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16078 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - - _ BUILDING PROJECT I DENTIFICATION -PERMIT NUMBER APPLICATION q L+OrJQ Out 2INc - I IJ 1 v ADOREss BUILDING -ELECTRICAL-PLUMBING-MECHANICAL - 24 Cv�be-r,N R,� PLAN CHECK Vs LIOATIO NAME - - OTY. ELECTRIC PERMIT FEE Iu a CONTRACTOR'S NAME LIT LETS-SWITCHES-RECEP 10.00/1.00 /' 35uc.No. ' LIGHTING FIXTURES 10.00!1.00 CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 - - ADDRESS - PHONE PANELS 10.00 - DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C:,NO ORq PANELS (OVER 200 AMP) 20.00 cwE R M4"L`f� Cs rAt`I NO.0 3 3�1 / SIGNS TRANS. 3.00 ARCH.OR Fvn PERMIT VALIDATION DDREs �5 SPECIAL CIRCUIT 5.00 r 970A 1-1G5 - iIP qV EMP.METER OR POLE INS. 20.00 APPLI rs MOTORS SEE FEE SCH. _' / ADDRESS �/-�/ - d ISERVICE CHANGE 20.00 'a 00 LICENSED CONTRACTORS DECLARATION a u I hereby affirm that I am licensed under provisions ol'Chapter 9 ISSUANCE DATE 1 i-a N (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H y z Professions Code,and my license is in full force and effect. •may Q iIn W License Class Lie.Number (L/ H w H J Date Contractor a IS BUILDING PERMIT m ISa OWNI?R-BUILDER DECLARATION a a a x ;U. H I hereby affirm that I am exempt from the Contractor's License MISC.- . REFER TO ORD or LL O¢ Law for the following reason.(Sec.703 1.5,Businessamd Professions PERMIT ISSUANCE 19'88- q VALUATION $/FT. r - Code:Any city or countywhich requires a permit to construct,alter, Q ¢ ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR.. LIC.NO. ELEC. Q V(p v ` V O u requires the applicant for such permit to file a signed statement that TOTAL 30 - PERMIT TO ' w$ he is licensed pursuant to the provisions ol'the Contractor's License riQ Law.(Chapter 9(commencing with Section 7000)of Division 3 of the i c Business and Professions Code)Or that he isexempt therefrom and OTY. PLUMBING PERMIT FEE ^T�Q z�Jkj De I-$ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR. s3 _ by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 ,CD of not more than five hundred dnllao($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 �E?.3property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 MET.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- r menti are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 O •'r or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM.OVER 4 IEA.) 2.00 BUILDING USE ;f builder will have the burden of proving that he did not build or no REB IND CON PB Other ft • " It�Q;e for purpose,of Sale.). INDUSTRIAL WASTE INTER. 30.00 - GAJ. 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 gSSES50R5 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-OVER 5(EA.) 1.00 contracts for such projects with a contmctons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec. LAP.C.for this WATER HEATER W/VENT 6.00 ' reason �-,p�- Owner Date WATER SYSTEM _5.00 ACC.DATE ACC,FILE NO. WORKERS OMPENSATION 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(Sce.3800,Lab.C.). policy No. Company O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. O Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑ Hy 690 FLOOD ZONE A.L.U.C. LU ; CERTI FICATE EXEMPTION FROM WORKERS'. �� , LU _ COMPENSATION PERMIT ISSUANCE fi INSURANCE PLG.CONTR. LIC.NO. PLG. CL o ' (This section need not he completed if the permit is for one TOTAL V❑ IN C] Y ❑ N❑ D Z hundred dollars IS I OOj or less.) �- V O . 1 certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued.I shall not employ any person in any manner So as to U become Subject to the Workers'Compensation Laws of California. as�� w Date, Applicant BUILDING sJV C. - ALTER OR ADD TO MECH. 5.00 } 0 NOTICE.TO APPLICANT: If,after making this Certificate of Ell- ? emption,you Shordd become subject to the Workers'Compensaturt APPLIANCE5.00 O'fl,� PLAN CHECK provisions or the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,ODOCF.M,) 4.00 CONSTRUCTION.LENDING AGENCY AIR HANDLING UNIT(OVER 10,000 C.F.M.) 6.00 SEISMIC FEE 3 3 I hereby affirm that (here 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.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U:)9.50 ELECTRIC Lender's Address ?:•1s 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 PLUMBING S v BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 � 7 p ordinances and state lows relating to building construcllon, and ✓ 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 keep harmless the City of _ MISC.-. REFER TO ORD. r -- upertino against liabilities,judgments, Costs and expenses which PERMIT ISSUANCE- }g.eB - CONST.TAX ay in any way accrue against said City in consequence of the mol g of this pe L - MECH.CONT, LIC.NO. MECH. x Q �SlTOTAL a.s Ne TOTAL Signature of Applicant ntractor Data UU - OFFICE COPY J -POST THIS CARD NEAR FRONT OF BUILDING PERMITNUMBERA.. CITY: OF CUPERTINO 16078 INSPECTION DIVISION JOB INSPECTION RECORD r '• 'PERMIT EXPIRATION 1."i JO B'ADDR ESS �l2'- / ANO (\.(� _ UNIT# _LOT# :• PERMIT EXPIRES IF WORK OWNER i¢ -CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIO ANCE OR 180.DAYS FROM 2V O-Ps-S • NOTE: LASTCALLED INSPECTION. LIFER - - ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. . GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - -UNDERGROUND /SLAB' PLUMBING ` �"'+ •I- ! ELECTRICAL .ISSUANCE DATE MECHANICAL - BLDG, ELECT PLG MEC. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR IrkVALUATION $JET. PLUMBING v - - MECHANICAL ' O ELECTRICAL FRAMING INSULATIONrr,PE CONSTR. DATE. . i QNZ OCC GHOUP UNITS 'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 1111A" .IAbt,1 ROOF - Nt FINALINSP' L BEFORE ' FLOORARCA TOTALACREAGE DIAPHRAGM TST CTIO B ILUION USE ROOF SHEATHING �Z- �- j j .`es TNG Pe omn --'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.q AssE RS PARccL No PLUMBING ELECT.ENERGY. TUBS 8 SHOWER PAN PLUMBING ENERGY - TRAcr PARCEL No MECHANICAL MECR ENERGY ELECTRICAL ACC.DATE ACc.PILE rvo. BUILDING ENERGY • FRAMING . - ELECT.FINAL TEST zow"c, ENc.sITE.No. INSULATION' - PLUMBING ' GAS TEST - GAS ' MECHANICAL - FIRE SIRINrc ENERGY Tao COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING v . "� "� EXTERIOR SHEAR �,2' .,2�- ELECTRICALRELEASE '• E(oOO ZONE ALuc. INTERIOR SHEAR . FIRE DEPT. - YL, NL. YL �L $HEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH . TEMPORARY-APPROVALS .'BUILDING SCRATCH COAT ELECTRIC PLAN CHECK, GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY T SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC {U F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PL'uMBiNG o PLEASE GIVE JOB ADDRESS WHEN PHONING. �— ' i Z ti - SEE PERMIT FOR EXPIRATION,DATE - MECHANICALCoo IMPORTANT! coNST:Tnx . PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY,