Certifl Sys firmediiih-_�Im c�tspectiov division. - MISC.- REFER TO ORD. Y ❑ N❑ v ❑ N❑ hcant CCw - - PERMIT ISSUANCE 10.00 Q;- FLODD zoNE A.L.U.C. OC CERTIFICATE E EXEMPTION FROM WORKERS' W �_ COMPIiNSATION'INSURANCE PLG.CONTE. - LIC.NO. _ PLG. ee _ n' !'this section need not he vcomple[eJ if sire'permit is for one - TOTAL �V' Y❑ NE] Y ❑ N❑ D 2 hundred dollars(8100)or I.S.) V O I certify that in the performance of lire work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL P: mil is issued,I shall not employ any person In any manner so as to 0 becomesubject to the Workers'Compensation Laws of California, - W Date APPICant ALTER OR ADD TO MECH. 5.00 - BUILDING m } m NOTICE TO APPLICAN L: If,after making this Certificate of , ,F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 ' PLAN CHECK . provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LFNDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE A� I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 3097,the CN ). e of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM - Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 .ELECTRIC ' Lenders Address dl I certify that I have read this application andstale)hut the above VENTILATION FAN (SINGLE) .4.00 information it correct. 1 agree to comply with all city and County -i -PLUMBING ordinances and stale laws relating to building construction, and BOILER-CQMPI3H.P.oi,100,000B.T.U.) 6.00 hereby entioed representativesofthis purl lwenter upon sire BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL �s' .- above-mentioned properly.for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperti_no against liabilities,judgments, costs and expenses which PERMIT ISSUANCE - 10.00 (J - 'CONST..TAX ay i any way accrue,against said City in consequence of the rr t' of this pe tit. If MECH.CONT. LIC.NO. MECH. 7 TOTAL .,/S � TOTAL l&� tgnature of Applicant/Contractor Dales G OFFICE'COPY POST THIS.CARD NEAR FRONT OF BUILDING ' � ♦ PERMIT NUMBER CITY OF CUPERTINO 14704 INSPECTION DIVISION JOB INSPECTION RECORD" PERMIT EXPIRATION JOB ADDRESSp4030 O' s ..a �('�L3'�` '✓�� UNIT# - _'LOTW' PERMIT EXPIRES IF WORK OWNER Q -` p� CONTRACTOR L 'p IS NOT STARTEDgWITHIN INSPECTION DATE INSPECTOR SPECTION RECORD 190 Dgvs of PERMIT lssu FOUNDATION . - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL'BE-INSTALCED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLRMIT VALIDATION CUPERTINO STANDARDS. GARAGE SCABS POUR NO CONCRETEUNTIL ABOVE HAS BEEN SIGNED 3-f2 .a- - 6-/16 4 2 o UNDERGROUND /SLAB -j.�'',S''�"CG•G. �{��� . °. `:,C ' ';�'`•.'°�. PLUMBING. ELECTRICAL 1ys - A ` ISSUANCE OnrE MECHANICAL - p_Z�- W/(,L �,p. �qG �.� LOG ELEcr PL., ♦ MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ,� tt G� BUILDING PERMIT WOOD FLOOR - INFORMATION ., QtAIIUATION PLUMBING MECHANICAL JCI�N,G7 T z0 0-t70 ' ELECTRICAL PERMIr TO FRAMING- /'V7 INSULATION STORIES TYPE CONSTR OCC.GROUP RES UNITS '`'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 51) IT I'UIIIII AIIIA TOTAL ACREAGL , ROOF ' ' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE O ROOF SHEATHING Res INcONory Pe OP­ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ROUGH SAN.a ASSESSORS PARCEL NO PLUMBING 0"_*�. ELECT.ENERGY rRncT No. PARCEL NO TUBSBSHOWER AN PLUMBING ENERGY .MECHANICAL �.� - MECH.ENERGY ELECTRICAL. ACC DATE ACC,FILE NO BUILDING ENERGY FRAMING ELECT.FINAL TEST INSULATION- PLUMBING ZONING ENGSITE NO. GAS TEST q GAS ' - FIRE SPRINK ENERGY T:24 ' MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ • "❑ Y p NO EXTERIOR SHEAR - - ELECTRICAL RELEASE .�.!/. ELDOD/0 NE A.L u.c. INTERIOR SHEAR - FIRE DEPT. Y ❑ N❑ 'v ❑ N❑ SHEETROCK -28X GRADE - FEESUMMARY EXTERIOR'LATH BUILDING( g INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF.BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED,BV BUILDING INSPECTOR. MICROFILM •. ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC UL! - ONE WORKING DAY BEFORE REQUIRED INSPECTION. -PLUMBING — Z PLEASE GIVE.JOB ADDRESS WHEN PHONING. _ — SEE'PERMIT FOR EXPIRATION DATE — MECHANICAL j. IMPORTANT!. CONST.Tqz, PLEASE READ REVERSE SIDE-BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY