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15614 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —.USE BALL POINT PEN ONLY ♦BU I LOING PROJECT I DENTIFICATI ON PERMIT NUMBER ( REss d7 cz-,e, q APPLICATION & PERMIT ,�'_- BUILDING — ELECTRICAL—PLUMBING—MECHANICAL 15 42 0�� s Ir Nf cRic OWNER'S NAME OL/ VCT / —_ PLAN CHECK VALIDATION II�� QTY. ELECTRIC PERMIT FEE �`�� .11 CCT c PHONE VIS 57J44615 c/ CONTRACTOR3 AME OUTLETS-SWITCHES-RECEP 10.00/1.00 CA­P12O7Y1 _ Lm.NO.39s77S 2giCLIGHTING FIXTURES 10.00/1.00 Sa CONTRACTOR'S ADDRESS - PPLIANCES-RESIDENTIAL 4.00 - 2(o00 LAM pd O PHONE PANELS 10.00DATE' OF APP`I LICATION ` ARCHITECT PLAN CHECK FEE D.C.NO. OR PANELS (OVER 200 AMP) 20.00 - ,. ENGINEER /C LIC.NO, SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION Z0300 srev-uJ CRX ZIP TEMP.METER OR POLE INS. 20.00 - APPLICANT'S e ADDRESS / MOTORS SEE FEE SCH. -- J Jr n N SERVICE CHANGE 20.00 w a o LICENSED CONTRACTORS DECLARATION a u U I herehy aflinn that I am licensed under pnrvisions of Chapter'9 z w ISSUANCE DATE `H ¢ (commencing with Section 7000)of Division 3 of the Rosiness and O z m professons Code�ld my licene coin full fo)q Ypd te7. 'S LOEL®T. PLG. MECH. Lie Number License Cho nuor_ LPv_Dntc � Y�Co �^ a in in OWNER-BUILDER DIiCLA RA'T'ION BUILDING PERMIT - 3 o a" FORMATION I hereby ol'firm that I am exempt(rum the Contractor's License MISC.'— REFER TO ORD u•O¢ Law for the following reason.(Sec.7031.5,Bminess and Professions 16'B� ALUATION $/FT. - PERMIT ISSUANCE i Code:Any city or county which rcquiresa permit to construct,alter, caM¢ 0 Improve,demolish,or repair any structure,prior to Its Issuance,also ELEG,CONTR. LIC.NO. ELEC. 2W OOO ¢ requires the applicant for such permit to file u signed statement that TOTAL/ Q s3 e Le m m he is licensed parsuunt to the provisions of the Contractor's License PERMIT TO Fz) Law(Chapter 9(commencing with Section 7000)of Division 3 of the - E i c Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Rt�n00 L L M r the basis fill the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a3 � by any applicant fora permit subjectstim lila civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five he prop rty,dollar,(my em: ❑ 1,as owner at the properly,or my employees with re is as BACK F LOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will Jo rhe work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions owner DRAINS-FLOOR,ROOF,AREA,COND. 5.00 13 Z Code:The Contractor's License Law does not apply to an ownof , property who builds Or Improves thereon,unit who does such work FIXTURES-PER TRAP .6=a2 SO.FT.FLOOR AREA TOTAL ACREAGE himself ts re of rote his own employees',provided that such improve- or OF,re concur is old or within rone(or year ((,however,the the o nee- GAS-EA.SYSTEM-11NC.4OUTLETS 6.00. 23 q00 or improvt]have is sold within one year of completion,the owner- / builder will hove the burden of proving the lie did nor build or iin- GAS-EA.SYSTEM-OVER 4(EA) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omer ❑ 1,as owner of the property,am exclusively contracting with V.B. .00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec 7044, Rosiness LAWN SPRINKLERS-1 INC 5 6ASSESSORS PARCEL NO. and Professions Code:The Co,umclol's License Low does not apply, to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to - theContrector'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ lam exempt under Sea ,B.&TIC I'or Ibisreason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 - ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofemsent to self-unsure, or u certificate of Workers'Compensation Insurance,or u certified ZONING ENG,SITE NO. copy therc< ( ec.3 ab.C. Policy Nov" J�P�.YrI P... O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T24 Z Z ❑ CerfiflevcjI� filoil witI the cl inspection division. Applicant�—RR__ ffI/w-.tL MISC.- REFER TO ORD, v ❑ NY ❑ N❑ LU H CIiNTI FICf OF EXEMPTIONFROM WORKERS' PERMIT ISSUANCE RS' FLOOD ZONE A.L.U.C. W � COCOMPENSA'T'ION INSURANCE PLG.CONTE, LIC.NO, PLG. CL 0 1'1'his section need not be completed if the permit is for one ` TOTAL I Y❑ N❑ v ❑ N❑ Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT / FEE FEE SUMMARY Uy U mit is issued,I shall not employ any person in any mminer sons to become subject to the Workers'Compensation Laws ofCalifornia. T Do Daft Applicata 2� ALTER OR ADD TO MECH. 5.00 BUILDING J L+ } N NOTICE TO APPLICANT' If,after making this Certificate of fix F ? emprion,you should become subject to the Workers'Compensation APPLIANCE 6.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10P=WQFEEF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,000C.F.M.) 6.00 SEISMIC FEE, 30 ft° 'I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perfonndnce 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's Name Lender's Address - HEATING UNIT(OVER 100,000 B.T.U.)8.50 ELECTRIC I ecrlify that I have read thlsapplicotian and stale that the above / VENTILATION FAN (SINGLE) 4(60414,M information is correct.I agree to comply with all city and county PLUMBING / ordinances and state laws riddling to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authorize representatives of This city to en ler upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspectiun'purposes. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - Cupertino against liabilities,judgments, costs and expenses which ORD CONST.TAX may in 'ny way accrue against Said City in consequence of the PERMIT ISSUANCE ra li of this perm std MECH.CONT. LIC.NO. MECH. zate TOTAL G�� S� TOTAL A(10 5t ') signature of Appl¢a /Conlnmtor Date - OFFICE COPY e POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO -INSPECTION DIVISION. X5614 , JOB INSPECTION RECORD, iC q `PERMIT EXPIRATION JOB ADDRESS a0 3.c 0 —F27:- �/� (',�a��� jT# _LOT# PERMIT EXPIRES IF WORK OWNER 6Z/✓tT CONTRACTOR- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR SPECTION RECORD 180 DAYS OF PERMIT"ISSU; FOUNDATION -NOTE: I .ANCE OR 180 DAYS FROM UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVEDLPLANS AND CITY OF PERMIT VALIDATION GARAGE"SLABS CUPERTINO STANDARDS. . - - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ..�- UNDERGROUND'/SLAB � m PLUMBING g � '" ' Y...c�vyy�O. 15sunNce DATE ELECTRICAL. ..Jl •�,dcp� -tSLC ,. MECHANICAL rn:CCT meo�, 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - J'1L 2 ING PERMIT WOOD FLOOR - - INFORMATION PLUMBING �E Cupe` lMd'N iS` SIFT. MECHANICAL CI,7 I`1� � V. .�.flGtV ELECTRICAL PERm1T o FRAMING EG _ 0 �E'�..• � '*j INSULATION (STORIES TYPE CONSTR. V \ I UCC.GROUP RES'UNITS .,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED , AL ACIIEAGE ROOF NOTE:NO FINAL INSP.SHALL SQ FTFLOOR A111.A TOT BE MADE BEFORE - ' Is DIAPHRAGM, THE CONSTRUCTION TAXIS PAID 23 1 yCo RUI LOING USE ROOF SHEATHING 1rns IND CON Pa 41APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALSDATE- INSP. ❑ El El ❑ El ' ASSESSORS PARCEL NO ROUGH SANA PLUMBING - ELECT.ENERGY TRACI NO. PARCEL NO TUBS 8 SHOWER PAN. PLUMBING ENERGY ' MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC Dore Acc.PILE No FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION . PLUMBING GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N'❑ Y ❑ N❑ EXTERIOR SHEAR - � ELECTRICAL RELEASE ,yyi FLOOD ZONE A.LOC. INTERIOR SHEAR FIRE DEPT. ' Y ❑ N❑ Y ❑ N❑: SHEETROCK GRADE . FEE SUMMARY EXTERIOR LATH - BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT. ELECTRIC . . ,PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEDOCCUPANCY SEISMIC FEE _OCCUPANCYOF BUILDING IS NOT PERM.ITTED UNTIL BUIL.DING FiNAL.ISSIGNED BY BUILDING INSPECTOR. MICROFILM w •• ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F�. ONE WORKING•DAY BEFORE REQUIRED INSPECTION. PLUMBING O - PLEASE GIVE JOB ADDRESS WHEN PHONING.'. ,(-7� - z-o - 6 K�� — SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE TOTAL Q�l CALLING FOR FINAL INSPECTION. ` OFFICE COPY