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11646 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTI EON PERMIT NUMBER BUILDING 0 - APPLICATION & MIT AOREss�a,.-3 [ t. an BUILDING -ELECTRICAL-PLUMBING-MEMECHANICAL 11646 OWNERS PLAN CHECK VALIDATION NAME CAIC fl r SWCM!50) 1 ��,5, QTY. ELECTRIC PERMIT FEE /q� -1_ �'J h N PHONE ZLJ / %� NAME CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 Vl� NAME�+�.. f/�� �,l T-7✓�InA>�'. POOLSUC.NO. 1_203 Z LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS til.0 &L-to•CA' PPLIANCES-RESIDENTIAL 4.00 +r7 S lOP410 „ONE73g'1576 1PANELS 10.00 DATE OFAWL'IaA ON ARCHITECT 0 ,F T' r,\I E&Q `, A( PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEES = .NO. OR AtSb S 1 •�.r KJW�.Vratvv+INyv ENGINEER (ogZS SIGNS TRANS. 3.00 rfrT 1) i MLLIC.NO. ARCH.OR ENG. PER41T VALIDATION _ ADDRESS SPECIALCIRCUIT 5.00 ZIP EMP.METER OR POLE INS. 20.00 J O,©9 �periin(1 ADDRESS ZIP SIN 1 O MOTORS SEE FEE SCH, gc7)T/'�sss 7 I A-w A 30SERVICE CHANGE 7 _T 20.00 IC t D O o LICENSED CON"fRACI'ORS DECLARATION ON U,u I hereby affirm (list I am licensed under provisions of Chapter 9 L_!_3L7 OST-, u' (,t(V 0 ISSUAN E DATE vHi¢vAwi (commencing with Section 7000)of Division 3 of the Business and "U r ,^^ BLDG. ELECT. PLG. MECH. F z Professions Code nd51� ease is in full for n of c 0 z - License Class Lic.Number 'L.. F (x t• l{• 7 4 v, H w Date_g...,.. Contractorld_j-,^j_LLi��....- Q` V�p a sa 2 Fou" Ca\t� BUILDING PERMIT W Is: w OWNER-BUILDERDECLARATION INFORMATION E: ;u r I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD ILD¢ Law forthe l'ollowingreuson.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 J '� VALUATION $/FT. F W 0 J Code:Any city or county which requires a permit to construct.alter, Qaa¢ 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �- v O¢ requires the applicant for such permit to file a signed statement that TOTAL 53 PERMIT TO /� n w m he is licensed pursuant to the provisions of the Contractor's License L'a'C, ' i La. 9(comnhencingwlth Section 7000)of Dlvision3 ofthe a Scue^� v�/G do Business and Professions Code)or tlmt he is exempt therefrom and DTV. PLUMBING PERMIT FEE' h o the basis for the alleged exemption.Any violation of SectioR7031.5 STORIES TYPE CONSTR. La n; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($500)J: (Tx/•�/7�r ❑ L as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 Dec.GROUP RES.UNITS sole compensation,will do the work,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or owner, RES IND CON PB DOW prove for purpose of sale.). INDUSTRIAL WAS JINTER. 30.00 ❑ 1,as owner of the property,um exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS_1 INC_ 6,V.B. 6.00 ASSESSORS PARCEL NO, and Professions Code:The Contractor's License Law does not apply " to an owner of property who builds or improves thereon,and who LAWN SPRINKLER$}-OV S1EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to - theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA,x2001t/10.00 TRACT NO. PARCEL NO. reason am exempt under Sec. ,11.&P.G.for this WATER HEATER W/V BNRf21"" 6.00 Owner Date WATER SYSTEMIC V• 5.00 ACC.OATE ACC.FILE NO, WORKF.RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to scl Nisure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or u certified Copy thereof(Sec.3800•Lab.CJ.!` sn y- Policy No. Company rr ra-, ti Q ❑ Certified Copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z X Cerfill• opy is fit• with the city inspeC'on division. O Applicant V misc.- REFER TO ORD. Y N Y NEI ~ m PERMIT ISSUANCE 10.00 O FLOOD ZONE A.L.U.C. LU CER 'I KATE E EXEMPTION FROM WORKERS' W � COMPCNSATION INSURANCE Plc.coNTR. _ LIC.NO. pLG, 44-- t1 0 (This section need not be completed if the Permit is for one TOTAL Y❑ IN Y❑ N❑ D Z hundred dollars(S 100)or li3O U O 1 certify that in the performance of the work for which this per- OTV MECHAN1_AJ_PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as toy.r U become subject to the Workers Compensation Laws.of California. ID Date Applicant ALTER OR ADD T('I ME 5.00 BUILDING a���, } N NOTICE TO APPLICANT: If,after making this Cerlificuln,of Ex- Z emption,you should become subject in the Workers'Compensation APPLIANCE\r., 5.00 PLAN CHECK provisions of the Labor Code, YOU must forthwith comply with ,,,sv FEE V Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TQd10iJi LF.M., 4.00 CONSTRUCT ION LENDING AGENCY AIRHANDLINO-UNI IDV IC11OPOC.EM.16.00 SEISMIC FEE 3 1 1 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 HEATING UN IT(OVER 100,000 B.T.U.)9.50 3 Oil Lender's Address ELECTRIC I certify that I have read this application and state that the shove VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and sate lows relating to building construction, and 130ILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 g / hereby authorize representatives of ec this city enter upon the inspection above-mentioned property forBOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL pZ f'7/v hies purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- jQ d REFER TO ORD./J- Cupertino against liabilities,judgments, costs andexpenseswhich PERMIT ISSUANCE 10.00 CONST.TAX - may in any way accrue against said City in consequence of the d g Ming of this permit S .�I V MECH.CONT. LIC.NO. MECH. x;,, h LA, TOTAL dxI va TOTALov u ature of Applcant/Contractor - Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING Cl* OF CUPERTINO PERMIT NUMBER INSPECTION DIVISION 11646 JOB INSPECTION RECORD, PERMIT EXPIRATION / JOB ADDRESS _LOT#' PERMIT EXPIRES IF WORK OWNER 17 CONTRACTOR IS NOT STARTED WITHIN _ 13SPECTION DATE I INSPECTOR ITNtPECTION RECORD180 DAYS OF PERMIT ISSU- FOUNDATI N /Q-��/- fJ�Pd4[,ti/TL I ANCE OR 180 DAYS FROM UFER LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION f POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �`�' UNDERGROUND /SLAB - t'- t'• PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL - - BLIM EEC . P Ec 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING ERMI INFORMATION WOOD FLOOR ,VALUATION $JET. PLUMBING . - - - - - MECHANICAL PERMIT TO ELECTRICAL I. FRAMING ! v STORIES TV CONSTR. INSULATION „ OCC.GROUP 'RES.UNITS ),PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT,FLOOR AREA TOTALACUEAGE DIAPHRAGM HUILDING•USE RESINO CON PH Omer E3 El Cl ED 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH gq/p/w f{olrr r'oA PLUMBING oL dT &j0 TRACT GAS TEST NO. PARCEL NO. ,�"I MECHANICAL k"t ACC DATE ALC.FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN.# ZONING ENG.SITE NO. INSULATION PLUMBING ' GAS MECHANICAL FIRESPRINK ENERGY T-24 v ❑ N[] Y COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING N❑ FLOOD ZONE A.L.u.c. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. YO NE] Y ❑ NEI SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPR VALS . BUILDING f' FIREWALLS ". ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE } 4 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM i I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC - ® I o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL " CALLING FOR.FINAL INSPECTION. OFFICE COPY ,