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18295APPLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION N&PERMIT APPLICATIO/Oy00Vo ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER ;q OG .[ AO. IND a,OREs/3e eod F3!�F7BUILDING- S-0 14 OWN 'S raAME (409 e 1 uc Q PHONE OTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ^`1 OQ 1 w 1 / r l� `� f^` 1, APPLICATION CONTRACTOR'S CONT /n� //OUTLETS 2 r/G1� uC Na 6 -SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ORs OREss ADDRESS (/ PHONE Z APPLIANCES 4.00 PANELS 10.00DATE ARCHITECTPANELS ENGINEER _G.ND. (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NN O. K SIGNS TRANS. 3.00 ADDRESS erect SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zlP EMP. METER OR POLE INS. 20.00 �� l 0 tY/ ADDRESS �phn Ls.ca ADDRESS S % IZlo W. Washrl,y A-Vc x I SUnn vu le • CR ,,v, MOTORS SEE FEE SCH. SERVICE CHANGET 20.00 - LICENSED CONTRACTORS DECLARATION /s IMPBLD I hereby affirm that I am licensed under provisions of Chapter 9I (emnmencing with Section 7000) of Division 3 of the Business and Professions Code, and in, license is in full force and effect. License Class Lie. Number Date Contractor ISSUANCE DATE ; ELECT. PLG. MECH. Pi1u of CURD ifM BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contract.,', License Law for the following reason, (See. 7031.5. Business and Professions Code: Any city or county which requiresa permit tocorotruct. alter, a�C��� M TSC.- REFER TO ORD PERMIT ISSUANCE 10.00 /VALUATION y LUATI/ Z//(J S/FT. ELEC. CONTR. LIC. NO. ELED. TOTAL improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement That Ire is licensed Pursuant to the provisions of the Contractors License Law (Chapter 9(Eoninu,p,ngwill, SEctun 7000) ulDivision 3oflhc Business and professions Code) or that lie is exempt therefrom and ` PERMIT TO I11'�'EVl I MOVE IY F-' QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis (or The alleged exemption. Any violation of$ection 7031.5 by any applicant for it permit subjects the applicant Toa civil penalty of nut more than five hundred dollars ($500).)'. ALTER -DRAIN -WATER IEA.) 5.00 ❑ I, as owner of the properly, or my employees with wages as their sole coripensation, will do The work, and The structure is not BACK F LOW PROTECT. DEV ICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 intended or offered for sale (Sac. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owrier of FIXTURES - PER TRAP 5.00 so. ET. FLOOR AREA TOTAL ACREAGE property who builds or improves thereon, and who does such work himself or through his awn employees, provided that such improve- meats are not intended or offered for sale. IL however, the building GAS -EA. SYSTEM-11NC.40UTLETS 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 famposeofsale.). ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PS Other p ❑ p ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 licensed Eon Vectors to construct The project (Sec. 7044, liminess and Professions Code The Contractors License Law does not apply to an owner of properly who builds or improves thereon, and who LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. The Contaor suchts Lwith acmptructorts) licensed pursuant contracts fctor', License License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ Iamexemptumder Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Dat, WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WORKERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to sell -insure, or a certificate of Workers' Conhpensation Insurance, or a certified , ZONING ENG. SITE NO. copy thereof (Sec. 3800. Lah.C.). Policy No. Co pony FIRE SPR INK Y❑ N❑ ENERGY T24 Y❑ NN[:]I ❑ Certitcd op 777=7is crchy - rn ed y ti n`ificJ lair+k l city usP,ction division. ApFy k u MISC.- REFER TO ORD. CERT' ILFIGCI'Ii OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTE. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE 1'1'his section need not be Completes! if the permit is for one YE] N ❑ Y ❑ N ❑ hundred dollar, IS 100) or Icss.) I ev,tity amt in tile pi,im'mance of the work for which this per mil is issued. I shall riot employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant QTY. - MECHANICAL PERMIT FEE ' FEE SUMMARY Z ALTER ALTER OR ADD TO MECH. 5.00(Q53 N APPLICANT': If, after taking this Certificate of FS ifilim? ye you heLbor mee.byo to ustWrthwithcoyxmston APPLIANCE 5.00 provisions io ire Labor Code, you must forthwith comply with the such provisions or this permit shall be JecmcA revoked. AIR HANDLING UNIT (TO 10,000 C.F.M.) 4.00 _ AIR HANDLING UNIT (OVER 10PMC.F.M.) 6.00 FELECTRIC 15 - CONS'T'RUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the per ioReance of the work for which this permit is issued (Sec. T. Name HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OVER 100,000 B.T.U.)9.50 Lender's Lender's Address I certify that l have read this application andsate thm l he above VENTILATION FAN(SINGLE) 4.00 information is correct. I agree m comply with all city I'dcounty ordinances and state laws relating to building on Rut inanJ PLUMBING BOILER-cOIY1P 13 H.P. Dr 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby vETho,i,e represenatives of this city w enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and cep hanmless the City of Cupertino against liabilities, judgme , costs and expehses which may in ny s�ry accrue against City in c.nsCyuOmce of the PERMIT ISSUANCE 10.00 rumin Of th' MECH. CONT. LIC. NO. MECH. TOTAL TOTAL Sig 4r, r, fApplicunl bftrTactor Uum OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF I CUPERTINO INSPECTION DIVISION JOB INSPECTION RECO D '/ [ / JOB ADDRESS -112-70 I/✓d {'{� �` UNIT_# _LOT# �j OwrvER J- Cl. CONTRACTOR PERMIT NUMBER 18295 TMIT EXPIRATION `h ,f RMIT-EXPIRES IF WORK IS N0 9TARXED WITHIN 180 DAYS OF PERMIT ISSU" ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DATE INSPECTORy�,. INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. `a" 4�'/l UFER PREGUNITE PEHMn VALUATION r- -b/• ISSUANCE LIATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGREO I, UNDERGROUND/SLAB PLUMBING 1989 ELECTRICAL- MECHANICAL IO ot Comm BLoy © ELECT PLG. MECH ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED I BUILDING PERMIT INFORMATION WOOD FLOORYVALUATION (V SIFT. PLUMBING MECHANICAL PERro�It ro ELECTRICAL FRAMING STORIES TYPE CONSTH INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS'BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID $fl.li I'I, V(IH ANCA TOTAL. ACREAGE DIAPHRAGM -BUILDING ON USE Hes IND CON PR om., F-1❑ El 1:1 ❑ ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH. - SAN.# PLUMBING ELECT. ENERGY THAC1 NO PARCEL NO TUBS &SHOWER PAN PLUMBING ENERGY MECHANICAL MECH. ENERGY ACC GATE ACG FILE NO ELECTRICAL BUILDING ENERGY ' FRAMING ELECT, FINAL TEST ZONING ENG. SITE NO. INSULATION PLUMBING GAS TESTGAS ' FIRE SYHINK v ❑ N❑ ENERGY T-74 , ❑ N❑ MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD LONE `" ❑ N❑ ALUC t ❑ No EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. FEE SUMMARY SHEETROCK GRADE EXTERIOR LATH BUILDING BUILDING'= INTERIOR .LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK F EE " GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY - OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM .� ARRANGE FOR INSPECTION BY PHONING 252-4505, LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! • PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL / OFFICE COPY