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C 8344 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFIC! 1N ERMI NUMBER SUILDING APPLICATION & PE?�SIIT 11"Ell �� �� 8344 $CYO BUILDING -ELECTRICAL-PLUMBING-MECHANICAL CWNER'S,A ///'f PLAN CHECK VALIDATION (NAME yl�l� •" vim. t t Abe S/� ELECTRICPERMIT � ,+i� .`{3'F88Krt vlsoNE l/ croRs NAME UTLETS-SWITCHES-RECEP 10-MM.00 S NAME I OT x,o , TT N WV uc NO .S LIGHTING FIXTURES 1=/1.00 CONTRACTORS aRs PPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT �w a.f FITG'ayt7 ( PANELS (OVER 200 AMP1 20,00 PLAN CHECK FEE P.0 NO. OR /OM1 1 r1 1✓✓f IG�� ENGINEER uc.No L• 24z SIGNS TRANS. 3.00 AR HEOR ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION 948 EKYFwr Sr SF ct1R41d7 ZIP TEMP.METER OR POLE INS. 20.00 4PPLICA Ta C s MOTORS SEE FEE SCH. DDRESSJ• i/bL N�/h+c 2G'PjE33 576T/C ��42EEK SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 // �F�.�/�f 20 1 hereby affirm that I am licensed under provisions of Chapter 9 ' a ISSUANCE DATE H G w (commencing with Section 7000)of Division 3 of the Business and BLOC. ELECT. PLG. MELH. z Professions Code,and my license is in full force and effect. ❑ ❑ o= - License Class Lic.Number wDale Contractor Cl t(�0 y s -a BUILDING PERMIT, w ¢ OWNER-BUILDER DECLARATION INFO T19N - oa " MISC.- REFER TO ORD 1 hereby affirm [hal I am exempt from the Contractor's License VALUATION, S/FT. Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCED - - Code:Anycity or county which requires a permit m construct.alter. `- aa a- 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC / �� 1 O n requires the applicant for such permit to file a signed statement that TOTAL /p �- PE MIT TO' w $m he is licensed pursuant to the provisions of the Contractors License FiQ Law(Chapter 9(commencing with Section 7000)of Division 3 of the I'U7 /y QJCL Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE` ns M t$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES— . by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars I S500L1: ❑ I,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,AR EA,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(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- REB IND CON PB Omer prove 1,aso nee of sale.(. INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ N% d as owner Of the property he elusively contracting with licensed contractors m construct the project(Sec. does,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The who builds o License Law Joos not apply to tr owner of property wlso builds t r improves thereon,and who LAWN SPRINKLERS OVER 5 IEA.) 1.00 contracts for such projects with a contraclosl s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the COn UaRors License Law. TRACT N0, PARCEL N0. ❑ I am exempt under Sea ,B.&P.C.for ilii WATER HEATER W/VENT 6.00 \ reason res S WATER SYSTEM 5.00 ACL.DATE ACC.FILE NO. OR'ERS' PENSATI N DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsenI to self-murr. ZONING of a certificate of Workers'Compensation Insurance.or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy Na, Company Q ' ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z 2 ❑ Certified copy is Bled with the city inspection division. MISC.- REFER TO ORD. O Applicant Y❑ N❑ Y ❑ N❑ M T CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.L. LU 1 COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. V❑ N❑ Y ❑ N[3CL Z AL (This section need not be completed if the permit is for one TOT hundred dollars IS 100)or less.) - U O 1 certify that in the performance of the work for which this per, CIT Y. MECHANICAL PERMIT r� FEE': - FEE SUhBNARV-e LL 1- mit is issued,I shall not employ any person in any manner so as to - U become subject to the Workers'Compensation Laws of Califomia. p 0. Date Applicant BUILDING �4 a ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: IL after making this Certificate sa Ex- ♦- 2 er vision you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions io the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10,0MC.F.M.) 6.00 SEISMIC FEE -SJ 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC • 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING ordinances and state 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 BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX ny way seems against said City in consequence of the \ granfing0 this perrtyL ! MECH.CONT. LIC.NO. MECH, TOTAL TOTAL �S n ignature of Applicant/Contracto ale '- -' �,�,� ,�A �tc ,777774, OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRVIT NUN19FR CIT' ' OF CUPERTINO 0 r. INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS NIT _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INS P CTION DATE INSPECTOR INSPACTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB ll� PLUMBING �/ A_l ELECTRICAL ISSUANCE DATE MECHANICAL Loc E ECT. PLO. MEC.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT I FORMATION WOOD FLOOR '5VALUATION7z SIFT. PLUMBING /f MECHANICAL cS ELECTRICAL �/��JJPERMIT FRAMING I�. /"� �L� . INSULATION STORIES YPE CONSTR. OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF $O FT,FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE RES IND CON PB Owes APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO PLUMBING GAS TEST TRACT NO. PARCEL NO MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE N0 FRAMING L ;,� _ _I SAN # ZONING ENG.SITE NO. INSULATION IPLUMBING GAS FIRE SPRINK ENERGY T 24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ] IN[] Y ❑ N[] LATH—INTERIORELECTRICAL !�, .� FLOOD ZONE A.L.uc.- LATH—EXTERIOR FI RE DEPT. Y❑ IN Y ] N� SHEETROCK GRADE FEESUMMARY SHEAR INTERIOR BUILDING `r BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS _ FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED 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 CONST.ONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITE OF CUPERTINO '� MITNUMRea INSPECTION DIVISION 87. f,/j.■y( j4,�} � V I 9 JOB INSPECTION RECORD ' PERMIT EXPIRATION, JOB ADDR ESS NIT _LOT#' - .. c - - PERMIT EXPIRES IF WORK OWNER CONTRACTOR i .f IS NOT STARTED WITHIN INSPECTION// DATE INSPECTOR INSP TION RECORD 180 DAYS OF PERMIYiSSU- FOUNDATION - ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PR EG UNITE } - PERMIT.VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING - s ••/ L ELECTRICALil L. ISSUANCE DATE 'MECHANICAL ' LtIG E ECT. PLG. MECH. ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE-HAS BEEN SIGNED BU oI G PERMIT WOOD FLOOR - I FORMATION PLUMBING VALUATION SIFT, MECHANICAL ELECTRICAL PERMIT FRAMING INSULATION WSTORIES YPE CONSTR. OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT FLOOR AHEA TOTAL ACREAGE DIAPHRAGM >I� ".BUILDING USE _ - - RES,:, IND CON PB OHinr APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ROUGH - - - ASSESSORS PARCEL NO. PLUMBING GAS TEST— TRACT NO. PARCEL NO. MECHANICAL ' ELECTRICALFINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING .L 'u SAN'# - INSULATION PLUMBING ZONING ENG.SITE NO. GAS ' . MECHANICAL' -FIRE SPRINK ENERGY Th 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ,'Y ❑ 'N0 'Y ED F "❑ LATH-INTERIOR ELECTRICAL _� FL000 zoNE A,L.u.o- . LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y'❑ IN SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING - -- ,}'• SHEAR EXTERIOR BUILDING TEMPORARY APPROVALS • ,r FIREWALLS ELECTRIC - 'PLAN CHECK , .� GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. ' MICROFILM' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC'. o�, ONE WORKING DAY BEFORE REQUIRED INSPECTION. ' PLUMeiNG z 4� PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE MECHANICAL CONST.TAX IMPORTANTI PLEASE READ REVERSE SIDE BEFORE TOTAL r CALLING FOR FINAL INSPECTION. - - - - OFFICE COPY - '