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12429 (2) APPLICANT TO FILL IN IN, RMATION WITHIN RED LINES- USE BALL POINT PEN ONLY 'BUILDING PROJECT IDENTI FI ON - PERMIT NUMBER BUILDING APPLICATION & MIT 12429 'L AOD s BUILDING-ELECTRICAL-PLUMBING-MECHANICAL GONE RS PLAN CHECK VALIDATION CITY. ELECTRIC PERMIT FEE HLI PNON CONTRACTOR NAME UTLETS-SWITCHES-RECEP 10.00/1.00 0 N LIC.No, LIGHTING FIXTURES 10.00/1.00 CTRACDRASrDRs ADDRESS PPLIANCES'-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMPI 20.00 PLAN-CHECK FEE P.C.NO. OR ENGINEER u , c.No, SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ADDRESS IIP EMP.METER OR POLE INS. 20.00 ^ - APPLICANTS MOTORS SEE FEE SCH. O IVllyw.+,A^ ADDDRESSDRESS '�\ SERVICE CHANGE /I Q/r 0 '02 LICENSED CONTRACTORS DECLARATION <U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE I- z:"' (commencing with Section 7000)of Division 3 of the Business and BLDG. EL G. MECH. H N i Professions Code,and my license is in full force and effect. ❑ Z O u,- License Class Le.Number /� G Date Conlcator City of Cape Ino DI P T z w¢ OWNER-BUILDER DECLARATION I A wOdeJ MISC.- REFER TO ORD 3 LL w I hereby collo that I am exempt from the Contractors License vy{��ATIgN $/FT. uO¢ Law forthefollowing reason,(Sec. uires Business locnd Professions PERMIT ISSUANCE 10.00 �- ayfprll► Co�O �n0 rN Code:Any city or county which requiresapermit toconslruct,alter, ac S Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. 2 l a a O u requires the applicant for such permit to file a signed statement that TOTAL aJ O PERMIT TO X m he is licensed pursuant to the provisions of the Contractor's License Hies L'aw(Chapter 9(commencing with Section 7000)of Division 3 oflhe Djj�r�, a Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE �� M IC r o the basis for the alleged exemption.Any violation of Section 703 LS STORIES TYPE CONSTR. i;m by any applicant for a permit subjects the applicant tog civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars($5001.1: {{&� I as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS tl(sir`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 FIXTURES-PER TRAP 5.00 50.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve - memsarenUtintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 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- RES IND CON PB Other prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the properly,am exclusively contracting with E] ❑ ❑ C] ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL 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 (EA.) 1.00 contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ lamexemptunder Sec. ,B.&P.C.I'milus WATER HEAT 6.00 reason_ _. w Date WATER SVSTE 5.00 ACG DATE ACC.FILE NO. WORKERS'COMPENS N DECLARATION WATER TREATINUffflippdinp5.00 I 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(Sec.3800,Lab.C.). Policy No. Company O ❑ Certified copy is hereby fumisbcd. FIRE SPRINK ENERGYT-24 ZZ ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y y N O Applicant ❑ N E] E] ❑ � y CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 M - FLOOD ZONEA.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ N❑ Y❑ NE]0 (This section need not be completed if the permit is for one TOTAL 0 Z hundred dollars($100)or less.) U O 1 certify that in the performance of the work for which this per. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I'shall not employ any person in any manner so as to g G U become subject to the Workers'Compensation Laws of California. BUILDING J p U., Date Applicant 'ALTER OR ADD TO MECH. 5.00 >_ N NOTICE TO APPLICANT: If,after making this Certificate of Ex. remp!ion, f" ? you should become subject to the Workers'CompensationAPPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEEsuch provisions or fi ixPermil shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10j"C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency farEXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 1 ,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). 00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 30 Lender's Address I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city,and county BOILER-COMP 13 H.P.or 100,000 B.T.U.1 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP IONer 100,000BTUI SEE FEE SCH. MECHANICAL - above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities, . it encs, costs and expenses which CONST.TAX may in any way accrue,again said City in consequence'of the PERMIT ISSUANCE 10.00 g his permi MECH.CONT. LIC.NO. MOTAL TOTAL g are o p n t/Comore - al OFFICE COPY i POST THI RD NEAR FRONT OF BUILDING ', PERMIT NUMBER ' Cl ., 0F 'CUPERTINO 12429- INSPECTION DIVISION JOB INSPECTION RECORD' .. .. 1 ` .. 2 'PERMIT EXPIRATION JOB AD ESS DO UNIT# _LOT#' PERMIT EXPIRESIF WORK- owN - CONTRACTOR " IS NOT STARTED-WITHIN IN PECTION D INSPECTOR I PECTI N RECORD ,•180 DAYS OF PERMIT ISSU. FOUN ATI ON - ANCE OR 180 DAYS FROM " .LIFER - , - 'LASTCALLED INSPECTION. PREGUNITE , �. PERMIT VALIDATION POUR NO CONCRETE UNTIL A HAS BEEN SIGNED -UNDERGROUND /SLAB �J PLUMBING .. ELECTRICAL" • ' - • - +'` .ISSUANCE DATE MECHANICAL BDG ELUffj MECH.q DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 7a 8U1 I G P RMIT IN FARM TION WOOD FLOOR :.I .. VALUATION $/FT. . PLUMBING. ' MECHANICAL •• ELECTRICAL - - PER D FRAMING1 ' . INSULATION - Es TYPE corvsTR. OCC.GROUP ' RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED %ROOF . SO:FL FLOOR AREA TOTAL ACREAGE DIAPHRAGM rt• I/ C f e Ptid. rtC,f *l'�`Q v RES "IND ILoCON usEPB OM" APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED (' ❑ ❑ ❑ El El ASSESSORS PARCEL NO ROUGH ' PLUMBING - - GAS TEST ' TRACT NO. PARCEL NO. MECHANICAL 0 ELECTRICAL.. - ncc.DATE - ACC.FILE No. `y„7(J. 7 'FINALS DATE INSP. " , FRAMING '-1� 7- SAN r '" —, ZONING . ENG.SITE,NO.- INSULATION, PLUMBING ,$-2�j� GAS - MECHANICAL FI�REIMINK ENERGY T-Za' COVER NO WORK UNTIL ABOVE HASIBEENISI NEO` HEATING ° E] N[ ° � NE LATH-INTERIOR - ``6 ` ) ELECTRICAL. S--� Pi000 zorvE - AL.u.c. LATH-EXTERIOR C.___.� FIRE DEPT. v❑ N� v I] ` N❑ _ SHEETROCK - �$ - GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING - SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS' " ELECTRIC - PLAN`CHECK' !?� - GAS ..FEE NO TAPE 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 Lw. �`.'ONE'WORKING DAY'BEFORE REQUIRED INSPECTION. 'PLUMBING ' O PLEASE.GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE ,- MECHANICAL fMPORTANTI CONST.TAX PLEASE READ REVERSE SIDE BEFORE. . TOTAL , ,— CALLING FOR FINAL INSPECTION.. OFFICE CODV I 1