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13046 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER So ILDIND APPLICATION & PERMIT ADDRESS 13-046 ,I J�,v „ s (� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION I s NAME n OTY. ELECTRIC PERMIT FEE (5 PNONE NNAME croRs .OUTLETS-SWITCHES-RECEP 10.00/1.00 N Aa.yT� aa /9rAC,14 uC.No. 70 LIGHTING FIXTURES 10.00/1.00 rorvrRAc R's PPLIANCES-RESIDENTIAL 4.00 ADDRESS C/ /� ' x O I lr tiw. is PHONE - DO PANELS 10.00 DATE OF APPLICATION T� OORRCHIr ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINec}� Ea LIC.No, SIGNS TRANS. 3.00 / ARC"OR ENG. SPECIAL CIRCUIT S,QQ PERMIT VALIDATION Y ADDRESS ZIP TEMP.METER OR POLE INS. 20.00 PAID. ""- APPucANrs MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20,00 , P7 woo LICENSED CONTRACTORS DECLARATION rx a v U I hereby affirm that I am licensed under provisions of Chapter 9 y r (`ISIS }Apo ATE w Z "' (commencin with Section 7000)of Division 3 of the Business and a w 6 I LD ELECT. PLG: MECH. o Professions CodLV.ea7ry1 m license is in full fic,0�p4�Ld ef�ct ❑ ❑ ❑ z O w�C( License CI ss_� Lic.Number SCe70 G y r Date s�'Z(1e Contractor ' a Y 2 BUILDING PERMIT ¢ ¢ w ¢ OWNER-BUILDER DECLARATION Loa " INFORMATION MISC.- REFER TO ORD w ; y 1 hereby affirm that I am exempt from the Contractor's License FwN ¢ Law forlhe following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 VALUATION $/FT. Code:Any city or county which requires a permit toconstruct alter, r('6 2 ¢ 4 M improve,demolish,or repair any structure,prior its issuance,also ELEC. U � - D ¢ requires the applicant for such permit t0 file a signed ELEC.CONTE. LIC.NO.ed statement that TOTAL PERMIT TO w$ he is licensed pursuant to the provisions of the Contractor's License 23z- 1 /< � L L r z i La..(Chapler 9(commencing with Section 7000)of Division 3 of the LOG a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ F$ the basis for the alleged exemption.Any violation o(Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00 of not mare than five hundred delta.(8500).): ❑ 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,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- ' 'ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 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- RES IND CON PB Other prove fors owner of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the property,he exclusively contracting with - ❑ ❑ ❑ ❑ ❑ Yom\ licensed contractors to construct the project(Sec. does nBusiness LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and n owner of Code:The Contractor's License Law does not apply DO to tr owner of property who builds t r improves thereon,and t to LAWN SPRINKLERS•OVER 6(EA.) 1.00 C* contracts ctor'sor hcenects Lwith acontractorts)licensed pursuant to SEWER-SANITARY-STORM EA.200f1/10.00 TRACT NO, PARCEL NO. the Contractor's License Law. ❑ tem exempt under Sec. ' ,B.&P.C.for this WATER HEATER WIVENT 6.00 reason 3 Owner Date WATER SYSTEM 5.00 ACC.GATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance:or a certified ZONING ENG.SITE NO. Is opy thereof(Sec.3800,Lab.CJ. ' olicy No. Company �__QErn/j�/$ ..zD• 0 ❑ Certified copy ishereby furnished. FIRESPRINK ENERGY TZ4 Z Z ❑ Certifie co is ed wh the city inspection division. MISC.- REFER TO ORD. QrAPPlicantr� E) N❑ Y N❑ Xy CE TIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A,L.U.C. W > COMPENSATION INSURANCE PLG.CONTE. LID.NO. PLG. ❑ ❑ E] N❑ CL O (This section need not be completed if the permit is for one TOTAL Y N Y D Z hundred dollars IS IOD)or less.) 0 O 1 certify that in the performance Of She work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued, I shall not employ any person in any manner so as to V become subject to the Workeri Compensalion Laws of California. IN a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3 } N NOTICE.TO APPLICANT: If,after making this Certificate Of Ex- Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 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 10AWC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE S 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 - the 3097LCi�C.). of the work;or which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's NameHEATING UNIT(OVER 100,000 B.T.U.) Lender's Address ELECT I C 4, l certify that l have read this application and state that the above VENTI LATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and county PLUMBING c-dinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ,.ereby authorize representatives Of this city to enter upon the BOILER-COMP Over t00,000BTU)SEE FEESCH. MECHANICAL ! ,. move-mentioned property 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 may in any way accrue against said City in consequence of the grant' go tis permit MECH.CONT, LIC.NO. MECH. s TOTAL TOTAL 37,P5 ature of Applicant Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING FFRNIIT NUMBER CITY OF CUPERTINO 13046 INSPECTION DIVISION -�: JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS Stevens Creek & Highway _9 UNIT# _LOT# PERMIT. EXPIRES IF WORK OWNER Byers CONTRACTOR M. Blach IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION.RECORD 180DAYS OFPERMIT ISSU- �`� ! rS tw. ANCE OR 180 DAYS FROM FOUNDATION % '�� 3 LASTCALLED INSPECTION. UFER Z7�. Eek kelift PERMIT VALIDATION PREGUNITE - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL BLG.DFLECT F PLG. MECH. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR - 'VALUATION $/FT. PLUMBING MECHANICAL - PERMIT T ELECTRICAL l< r A FRAMING ' - ;�L STORIES TYPE GUNS I R, INSULATION , OCC.GROUP RES.UNITS jLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 50.FL FLOOR ARIA TOTAL ACREAGE ROOF y 'DIAPHRAGM BUILDING USE RES IND CON PB 00 , A•"dPPXY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ROUGH PLUMBING GAS TEST TRACT NO, PARCEL NO, MECHANICAL - ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING ISAN # ZONING ENG.SITE NO, INSULATION PLUMBING GAS FIRE SPRINK ENERGY LZJ MECHANICAL Y N❑ Y ❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED • HEATING FLooD ZONE ILL.u.c. LATH-INTERIOR ELECTRICAL r� N[3 Yo N[]LATH-EXTERIOR FIRE DEPT. -.`!S' _ SHEETROCK - GRADE FEE SUMMARY SHEAR INTERIOR BUILDING 5 1, SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOC6UPANCY SEISMIC FEE OCCUPANCY OF BUILDING ISNOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 of uS ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC of ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. ✓lZ MECHANICAL - SEE PERMIT FOR EXPIRATION DATE = CONST.TAX - - IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL Jl CALLING FOR FINAL INSPECTION. OFFICE COPY