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13117 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BDILDnNGAPPLICATION & PERMIT ' - ADDRESS '1 C1L2 be BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 13117 2C OWNER'5 PLAN CHECK VALIDATION NAME _,4V r r��-••''''pp ��J.y, CITY. ELECTRIC PERMIT FEE S I �- PHONEI L_rJR'•' CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 ADDRESS PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 26.00 PLAN CHECK FEE P.C.NO. OR ENGINEER ' LIC.No. lSIGNS TRANS. 3.00 ARC H.OR ENG. $PEEIAL EIREDIT 5.66 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS - MOTORS SEE FEE SEH. ADDRESS SERVICE CHANGE 20.00 Doo LICENSED CONTRACTORS DECLARATION I hereby affirm that I um licensed under provisions Of Chapter 9 ISSUANCE DATE n< e. (commencing with Section 7000)of Division 3 of the Business anti BLDG. ELECT. PLG. MECH. r 0 z Professions Code,and my license is in full force and effect, ❑ ❑ ❑ Z 0 or- License Class Lic.Number 0 D Contractor a x E BUILDING PERMIT 2 ¢ wOWNER-BUILDER DECLARATION INFORMATION woMISC.- REFER TO ORD 3 a u m 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. H a.0j Lawfor the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE - 10.00 Code:Any city or county which requires a permit toconstruct,alter, IC Q Q 0 Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. E O LL requires the applicant for such permit to file a Signed statement that TOTAL PERMITTO A w m he is licensed pursuant to the provisions of the Contractor's License p riQ Low(Chapter 9(commencing with Section 7000)of Division 3 ofthe LO I P D Business and Professions Code)or that he isexemp(therefrom and QTY. PLUMBING PERMIT FEE QZ the basis for the alleged exemption.Any violation of Section 7031.5 ST RIES TYPE CONSTR. a $� by any applicant for a permit subjects the applicant to a Civil penalty gLTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than live hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages us BACK FLOW PROTECT. DEVICE 4.0 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 5.60 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. menus are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 Or improvement is sold within one year of completion,the owner, GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE buiNer will have the burden of proving that he did not build or To RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑. ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The COntmetor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OV .) 1.00 contracts for such projects with a contractor(s)licensed pursuant to SEW ER-SANITARY-STORM EA.200ft11 .00 the Contractors License Law, TRACT N0. PARCEL N0. Cl I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/V a G .00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQak f up 0 I hereby affirm that I hove o Certificate of consent to self-insure, 7 ZONING ENG,SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ. Policy No. Company 0 ❑ Certified copy is hereby furnished FIRE SPAINK ENERGY T2 Z p Applicant tilieJ eopY is fled with Om city inspection division. MISC.- REFER TO ORD, yv N CC va PERMIT ISSUANCE 10.00 ❑ N❑ E] ❑ CC CERTIFICCOMATE PENSATION INSUR017 EXEMPTION ANCE LI PLG.COKER. LIC.NO. I.G.Pd FLOODzorvE A.L.u.c. Q. Q (This section need not be completed if the pennit is for one TOTAL ,-� V❑ N❑ Y❑ N❑ D 2 hundred dol hot 1$100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY Q- F mit is issued,1 shall not employ any person in any mannerso as to Q W become subject to the Workers'Compensation Laws of California. BUILDING CL Date Applicant ALTER OR ADD TO MECH. 5.00 } N NOTICE TO APPLICANT': HL after making this Certificate of Ex- Z 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 U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the 3097 performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name ELECTRIC I C HEATING UNIT(OVER 100,000 B.T.U.)9.50 ress Lender's Add I certify that I have read this application sod smte that the above VENTILATION FAN'(SINGLE) 4.00 r information is correct.1 agree to comply with all city end county PLUMBING ordinances and state laws relating to building construction, and BOILERMP -CO (3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to anter upon the BOI LER-COMP(Over,100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which' CONST.TAX ' To i any way accrue,against s ' Cy "m consequence of the PERMIT ISSUANCE 10.00 gre n of lhi5 unit MECH.CONT. LIC.NO. MECH. �lc - -F TOTAL TOTAL Si ora of Applicant/Co ru _Date OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF , CUPERTINO 1311 ? INSPECTION DIVISION JOB INSPECTION RECORD . PERMIT EXPIRATION JOB ADDRESS 20311 Stevens Creek Blvd. ' UNIT# Suite 3-AOT#.- ' - PERMIT EXPIRES IF WORK OWNER JoAnn Hill .CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 1BODAYS OFPERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. LIFER ' PREGUNITE PERMITV ALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB V PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL eLDc. ELECT. PIN. mECH. ❑ ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT. PLUMBING MECHANICAL .ELECTRICAL - - PPERIMMIIT TO FRAMING INSULATION - - STORIES TYPE CONSTR, OCC.GROUP .RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.IT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILD USE • REST MD CON PB Otlun APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 'Q- ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. ROLIGIII PLUMBING GAS TEST TRACT NO, P—CEL,ND. MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS , " DATE INSP. FRAMING SAN # ZONING ENG.SITE NO. INSULATION � � PLUMBING GAS - MECHANICAL FIRE SPR INK ENERGY T 24N NERGYTN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING NE] � LATH—INTERIOR' VELECTRICAL FLOOD ZONE A.L U.C. LATH—EXTERIOR Y❑ N❑ . Y NSHEETROCK FEESUMMARY SHEAR INTERIOR SHEAR EXTERIOR A PR VALSBUILDING FIREWALLS PLANCHECK FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE.FOR INSPECTION BY PHONING 252-4505, ELECTRIC oONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE WHEN .PHONING. °�� LEAE GIVE JB ADDRESS .PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY