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15237 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLYBU _ { 'PERMIT NUMBER DING TNG PROJECT IDENTIFICATION APPLICATION ' 15237 uUILR Nc • dry/, a/kfz^ • ADOREss 'b ✓V Is O r ate. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL Ow ER'S PLAN CHECK VALIDATION NA En P ( QTY. ELECTRIC PERMIT FEE py''/�/!^/' `; 1 ll/k J• PHONE �'� ! a / CONTRACTORSI OUTLETS-SWITCHES-RECEP 10.00/1.00 NO�TAME W/1I1W, A 1 1 `•I'J�rrn/- Llc.N4o Cu LIGHTING FIXTURES 10.00/1.00 � roNTRAcroRS �y{p y�SAPPLIANCES-RESIDENTIAL 4.00 Aoonsss /„��,�, ((JJ 1l,, Z5 e I.'(/ PHONE Z 2 0-q,?W PANELS 10.00 DATE OF APPLICATION `. ARCHITECTPANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc,No. SIGNS TRANS. 3.00 AADDRESS SPECIALCIRCUIT RCH.OR ENG. PERMIT VALIDATION / 5.00 ZIP TEMP.METER OR POLE INS. 20.00 AMICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 o a o LICENSED CONTRACTORS DECLARATION C a L,u I hereby affirm that I am licensed under provisions o(Chxpter 9 ISSUANCE DATE H a w (commencing with Section 7000)of Division 3 ,f the Business and ELECT. PLG. MECH. Pret(ession,Cod, d my license is in full I'o pui}dfy.tpD ❑ ❑ z o" LicensLLClass S7 hie.Number�/YJ ji w H Datc�f.23-Contractor�^yJ _6y(,a. - a y s �'� U LDING PERMIT ¢ ¢ w < OWNER-BUILDER DECLARATION INF ATION w3 A N 1 hereby affiDu that I ant sxenmt from the Contractor's License MISC.- REFER TO ORD a_ o a Law for the following reason.(Sec.7031.5,liusincssand Prol'essioos PERMIT ISSUANCE 10.00 N S/FT. H - Code:Any city or county which requires a permit to construct,alter, ' QQ Q 20 Improve,demolish,or repair any Sfruelure,poor 10115 issuance,also ELEG CONTR. LIC,NO, ELEC. O u requires the applicant for such permit t0 file a signed statement that TOTAL / PERMIT a w m be is licensed pursuant to the provisions of the Contractor's License Hza Law(Chapter 9(commencing with Section 7000)oI'Division 3ofthe i o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢ H o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. n; m by any applicant for a permit subjects the applicant to a civil penaltygLTER-DRAIN& VENT-WATER (EA.) 5.00 of not more than five hundred dollars(S500).): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS the it sole coupcnsalten,will do the work,and the structure is not intended or offers([ for sale (Scc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 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 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- meets are not intended or o(fercd for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 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 dad not build or im- provefor purposcofsale.). INDUSTRIAL WASTE INTER. 30.00 RES Irv! CON vR Omer O 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ 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 docs eat apply b)an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts for such projects will,u co rrelons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. 0 lam esempl under Sec.-,IL&P.C.lie this WATER HEATER W/VENT 6.00 !Cason Owner Date WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hcrcby umrm that I have, ertifican•of consent to elf-insure, or a cenlf¢at�eg�of Workers'(41Mtemadion Insurance,or a certified ZONING ENG.SITE N0. Copy Cher¢e�µ(O 3R $.C.).�Ilir Policy Nok Gs�-O( any O Certitic mhy fur FIRE SPRINK ENERGY T 2 z_� 0 Cenil is s tilpl t tl�^Sty inspection division. MISC.- REFER TO ORD. v N v N Applicant_ _ ❑ ❑ ❑ ❑ CC w CERTIFICATEOF IiXli\IpTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. > COMPENSA'T'ION INSURANCE PLG.CONTR. LIC.NO. PLG. CL 0 (1[its Seel hie sed not be completed if the pemttt is for one TOTAL Y❑ N❑ Y ❑ N❑ Z) Z hundred dollars(S 100)or less.) U O 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H' mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. O w ) p BUILDING ¢- Dun+ ICAN 1:n1 ALTER OR ADD TO MECH. 5.00 } v3 NOTICE TO AunfldCANT: II',utter making This Cell iom,c ,a P;x- engrtiion you shouldbecomesubject 1.tire Workers'Ccomply vith APPLIANCE 5.00 PLAN CHECK provisions io the Labor Code.shall you mull drevoke comply with FEE U wch provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 110,000C.F.M.) 6.00 SEISMIC FEE eaZ Zs- 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 tire performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.CJ. HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(0 VER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address I certify 1hu11 have mud ills appllcalton:uul slate flim the allot VENTILATION FAN (SINGLE) 4.00 information is correct,I agree 10 comply with all� cit and count PLUMBING ordinances and state laws relating) y y BOILER-COUP 13 H.P.or 100,000 B.T.U.) 6.00 m building construction, and hereby authorue representatives of this city to enter upon the BOILER-COMP Over 100,000BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indenmify and keep harmless the City of MISC.- REFER TO ORD. mrtino uguinsI liabilities,judgments, costs and expenses which CONST.TAX w in any esu ac a against ss City in Corse ren • of the PERMIT ISSUANCE 10.00 ting of this ps 11. ECH.CONT. UC.NO. MECH. \y\ 1;fgoI TOTAL TOTAL a /\\ Signe tureof pelican Dere gar Ute ✓✓✓✓✓ OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15237 INSPECTION DIVISION JOB INSPECTION RECORD I =PERMIT FjXPI RATION JOB ADDRESS �� PL-Fc T�Q UNIT# _LOT# � PERMIT EXPIRES IF WORK OWNER �, CONTRaCTOR E' z�t IC-7IS NOT STARTED WITHIN INSPECTION D TE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATIONANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PR EG UNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB p,/ /�J f' PLUMBING ( 1 b '� F' d�-: . (`USS 3`eC� rr ! ELECTRICAL l ISSUANCE DATE MECHANICAL �i_I6 C e f RLuc ELECT PLc. l I ❑ El 1:1-0-1 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ok C15 h3oOV 4n5 e.,p eP• Li,`Z' BUILDING PERMIT INFORMATION WOOD FLOOR -to C',N - ILLATION SIFT. PLUMBING -3b -8b e. eG A) tooLlf I %�_zC B OYrbl MECHANICAL ELECTRICAL Peunln r FRAMING INSULATION STORIES TYPE CONSTR Dcc.GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLOOII IIA TOTALACREAGI: ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID auILOI usE ROOF SHEATHING RES INO cONory PR Du.., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. � ❑ ❑ 0 ❑ ASSESSORS PARCEL NO ROUGH SAN.# 1 PLUMBING ELECT:ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC OarE ACC FILE No ELECTRICAL - BUILDING ENERGY ! FRAMING ELECT.FINAL TEST zoNiNc ENc.SITE Na INSULATION PLUMBING ' GAS TEST GAS FIRE SPRINK ENERGY T.19 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' ' ❑ N❑ . ❑ N� FLOOD zome A.Luc. EXTERIOR SHEAR ' ELECTRICAL RELEASE N❑ N INTERIOR SHEAR � FIRE DEPT. L7 ❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING p-e� • SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY.PHONING 252-4505, ELECTRIC Ul O�P ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY