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13086 .APPLICANT TO FILL IN IN LATION WITHIN RED LINES - USE BAS L POINT PEN ONLY . - BUILDING PROJECT I DENTI FICA ON PERMIT NUMBER SDI LEING APPLICATION & PE T AOORESa 1 J O Q C ��.�l�w' a �7�,1�-,t►,�gl„�/� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I J 86 OWNERS PLAN CHECK VALIDATION NAME ° QTY. ELECTRIC PERMIT FEE I PHONE �]�+- CONTRACTOR NAME UTLETS-SWITCHES-RECEP 10.00/1.00 NAME CRS I LIC.NO. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL' 4.00 AOORESS 20aclo PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR � �wW ` ENGINEER LfC.NO. -W'Aob SIGNS TRANS. 3.00 ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 n �IgJ�I�.'PctJGS<-O ',} iIv EMP.METER OR POLE INS. 20.00 �Iv AvvucANrs MOTORS SEE FEE SCH. ADDRESS 0yssacc CcX-nfr 't-t tez>4zS ISERVICE CHANGE. 20,00 � ����7 D 02 LICENSED CONTRACTORS DECLARATION City QI � /yCs)�s a i pj 1 hereby affirm that I am licensed under provisions o1'Chapter 9 - I $[JA gNTE a m (commencing with Section 7000)of Division 3 Of the Business nmd BLDG. ELECT. PLG. MECH. H m z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ 0 C V,w License Class Lia Number H w H J Dat, Conactor a ><E t BUILDING PERMIT a aOWNER-BUILDER DIECLARATION W u INFORMATION X ;. 1 I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD F Ix04 Law for the following reason.(Sec.703 1.5,Business and Professions 10.00 PERMIT ISSUANCE VALUATION SIFT. 7 �0 Code:Anycity orcounly which requires a permit to construct.alter, 33 de-0 in Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 0 u requires the applicant for such permit to file a signed stalennenl that TOTAL w$ PERMIT TO he is licensed pursuant t0 the provisions of the Contractor's License (' R z a Law(Chapter 9(commencing with Section 7000)of Division 3 o fthe C� s i o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE TO/L-a-�I�F"(f/ ce I- the basis for the alleged exemption.Any violation of Section 7031.5 I STORIES TYPE CONSTR. a; by anyapplicinl fora permit subjects theapplicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not mom than five hundred dollars(SS00).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECTDEV ICE 400 their sole compensation,will do the work,and the structure is not . . OCC. . GROUP RES.UNITS 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- mentsarenotintendedorofferedforsale.If,however,the budding GAS-EA.SYSTEM-I INC.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 in. BUILDING USE p(ov.e for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB one, )k 1,as owner of the property,am exclusively contracting with ❑. ❑ ❑ ❑ ElIi)kC d contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of operty who builds or improves thereon,and who LAWN SPR IN KLERS-OVER 5 (EA.) 1.00 the Co lln't hprojec(({{with aconlractorfs)licensed pursuant to SEWER-SANITARY-STORMEA.200ft/10.00 fhc Contractor I n , ac. TRACT NO, PARCEL NO. ❑ lam y. to rSec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 son OwnerUate WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERTCOMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofconwnt to set Ginsure. ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 F p tified copy is inspection with the city ineclian division. ApplicantMISC.- REFER TO ORD. y N E v N H CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG. CL Z (This Section need not be completed if the permit is for one TOTAL Y[:] N❑ V E] N❑ hundred dollars($I Do)or less.) U O I certify tlmt.in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to O w become subject to the Workers'Compensation Laws of California. n Date Applicant BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Fx- ALTER OR ADD TO MECH. 5.00 -� ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK - provisions of the Labor Code, you must forthwith comply with U� U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE B I hereby aff rn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perfornnmme 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read 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 ordinances and stale laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives forms inspection this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL hereby coauthored properly forinsp of purposes. (We) agre to Save, indemnify and keep harmless the City of Misc.- REFER TO ORD. Cupertino a ainsl liabi lies,judgments, costs and expenses which' PERMIT ISSUANCE 10,00 CONST.TAX may in a 'ac a against Said City in consequence of the granting r MECH.CONT.. LIC.NO. MECH. 6z. 6 Q TOTAL TOTAL �- ign ure of Applicant/Contractor Dae OFFICECOPY POSTTHISWD NEAR FRONTOF BUILDING CITY OF CUPERTINO PFRN,Ir NUMBER INSPECTION DIVISION 13086 •r� "� JOB INSPECTION RECORD PERMIT EXPIRATION - r• JOB ADDRESS 20350 Stevens Creek Blvd. UNIT# LOT# - PERMIT EXPIRES IF WORK OWNER CCC Assoc. "D" CONTRACTOR Cal Prom IS NOT.STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION g y,� ANCE OR 180 DAYS FROM LIFER �`{�7,.,��?gZ LAST CALLEDINSPECTION. PREGUNITE a�y.� tpCXL RI � PERMIT VALIDATION O Q �pL1D POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED + UNDERGROUND./SLAB juN jg47 PLUMBING ELECTRICAL9fE 'MECHANICAL eL ELECT, PLG. MECR. ❑ El 1:1 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION .. PLUMBING VALUATION $/FT. MECHANICAL .. ELECTRICALPERMIT TO FRAMING INSULATION - STORIES TYPE CONSTR. OCC,GROUP RES.UNITS kP,L•'ACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF SO,FT.FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PR O,h,, —APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST - TRACT NO, PARCEL NO. MECHANICAL ACC.DATE ACG FILE NO, ELECTRICAL FINALS - DATE INSP. FRAMING SAN 0 INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T.ZC COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° "� "� FLOOD , LATH—INTERIOR ELECTRICAL ZONE A.LUC. LATH—EXTERIOR FIRE DEPT, Y❑ "❑ Y ❑ N[]SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING �• _ SHEAR EXTERIOR TEMPORARY APPR VALS BUILDING FIREWALLS - ELECTRIC - PLAN CHECK o GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE• ,� _ OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL.ISSIGNED BY.BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 0o ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. , — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL CONST.TAX IMPORTANT[ PLEASE READ REVERSE SIDE BEFORE TOTAL ` CALLING FOR FINAL INSPECTION. '- OFFICE COPY .