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12606 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMITNUMBER r BUILDING APPLICATION & PERMIT - ADORES n 12606- ��ZO • IJOHK \11r BUILDING-ELECTRICAL-PLUMBING-MECHANICAL I OWNER'S PLAN CHECK VALIDATION X NAME . - QTY. ELECTRIC PERMIT FEE ICS j�.!�� PHONE Sb 2-2, CONTRACTOR'S NAMF ( p �/OUTLETS-SWITCHES-RECEP 10.00/1.00 0 CVS[r a.jl�HhQ. Jr) LIC.No.�f- LIGHTING FIXTURES 10.00/1.00 t r,DrvTEACTDBs APPLIANCES-RESIDENTIAL 4.00 IO6Z�.. r'Q/(q U1 ONE I �'� PANELS 10.00 DATE OF APPLICATION ' ARCHITECT PLAN CHEC7 P.C.N0. DR PANELS (OVER 200.AMP) 20.00 ENGINEER - ' LIC.No. SIGNS TRANS. 3.00 TRCH OR ADDRESS ENG SPECIAL CIRCUIT - 5,00 PERMIT VALIDATION ZIP FEMP.METER OR POLE INS. 20.00 APPLICANTS ADDDRESSDRESSMOTORS FEE SCH. SERVICE CHANGE -20.00 'I9/ woo LICENSED CONTRACTORS DECLARATION APR Lyl/( � ` a I hereby affirm that 1 am liceGINd under prOvT pre 1'1 f'IISSS NC(E Odd111 (commencing with Section 7000)of Division 3 ofthe usin �n < �. BLDG. E ECT. PLG. MECH. H N w Professions Code d my license is in full fore,a f L / ❑ Q i _ O - License Class Lic.NumberC�y of H w Date-- � Contractor Q'y E ¢ ¢¢ OWNER-BUILDER DECLA TION BUILDING PERMIT 0 d v INFORMATION X ; y 1 hereby affirm that I am exempt from t e Contractor's License MISC.- REFER TO ORD . Fuoj Law for the following reason. 7031.5,Business and Professions PERMIT ISSUANCE 10.00 - VALUATION -$/FT. Code:Any city or county which requires a permit construct,alter, ¢ ¢ ¢Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. r� �, - /�V v V wO¢ requires the applicant for such permit to file asigned statement that TOTAL p'-O PERMIT TO $ y he is licensed pursuant to the provisions of the Contractor's License- HZ > Law(Chapter 9(commencing With Section 7000)ofDivision 3 of the '')1 4 o Business and Professions Code)or that he is exempt therefrom and. QTY. PLUMBING PERMIT FEE /'7��v/ 7-L the basis for the alleged exemption.Any violation of$eclion 7031.$ - 1 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 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 whoo-builds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 50.IT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SVSTEM-1 6.00 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 RES IND CON PB Other prove for purpose of sale.).p INDUSTRIAL WASTE INTER. 30,00 ❑ d as owner of the properly the exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors In construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's Licensedoes not apply to owner of property who builds improvess thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts onts for such projects with a contrtractorfs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL N0. ❑ I am exempt Under Sec. ',BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Dale WATER SYSTEM 5.00 ACC.DATE ACG FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate Of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a Certified ZONING ENG.SITE NO. copy thereof(Sec,3800,Lab.CJ. - - �: Policy No. Company Q ❑ Certified copy is hereby furnished I FIRE SPRINK ENERGY T 24 Z Z ❑ Certified copy is filed with the city,inspection division. MISC.- REFER TO ORD. (] Applicant Y❑ N❑ Y ❑ N❑ ~ rn�. PERMIT ISSUANCE 10.00 LU CERTIFICATEOFCOMPENSATION INS FROMWORKERS'.ERS' FLOOD ZONE ALu c. W COMPENSATION INSU RA NCE PLG.CONTE. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑ j Z (This section need not he completed if the permit is for to TOTAL hundred dollars($100)or less.) U O I certify that in the performance of 1 erlL which t er- QTY. MECHANICAL PERMIT FEE FEE SUMMARY EL I- mit is issued,I shall not employ any iso n' to O W becom�¢'�ub��'e��y{t Workers'Com 5a n o s of y Da1e�LVpplicant ALTER OR ADD TO MECH. 5.00 BUILDING O 4 } ED NOTICE TO APPLICANT: If,a to makm ¢ate of Ex- L.. ? emptim"you should become subje to the•Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, yo must forthwith comply with - FEE U 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 10=C.RM.) 6.00 SEISMIC FEE 77 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,Civ.C.). t - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC �G - y, Lender's Address '.� I certify that 1 have read this application and state that theabove VENTILATION FAN (SINGLE) 4.00 - -l' information is correct.1 agree to comply with all city and county PLUMBING ordinances and,state.laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 ,r -.. 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 kt harmless the City of MISC.: REFER TO ORD, Cupertino against li iliti , udjB encs [s and expenses which' CONST.TAX may in any v�uy a�Pcrue , nsr.-sgt in consequence oF[he PERMIT ISSUANCE 10.00 - grantingoftlrlpeltlt MECH.CONT. LIC.NO. MECH. h _ -10-F TOTAL TOTAL l0 a 7 Signature pp mant/Contractor Date � ' OFFICE COPY FPOST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 12606 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 20820 Bonny Drive UNIT# LOT# PERMIT EXPIRES IF WORK OWNER Ed Kulluck CONTRACTOR Sohn Costello IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCEOR 180 DAYS FROM FOUNDATION - LASTCALLED INSPECTION. LIFER rn PERMIT VALIDATION PREGUNITE - ' r v POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED /J UNDERGROUND /SLAB 7� /� PLUMBING iSSUA CE DATE ELECTRICAL a DG LE PLG. MECH. MECHANICAL ❑ ' 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. f 1 PLUMBING ' MECHANICAL PERMITTO ELECTRICAL FRAMING STORIES TYPE CONSTR, 'INSULATION C` _ OCC.GROUv RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED o.FT.FLDDRAREA TDTALACREACE ROOF r� DIAPHRAGM auILDIUSE s—( RES IND CONON PB 0'1,'., MNI APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED P ASSE❑ R SSORS PARCEL NO. ROUGH PLUMBING ,.Fig TRACTNO. PARCEL NO, GAS TEST S �'� prVU` 2O p MECHANICALACC.DATE ACG FILE-NO ELECTRICAL FINALS DATE INSP. FRAMING r - �`7 -'-I�� - J SAN # PLUMBING zoNlNc ENG.SITE ND. INSULATION _/q.p"J GAS FIRE SPRINK ENERGY TT? MECHANICAL Y❑ N❑ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - ELECTRICAL FLOOD ZONE A.L.u.c. LATH INTERIOR - Y❑ N❑ Y ❑ N❑ LATH-EXTERIOR _ FIRED PT. SHEETIR -yp GRADE FEE SUMMARY SHEAR INTERIOR BUILDIN ! b`� BUILDING SHEAR ES TEMPORARY APPROVALS ELECTRIC PLAN CHECK , FIREWALLS FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE J OCCUPANCY OF BUILDING ISNOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM 1 ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC LU ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING (r� O� PLEASE GIVE JOB ADDRESS WHEN PHONING: Z - SEE PERMIT FOR EXPIRATION DATE _ MECHANICAL CONST.T-AI�` IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY '