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13643 AA$LICANT TO FILL IN INF�MATION WITHIN RED LINES - USE�LL POINT PEN ONLY BUI ILDI NG PROJECT I DENTI FOWN PERMIT NUMBER BIIILDINo > APPLICATION &'P IT r\; nooREss �� �T���, ,f BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13643 ` OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE (/j HONE CONT crags NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME y LIGHTING FIXTURES 10.00/1.00 \\\ CONTRACTORS' Aar�n(/��y��/Da(f�i�, C'9' APPLIANCES-RESIDENTIAL 4,00 ADDRESS FSI l/aT/ 7 )�Q PH.(�� 10 PANELS 10.00 DATE OF APPLICATION \ 0 AR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ER LIC.rvo. SIGNS TRANS. . 3.00 ARCH.OR ENG. / ' PERMIT VALIDATION ADDRESS ,Q���� / 1-5556 SPECIAL CIRCUIT 5.00 CdA)r"`^ N5 P TEMP. METER OR POLE INS. 20.00 APPLICANTS WAD MOTORS SEE FEE SCH. ADDRESS J / CORP SERVICE CHANGE 20.00 wo o LICENSED CONTRACTORS DECLARATION IN 'ISS,a so v I hereby affirm that I am licensed under provisions of Chapter 9 - V'--\- I ISSUANCE DATE I, Q w (commencing will,Section 7000)of Division 3 of the Business anti BLDG. ELECT PLG. MELH, H N z \ Professions Code,j nd m license is in full for e'nd IT I ` �(10❑ ❑ z i License Class_��ls/. Lica Number 3 '.Ns fll U Q Date 9-Z-07__Commc[ 1Zo < x 7 �/-T! l'p/ BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLARATION S, a " MISC.- REFER TO ORD INFORMATION wg LL y I hereby affirm that I am exempt from the Contractor's License VALUATION LLo J Law forthe following reason.(Sec.7031.5,Businessznd Professions PERMIT ISSUANCE 10.00 S/FT. H - Code:Any city or county which requires a permit to construct,alter, ��4V1 OO ea p P y prior to its issuance,also ELEC.LONTH. LIC.NO. GC/! ¢p improve,demolish,or repair an structure,p ELEC. c requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO e w $ he is licensed pursuant to the provisions of the Contractor's License Hit Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe �l FS`1l ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ Is- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 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 holds or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsara not intended or offered for Side.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im .. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR Other ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct lire proieet(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:Tire Contractor's License Law dues 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 a contractor(s)licensed pursuant to -SANITARYTRM EA200ft -SO . 1000. the Contractors License law. SEWER / TRACT NO, PARCEL NO. ❑ I am exempt under Sec,-,B.&P.C.I'or this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARA'f10N WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of couscnt In self-insure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, Lab.C) PolcyNo. Conmany re. ���� 0 O CeftifeJCopyelerebyfu _ FIRESPRINK ENERGYT-24 Z 2 I 'Ceniii col Is I w t the city inspection division. 0 p(fplicint �rud - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ US CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE10.00 FLOOD ZONE A.L.U.L. LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLTOTG. CL O (This section need not be completed if the permit Is for one AL Y❑ N❑ Y❑ IN D Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of Ne work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY 1L F mit is issued,1 shall not employ any person in any manner so as to DW become subject to the Workers'Compensation Laws of California. � y BUILDING g7 Date Applicant - } N NOTICI7 TO APPLICANT': If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 Z empiion,you should become subject It,the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 0 2 provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the erforCie.0 ante 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(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC • I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 801LER-COMP (Over 100,000 BTU(SEE FEE SCH. - MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against abilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX , may in any wa a cme•against said City in consequence of the gmnD Ofth a it MECH.CONT. - - LIC.NO. MECH. b TOTAL TOTAL GyCOz gnammof p cant/Con cor Date (/ OFFICE COPY Ci POST THI RD NEAR FRONT OF BUILDING CN, OF CUPERTINO PERIITN,IMBEH INSPECTION DIVISION 13643 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 20770 STEVENSCREEKUNIT#T—_LOT# PERMIT EXPIRES IF WORK OWNER PIZZA HUT CONTRACTOR ACME - WILEY IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PR EGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ' Cr c ELECTRICAL � S[,.1 � ISSUANCE DATE MECHANICAL - BLDG. EI ECT, PLG, MECH. Cih OI❑D Or' ❑ 1 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BOILDING PERMIT INFORMATION _ -WOOD FLOOR - VALUATION SIFT. PLUMBING - � � . .- MECHANICAL ✓' •'� ' " ELECTRICAL � PERMI To FRAMING L� INSULATION STORIES -TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOH AREA TOTAL ACREAGE DIAPHRAGM auILO uS HES IND CON PB OiM1e, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 D Cl ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO', � - ' MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN #" ZONING ENG"SITE NO. INSULATION PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NO Y ❑ N❑ LATH-INTERIOR ELECTRICAL 12 FLOOD 20NE A.L.DO LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING / / -ip SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING .• FIREWALLS ELECTRIC PLAN CHECK GAS . FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE ^, OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE,PERMIT FOR EXPIRATION DATE - , MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL f `+ \ CALLING FOR FINAL INSPECTION. -- J OFFICE COPY AA$LICANT TO FILL IN INF�MATION WITHIN RED LINES - USE�LL POINT PEN ONLY BUI ILDI NG PROJECT I DENTI FOWN PERMIT NUMBER BIIILDINo > APPLICATION &'P IT r\; nooREss �� �T���, ,f BUILDING - ELECTRICAL-PLUMBING-MECHANICAL 13643 ` OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE (/j HONE CONT crags NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME y LIGHTING FIXTURES 10.00/1.00 \\\ CONTRACTORS' Aar�n(/��y��/Da(f�i�, C'9' APPLIANCES-RESIDENTIAL 4,00 ADDRESS FSI l/aT/ 7 )�Q PH.(�� 10 PANELS 10.00 DATE OF APPLICATION \ 0 AR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ER LIC.rvo. SIGNS TRANS. . 3.00 ARCH.OR ENG. / ' PERMIT VALIDATION ADDRESS ,Q���� / 1-5556 SPECIAL CIRCUIT 5.00 CdA)r"`^ N5 P TEMP. METER OR POLE INS. 20.00 APPLICANTS WAD MOTORS SEE FEE SCH. ADDRESS J / CORP SERVICE CHANGE 20.00 wo o LICENSED CONTRACTORS DECLARATION IN 'ISS,a so v I hereby affirm that I am licensed under provisions of Chapter 9 - V'--\- I ISSUANCE DATE I, Q w (commencing will,Section 7000)of Division 3 of the Business anti BLDG. ELECT PLG. MELH, H N z \ Professions Code,j nd m license is in full for e'nd IT I ` �(10❑ ❑ z i License Class_��ls/. Lica Number 3 '.Ns fll U Q Date 9-Z-07__Commc[ 1Zo < x 7 �/-T! l'p/ BUILDING PERMIT ¢ ¢ ¢ OWNER-BUILDER DECLARATION S, a " MISC.- REFER TO ORD INFORMATION wg LL y I hereby affirm that I am exempt from the Contractor's License VALUATION LLo J Law forthe following reason.(Sec.7031.5,Businessznd Professions PERMIT ISSUANCE 10.00 S/FT. H - Code:Any city or county which requires a permit to construct,alter, ��4V1 OO ea p P y prior to its issuance,also ELEC.LONTH. LIC.NO. GC/! ¢p improve,demolish,or repair an structure,p ELEC. c requires the applicant for Such permit to file a signed statement that TOTAL PERMIT TO e w $ he is licensed pursuant to the provisions of the Contractor's License Hit Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe �l FS`1l ¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ Is- $ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4,00 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 holds or improves thereon,and who does Such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsara not intended or offered for Side.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or im .. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PR Other ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct lire proieet(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:Tire Contractor's License Law dues 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 a contractor(s)licensed pursuant to -SANITARYTRM EA200ft -SO . 1000. the Contractors License law. SEWER / TRACT NO, PARCEL NO. ❑ I am exempt under Sec,-,B.&P.C.I'or this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARA'f10N WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of couscnt In self-insure' ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, Lab.C) PolcyNo. Conmany re. ���� 0 O CeftifeJCopyelerebyfu _ FIRESPRINK ENERGYT-24 Z 2 I 'Ceniii col Is I w t the city inspection division. 0 p(fplicint �rud - MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ US CERTIFICATE OP EXEMPTION FROM WORKERS' PERMIT ISSUANCE10.00 FLOOD ZONE A.L.U.L. LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLTOTG. CL O (This section need not be completed if the permit Is for one AL Y❑ N❑ Y❑ IN D Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of Ne work for which this per OTY. MECHANICAL PERMIT FEE FEE SUMMARY 1L F mit is issued,1 shall not employ any person in any manner so as to DW become subject to the Workers'Compensation Laws of California. � y BUILDING g7 Date Applicant - } N NOTICI7 TO APPLICANT': If,after making this Certificate of fix- ALTER OR ADD TO MECH. 5.00 Z empiion,you should become subject It,the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 0 2 provisions of the Labor Code, you must forthwith comply with FEE V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the erforCie.0 ante 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(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC • I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 801LER-COMP (Over 100,000 BTU(SEE FEE SCH. - MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against abilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX , may in any wa a cme•against said City in consequence of the gmnD Ofth a it MECH.CONT. - - LIC.NO. MECH. b TOTAL TOTAL GyCOz gnammof p cant/Con cor Date (/ OFFICE COPY Ci POST THI RD NEAR FRONT OF BUILDING CN, OF CUPERTINO PERIITN,IMBEH INSPECTION DIVISION 13643 JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 20770 STEVENSCREEKUNIT#T—_LOT# PERMIT EXPIRES IF WORK OWNER PIZZA HUT CONTRACTOR ACME - WILEY IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PR EGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ' Cr c ELECTRICAL � S[,.1 � ISSUANCE DATE MECHANICAL - BLDG. EI ECT, PLG, MECH. Cih OI❑D Or' ❑ 1 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BOILDING PERMIT INFORMATION _ -WOOD FLOOR - VALUATION SIFT. PLUMBING - � � . .- MECHANICAL ✓' •'� ' " ELECTRICAL � PERMI To FRAMING L� INSULATION STORIES -TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOH AREA TOTAL ACREAGE DIAPHRAGM auILO uS HES IND CON PB OiM1e, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 D Cl ❑ ❑ ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO. PARCEL NO', � - ' MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN #" ZONING ENG"SITE NO. INSULATION PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NO Y ❑ N❑ LATH-INTERIOR ELECTRICAL 12 FLOOD 20NE A.L.DO LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING / / -ip SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING .• FIREWALLS ELECTRIC PLAN CHECK GAS . FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE ^, OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� . ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE,PERMIT FOR EXPIRATION DATE - , MECHANICAL IMPORTANT! CONST.rnx PLEASE READ REVERSE SIDE BEFORE TOTAL f `+ \ CALLING FOR FINAL INSPECTION. -- J OFFICE COPY