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18824 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ✓,'" BUILDING PROJECT IDENTIFICATION ,PERMIT NUMBEER . BUILDING APPLICATION & PERMIT 18824 ADORas / 16 1/4�Cd BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ,? OWNER'S - PLAN CHECK VALIDATION + NAME '/I p(r-�p�kIL��I�//I/��/yK�{y�ls Y7�J TY. ELECTRIC PERMIT FEE 4 F'✓ rr1� �++•Y PHONE '_ CONTRACTOR'S NAME / OUTLETS-SWITCHES- RECEP 10.00/1.00 'M / LIGHTING FIXTURES - 10.00/1.00 ' CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 A00 EE�ss �J ,e s67/ PHONE .7 l� PANELS 10.00 DATE OF APPLICATION r ARCHITECT PANELS (OVER ZOO AMP) 2QDD PLAN CHECK FEE OR P.C.NO. ENGINEER LIC.NO. SIGNS TRANS. 3.00 ' ARCH.OR ENG. PERMIT VALIDATION ADDRESS SPECIAL CIRCUIT 5.00 EMP.METER OR POLE INS. 20.00 t APPucarvrs ADDRESS ZIP MOTORS SEE FEE ICH. '"(t SERVICE CHANGE 20.00 o o LICENSED CONTRACTORS DECLARATION L a o v I hereby affI,..tb.t 1 am licensed under provisions of Chapler 9ISSUANCE DATE y a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. -MECH. r y i Professions Code,an m to se is in full fm fe L '❑ ❑ ❑ ❑ Z, o y- License Class Llc.Numbe ��/��,� H r.� Uate Contractor -ADD .V0 41_ ' rc m ¢ a O NER�BUILDER U ARATION BUILDING PERMIT _ ¢ u, u INFORMATION K O e- H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD w 3 u y VALUATION $/FT. H .. o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 12 Code:Any city or county which requires a permit to construct,alter, ¢ ¢Q improve,demolish,Or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D ¢ requires the dp pursuant to such pennh to file a signed actor's License that TOTaL -� PERMIT To a w m�` re ui licensed pursuant rsuc provisions of the Cned Statem LoheC,gi-•O H z i Law(Chapter 9(commencing with Section 7000)of Division 3 of the a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT_ FEE STORIES TYPE CONSTR. M ¢ ¢I-o tile n e basis for the alleged exemption.Any violation of Section 703 LS PAI ' n ; m 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.-DEVICES ;j 4.00 {89 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,CON D. 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 GAN Q,P.m firm 50.FT.FLOOR AREA TOTAL ACREAGE '0 himself or through his own employees,provided that such improve- .GAS-EA.SYSTEM'-11NC.40UTLETS 6.00 mount are not intended or offered for sale.If,however the budding 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 Omer prove for purpose of sale.). I N D USTR I A L W ASTE INTER.R. 30.00 ❑ I,as owner of the property,am exclusively contracting with ` ❑ El El 1:1 1:1 licensed'contractors to construct the project(Sec. 7044,Business - LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL N0. and Professions Code:The Contractor's License Law does 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 ' eason Owner Date. WATER SYSTEM 5.00 ACC.DATE 'ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, - - 20NING ENG.SITE N0. - or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec,3800,Lab.C.). Policy No. Company O �❑,/.Certified D Is Iter y(untished. FIRE SPRINK ENERGY T-24 z Z R Certifiedy I d ity inspection division. 0 RppiicantItLt MISC. REFER TO ORD. Y❑ rv❑ Y ❑ N❑ '{ ~ va PERMIT ISSUANCE 10.00 CC - CE CATE OF EXEMPTION FROM WORKERS' FLOOD ZONE, A.L.U:C. W > COMPENSATION INSURANCE. - PLG.CONTE. LIC.NO. PLG. - C 0 (This section Dead-Got be completed if-the permit is for one TOTAL V❑ N❑ Y ❑ N❑ 0 Z hundred dollars(S 100)or lean.) . ' U 0 I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE + FEE SUMMARY ,LL H mit is,isseed,I shall not employ any person in any manner so as m U become subject to the Workers'CompensatiomLaws of California. y Date - Applicant _ ALTER OR ADD TO MECH. 5.00 BUILDING } In NOTICE TO APPLICANT: If,after making this Certificate of Ex. , -Z emption,you should become subject to the Workers'Compensation - APPLIANCE 5.00 PLAN CHECK proAIR HANDLING UNIT(TO 10visions-of the Labor Code, you must forthwith comply with 'FEE ' U Such provisions or this permit shall be deemed revoked. p000.F.M.) 4,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .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(Sec. 'MICROFILM_ 3097,Civ.C.L - H EATING UN IT(TO 100,000 B.T.U.). 8.00 Lender's Name - HUN EATI NG IT(OV ER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC a 1 certify that I have road this application and state that the above VENTILATION FAN(SINGLE) ' - 4.00 - information is correct. Lagree to comply with all city and county PL,U MBING • ordinances and state laws relating to building construction: and BOILER-CGMPI3 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 propeity 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 CONST.TAX may in way ccrue against said City,in consequence of the PERMIT ISSUANCE 10.00 _ matin D his nit. '- MECH.CONT. - - LIC.NO. MECH. /O. TOTAL TOTAL 93 are of Applicant/Contractor - ate OFFICE COPY POST THIS CARD NEAR FRONT OF,BUILDING PERMIT NUMBER CITY OF CUPERTINO . 18824 • INSPECTION DIVISION JOBA INS ECTI N RECORD• ��((� pp�Q�- ✓,/K ��[.�,�.(� (-'A�' #Ao L— PERMIT EXPIRATION JOB ADDRUNIT# _LOT# / , PERMIT EXPIRES IF WORK � OWNER [N CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION ORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. - UFER - ,ALL GRADING AND DRAINAGE SHALL BE INSTALLED .: PREGUNITE '- TO COMPLY WITH THE APPROVED PLANS AND CITY OF I PERMIT VALIDATION CUPERTINO STANDARDS. _ GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEENSIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL - ISSUANCE DATE BLDG. EL[Ci. PLG. MECH, MECHANICAL - PAZ � ❑ ❑ 1, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED PAZ^�� BUILDING PERMIT WOOD FLOOR 1- I J (,� I:i INFORMATION + - VALUATION, $/FT. IIF PLUMBING Cb of CIIDP,I':IRD MECHANICAL PERMIT TO ELECTRICAL 1 - J� .�+A FRAMING [ STORIES TYPE !TYPE CONSTR. INSULATION OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - SO;FL,FLOOR AREA TOTAL.ACREAGE • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING ' RBS NO CON PB 09", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SAN.H PLUMBING ELECT.ENERGY TUBS B SHOWER PAN' PLUMBING ENERGY TRACT No, PARCEL NO MECHANICAL MECH.ENERGY - ACC DATE ACC.FILE No ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GASTEST GAS FIRE SPRINK ENERGY T 24 MECHANICAL ❑ NE Y.❑ NEICOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ELECTRICAL RELEASE FLOOD zoA.L.u,c. EXTERIOR SHEAR p- INTERIOR SHEAR - FIRE DEPT. Y ❑ N❑ v ❑ NO SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC - PLAN CHECK. GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL19SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC, . ' I- ONE WORKING DAY BEFORE REQUIRED INSPECTION,. ' PLUMBING ' 00 PLEASE GIVEJOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONS T.rnx PLEASE READ REVERSE SIDE BEFORE ,+ ,a 1'yr TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY . -----j -- ----- � - 11" E _! - - — - - — -- - -----— s- �" 40 j _ E _ q Av f Lam'i`_- "L 0�7 t _ `T El (Blr7\L '7 -L-N DD 7 XmITA`\-� ll �--` I�k, �-.�'�:sr.l='7 C_►J . L F ! t f D H OCT3 O 1�83 — if BLD6. Ii7�P't TiOW DEPARTiv1"' �z o► �T 1= —Etlp-T 1 c� �—� M —� , cmc Of cuWNa Vi ACCORD!"FEN{ITgTb CI JPFPT TE © � �Cl i THIS IS AN ORIGINAL UNPUBLISHED DRAWING pxCONTRACT NO. JOB NAME aNED } CREATED BY MIDWAY SIGNS. IT IS SUBMITTED FOR OA- pv.� 4-4 -t2 /A- 4 4 -- . ,; _ _ YOUR PERSONAL USE IN CONNECTION WITH A PRO JOB LOCATION: PHONE: I s� APPROVALS DATE keit o. : JECT BEING PLANNED FOR YOU BY MIDWAY SIGNS IT �` _;� ;'v r uItor IS NOT TO BE SHOWN TO ANYONE OUTSIDE YOUR DRAWN JOB ADDRESS: sv bu A ,• - o ORGANIZATION, NOR IS IT TO BE REPRODUCED, � e - -z ,xaicatione COPIED OR EXHIBITED IN ANY FASHION. 1, THE CHECKED ' L�-� a ALL KJi s -,2.' .;.'.; or to be " SIGN AND LIGHTING CUSTOMER AGREE TO PAY MIDWAY THE SUM OF CUSTOMER'S APPROVAL OF DRAWING: proval c` of I,y provisiorW $ IF THESE DRAWINGS ARE ENG F" any C'-y D or ;a Law. -vcaA c- j L7` �; SIGNATURE DATE 40 BASSETT ST. SAN JOSE CALIF. 95113 SHOWN TO ANY SIGN MANUFACTURING COMPANY _ SIZE DRAWN BY: SALES REP: ST., s FOR LAYOUT AND DESIGN. ,p` vim,. :! ' IS"! ^ le€.�i�_� V Is,�t.►,k1i�T�+rLOFFICECOPY (40$) 293-9696 APPROVED BY: DATE ��� SCALE trlgQ�0 jSHEEf OF