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17511 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES :- USE •BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUIL INC , APPLICATION & PERMIT 17511 ADDRESS Yr BUILDING-ELECTRICAL-PLUMBING-MECHANICAL �� G-10 ef AINERS PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE !�1-PR('� W r e •�PHD�� CONTRACTORS _ _ UTLETS-SWITCHES-RECEP 10.00/1.00 NAME Qyp.,y/�_�f yy� /// Ic.NO: ( VT & LIGHTING FIXTURES 10.00/1.00 CONTRACTORS L. APPLIANCES-RESIDENTIAL 4.00 ADDRESS 57 1 . '/ PHONEa�g PANELS 10.00 DATE OF APPLICATION ` ARCHITECTPANELS (OVER 200 AMP) - 20.00 PLAN CHECK FEE P.C.NO.. DR ENGINEER LIC,NO. ' SIGNSTRANS. 3.00 ARCH.OR ENG. 1 PERMIT VALIDATION ADDHESS _ . SPECIAL CIRCUIT 5.00 - - ZIP EMP.METER OR POLE INS. . " 20.00 4. _�, 1-r•���I APPLICANT'S., - MOTORS SEE FEE SCH. ry `(J ADDRESS Q I SERVICE CHANGE 20.00 sJl��1 S� woo LICENSED CONTRACTORS DECLARATION it I hereby affirm that I am licensed under provisions of Chu Pter 9 " 'ISSUANCE DATE NG vai (commencing with Section 7000)of Division.3 of the Business and BLDG. ELECT. PLG, -MECH. H z Professions Cod aappdd mmy license is in full force no ffefl. - Is.1JVkl( Z,O - License lass vt� Lie Number ) Z ❑ mE w Date �.. _Contmctor - - - ¢ ea51, BUILDING PERMIT Se ¢ Q OWNER-BUILDER DECLARATION acaw U INFORMATION w w 1 hereby affirm that I am exempt from the Contractor's License IMISC. REFER TO ORD e- Law for the followingreason(Sec.7031.5,Business and Professions VALUATION $/FT, � - Code:Any city.,county Se which requiresa permit to construct.altaq PERMIT ISSUANCE 10.00 Q p ¢ improve,dl'1110I1511,O!repair any allllChlrl',prior to its issuance,aISU ELEC.CONTE. -• LIC.NO. ELEC. wO u requires the applicant for such permit to file a signed itincuu nl that _ TOTAL PERMIT TO m he is licensed m to the provisions of the Contractor's License ,. ��� rzQ Law(Chapter 9(cor ,fcom mencingwitb Section 7000)ofOivisiou 3 of the 1 Il foo Business wul Professions Code).or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE Se r o the basis for the alleged exemption.Any violation of Section 7031.5 T ,' STORIES- TYPE CONSTR. a ;�2 by any applicant for a permit subjects the applicant to u civil penalty ALTER-DRAIN -WATER (EA.) 5.00 ' of not more thud five hundred dollars(8500).)', ❑ I,as owner ot'the property;or my employees with weges usBACK F LOW'PROTECT. DEVICE - 4.00 their Sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of '-' Properly who builds or improves thereon,and who does such work FIXTURES.-PER TRAP 5.00 5f1 FC FLOOR AREA TOTAL ACREAGE himself re through his own employees,provided that such im building hients mself a not through his or employeffered rsale.lf,ed that such building GA$-EA.SYSTEM-,I INC.4OUTLETS 8.00 e..• or improvement is sold within one year of completion, the owner- GAS EASYSTEM OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or - . - . . im- BUILDING USE prove for purPOW Of sale.). INDUSTRIAL WASTE, 30.00 RES IND CON PB Other ❑ 1,as owner of the properly,am,exclusively contracting with , ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the.projmr(Sec. 7044,Business ILAWN SPRINKLERS-1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does Rol apply - to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM 200fl/10.00 The Contractor's License Law. - TRACT NO. PARCEL NO. ❑ 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 N0, WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. '• 5.00 . I hcrvby-flim'that I have a me nri'em o(c ns t t t sell-i 1 are, or 1 certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy the[4yj,fSc 013 ?.1 C.)."NO Policy N CO any O' ❑ C liked copy is hereby furnished. FIRE SPRINK ENERGYT-24 Z p A phwn �tln wp-ir ilh tti city inspection division. p: MISC.- REFER TO ORD. y❑. NO Y NO CC r2 h PERMIT ISSUANCE- ' CERT'IFICATE OI•EXIMRTION FROM WORKERS' FLOOD ZONE A.L.U.C. LU > COMPENSATION INSURANCE ' - PLG.CONTE. .LIC.NO. PLG. CL Z (Phis section need not be completed if the permit is for one TOTAL V❑ NO V ❑ NO hundred dollars IS 100)or Iris.), ' U OI certify that in the performance of the work for which this per- DTV MECHANICAL PERMIT FEE FEE SUMMARY LL U mil is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. y Date Applicant ALTER OR ADD TO MECH. 5.00 UI LDING } N NOl'IC17 'f0 APPLICANT: If,.after.makiog this Certificate of Ex- - •' F 2 emptiou,you should become subject to the Workers'Compensation 'APPLIANCE. 5.00 ^AN CHECK Provisions of the Labor Code, you must forthwith comply with E U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONST RUCTION LENDING AGENCY, AIR HANDLING UNIT(OVER IOAODC.RM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 - the Performwwu of the work for which this permit is issued(Sec. .MICROFILM 3097,Cie.C.). '.L'•. H EATI N G UN IT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 ' Lender's Address ELECTRIC' I certify that l have read this application and state thin filo above VENTILATION FAN (SINGLE) 4.00 -nformation is correct. I-agree•to comply with all city and county" PLUMBING coC.LJ �• ordinances and state laws relating to building'construction, and BOILER-COMP(3,H.P.or 100,000 B.T.U.) 6.00 -• herebhereby authorize representatives'ec this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL ,J •� y authorize riz property for sp of thison city purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- ' REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 1080 t,'ny�mg of[his per MECH.CONT. LIC.NO. MECH. - Z�1✓J )� j � I TOTAL55� TOTAL I [TeaA ✓NQ Stgnalure of Apph t/Cnnlractorramor Dateso 1 J OFFICE COPY o POST THIS,.CARD NEAR FRONT OF BUILDING , _ f F MrNUMBER . CITY OF GVERTINO p 17 11 ' INSPECTION.D I VISI ON JOB INSPECTION RECORD PERMIT EXPIRATION y ! v X13,. A64vcf Oct -U � NIT# �� LOT 4f 1., PERMIT EXPIRES IF WORK .OWNER _ 4P�Lv co"rRacroR ' If ` IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD- ' •Iso DAYS OF'PERMIT ISSU� FOUNDATION - I . - ANCE'�OR. i80;D I FROM . NOTE: - LAST CALLED INSPECTION.,,, UFER ALL GRADING AND DRAINAGEdSHALL BE~INSTALLED , PREGUNITE . TO COMPLY WITH THE APPROVED PLANS AND CIN OF ,PERMIT VALIDATION UPERT NO STANDARDS. 3r = t 1' - GARAGE SLABS ..0, �\S- h .,� :4g POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED '7 -UNDERGROUND /SLAB' . . PLUMBING - ' " ELECTRICAL - . '.;' :„ . 1,III •Iay C�:: .ISSUANCE DATE AR`3 MECHANICAL '' �.. tlLUC `,E LECs. PLG M ctgi of El. : C�] 00 NOT.POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - - ` BUILDING PERMIT ` - -r INFORMATION WOOD FLOOR EVALUATION. ' - SIFT., - 'PLUMBING � � � � � -- MECHAN ICAL� ELECTRICAL �� - PERMIT To FRAMING1• ` vf^'�-,iyl- INSULATION STORIES ,`TYPE CONSTR ..f .. .DCC.GROUP ARES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS,BEEN SIGNED + `ROOF NOTE:NO FINAL'INSP.SHALL BE MADE BEFORE 'so Er:F yooR AREq TOTAL na�encL DIAPHRAGM _ - THE CONSTRUCTION TAXIS PAID ROOF SHEATHING ^' ' I Ii Ps Na UILD`NG USEPtl APPLY NO-ROOFING UNTIL ABOVE HAS BEEN SIGNED „ ';;FINALS �': ' ,r;DATEw iINSP: �� '❑ ❑ :0 ❑ ❑f ASSESSORS PgRCEL NO. 'ROUGH � � � 'SAN.N " _ PLUMBINGr'" ELECT,ENERGY• TRACT No PARCEL NO, TUBS&SHOWER PAN .. - - PLUMBING ENERGY _ ` 'MECHANICAL MECH.ENERGY '+ - ELECTRICAL ' BUILDING'ENERGY. ACC DATE qcc.FILE No, FRAMING, ELECT.FINAL'TEST ZONING ENG.SITE No. INSULATION - - PLUMBING GAS TEST GAS - .. e F IRE SPRINK ENERGY L24 ". MECHANICAL Y — _ + - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ "❑ ❑ E] COVER EXTERIOR SHEAR , - ELECTRICAL RELEASE _sy_ FLOOD ZONE 'n.L.uc. . INTERIOR'SHEAR - FIREbEPi, : . - `d - I';YI "❑ ?"`❑ `N❑' SHEETROCK. _ - - GRADE FEE SUMMARY EXTERIOR LATH BUILDING :-,x- INTERIOR LATH _ - .TEMPORARY,APPROVALS "BUILDIN . . ' SCRATCH COAT '±++ +• ,] ELECTRIC ` tPL'AN CHECK GAS - ..EEE ' t NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY --' SEISMIC FE€>,� OCCUPANCY OF BUILDING ISNOT PERMITTEDUNT"ILBUILDING FINALISSIGNED BY BUILDING INSPECTOR' MICROFILM ARRANGE'FORINSP.ECTION BY PHONING,2524505, ELECTIRIC ' H� . ' ONE WORKING DAY.BEFORE REQUIREDANSPECTION PLUMBING 'I I 1 O PLEASE GIVE'JOB ADDRESS WHEN PHONING z SEE PERMIT FOR EXPIRATION,DATE = MECHANICAL J •, ' ='° IMPORTAN' . coNsr.TAx' PLEASE' READ REVERSE SIDE BEFORE . CALLING FOR FINAL INSPECTION. TOTAL ,E OFFICE COPY .