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16065 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY PERMIT NUMBER `- - BUILDING PROJECT IDENTIFI TION APPLICATION & PERMIT % DG"D,NG ° 16065 1G AD as ' BUILDING-ELECTRICAL-PLUMBING-MECHANICAL zaB -- IJP � / Ow(a ER's PLAN CHECK VALIOATIO 3V &AFIE CITY. ELECTRIC PERMIT FEE • '56D5 c /Sl NAMERAcroR's UTLETS-SWITCHES-RECEP 10.00/1.00 L,c-No. 'I'35"' g J LIGHTING FIXTURES 40:0071'00 -" cONTRACTOR3 PPLIANCES-RESIDENTIAL 4.00 \ / AooREss p Y a7 ` HONE `s PANELS 10.00 DATE OF APPLICATION OgCNITECT r.�• PANELS 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No, SIGNS TRANS. 3.00 ARCH.OA ENG. A°oREss z�// SPECIAL CIRCUIT 5.00 PERMIT VALIDATION LO Jere b nP v1p EMP.METER OR POLE INS. 20.00 APPLICANT'S 9yDS( MOTORS SEE FEE SCH. ADDRESS (� SERVICE CHANGE 20.00 woo LICENSED CONTRACfO S DECLARATION a u u I hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE 1�¢ w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. -MECH. y D A F 7 i Professions Code,it my license is in full foe•'ne E3 1:1 1:1 ❑ z - Lic.Number 4 o Liters CI H.w Date Contractor 7 ¢ Y E BUILDING PERMIT tl: w u OWNER-BUILDER DECLARATION INFORMATION X ;e. w 1 hereby affirm that I am exempt from[he Contractor's License orMISC.- REFER TOO vgLUATION a. Law Law for the following reason.(Sec.7031.5,Buslnessend Professions PERMIT ISSUANCE 1QV� w Code:Any city counly which requires a permillo construct,alter. peJ'j`�' QQ Q Improve,demolish,or repair any structure,prior to Its Issuance,also ELEC.CONTR. LIC.NO. ELEC. Orr requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO o. w m u he is licensed pursuant to the provisions of the Contractor's License �_ Hi z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /�'r�,g2 •1/.T Q,d� a Business and Professions Code)or that he is exempt therefrom andCITY. PLUMBING PERMIT FEE It 1- the basis for the alleged exemption.Any violation ofSection 7031.5 STORIES TYPE,CONSTF. by any applicant for a permit subjects the applicant toacivil penally ALTER-DRAIN -WATER (EA.) 5.00 of not more(ban five hundred dollars($500).): ❑ 1:as owner of the property,or my employees with wages as BACK F LOW 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 • properly who builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SG.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mepts are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that h .e did not build or im- RES IND CON PB Other prove for purpose ofsale.). INDUSTRIAL WASTE INTER3000 ❑ I,as owner of the Property,am exclusively contracting with . . ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-I INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 con tracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. - the Contractor's License Law. ❑ I am exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure' ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). Policy Nca r-P 0 ❑ Certifie copy is hereby in at he - FIRE SPRINK ENERGY T 24 z ❑ Certif c Is filed ! ,e city inspection division. MISC• REFER TO ORD. 0^ Applicant Y[:] N❑ Y ❑ N❑ Hy - PERMIT ISSUANCE - 10.00 FLOOD ZONE A.LU.C. = CERTIFICAT OF EXEMPTION FROM WORKERS' 111 > COMPENSATION INSURANCE PLG.CONTR. uc.NO. PLG. CL C) (This seettoo need not be completed if the permit is for oe nTOTAL Y[JN❑ Y❑' NE]N hundred dollars($100)or less.) U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Com ensation Laws of California. O w p BUILDING .SV a Date Applicant ALTER OR ADD TO MECH. 5.00 } U1, NOTIC17 TO APPLICANT: 11,after making this Certificate o1'Ex- F- ? empthem,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you nmsi forthwith comply with FEE f,) such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 100MC.FM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT). 5.00 3097 performance of the work for which this permit is issued(Sec.. HEATING UNIT(TO 100,000 B.T.U.) 8.001 - MICROFILM Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC is I certify 11,311 have read this application and slate Ila,the above 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-DOW(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. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue agai t said City in consequence of the rap ' of is permit. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Khmer re of lie t ontractor Uute f OFFICE COPY POST THIS CARD NEAR FRONT OF'BUILDING' �• PERMIT NUMBER - I CITY OF ^.CUPERTINO : 16065 �F INSPECTION DIVISION JOB INSPECTION RE " CORD • JOB ADDRESS ' r PERMIT EXPIRTION # T' r' PERMIT EXPIRES IF WORK ' OWNER CLe-pC E ,Qw CONTRACTOR IS NOT STARTED WITHIN' r INSPECTION1%1� DXTE INSPECTORI INSPECTION RECORD - 180 DAYS OF PERMIT ISSU FOUNDATION ' - nNCE OR 180 DAYSFROM NOTE: - LASTCALLED INSPECTION'.'f! ' UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF. PERMIT V.LIDA ION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB _ f PLUMBING ELECTRICAL ' ISSUANCE DATE MECHANICAL � PLOD. ELECT PLG. MECH. P611) ❑ ❑ ❑ ❑' 00 NOT POUR FLOOR UNTIL LOOINFORMATION ILVE HAS BEEN SIGNED SEP 2 I UIIT WOOPLUMBINGATION - 'S/FT. MECHANICAL CdY 0f upe ELECTRICAL PERMIT TO` "'£• FRAMING - - IM/T�R/0.�.//-f /LO✓ INSULATION - - STORIES TYPf CONSTR. . OCG GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SD.FT FLOOR AREA TOTAL ACREAGE • ROOF NOTE:NO FINAL'INSP.SHALLBE MADEBEFORE . ' DIAPHRAGM THE CONSTRUCTIONTAX IS PAID 'BUILDING USE ROOF SHEATHING - RES IND GONE-„ae APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS .DATE INSP. ❑ ” El � �E' ``O E-] .ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY -- TUBS&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 . GAS TEST - G'AS • MECHANICAL FIRE SPRINK ENERGY T.24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING "� NE] FL000 zoNE ALuc. EXTERIOR SHEAR,' - ELECTRICAL RELEASE INTERIOR SHEARFIRE DEPT. v❑ "❑ Y ❑ rv� SHEETROCK - GRADE - FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH - TEMPORARY.APPROVALS BUILDING . . SCRATCH COAT - - ELECTRIC - PLAN CHECK GAS v FEE, NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE cro r OCCUPANCY OF BUILDING ISNOT PERMITTED_UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505,'.~ ELECTRICd � � ONE WORKING DAY BEFORE REQUIRED INSPECTION.. _ PLUMBING ! z PLEASE GIVE JOB ADDRESS WHEN PHONING. ol — SEE PERMIT FOR.EXPIRATION DATE — MECHANICAL;, ^�S". CONST,TAX ' IMPORTANT! PLEASE READ REVERSE SIDE BEFORE $ T• ' ' TOTAL CALLING FOR FINAL INSPECTION. Y OFFICE COPY `— F