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15060 APPLICANT TO FILL IN INFORMATION WITHIN-RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT � A s 15060 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL N 'S PLAN CHECK VALIDATION N r/ OT�Y. ELECTRIC PERMIT FEE 1 VpHONE TRAC O S -('- ME UTLETS-SWITCHES-RECEP 10.00/1.00 W� M { S PIVe Ic.No..5 2- LIGHTING FIXTURES 10.00/1,00 �" ^ CONTRACTOR'S APPLIANCES 4.00 ADo�nlliss " - f s tw/ .SNN/J O GQHONE 3�I�j OI. PANELS 10.00 GATE OF APPLICATION . opcmTEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. . E En t uc.N SIGNS TRANS. 3.00 ADON,SR NG. I SPECIAL CIRCUIT '5.00 PERMIT VALIDATION C/ EMP.,METER OR POLE INS. 20.00 APPLICANTS ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 F0 O LICENSED CONTRACTORS DECLARATION aewi I hereby affirm that I am licensed under provisions of Chapter J $DANCE DATE y w (commencing with Section 7000)of Division 3 of the Busines nd D^Ps�A BLD ELT. PLG. MECH. r N z Y Professions Code I y license is in full for :yI l� PUT oD License ss Lia Number L , ,0,i= w Lice Contractor \ m s C�51-. P `A ING PERMIT ¢ «w OWNER-BUILDER DECLARATION CV MISC.- REFER TO ORD t INFORMATION E: ;LL R I hereby affirm that I am exempt from the Contracmri License w VALUATION' Hu Oa Law forthe following reason.(See.7031,5.Business and Professions PERMIT ISSUANCE f f Code:Any city orcountY which requires a permit to construct,alter, %O �1}� �s- improve,demolish,orre airaB ELEC.CONTR. LIC.NO. s0 rt 4 O p p'' Y sl mel are,prior to its issuance,also ELEC. 'J/ / O u requires the applicant for such permit to file a signed Statement that _ TOTAL CJ PERMIT TO E: ro va ho is licensed pursuant to the provisions of the Contractor's License Sal��/ /`0 N r z a Law(Charter 9(commencing with SCUlum 7000)o f Division 3 ofthc H Business and Professions Code)or that lie is exempt therefrom andQTr V. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 / STORIES TYPE CONSTR. age by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA) 5.00 of nm..lore than five hundred dollar,f$500).): . - ❑ I,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 docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 590 himself or through Ills own employees,provided that such Improve- O SD.FT.FLOOR AREA TOTAL ACREAGE ' C menu a no not intended or offered lot sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will have the burden of proving that he did not build or it,- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PS oma, ❑ 1,as owner of the property,ant exclusively contracting with ❑ 0 ❑ 0 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who huilds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with x contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO, PARCEL NO. reas❑on I am exempt under Sec._,B.&P,C.for this WATER HEATER W/VENT 6.00 CivetCivet, Date WATER SYSTEM 5.00 ACC.DATE ACL.FILE NO. WORK ERS'COMPENSAT'ION DECLARA'r1ON WATER TREATING EQUIP, 5.00 1 hereby affirm that I have a cerlificate of consent to self-insure' ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified - copy the rr�ppfj�Seyy' 38gpB,I,,/L� b�j 1c� 2o�kL Policy Nd7-L�py is h ereby f / Q ❑ Certilied copy is hen:by furnishnl' FIRESPRINK ENERGY T-24 Z Z Certified p is filed with the city Ins ectign"��vision. F p.. Applicant S��i'wl-CriNS:�-p�� MISC.- REFER TO ORD. Y � NE] YE] NQ J PERMIT ISSUANCE Itm- CB RTI FICATE OI�IiXEMI''1'ION PROM WORKERS' Id-^ FLOOD ZONE A.L.U.C. LUQ COMPENSATION INSURANCE PLG.CONTR. - LIC.NO. PLG, �a CL Z( This section need not be completed if the permit is for one TOTAL y❑ N� Y 0 N� hundred dollars CS 100)or less.) U O 1 certify that in the performance of the work for which this Per, PTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person in any manner so as lu Owbecome subject to the Workers'Compensation Laws of California. BUILDING `Sb y Datc Appt¢am ALTER OR ADD TO MECH. S00 47 } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- - F Z caption,you should become subject la the Workers'Campensatmn APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be maimed revoked AIR HANDLING UNIT(TO 10=C.F.NL) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE - 4 ,V 1 hereby affirm that there is n 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Names ELECTRIC- 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.1 agree to comply with all city and countyg01LER-COMP.(3 H.P,of 100,000 B.T.U.1 6.00 PLUMBING p j7 ordinances and stale laws relating to building construction, and harehy ent7mrize representatives ec this city to enter upon the BOILER-COMP (Over 100,000 BTUI SEE FEE SCH. MECHANICAL uerchy authorize properly for inspection purposes. v (We) agree o save, indemnify and keep harmless the City of MISC.- . REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX PERMIT ISSUANCE 7b-00 may in any way.accrue against said City in consequence of the fun ling of this permit e MECH.CONT, LIC.NO. MECH: ��ts S � 7/sr ISD °TALp / �= TOTAL �d0 Signature of A ppheanl/ atm Date '.OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PEdmIr NUMBER ' CITY `OF CUPERTINO 1 X060 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS // `�7 CYTO n/ )K UNIT# LOT# ' �/-•, PERMIT EXPIRES IF WORK ' DOE NER vcIQC( CONTRACTOR /�J So/t/c L..�/J IS NOT STARTEDWITHIN INSPECTION DATE I INSPECTOR INS E Tign RECORD -180DAYS OFPERMIT ISSU- FOUNDATION - -'L�_ NOTE: ANC. OR 180 DAYS FROM UFER . - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PF.RMrt VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �- Qlerz> 0 2tcceIF 0117 UNDERGROUND /SLAB PLUMBING . � - Ufl BV' (Mrd�r��,a, m�.µ cr ELECTRICAL PjorAb1YU C) K Sar 7'-,A,,,`i 1450r ISSUANCE.Uaif: iLUG ELECT. PLG. MFCH " MECHANICAL _ P . `❑,• � ,Q a DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED � 2 ILDING PERMIT WOOD FLOOR . V INFORMATION PLUMBING TION grPT. MECHANICAL l(.ci�d d'O FRAMING ELECTRICAL - - g Pe RnHT rD STORIES TYPE CONSTR, ' INSULATION „ OCC GROUP RES UNITS PLACE NOSUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO fT.FLOOR AREA TOTAL ACRE AGE 1 ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID ROOF SHEATHING HIS IND ILOCOON USEPB0"',, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 11 El F-1 ASSESSORS PARC ROUGH � SAN.k . EL NO PLUMBING - q-3o-1Fr/ ELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING'ENERGY \L f MECHANICAL MECH.ENERGY \\ ACC DATE ACC.FILENO ELECTRICAL . BUILDING ENERGY N FRAMING Pe. ELECT.FINAL TEST ll ZONING ENG SITE NO, INSULATION J- - - PLUMBING GAS TEST GAS i( FIRE SPRINK ENERGY LP< MECHANICAL ll COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING " ll Y "� "� EXTERIOR SHEAR ,l2-$1;j ELECTRICAL RELEASE 11 FLOODZONE A.L UC INTERIOR FIRE DEPT. vO NE] Y ❑ N❑ SHEETROCK IGRADE FEE SUMMARY EXTERIOR LATH BUILDING ' INTERIOR LATH TEMPORARY APPRO ALS BUILDING •.,S�AT . SCRATCH COAT - ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE td a OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR, MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ~O� ONE WORKING DAY BEFORE REQUIRED INSPECTION. 0-0 PLUMBING z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL as CALLING FOR FINAL INSPECTION. OFFICE COPY