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18039 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY + BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING //•1(/� // a APPLICATION & PERMIT 839 Must- 1 IZ Ch/Swn Im ' /1 yk BUILDING-ELECTRICAL-PLUMBING-MECHANICAL t; 9 OWNER's PLAN CHECK VALIDATION NAE CITY. ELECTRIC PERMIT FEE 'NONE - CONTRACTO NPOU ETS-SWITCHES-RECEP . 10.00/1,00 - OL4' IT`a^''r"n Llc.r+b' ' " UGH NG FIXTURES 10.00/1.00 SONTRACTORS PPLIA ES-RESIDENTIAL 4.00 155 Loh, Vil1u HONE 739 os710 PANELS 10.00 DATE OF APPLICATION '- ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OV 200 AMP) 20.00 ENGINEER L.C.No. SIGNS TRANS. 3.00 ARCH,OR ENG. - : PERMIT VALIDATION AODREss SPECIAL CIRCUI 5.00 I zIP EMP.METER OR E INS. 20.00 I.A. ANTbN�G� APPLICANT'S MOTORS SEE FEE SCH. ADDREss _ SERVICE CHANGE 20.00 Woo LICENSED CONTRACTORS DECLARATION 1989215-89- Fi w 1 hereby affirm that I am licensed under provisions Uf Chapter 9 ISSUANCE DATE - ¢ a (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH. H o i Professions Code nd I' cnse is id full force' f 1/O 0 i,°/, o License Clas Lie.Number - - r w H j Dale '� dutch., El 1:1 O NER-BUILDER DECLARATION BUILDING PERMIT a o u X ; m I hereby affirm that 1 and exempt from the Contractor's License MISC.- REFER.TO OR u o ¢ Law for the following reason.(Sec.7031.5,Business and Professions VALUATION $/FT. H _ PERMIT ISSUANCE 10.00 Code:Any city or county which structure permit to is immuCLaReq - 2 rt¢ improve,demolish,or repair any structure,prior to its issuance;also ELEC.CONTE. LIC.NO. ELEC. u m m¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO he is licensed pursuant to the provisions of the Contractor's License Law(Chapler9(commencing with Section 7000)of Divismn3nf(he �IIA. 1�1 i a Business and Professions Code)or that he is exempt therefrom and Q Y. PLUMBING PERMIT FEE -IHIY L. ¢I-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. u y by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).) LTER-DRAIN&VENT-WATER (EA.) 5.00 r-O, I,as owner of the property,or my employees with wages as NGAS-EA. ROTECT. DEVICE. ' 4.00 OCC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended or offered 1'or sale (Sec. 7044, Business and Professions R,ROOF,AREA,GOND. 5.00 Code:Thi Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and who does such work R TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself re through his own employers.Provided that such improve- menls are not intended or offered for sale.If however,the building EM-1 1NC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- TEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- prove RES IND CON PB Other prove for purpose ofsale.). - I INDUSTRIAL STE INTER. 30.00 E IN ❑ ❑ I,as owner of the property,am exclusively contracting with ED 0 licensed contractors to construct the pmject(Sec.7044,Business LAWN SPRINKLE S-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs not apply. to an owner of property who builds or improves thereon,and who LAWN'SPRINKLER OVER 5 (EA.) 1.00 contracts forsuch projects wish a contraclor(s)licensed pursuant m SEWER-SANITARY-ST MEA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec. -B,&P.C.for this WATER HEATER W/YEN 6.00 reason Owner Date WATER SYSTEM 5.00 ACC GATE ACC.FILE NO, WORKIERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm Wal I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Instrance•or a c•r�fi d ZONING ENG.SITE NO. copy Ther��f��X�1a8❑0,Lab.C.).Q n/ - Policy Nop6(.x?T4ompany �/ , O ❑ Certified copyris hereby furnish FIRE SPRINK ENERGY T44 Z Z Certified co I lh t cit asDeclion division. - O Applicant FY � + MISC.- 'REFER TOO Y� N❑ v � N� ~ y �- PERMIT ISSUANCE 10.01) FLDDD zoNE A.L.0 c. CERTIFICATE OF EXEMPTION FROMW KERS' LLQ COMPENSATION INSURANCE PLG.CONTE. LIC.NO. .PLG. Y� N� v � N� D' O (This section need not be completed if the permit is for one TOTAL Z hundreddollars(S100)or less) 11 V O I certify that in the performance of the work for which this per, FEE SUMMARY LL F- mit is issued,I shall not employ any person in any manner so as to CITY. MECHANICAL PERMIT FEE O W become subject to the Workers'Compensation Laws of Califomia. PELECTRIC y Date-Applicant ALTER OR ADD TO MECH. 5.00 } W' NOTICE TO APPLICANT: If,after making this Certificate of Ex. F'? emption,you should become subject to the Wmkeri Compensation APPLIANCE 5.00 provisions of the Labor Code, you must forthwith comply with V such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO i09MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.RM.) 6.00 ' 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.3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) �c9Q .D 'Lender's Name HEATING UNIT(OVER 100,000B.T.U.)9.50Lender'sAddress information that correct. read agrees application and allStatec hour the above VENTILATION FAN (SINGLE) '4.00 information n correct.1 agree to comply with all city and county 'PLUMBING ordinances and slate laws relating Inbuilding construction, end BOILER-(X1MP(3 H.P.Dr 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to eater upon the BOILER-COMP 1Oser100,0008TU)SEEFEESCH: MECHANICAL �• DD ebovesmentioned property for inspection purpows. f (We) agree to Save, indemnify.and keep harmless the City of MISC.- REFER TO ORD. ' apertino against liabilities,judgments, costs and expenses which ;,s,s 12,00 CONST.TAX may in any way accrue against said City in con quenc of the PERMITASSUANCE - 'w.l VV r li this permit MECH.CONT. - LIC.NO. MECH. �tJY/7P/LfL__ d �� . ITTIR v$2G6 TOTAL Db TOTAL Ignature of Applicant/Contractor Uale S OFFICE PY , POST THIS CARD NEAR FRONT OF BUILDING c/ l � PERMIT NUMBER CITY OF CUPERTINO 18039 INSPECTION DIVISION ' 'OB INSPECTION ORD ' PERMIT EXPIRATION JOB ADDRESS UNIT# _LOT# - PERMIT EXPIRES IF WORK r OWNER CONTRACTOR IS NOT STARTED WITHIN . . INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 D '�YS FROM ' FOUNDATION NOTE: LASTCALLEOINSVECTION. UFER ALL GRADING'ANDDRAINAGE SHALL BE INSTALLED s TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT vq.Ioar ION PREGUNITE CUPERTINO STANDARDS. h . 4 GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB 1989 . PLUMBING � ELECTRICALSSUANCE.UATE MECHANICAL ruppmnh LEcr. PLC, MEPC./ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' BUILDw(LIPERMIT WOOD FLOOR INFORMATION . VALUATION SIFT. PLUMBING 'tii ' - _ MECHANICAL ELECTRICAL - PERMIT ro: ' I y FRAMING INSULATION - STORIES TYPE CONSTR. T OCC.GNOUP ARES,UNITS IP LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1 SO.FT,FLOOR AREA TOTAL ACREAI:E \� ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE -i DIAPHRAGM - THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING I I _ - REE IND COI' PB O"..., F APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. D ❑ ❑ ❑ ASSESSORS PARCEL NO. ROUGH SANA PLUMBING - ELECT.ENERGY' TRACT NO PARCEL NO TUBS 8 SHOWER PAN - PLUMBING ENERGY - MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC.oATE ACC FILE No FRAMING - ELECT.FINAL TEST - zomwc END.SITE No. INSULATION - PLUMBING GAS TEST GAS ' FIRE SPRINK ENERGY T_24 MECHANICAL Y ❑ rv❑ Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A_.0 C, EXTERIOR SHEAR ELECTRICAL RELEASE . ❑ Ny L ❑ INTERIOR SHEAR FIRE DEPT. Y ❑ N SHEETROCK - GRADE Di FEESUMMARY EXTERIOR LATH BUILDING , .INTERIOR LATH . - TEMPORARY APPROVALS eulLDuvG SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE SND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY'OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. •MI CROFILM ARRANGE FOR INSPECTION BY PHONING 252;4505, ELECTRIC a� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. s Z - SEE PERMIT FOR EXPIRATION DATE.- MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE' TOTAL •U�3 .CALLING.FOR FINAL INSPECTION. OFFICE COPY..