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C 8386! t APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY P� BU I LDING PROJECT I DENTIFICATI ON PERMITNUMBER BWLOING APPLICATION & PERMIT 8386 aAooR,-ss BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER cA/aCL�� NAME `, / It r1I .t I 1r . ;t ­PLAN CHECK VALIDATION ELEQTYCTRIC PERMIT FEE� CC. (d( - PHONE WA a . ,/ , ✓ / fhHACTOHS NAMEOUTLETS-SWITCHES•RECEP 10.00/1.00 'Z' P`(ZOM'\ uc.NO LIGHTING FIXTURES 10.00/1.00 noonEs TORS 3d,0 'gYl�p PPLIANCES-RESIDENTIAL 4.00 PHoNE {T _ PANELS 10.00 GATE OF APPLICATION AOPRCMITECT PANELS (OVER 200 AMP) 20.00 PLANCHECKFEE .C.NO. ENGINEER uc.No. (] SIGNS TRANS. 3.00 AO0RE55 ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION as�hll�� La ZIP TEMP.METER OR POLE INS. 20.00 / APPLICANT'S AOOREss MOTORS SEE FEE SCH. 0 0:i P A - SERVICE CHANGE 20.00 Foo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 1 9 <u I hereby affirm that 1 am thenud under provisions of Chapter 9 MAY ISSUANCE DATE G<i (commencing with Section 7000)of Division 3 of the Business and _ BLDG. Lp �. MECH. H Professions Code J my license is in full force ar I v�gcl. 1G o i_o 'License Clan , Lic.Number _�,�_�_1� w H w a Y Ws a Date_ Cmao,co,"OW-ZIGLDER �' CPyjo DECLARATION BUILDINQ PERMIT;;;:,Iq.; 'xu 3' su- 1 hereby all'inn that I ata exempt from the Contract.,',License MISC.- REFER TO ORD 'v'DaK4a+"INFORMATION"II ?t�l„";3'yj w o Law for the following reason.(Sec.7031.5,Busines,,nd Professions VALUATION S/FT. t -m PERMIT ISSUANCE 10.00 3 w� I Code:Any city or county whichreyuiresa permiuoconstrucl,ulleq w rt a o improve,demolish,or rvfai...y,ime[are,prior m its iswanee,also ELEC.CONTR. LIC.NO. ELEC. /Q D, DO O A E O a requires the applicant or such felony to file a signed statement that TOTAL PERMIT TO Km 9 m he is licensed pursuant 10 the provisions of the Contractor's License 31 Q Law(Chapterand 9fcommenC Code) Section 7s exempt Dinsmn3of the t ; -'. FEE r-N'j �M/�'�.O VE�y 4 o Business and Professions Code)ur thus he is exempt thenfium ofd QTY. PLUMBING PERMIT n ler 0 the basis for the alleged clsemption.Any violation of Section 7031.5 t STORIES TYPE CONSTR. i3 by any applicant for a permit subjects the applicant a civil penalty gLTER-DRAIN -WATEfl of not more thal i n ,c hwWred dollars($500l): (EA.) 5.00 ❑ 1,as owner of o,e properly,nr my employees with wages as 14 BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS their sole compensation,will(S the work,and the structure Prole is mol intended or offered for ole (Sec. 7044, Business and Professions DRAINS-FLOOfl,ROOF,AREA,COND. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds Or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 60.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees.provided That such improve- -� memsarenot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 • °r improvement is sold within one year of completion, file owner- GAS-EA.SYSTEM•OVER 4 (EA.) 2.00 builder will Imv< Iha burden of proving Ihw he AiJ nal build or inr BUILDING USE prove for purpose.fsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON Pa Omer ❑ 1,as owner of the pro Perry,all,exclusively contracting with ❑ ❑ ❑ C3 11licensed contractors w construct the project(Sec. 7044,liminess LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSOR S PARCEL NO, and Professions Code:The Contmcmr's License Law does nm apply to an owner of property who builds or improves(hereon,and who LAWN SPRINKLERS•OVER 5(EA.) 1.00 ccontracts far such projects with a"'o""c ons)licensed pursuunf t. low Cosn,aators License Law. SEWER-SANITARY-STORM EA.200tt/10.00 TRACT NO. PARCEL NO. rean ❑ I am exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT 6.00 so Owner Uute WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 _ I hereby affirm that I have a certilicale of consent to self-insure• or a certificate of Worked Compensation Insurance,or a"Hified ZONING ENG.SITE NO. copy tlwrcof(See.3800,Lab C.). p Policy No. CmnpanAAL_P_.f.dQ_�QQ�p_�Ca 0 Certified cup)is hcreEy furnished. FIRE SPRINK ENERGYTN _Z 2 Certified is fllea�$viB�l city impeclion division. MISC.- REFER TO ORD. A PhCant_ ,- Y ❑ N❑ Y ❑ N❑ ~ rA •gyp\-.� PERMIT ISSUANCE 10.00 LU - CERTIFICATE FR hl WOO RKgg$' FLOOD ZONE A.L.U.C. W � COMPIiNSA'fION INSURANCE PLG.CONTR. LIC.NO. PLG. d O (This section need not be completed if the permit is for one I TOTAL Y❑ N❑ Y❑ N❑ Z hundred dollars($100)or less.) LL O I certify that in the pvrlonuance of the work for which this per- OTV.- MECHANICAL PERMIT t .'t/' FEE'; Iv 1"FEE SUMMARY; LL U mil is issued,I shall not enl Ploy anY Perron in any manner s°as to s•," C) ur become subject to the Workers'Compensation Laws of Califuntia. '•' " BUILDING J D+a 0. Date Applicant ALTER OR ADD TO MECH. 5.00 L7 >_ Z NOTICE TO APPLICANT If,after making this Certificate o1'Ex- _ emption,you should became subject to the Workers'Cotuprnszliull APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with L.1 FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=1C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE GC I hereby affirm that [here is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of[he work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). , HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address I ' A HEATING UNIT(OVER 100,000B.T.U.19.50 ELECTRIC I certify(hal l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county PLUMBING ordinances and ,tate laws relating to building c°nstrucfi.10 and BOILER-CDMP(3 H.P.or 100,000 B.T.U.) 6.00 N.Q. ereby authorize repreuntat Ives of This city to enter'upon the BOILER•COMP(Over 100,000 BTU(SEE FEE SCH. bove-mentioned property for inspection purposes. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs uad expenses which CONST.TAX may in any way accrue against said City in consequence of IN, PERMIT ISSUANCE 10.00 MECH.CONT. LIC.NO. MECH. granting o(this p nm> -^ TOTAL C �-�-$�f` TOTAL .., 600 Signa of Applican IConlmctor Utile OFFICE COPY .t0- POST THIS CARD NEAR FRONT OF BUILDING y' ERART NUMBER CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD /'j7 PERMIT EXPIRATION • JOB ADORES �fOD �/ Y�t44C UNIT# LOT# Pia PERMIT EXPIRES IF WORK OWNER CONTRACTOR It:, IS NOT STARTED WITHIN ! 'i"'­ .-:'INSPIECTION DAT INSPECTOR INSPECTION RECORD jou DAYSOFPERMIT ISSU- ANCE OR 180 DAYS FROM MELECTRICAL N ST CALLED INSPECTION. O S Y e PER MIT VALIDATION ONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ��7 • .. ISSUANCE DATE eL ELECT. PLO, MECHANICAL m cR. -DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION -- WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL PERMIT FRAMING INSULATION STORIES TYPE ONSTH. OCC.GROOP RES.UNITS ial NTIL ABOVE HAS BEEN SIGNED ROOF SO FT FLOOR AREA f0TAL ACREAGE BUILDING USE RES IND CON PB 011lal TIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRACT N0. PARCEL NO. MECHANICAL — p ELECTRICAL J`�yl-� FINALS DATE INSP. aCC.DATE- ACC.FILE NO. FRAMING S a/-P SAN u ZONING ENG.SITE NO. INSULATION PLUMBING GAS -�•) MECHANICAL FIRESPRINK ENERGY T2 COVE 0 WORK UNTIL ABOVE HAS BEEN S NEO HEATING v N[) v "� , . LATH-INTERIOR ELECTRICAL b.. FLOOD ZONE ALU.C.� LATH-EXTERIOR FIRE DEPT. 1 Y ❑ N❑ Y 0 N� SHEETROCK GRADE n FEE SUMMARY . SHEAR INTERIOR BUILDING - 7- e SHEAR EXTERIOR TEMPORARY RROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY I I SEISMIC FEE UCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC a� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION'DATE - MECHANICAL CONST.TAX IMPORTANTI PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING FH MIT NUMBER CITY OF CUPERTINO i; .. ''INSPECTION DIVISION .8386 JOB INSPECTION RECORD , � �PERI�IT EXPIRATION h� JOB ADDRESSUNIT, _LOT# ' " D PERMIT EXPIRES'IF.WORK OWNER •' CONTRACTOR pieD IS NOT STARTED WITHIN INSPECTION DAT INSPECTOR INSPECTION RECOR .180 DAYS OF PERMIT ISSu. FOUNDATION /J ANCE OR 180 DAYS FROM O s STCALLED INSPECTION LIFER .' PREGUNITE - ERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ' UNDERGROUND /SLAB PLUMBING ,./�•/ «..�_ ELECTRICAL - ISSUANCE DATE f• MECHANICAL BL ELECT PLG. ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION VALUATION' $/FT. PLUMBING ' MECHANICAL - - ELECTRICAL PERMIT FRAMING r7.. INSULATION . STORIES TYPE ONSTR. OCCGROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF' - SQ FT.Fl OOR AREA TOTAL ACREAGE 1 DIAPHRAGM BUILDING USE RES IND CON PB "Omin APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED E] ❑ ❑ ❑ Cl ROUGH - ASSESSORS PAHCEL NO. PLUMBING - - GAB TEST TRACT NO. PARCEL NO. MECHANICAL - - ELECTRICAL J yl-� FINALS DATE ACC.DATE ACC.FILE N0. INSP. - . • FRAMING SAN # ' INSULATION PLUMBING ZONING - ENG.SITE NO. ' � GAS ' Off I �} /� , MECHANICAL _� ^� t "FIRE SPRINK ENERGY T 24 COVEFMO WORK UNTIL ABOVE HAS BEEN S NED HEATING ❑ "❑ Y.❑ "� .LATH-INTERIOR ELECTRICAL' 6- J FLOOD ZONE A.L.UC.Y❑ . N❑ ❑ N❑ . LATH-EXTERIOR FIRE DEPT. 2 SHEETROCK GRADE - FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY RROVALS . BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC F ONE WORKING DAY BEFORE REQUIRED INSPECTION'. ..'PLUMBING" O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE -' MECHANICAL CONST.TAX• IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION: TOTAL OFFICE COPY• - h APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ee- ILDING PROJECT IDENTIFICATION PERMIT NUMBER BD,L ,NG APPLICATION & PERMIT �s DOPS ♦♦__ p� �� C� 1` BUILDING - ELECTRICAL-PLUMBING-MECHANICAL8386 OWNER -PLAN CHECK VALIDATION NAME - /tIr^ / /'' D/� QTY. ELECTRIC PERMIT FEE � �1 /JY(//� ec V I v (oc' -E�+N PHONE o CONTRACTORS NAME OUTLETS-SWITCHES-RECEP 10,00/1,00 Q, 1.- Q�FjOW\ LIC.No. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS A:RPPLIANCES-RESIDENTIAL 4.00 AODR 3a0 ,.YIp0 iCli. PHONE {T _O 'I PANELS 10.00 DATE OF APPLICATION ARRCHITECT PANELS (OVER 200 All 20,00 PLAN CHECK FEE P.C.NO. O ENGINEER LION. C rl kir SIGNS TRANS. 3.00 ABC",08 ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION pq l hl-1LLILa- E,R TEMP.METER OR POLE INS. 20.00 ^ AMOTORS SEE FEE SCH. ADDRESS OREss q SERVICE CHANGE 20.00 w 00 LICENSED CONTRACTORS DECLARATION TEMP.POLE 30,00 a u U I hereby affirm out I am licensed under provisions of Chapter 9 MAY ISSUANCE DATE H< e. (commencing with Section 7000)of Division 3 of the Business and BLDG. EL CTD. �'P MECH. H m Professions Code d my license ism full forte a��9{{{III e�ct. License Class_Lin.Number�'1Ly-V nom• 4 m r w Data _ ng ConUuctor M.a OWNIi BUILDCR DECLARATION r�V BUILDING PERMIT °' " - INFORMATION ww ; w I hereby affirm that I am exempt from the Contractor's License REFER TO ORD MISC.LL p J Law fertile following reason.(Sec.7031.5,Business and ProfessionspERM1T ISSUANCE 1000 VALUATION E/FT. . T Code:Anycily orcounty which requires a permit to construct,after, / X ¢ improve,mprove,demolish,or repair any structure.prior m its issuance,also ELEC.CONTR. LIC.NO. ELEC. /00 OO D o u requires the applicant for such permit to file a signed statement that TOTAL w 9 a- he is licensed pursuant to the provisions of the Contractor's License PERMIT TO H z r Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe � E i o Business and Professions Code)or that it,is exempt therefrom and GTY. PLUMBING PERMIT FEE r-4" /Mr0rfO VVW51'4f cr s- 0 the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant fore permit delta. $500).he licant ton civil penalty ALTER-DRAIN 5.00 of not more than five hundred dollars(my employees ❑ I,as owner of the property,or my employees with wages as BACK FLOW 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 Cade: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 50,FT,FLOOR AREA TOTAL ACREAGE himself re through his own employees, le,I provided,h.out such improve- Rents arenot intended or employees, that sthebudding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Other ❑ I,as owner of the properly,am exclusively contracting with . . El El El licensed contractors to construct the Project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. aB 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 forsuch projects with a contractors)licensed pursuant to SEWER-SAN V-STORM EA.2001tI10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy No. Companmi C I e p LOQ Q 9g= O Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z CertifieA m �is filed..��lvv�ith the city inspection division. F m A pbcant L� ,e MISC.- REFER TO ORD. YE] N Y ❑ No - CIiRTII§CATS OF 1. :MPT ON PR'NNMPR M WORKERS' PERMIT ISSUANCE 10.00 FLDDD ZONE A.L.U.C. W - COMPENSATION I NSURANCE PLG.CONTR. LIC.NO. PLG. CL 0 TThis Section need not be Completed if the permit is for one TOTAL Y N� Y N� � Z' hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per- QTY. .MECHANICAL PERMIT FEE FEE SUMMARY LL H not is issued,1 shall not employ any person in any manner so as to O L) become subject to the Workers'Com pensat fon Laws of California. Dae Applicant ALTER OR ADD TO MECH. 5.00 BUILDING A NOTICE TO APPLICANT: If,after making this Certificate of Ex- Z emption,you should become subject m the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the labor Code, you must finthwfth comply with FEE U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE JC I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 71 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). 1 HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Addre-p-Q' - HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 'ELECTRIC I c1nify That 1 have read thus application and stole that the above VENT I ENTI•� LATI ON FAN (SINGLE) 4.00 inlmounion is correct. I agree to comply with all city and county - PLUMBING ordinances and state laws relating to building construction, and BMP OILER-CO (3H.P.or IO0,000B.T.U.) 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 SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of misc.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the granting of this BrImiN MECH.CONT. LIC.N0. MECH. TOTAL TOTAL 4D SlgnalUlE of Apphcan/Contractor Date ,,Io OFFICE COPY