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13394 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER t BUILDIN4 APPLICATION & PERMIT 13394 ADDRESS _ 9 9 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL NER'5 PLAN CHECK VALIDATION NAME OTY. ELECTRIC PERMIT FEE // , P , VowD CONTITACTURs UTLETS-SWITCHES-RECEP 10.00/1.00 NAME C,%Q 4",4 ryl.i LIc.rvO LIGHTING FIXTURES 10.00/1.00 O .ONTHACTCA'e APPLIANCES-RESIDENTIAL 4.00 ADDRE55 S PHOrvEPANELS 10.00 Q DATE OF APPLICATION ARCMITECi I PANELS (OVER 200 AMPI 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEERse3.00 c.rva. SIGNS TRANS. Q ARCH.OH ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ADDRESS ZIP TEMP.METER OR POLE IN§,, 1). "t 20'.00 APPLICANTS MOTORS SEE FEE SCH- ) ADDRESS SERVICE CHANGE .x„ { Ci11301. ury w O o LICENSED CONTRACTORS DECLARATION n2�/a 7 v 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE w Q N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F m z Professions CI pppp license ism full force ort e 1. ❑ ❑ ❑ z O,�- License ss Lie.Numher q I°a Dale Contractor BUILDING PERMIT H N w ¢ OWNER-BUILDER DECLARATION INFORMATION X LL ILI - 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION YET. VALUATION oc LL 04 Law for the following reason.(Sea 7031.5.Busimessand Professions PERMIT ISSUANCE 10.00 -V N Code:Any city or county which relryiresa permitt ocoustruaLah"' ec Q 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -o a; requires the applicant for such permit to file a signed statement that TOTAL /330�_eA. PERMIT TO wm or he is licensed pursuant to the provisions of the Contractor's License r r z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE f x O STORIES TYPE CONSTR. IF I_$ the basis for the alleged exemption.Any violation of Section 7031.5 a ; _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($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 does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOORAREA TOTAL ACREAGE himselforthrough his own employees,provided that such improve- GAS-EA.SVSTEM-1 6.00 ments are not intended or offered for sale.If,however,the building or 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 did not build or im- RES IND CON Pe Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with 11 11 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.S. 6.00 ASSESSORS PARCEL NO. 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-OVER 5 IEA.) 1.00 contracts for such projects with a contortions)licensed pursuant to SEWER-SAN ITAR V-STORM EA.200ft110.00 TRACT NO. PARCEL NO. the Contractors License Law. ❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKERS'COMPF-NSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to sell'-insure, ZONING ENG.SITE NO. or acertificate of Workers'Compensation Insurance,or a certified x copy thereof(Sec. Co Lab.C.)ll F�4 Policy No. Company�/ Q O Cetlil'ied copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified,copy led troth the cid inspection division. MISC.- REFER TO ORD. Y❑ N Y ❑ NE] Applicant -f' CL CERTIFICATE OF EXEMPTION WORKERS'F",H PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. - W >_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. Y El N Y N❑ CL (This section need not be Completed if the Penntl is for one TOTAL D Z hundred dollars 1$100)or less.) U O I certify that in the performance of the work for which this per QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL our is issued,I shall not employ any person in any manner so as to Ow become subject to the Workers'Compensation Laws of California. BUILDING Dare ApplicantALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: If,after making this Certificate of 1!x- F ? emption,you should become subject to tare Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with AIR HANDLING UNIT(TO 10 C.F.M) 4.00 FEE U such provisions or this permit shall be deemed revoked. .� CONSTRUCT ION LENDING AGENCY AIRHANDLING UNIT(OVER IQOOOC.EM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance Of the work for which this permit is issued(Sec. MICROFILM 3097,CivTt HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC /3,3 Lender's Address 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county PLUMBING BOILER-COMP(3 H.P. r 100 00 ordinances and state laws relating to building construction. and . ,000 B.T.U.) 6. 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 against said City in consequence of the gran,y``ng of this permit MECH.CONT. LIC.NO. MECH. TOTAL TOTAL _ Signature o a[ure rApphcanllCon[raclor /f Date OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING � 1'1'HWIi NUMBER CITY OF CUPERTINO \ 3394 INSPECTION DIVISION l JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 11000 WOLFE ROAD UNIT# _LOT## 4 PERMIT EXPIRES IF WORK OWNER HEWLETT PACKARD CONTRACTOR FARRIS ELECT IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLABn PLUMBING 1U� I 0- • 7 ELECTRICAL J LEAN DATE1 MECHANICAL D c oc. ELECT. PLG. Me❑l Ci�Y ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI DING PERMIT INFORMATION WOOD FLOOR VALUATION siFr. PLUMBING MECHANICAL PeRMIr To ELECTRICAL 5/f cry FRAMING Yf•/~ STORIES TYPE CONSTR. INSULATION UCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED — SO.Fi.FLOON ANEA TOTAL ACHEPGf DIAPHRAGM ROOF BUILDING use NE$ IND CON PB 0".... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 ASSESSORS PARCEL NO. ROUGH PLUMBING TRACT N0. PARCEL NO GAS TEST MECHANICAL ACC.DATE ACC.FILE NO. ELECTRICAL FINALS DATE INSP. FRAMING SAN # 20NING ENG,SITE NO. INSULATION PLUMBING GAS FIRE SPR INK ENERGY TPG MECHANICAL v ❑ NE3 v ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. v SHEETROCK GRADE FEEE F] N v ❑ N❑ SUMMARY S SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC " LIJ ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING F- PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION.' OFFICE COPY