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12344 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE LL POINT PEN ONLY .BUIltbrNG PROJECT IDENTIFI N PERMIT NUMBER BUILDING APPLICATION & P IT 12344 GORES$ ujrye�o�-e�g_pj G�v�pLyp BUILDING -ELECTRICAL-PLUMBING-MECHANICAL [ OWNER'$ PLAN CHECK VALIDATION NAME 0Lz V4077/ 7cL�-T MG;..y�r7rJ''C��+4i OTY. ELECTRIC PERMIT FEE /Ot eG GCC�cD PHONE"1'�-a ' CONTRACTORS MUTLETS-SWITCHES-RECEP 10.00/1.00 3 NAE CfcupP✓ti LIC.No.39s7 LIGHTING FIXTURES 10.00/1.00 ADDRESS APPLIANCES-APPLIANCES-RESIDENTIAL 4.00 COONTRACCTOR /per �p�� a✓o-co �/t�'�`-+�^rTflbpE�`�p PANELS 10.06 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.N0. OR q ENGINEER 1 xLY1'P.�fyad,!r," uc.rvaSIGNS TRANS. - 3.00 ADDRESS ENG, SPECIAL CIRCUIT 5.06 PERMIT VALIDATION 1775N C7.500 ZIP rEMP.METER OR POLE INS. 20.00 APPLICANT'S ADOR APPLICANT MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ow '09 LICENSED CONTRACTORS DECLARATION au b I hereby affirm that I out licensed under provisions of Chapter 9 ISSUANCE GATE Z"I (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. a Professions Code,and my license is in full fo a nd eft• t z 0 License Class Lic.Number S 7 �- E: ElC r Date Z-`t'>-� Contractor-( � y s BUILDING PERMIT � ¢ OWNER-BUILDER DECLARATION E ¢ w v INFORMATION 0o MISC.- REFER TO ORD w 3 u y 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. a. 0¢ Law forthO followingrcason.(Sec.7031.5,Business and l'fofessions PERMIT ISSUANCE 10.00 E N J Code:Anycily orcounty which requires a permit toconstruct,alter, eW 3 �L Sa¢ improve,demolish,or repair any Structure,prior to its issuance,also EIEC.CONTR. LIC.NO. ELEC. iL DLL requires the applicant for Such permit to lite a signed Statement that TOTAL T TO e w m he is licensed pursuant to the provisions of the Contractor's License PERMIT /4/T, MI fT Uzi Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE QC =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u ; _ by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars($500),1: ❑ 1,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,GOND. 5.00 Code:The Contractor's License Law does not apply to an owner of "T'' •t,ja property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 s0.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve °•� meats are not intended or offered for sale.If,however,the building . GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner. GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he.did not build or on. BUILDING USE �e•... RES IND CON PB O[M1er prove for purpose of sale.). C1 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 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 SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with s conto ctor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,BAPC.for this WATER HEATER W/VENT 6,00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. or a Certificate of Workers'Compensation Insurance,or a certified copy thereuf(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished FIRE SPRINK ENERGY T-24 Z Z ❑ CertiX apyy? Icd with the city inspection division. OyC Applicant `` !! MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ Fy - LU - CERTII'ICATE OIe EXEMPTION FROM WORKERS' PERMIT ISSUANCE10.00 FLOOD ZONE a.L.U.C. W � COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL a Z (This section need not be completed it the permit is for one TOTAL Y❑ . N❑ Y ❑ ❑ N hundred dollars IS 100)or IcssJ - U O_ I certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL H' mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. w Dstn Applicant BUILDING a ALTER OR ADD TO MECH. , 5.00 } ti NOTICE TO APPLICANT: If,after making this Certificate sa Ex Z emvisionyou should become subject to Ise Wrthwit Compensation APPLIANCE 5.00 PLAN CHECK provisions io the Labor Code, you must forthwith comply wiOl FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 4.00 CONSTRUCT ION LENDING AGENCY - AIR HANDLING UNIT(OVER IOAOOC.FM.) 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 HEATING UNIT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC 1certify that l haveread this application and slate that the above VENTILATION FAN (SINGLE) 4.00 information is correct I agree to comply with all city and County PLUMBING Ij ordinances and state laws relating to building construction, and BOILER-COMPI3H.P.or100,000B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILE above-mentioned property for inspection purposes. R-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL -r fl (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. J Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may i any w accrue against said City in consequence of the PERMIT ISSUANCE 10.00 gr gof hid p m2 MECH.CONT. LIC.NO. MECH. '\Xv_. TOTAL cr m�x.e 2-a.7-87 TOTAL 0911 Slgnatureof Applican l/Contractor Dutc OFFICE COPY POST THI ARD NEAR FRONT OF BUILDING • PERMIT NUMBER CI OF CUPERTINO X2344 INSPECTION DIVISION JOB INSPECTION RECORD ' 1 _ �D ^ •(/�. PERMIT EXPIRATION ,Y .k JOB ADDRESS .6 �� /✓AI` d1�17# LOT# _ A , PERMIT EXPIRES IF WORK OWNER O CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION _ ANCE OR 160 DAYS-FROM - LIFER ' LASTCALLEDINSPECTIOW PREGUNITE - PERMIT VALIDATION i POUR NO CONCRETEUNDERGROUND /SLAB BEEN SIGNED PLUMBING / ELECTRICAL ISSUANCE DATE MECHANICAL BL ELECT, PLG. MECH. 00'NOT FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. _ � -' _ - MECHANICAL ELECTRICAL - P RMfTTO FRAMING INSULATION OWES TYPE CON OCC.GROUP RES.UNITS I, K,PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO.FT FLOORAREA TOTALACREAGE 001 .1 DIAPHRAGM BUIL NG USE RES IND ON PB O'ne' T"APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ROUGH - ASSEsso HCR.I,NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL 2,-1 ACO.DATE ACC,FILE NO, ELECTRICAL FINALS DATE , INSP. FRAMING �.(, SAN * ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T@4 MECHANICAL Y ❑ N❑ Y ❑ .N❑ COVER NdWORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH-INTERIOR - - ELECTRICAL FLOOD ZONE -A.L.U.C. LATH-EXTERIOR FIRE DEPT. Y❑ No Yo No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS V BUILDING ^� FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE f OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC AIN �� 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 TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY . -