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18840 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY .BUILDING PROJECT I DENT]FICATI ON PERMIT NUMBER- - BahLmNGLLO VA - ADDRESS10 �Yt12� APPLICATION & ERMIT . O- ,rJ 'P BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 1884 OWNER'$ NAME PLAN CHECK VALIDATION MIVs 9fE�Me5 QTY. ELECTRIC PERMITTO-NTEE IAC IRS vHorvE -�' NAME CTORs !�`� UTLETS-SWITCHES-RECEP 10.00/1.00 NAME lT A �I C LIC.No.� ,�.� - LIGHTING FIXTURES 10.00/1.00 a Door.ACTORSD�` 1 •,^.'j RD• a As p ,•`LlW'' �/ PPLIANCES-RESIDENTIAL 4.00 :5AA1 Mk(:A. PHONE -(�ja PANELS 10.00 DATE OF APPLICATI ON • RCHITEC OPLAN CHECK FEE P.C.NO. OR _ PANELS (OVER 200 AMP) 20.00 ENGINEER , y , uc.NO. SIGNS TRANS. - 3.00 AENG. ADDRESS - SPECIAL CIRCUIT 5.00 ///��'MIT ALIDATION ' ZIPEMP.METER OR POLE INS. 20.00 nooLe ss Ts MOTORS SEE FEE SCH. - SERVICE CHANGE 20.00 a ¢ z r 02 LICENSED CONTRACTORS DECLARATION, _ , w r i �i I hereby affirm [hat I am licensed under provisions of Chapter 9 il� 0! - ISSUANCE DATE I ¢a (commencing with Section 7000)of Division 3 of the Business and -H w iBLDG. ELECT.' Professions Code,and my license is in full force and effect. PLG. MECH. El O m - License Cass Lin.Number 9 z H Date 1� Contracto;A s �)J" IJ�y ¢ m M J W - -^^�' BUILDING PERMIT 0 w OWNER-BUILDER DECLARATION INFORMATION X LL y I hereby affirm that I am exempt from the Contractor's License MISC.- ON Of biner]F-EFER TO ORD LLO ¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. � - Code:Any cityorcounty which requires a permit to construct,alter, PERMIT ISSUANCE. .�/ 1 ¢ c p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. /•U O ' ELED. wDLL mqulres the applicant for such permit to file a signed statement that TOTAL , PERMIT TO $0 he is licensed pursuant to the provisions of the Contractor's License r z rt Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe i o Business and Professions Code)orthat he is exempt therefrom and DTV. PLUMBING PERMIT .FEE . S, F$ the basis for the alleged exemption.Any violation of Section 7031.5. STORIES TYPE_CONSTR. i by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN IEA.) 5.00 of not more the,,five hundred dollars($500)J: - ❑ I,as owner at the property,or my,and t employe"with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS titter sole compensation,will(S 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 himself who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 S0.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such improve- orimprovemenetnnicndedoroffered oneyeaalt.If,however,the building GAS-EA.SVSTEM-1 INCA OUTLETS 6.00 or improvement is sold within one year of completion,ate owner, builder will have the burden of proving Thai he did not build or im- GAS-,EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE Prove for purpose of saleJ. - INDUSTRIAL WASTE INTER: 30.00 RES IND' CON PB "Omar ,. ❑ I,as owner of the property,an,exclusively contracting with t licensed-contractors,to construct the project(Sec. 7044,Business . LAWN SPRINKLERS-'1 INC 5 V.B. 6.00 ASSESSO and Professions Code:The Contractor's License Low does not apply .fl6PARCEL NO. 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 - :� the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under sec. ,B.&NC.for this - WATER HEATER W/VENT 6.00 rea50n Owner Date WATER SYSTEM 5.00 , ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION'DECLARATION WATER TR EATING EGU IT 5.00 1 hereby affirm that I have a certificate of consent to sdf-insure, or a certificate of Workers'Compensation Insurance,or o certified ZONING ENG.SITE-NO. copy thereof(Sec.3800,Lab.CJ. u Policy No. Company 0 ❑ Certified copy is hereby,furnished. FIRE 6PRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. 0 Applicant - MISC.- REFER TO ORD. y N v N[:)CC y CERTIFICATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE � 10.00 FLOODZONE A.L.U.C. LU > COMPENSATION INSURANCE PLG,CONTR. LIC.No. pLG/ ' O' 0 (This section need not be completed if the permit Is for one TOTAL a Y 0_ N Y [] N Z hundred dollars($100)or - V'Q 1 certify that in the performance of the work for wldch ihix per- CITY MECHANICAL PERMIT FEE FEE SUMMARY -U 'f- mil is issued,I shall not employ any person in any manner so aS to 0 W become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT'. If,after making this Certificate of Ex- F-. Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 'PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IQOOOC.RM.) 6.00 SEISMIC FEE ' I 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(See. 3097,Cie.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 "MICROFILM u Lender's Name Lender's Address HEATING UNIT(OVER l 00,000B.T-U.)9.50 ELECTRIC ~ 7.Jt� ' 'I certify that have read this application and state that theabove 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-DOMP(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 property for inspection purposes. -(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO'ORD. upertino 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 - ran`n o t i5 enni / MECH:CONT. LIC.NO. MECH. G / TOTAL P-1 /O TOTAL 4J Signature of Applicant/Contractor at OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING RMIT NDmBER ` CITY OF CUPERTINO 18840 INSPECTION DIVISION JOB INSPECTION RECORD • �/[�� E 7T PERMIT EXPIRATION [.� ��.P JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNERLyrl"��//�j CONTRACTOR �7% ✓� �eZ54!! .r IS NOT STARTED WITHIN ' INSPECTION DATE .INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION . . ANCE OR 180 DAYS FROM NOTE: I LAST CALLED INSPECTION. UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED ' TO COMPLY WITH THE APPROVED PLANS AND CITY OF E MITO LIDATIO" PREGUNITE CUPERTINO STANDARDS.' GARAGE SLABS J �J' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING �pp ELECTRICAL - 1!-G'iVl l!� '. - ISSUANCE DATE MECHANICAL- BLDG ELECT. G. MECH. El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT - WOOD FLOOR &l0(cRQRttIOfl INFORMATION VALUATION SIFT. - PLUMBING MECHANICAL ELECTRICAL ' PERMIT TO FRAMING INSULATION, STORIES TYPE CONSTH, . 'OCC.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • - ROOF - NOTE.,-NO FINAL INSP.SHALL BE MADE BEFORE so FT.aooB AREA _rorAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID . p BU .DING USE S ROOF SHEATHING - - - - HEs-' ,iND CON Pu " ow.,'• APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ E '❑ ❑" ❑ ROUGH SAN.N ASSESSORSPAHCELNO PLUMBING ELECT.ENERGY + - TUBS 8 SHOWETRACT NO. PARCEL NO.R PAN PLUMBING ENERGY ' MECHANICAL - MECH.ENERGY o ELECTRICAL BUILDING ENERGY ACC.DATE ACC FILE No. FRAMING' ELECT.FINALTEST ZONING ENG.SITE NO. _ INSULATION PLUMBING ' GAS TEST GAS - MECHANICAL- •FIRE SPRINK ENERGY T:24 COVER NO WORK UNTIL ABOVE HAS EN SIGNED HEATING ❑ "❑ ` "❑ BE . EXTERIOR SHEAR ELECTRICAL RELEASE _ EL000 zorvt ACL u.c. INTERIOR SHEAR, FIRE DEPT. - _ Y❑ rv❑ v L1 rv❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING- , INTERIOR LATH - TEMPORARY APPROVALS BUILDING .I SCRATCH COAT ELECTRIC PLAN CHECK - GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 5� • LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. z 0t PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING - SEE PERMIT FOR EXPIRATIONDATE - MECHANICAL IMPORTANT! CONST:TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - i