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17099 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NPP"JEM IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 1700% )�O�7 a7 n o ADDRESS O /� F\ °" I BUILDING - ELECTRICAL-PLUMBING-MECHANICAL , OWNER' .Pp LX PLAN CHECK VALIDATION NAME DTV. ELECTRIC PERMIT FEE ��ONE CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 n ' W fLS LIGHTING FIXTURES 10.00/1.00 CONTRACTORSPPLIANCES-RESIDENTIAL 4.00 ' A RESa ,,.. 11 , �W rHoiNe PANELS 10,00 DATE OF APPLICATION RcnfTEcr PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.NO. O OR ENGINEER , uc.No. SIGNS TRANS. 3.00 AARCH.OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS a SERVICE CHANGE 20.00 1` woo O�LICENSED CONTRACTORS DECLARATION iI hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. N i, Professions Co an icense is in full fort ff z o m ! License Class ' Lic.Number _ gr ❑ ❑ 0 y. iu Uale ��I--Con[recto, Q y `M J WN -� • BUILDING PERMIT ¢ ¢w OWNERBUILDBR DECLAR ION INFORMATION S o D ors License MISC.- REFER TO OR x ' H I hereby affirm that I am exempt from [he Comract L w l;i 0 4 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE .10.00' VALUATION $/FT. E Code:Any city orcounty which requires a permit to construct,alter, 50 0¢ 2 Q Improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELETAC. - 0 LL requires the applicant for such permit to file a signed statement that TOL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License F z a Law(Chapter 9(commencing with Section 7000)of0ivixum3 ofthe �` E 4 0 Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE CS at In the basis for the alleged exemption.Any violation of Section 7031.5 $TORIES TYPE CONSTR. c ; � by any applicant fora permit subjects the applicant macivil penalty ALTER-DRAIN&:VENT-WATER (EA.) 5.00 of not more than five hundred dollars(8500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 4.00 their sole compensation,will do the work,and the structure is not . OCC.GROUP RES.UNITS intended or offered for sale(See. 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.FLOOR AREA TOTAL ACREAGE j F himself or through his own employees,provided that such impruve- meetsare not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 Fps 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- 1 RES IND CO PB Osher I, for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ I,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 PAHCI,L 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(EA.) 1.00 contracts for Such projects with a con(ractons)licensed pursuont to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ I um exempt muter See..,B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dae WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5,00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance;or a certified copy thereof JSec.3800,L.b.C.). Policy No. rpvly 0 X ❑ Ifie Co Is e i L FIRESPRINK- ENERGY T-24 Z Z c0i[' d inspection division. MISC.- REFER TO ORD. O plicant V❑ N❑ V ❑. 'N❑ cc 5; PERMIT ISSUANCE - - 10.00 FLOODZONE A.L.U.C. UU - C17RVI ICATLPEEXEMPTION RAN WORKERS' 11J _ COMPENSATION INSURANCE PLO.corvTR. n- o (This sectionneed not be completed if the permit is for oneT L Oist I Y❑ N❑ Y❑ No Z hundred dollars(81000orless.), U O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL FEE FEE SUMMARY LL I- mit is issued,I Shall not employ any person in any manner so as to PE T of CURIt no 0 L) become subject to the Workers'Compensal ion Laws of California. BUILDING Date Appheant ALTER OR ADD TO MECH. 5.00 . �Lttar >_ N NOTICE TO APPLICANT: IL after making this Certificate of Rx- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you 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.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency lin EXHAUST HOOD(WITH DUCT) 5.00 ' the performance of the work for which this permit is issued(Sec. MICROFILM 30979 CR.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVERI00,000 B.T.U.)9.50 ELECTRIC Lender's Address 1' 11 certify [list I have read this application and state that the above VENTILATION FAN (SING LEI 4.00 Information is correct. I agree to comply with all city and county PLUMBING 'ordinances and state laws relating to building construction, and BOILER-COW(3 H.P.or 100,000 B.T.U.1,6.00 hereby authorize representatives of (his 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. - upertino ag ' st liabilities,judgments, costs and expenses which - PERMIT ISSUANCE 10.00 CONST.TAX ma ay Crue ai st said City in consequence of the ting rs MECH.CONT. LIC.NO. MECH. A L �I TOTAL TOTAL 514,00 JSIJairi oWidsfit7ebnracr OrD Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17099 INSPECTION DIVISION JOB INSPECTION RECORD (� c� PERMIT EXPIRATION JOB ADDRESS-Is1� U UK7� �1-U' UNIT# LOT# PERMIT EXPIRES IF WORK - OWNER ' Irl TT"�� CONTRACTOR ' O�J�` IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 18oDnYsOFPERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM NOTE: ' LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PLHMIT VALIDATIpN CUPERTINO STANDARDS. I GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB MALE ,v \M---A ' PLUMBING • _ �+lJ ' , ELECTRICAL nompUTF ISSUANCE DATE MECHANICAL " BLDG E.LMECH rEc;T. PLc. DATE • DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDBUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING ,�vALuanoN slur. IA MECHANICAL 2a ' ELECTRICAL PERMIT TO FRAMING o. J INSULATION 1 STORIES TYPE CONSTR. 1 OCC CROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT.FL00H AREA TOTALACFEAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE ..+1 • DIAPHRAGM THE CONSTRUCTION TAXIS PAID I r 1 /V BUILDING USE tH.y ROOF SHEATHING RES• IND co Pe 06, APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. L ASSESSOHStrAHCEL NO. ROUGH SAN.N PLUMBING ELECT.ENERGY _ tix,.rRAcr No. PARCEL No TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ELECTRICAL BUILDING.ENERGY ^ f ^cc DATE ACC.FILE No FRAMING ELECT.FINAL TEST `i ZONING ENO.SITE No. -- INSULATION PLUMBING ' GAS TEST GAS MECHANICAL FIRE SPRINK' ENERGI.T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ' Y NL E �9, FLOOD'ZONE A L U C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. A YE] No YL NL SHEETROCK GRADE FEE SUMMARY EXTERIOR'LATH BUILDING , INTERIOR LATH. TEMPORARY'APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS LFEE NO.T,'41RE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY