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18444 (2) APPL'{CANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ' ILDING PROJECT I DENTIFICATION FERMITNUMBER - ; `. BUILDING APPLICATION & PERMIT pRE66 AN1�8 4 4 4 Q/ UILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION wwNAME M DO v.oNE CITY. ELECTRIC PERMIT FEE NAME croRs UTLETS-SWITCHES-RECEP 10.00/1:00 . LIC.No, LIGHTING FIXTURES 10.00/1.00 _ ADDRESS R's .[APPLIANCES-RESIDENTIAL 4.00 CO TRAC PRONE IPANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE + P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER / [V AI�r _ /11 [VAI` LIC.rvo. SIGNS TRANS. 3.00 ARC..OR ENO. - PERMIT VALI DATION I ADDRESS SPECIAL CIRCUIT 5.00 f. (� 4 zip TEMP.METER OR POLE INS. 20.00 APPLICANT'S MOTORS E SDH. ADDRESS 0-/ U SERVICE CHANGE •20.00' - w o o LICENSED CONTRACTORS DECLARATION L - a u I hereby affirm tat I am licensed under provisions of Chapter 9 - ISSUANCE DATE azw (commencing with Section 7000)of Division 3 of the Business andDG. ELECT. PLG. MECH. i Professions Code,and my license is in full force and effect 4f ❑ ❑ ❑ o zo T W License Class Lia Num her sMPIL H Date Contractor a x BUILDING PERMIT It G,wOWNER-BUILDER DECLARATION. INFORMATION w0 w 1 hereby affirm that I am exempt from the Contractor's License IMISC.- REFER TO ORD '//+LUA,ID Fa. J Law for the following reason.(Sec.7031.5,.Business and Professions PERMIT ISSUANCE 10.00 O S/FT. Code:Any city or county which requires a permit to construct,alter, ac 6¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE, LIC.NO. ELEC. `l V u w m u requires the applicant(m such permit LO file a Signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License F z a Law.(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 o Business and Professions Code)or that be is exempt therefrom and GTY. PLUMBING PERMIT FEE ¢ I-o the basis for the alleged exemption.Any violation o(Scction 7031.5 STORIES TYPE CONSTR. aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATEfl (EA.) 5.00 - of not more than five hundred dollars(5500).): ❑ 1,as owner of the Property,or my employees with wages as BACK F LOW PROTECT.DEVICE 4.00 OCC.GROUP REB.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 F IXTUR ES-PER TRAP 5.00 SQ FT.FLOOR AREA TOTAL ACREAGE menta are Got hrough ownemployees,forsaalcprovidedhowever,the improve- GAS-EA.SYSTEM-1 INC.40UTLETS 6.00 menta are not intended or offered for sale.If,however,the building or improvement is sold within one year of wmp"dio the owner- GAS-EA.SYSTEM-OVER 4(EA.) 200 BUILDING USE .. builder will have the burden of proving that he did nott build or an.. . RES r IND CON PB Other Prove for purpose of(be INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the property,am exclusively. 7044,Bu with - ❑ ❑ •❑ ❑ ❑ licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's's License Law docs not apply m an owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts foror's L cenjeeL with a contraetotsl licensed pursuant m SEWER-SANITARY-STORM EA:200ft/10.00 TRACT No. PARCEL No. the Contractor's License Law. sQ ❑ empt under Sec. R.k1'.C.fnrtds WATER HEATER W/VENT 6.00 O naso DWOr Date IWV WATER SYSTEM 5.00 ACC.FILE NO, WORKERS'COMPE:NSATION DECLARATION WATER TREATING EQUIP. 5.00 C/ I hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified co there .3800,La b.C.) ply �( ��p o��my1 o. Company"W691 C-0-1! ✓ Q p[Cetlilied copy is hereby furnished. FIRE SPRINK ENERGY T04 Z Z [6]� Certified copy is fled with the city inspection division. MISC.- REFER TO ORD. O Applicant Y❑ N❑ Y ❑ N❑ I"• rn PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. er 1 CI>RTIPICCOM E EXEMPTION FROM WORK ENS' - LU _ - COMPENSATION INSURANCE PLG.CONTE. .LIC.NO. PLG. Y❑ N❑ 'Y❑ 'N❑ CL 0 (This section need not be completed if the permit is for one TOTAL D Z hundred dollars(5100)or less.) U 0 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMITFEE FEE SUMMARY LL F mit is issued„I shall not a ny person in any anner so as to U beco su 1 I�a�K'W kers' o fig.ion Luw 'California. _ O.w Dam Ad-7Appli'a BUILDING V a rTrLe ALTER OR ADD TO MECH. 5.00 - } to NOT" O A ICAN ''lo," r na I h c i F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, yol must forthwith comply with FEE. /J U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCRM) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE E t I 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. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.1: Lenders Name HEATING UNIT(OVER 100,000 B.T.U39.50 Lender's Address 'ELECTRIC I certify that 1 have read(his application and state(hat the above VENTILATION FAN (SINGLE) 4.00 information is correct.'"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 ��• hereby aulhuriee representatives of (his'cby-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, coals and expenses which CONST:TAX ' may in any way accrue against said City inconsequence of the PERMIT ISSUANCE 10.00 rant o Ih' permit I MECH.CONT. LIC.NO. MECH. - TOTAL TOTAL Signature ofA p cant/G r Date - O. OFFICE COPY M POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER 4 CITY 'OF CUPERTINO INSPECTION DIVISION �� JOB INSPECTION RECORD D 3 S� Gke PERMIT EXPIRATION B JOADDRESS_ y�AE # _LOT# PERMIT EXPIRES IF WORK OWNER _ yV- ( CONTRACTORS- IS, NOT STARTED WITHIN I INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. �UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPRO� PLANS AND CITY OF PERmrt vaLroanoN PREGUNITE CUPERTINO STANDARDS. A'YAN GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ALIU 2 1 1969 UNDERGROUND /SLAB PLUMBING - dOWN ELECTRICAL ISSUANCE DATE MECHANICAL Lo; ELECT. PLG. MECR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION SIFT. MECHANICAL ELECTRICAL - r/ PEHmir TO ` FRAMING - ' ,QT1, e' - :e " - INSULATION - STORIES, TYPE CONSTR. OCC GROUP RES.Y.NI T 5, (PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 5D.Fr FLOOD AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IN❑D CON .-O DE APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ID ASSESSORS PARCEL No ROUGH - SAN.# - PLUMBING ELECT.ENERGY TRACT NO. PARCEL NO. TUBS&'SHOWER PAN - PLUMBING ENERGY MECHANICAL - MECH.ENERGY . ELECTRICAL BUILDING ENERGY ACCDATE ACC FILE„NO, FRAMING . ELECT.FINAL TEST ' INSULATION PLUMBING ZONING ENG,f SITE, NO., I GAS TEST GAS ' FIRE SPRINK ENERGY T.24 MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NE ❑,• N❑ FLOOD 20NE A L U,C EXTERIOR SHEAR ELECTRICAL RELEASE - y ❑ N❑ - Y ❑' N❑ ~ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY _ EXTERIOR.LATH BUILDING i i INTERIOR LATH TEMPORARY APPROVAL BUILDING. � 'p,'.0 SCRATCH COAT ELECTRIC,', PLAN CHECK GAS FEE _ NO TAPE OR PLASTER UNTIL ABOVE,HAS BEEWSIGNED'T OCCUPANCY - '• SEISMIC FEE I OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM W ARRANGE FOR INSPECTION BY PHONING M-4505, ELECTRIC I-0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE".GIVE JOB ADDRESS WHEN PHONING. z - MECH - SEE PERMIT FOR EXPIRATION DATE - ANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE Z CALLING FOR FINAL INSPECTION. TOTAL I OFFICE COPY r