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13931O Z F- LU EL EL D U LL O } a' APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY .�. a 'BUILDING PROJECT I DENTI FICATI ON APPLICATION & PERMIT BUILDING-ELECTRICAL-PLUMBING-MECHANICALO PERMIT NUMBER 12931 9UIla/11 ADDEsO OWNER'5 NAME o (ri�RONE 1�3g� Jj��\ (fr QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTORS NAME UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 ^ S m C,O nc. No.a1 ADDRESCTDRs CONTRA 15 ,3O4�''J\y,iGGI- PHONEDRB-)41.L PPLIANCES- RESIDENTIAL 4.00 DATE OF APPLICATION PANELS 10.00 RcnrtscT OR E R py.� uc. No. v25 SFO PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3,00 OR AR N. OR ENG.SPECIAL AooREss IJ p 0--e-A <4 3�%� • ZIP ISDSI,EMP. CIRCUIT 5.00 PERMIT VALIDATION METER OR POLE INS. 20.00 APPLICANTS 5�ino. GI Q.� ADDRESS MOTORS SEE FEE SCH. ' SERVICE CHANGE 20.00 _PAID O LICENSED CON'T'RACTORS DECLARATION u i wDate I hereby affirm that I am licensed under provisions of Chapter 9I (commencing with Section 7000) of Division 3 of the Business and Professions Code, my license is in full fore an e( cl LL License a's Lic. Number Contractor v A E DATE GGG L G. LECT. I PLG. MECH. El❑ city iu ' y is 4 te �> a o O.P. LeS WNERBUILDER DECLARATION I hereby affirm that l am exempt from the Contractor's License Law for the fallowing reason.(Sec. 7031.5, Businessand Professions Code: Any city or counly which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that Ire is exempt therefrom and ilia basis for the alleged exemption, Any violation o(Section 7031.5 BUILDING PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 VALUATION $/FT. / ELEC. CONTR. LIC. NO. ELEC. TOTAL- - PERMIT TO LOw.�-L L C QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. by any applicant for a permit Subjects the applicant o a civil penalty of not more than five hundred dollars (S500).): ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES, UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- nientsarenotintendedorofferedl'or sale. IL however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for purpose ofsale.). ❑ I, as owner of the property, um exclusively contracting with GAS - EA. SYSTEM -OVER 4 IEA.) 2. 00 BUILDING USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct ilia project (Sec. 7044, [justness and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 - LAWN SPRINKLERS - OVER 5 IEA.) 1.00 ASSESSORS PARCEL NO. contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WATER TREATING EQUIP. 5.00 - WORK ERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. copy thereof (Sec. 3800, Lab.Cd. Policy No.-Company�l"bnd'1 OLaI , FIRE SPRINK Y❑ N❑ ENERGY T44 Y❑ No Z ❑ Cern ied copy is hereby furnished. : ❑ Certified copy is filed with the La insp 4ion Aivision. Applicant ( y1G-'fnh'v t>IA.6("E:- �z 77iTlSC-�REFER TO ORD. rn > CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('flus section need all( be completed if the Permit is for one PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ N❑ A.L.U.C. Y ❑ N❑ PLG. CONTR. LIC. NO, PLG. TOTAL 2 0 I- U w y N Z hundred do1lurs($100) or lass.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner us as to become subject to the Workers' Compensation Laws of Calitornia. Dote Applicant NOTICE 1'0 APPLICANT: If, after ....king this Certificate of E. - emption, you should become subject to the Workers' Compensation QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING t�Q ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you Most forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10,00041F.M.) 4.00 FEE AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 'SEISMIC FEE - CONSTRUCTION LENDING AGENCY I hereby affirm tied there is a Construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 J09 , Civ C ante of the work for which this permit is issued (Sec. MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 d information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING BOILER-ODN1P (3 H.P. Of 100, 000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. (we) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue, against said City in consequence of the CONST. TAX PERMIT ISSUANCE 10.00 gn�'"ding Of this per mit. Z1�.x��n)�O.�Aw.f�- V �7 - MECH. CONT. LIQ NO. MECH. TOTAL TOTAL Signature of Applicant/Contractor Dale OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS 20401 $}Wens, Creek Road UNIT# LOT# - 'OWNER DeAnza Pronerties CONTRACTOR pnrpq- PFRMIT NNti'dER ' 12931 PERMIT EXPIRATION - PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS of PERMIT ISSU. ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. rr INSPECTION DATE INSPECTION RECORD FOUNDATION _(—(-(6_R7 F00 Y' XCX61L`t w4, a(Kd 8( UFER - �waI'C PREGUNITE NSIGNED ��(e—S% Y:�•Vl �/✓�, ErPe 'fir(-• PERMIT VALIDATION ,D IssunNCE�uA'te POUR NO CONCRETE UNTIL ABOVE HAS BE1 �f b -£fl SCDoL •• U&e- WhxF_ UNDERGROUND/SLAB PLUMBING. ELECTRICAL MECHANICAL MAY BLDG. 1,1� M i,eEl I 1 PC0 M�. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED; City B ILDING PERMIT f Cu errbMRMATION , WOOD FLOOR 'VALUATION PLUMBING. .MECHANICAL ELECTRICAL_ - r PERMIT TO -tOC J a1 FRAMING INSULATION STORIES TYPE CONSTR. SP,LIACETNO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC. GROUP RES. UNITS a ; ROOF 0 Ci FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE NES IND CON PB 'ONer ❑ 0 ❑ 11 ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ROUGH - ASSESSORS PARCEL NO. PLUMBING GAB TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL � FINALS DATE INSP. ACC.DATE ACCFILE N0, ., FRAMING SAN # INSULATION PLUMBING ZONING ' ENG. SITE NO. GAS ' MECHANICAL FIRE SPRINK ° "� ENERGY T 24 yo "E] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING LATH—INTERIOR ELECTRICAL ' FLOOD ZONE Y[:] IN A.L.U.C. Y ❑ N❑ LATH—EXTERIOR - FIRE DEPT. SHEETROCK- GRADE - FEE SUMMARY SHEAR INTERIOR; BUILDING —( BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS _ ELECTRIC PLAN CHECK FEE - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, Iw—x, ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z k.°, PLEASE GIVE JOB ADDRESS WHEN PHONING. =SEE PERMIT FOR EXPIRATION'DATE - ELECTRIC PLUMBING t..... MECHANICAL CONST. TAX ' IMPORTANT!' PLEASE READ REVERSE SIDE'BEFORE CALLING FOR FINAL INSPECTION. TOTAL / (; / OFFICE COPY