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16625APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LD1 NG PROJECT IDENTIFICATION 'APPLICATION&PERMIT BUILDING—ELECTRICAL—PLUMBING—MECHANICAL PERMIT NUMBER 16625- BUAFEEING - -�_ 7-[Qd�7 y1s' /OLL �L/GL WNER'S �`'i !�/Y -" PLAN CHECK VALIDATION _ P CITY. ELECTRIC PERMIT FE Tl R,ONTo=CTORS OUTLETS-SWITCHES-RECEP 10.00/1.00LIGHTING FIXTURES 10.00/1.00DORIES AO RESS PPLIANCES- RESIDENTIAL 4.00 _ O VHO I PANELS 10.00 DATE OF APPLICATION A CRIT T OR ENGINEER Llc. so. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. �+ SIGNS TRANS.3.00 ARCH. OR ADDRESS ENG SPECIAL CIRCUIT 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 ZIP 8 A- S ORE - - ... ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20 ' LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with . ection 7000) of Divis:,,):,no3 of the B samess and Profcsslons Code, I my license is In full I' License CI' s Lie. Isms c- Dalc !dL Contract ISSUANCE DATE BLDG. ELECT. PLG. MECH. BUILDINGRM PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that am exempt from the massaContractor's License Professions Low for tile Any city ersit to construct. orcoung ntson.(Srequirlapermit Code: Anymolish cor my which requiresn peror to its issuance, also improve, demolish, or repair any shuclure, prior to its issuance, also requires the applicant fur such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencingwith Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC. — REFER TO ORD PERMIT ISSUANCE ��+ VALUATION s' $/FT. ELEC. CONTE. LIC. NO. ELEC. © TOTAL -� PERMIT TO OTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): ALTER -DRAIN & VENT -WATER (EA.) 5.00 ❑ Las owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himscll' or through his own employees, provided that such improve - Wants are not intended Proffered forsale. If, however, the building FIXTURES - PER TRAP 5.OQ 50. FT, FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM -1INC. 4 OUTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im prove for purpose of sale.). 1, as owner of the property, um exclusively contracting with - . -.. GAS EASYSTEM OVER 4 (EA) 200 BUILDING USE RES IND CON PB Omer `13 El ❑ ❑ 1:1❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 -11 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 IEA.) 1,00 contracts for such projects Willi a conlractods) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec.—, BAP.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 WORKERS'COMPENSATION DECLARATION I 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 N0, copy thereof (Sec. 3600, Lab C -L Policy No. Company ❑ Cerlifi yis her' urn d. lff'Ce�' i N he city l ivision. Applic' FIRE SPRINK Y N ENERGY T-24 Y ❑ N� MISC.- REFER TO ORD. cERTIFICAT F EXE ON FROM WORKERS' PERMIT ISSUANCE , J6:60 oL FLOOD ZONE A.L.U.C. PLG. CONTE. LIC. NO. PLG. qq s� 010 TOTAL ^GOL C lPIiNSA ON INSURANCE (This section need not be completed if the permit is for one Yo N Y [:) N hundred dollars IS 100) or Tess.) I certify that in the performance of the work for which this per. mit is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING S BO become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TOMECH. 5.00 N01'ICIi TO APPLICANT: If, after making this Cerlificatc of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you innst forthwith comply with Such provisions or this permit shall be deemed revoked. APPLIANCE 5.00 AIR HANDLING UNIT (TO 1Q000C.F.M.) 4,00 PLAN CHECK FEE _rt �l AIR HANDLING UNIT (OVER 110ACC.F.M.) 6.00 SEISMIC FEE CONSTRUCT ION L17NDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT ITO 100,000 B.T.U.) 8.00 Lender's Narn Lender's AJAress Address HEATING UNIT 100;000 B.T.U.)9.50 ELECTRIC Cs �, VENTILATION FAN (SINGLE) 4.00 I certify that I have read Ihls i ppllcidimn and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and PLUMBING G12oZ q -� BOILER -COMP 13 H.P. or 100,000 B.T.U.) 6.00 801 LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspeclion purposes. MISC. - REFER TO ORD. (WC) e t save, indemnify and keep harmless the City of Ca no a' liabilities, judgments, costs and expenses which in ay accrue ag s 'id City in consequence of the PERMIT ISSUANCE 10.00 CONST. TAX ran' n is permit MECH. CONT. LIC. NO, MECH. TOTAL TOTAL(p lg of APPli•u r a eae OFFICE COPY V \ �I POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD � ;1PERMIT JOB ADDR ESS .%il •+CZ •�S T�/\�0� �L �// UNIT # ---LOT# OWNER pf/JG' tr LV�s CONTRACTOR E �N PERMIT NUMBER 16625 ' EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- 'ANCE OR 180 DAYS FROM LAST CALLED INSPECTION.. INSPECTION ATE INSPECTOR /INM RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS.. _ UFER . .PREGUNITE - - PERMIT VALIDATION G f �L' i• ISSUANCE DATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED .,UNDERGROUND/SLAB PLUMBING ELECTRICAL - MECHANICAL �� a BLDG ❑ ELECT. ❑ PLD. MECR 0 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED M pC BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBINGVALDATTON - SIFT. MECHANICAL ELECTRICAL PERMIT T ' FRAMING - INSULATION STORIF'.S TYPE CONSTR. I OCC CROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINALINSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so Fr FLOORARTA TOTAL ACREAGE -USE DIAPHRAGM ROOFSHEATHING' - ' BUILDING RES IND CDN PB Umrl ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SANA ASSESSORS PARCEL NO PLUMBING - ELECT. ENERGY TUBS BSHOWER PAN'- PLUMBING ENERGY TRACT NO �.. PARCEL NO MECHANICAL - MECH.ENERGY - ELECTRICAL � BUILDING ENERGY ACC DATE . ACCFILE NO FRAMING ELECT. FINAL TEST INSULATION I PLUMBING ZONING ENG. SITE NO. GAS TEST GAS - MECHANICAL, FIRE SPRINK Y ❑ N❑, ENERGY T@4 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ❑ N❑ A.L UC. Y ❑ N❑- INTERIOR SHEAR FIRE DEPT. SHEETROCK ("I GRADE FEE SUMMARY EXTERIOR LATH -%•� BUILDING - BUILDING d0•„I INTERIOR LATH TEMPORARY APR VALS SCRATCH COAT O' ELECTRIC PLAN CHECK FEE " GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE Is To OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM rz,,7.dd ARRANGE FOR INSPECTION BY PHONING 252-45051 ~,� ONE WORKING DAY BEFORE REQUIRED INSPECTION, PLEASE GIVE JOB ADDRESSWHEN PHONING. Z =SEE PERMIT FOR EXPIRATIONMECHANICAL DATE — ELECTRIC PLUMBING0'. CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL (� OFFICE COPY