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10814 (2) IPOST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PFR1T0814 INSPECTION DIVISION JOB INSPECT;. CORD 1 - f �/�/L�)//))�j�/ PERMIT EXPIRATION JOB ADDRES W " 6' UNIT )�1 # " PERMIT EXPIRES IF WORK OWNER CONTRACTORI�Dpw rumIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR 1 SPECTIONECORD 180 DAYS OF PERMIT"ISSU- FOUNDATION .. - ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER - -PERMIT VALIDATION PREGUNITE ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ,..�,: ELECTRICAL IssuANCE ATE ' MECHANICAL - BLDG. CT, LG: ECR. I DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING 4. TION $/FT. MECHANICAL I ELECTRICAL PER FRAMING VPE CONSTR. -INSULATION ' OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT.FLOOR AREA TOTAL ACREAGE i DIAPHRAGM - BUILDING USE RESIND 'O PB Other APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑• O 1:1 ROUGH ASSZPARCELNO. PLUMBING ' GAS TEST - TRACT 40, PARCEL NO, MECHANICAL ELECTRICAL - -�(� FINALS DATE INSP. ACC.DATE ACC FILE NO. FRAMING SAN # - ZONING ENG.SITE NO.' 'INSULATION PLUMBING GAS - MECHANICAL FIRE SPRINK ENERGY TR24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 'v 11 "� r ❑' '•N� LATH-INTERIOR ELECTRICAL - - FLOOOZONE A.L.U.C. LATH=EXTERIOR - FIRE DEPT. - Y N Y N1:3 SHEETROCK - GRADE - FEE SUMMARY",_._^•;, SHEAR INTERIOR - BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING r, , 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 FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM I ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC M ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING I z 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 - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL-POINT PEN ONLY e BUI LDI NO PROJECT I DENTI FICATION PERMIT NUMBER '.GOILDess Sir r.� 7 APPLICATION & PERMITADDR10814 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER' PLAN CHE,C,K jf��`!ALIDATION NAME /T'JILGS N3MI I QTY ELECTRIC PERMIT FEE 2,0,` TO dam S v oN .SS'pS vv"� o "Y CONTRACTORSW� NAME jCl-yg6 J�OUTLETS-SWITCHES-RECEP 10.00/1.00 16 a li .Nov. LIGHTING FIXTURES 10.00/1.00 O r-oN AcroR's �7,�Z`�b PPLIANCES-RESIDENTIAL 4.00 ADD E55 S PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.NO. OR ENGINEER LIC.NO. SIGNS TRANS. 3.00 ARCH.OR ENG. PER TION ADDRESS SPECIAL CIRCUIT 5.00 ZIP EMP.METER OR POLE IN 20.00 2ty,B APPLICANT'S (�[5 J ADDRESS MOTORS S E FEE SCH. JC1 SS SERVICE CHANGE 60 _, ` // � woo LICENSED ONTRACTORS DECL RATIONeitpOI►-J]L 9K`L a u U 1 hereby affirm that I am licensed under provisions of Chapter 9 of ISS ArvCE DATE I; a a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELEC PLG. MEggqH.))) H D i Professions Code, my license is in full fort qd'ff t. 0 2 o License Class Lic.Number l T EV H w H j Date Contractor ¢ sz BUILDING PERMIT ¢ ¢¢ OWNER-BUILDER DECLARA ION w v INFORMATION wI hereby affirm that I am exempt from[he Contractor's License IMISC.- REFER TO ORD n o Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Q q VALUATIONI1 S/FT. fw> I Code:Any city orcounty which requiresa permit to construct,alter, 60V G 2 ¢ D improve,demolish,or repair any structure,prior to its issuance,also ELEC:CONTR. - LIC.NO. ELEC, ¢ requires the applicant for such permit to file a signed statement that TOTAL 3 Q PERMIT r0 E $w he is licensed pursuant to the provisions ol'the Contractor's License FiQ Law(Chapter 9(commencingwithSecti6n 7000)of Division 3 cfthe //U 71E-AJolC Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE W Is-$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant tua civil penalty . ALTER-DRAIN&VENT-WATER (EA.) .5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the'property,or my employees with wages es 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 �I property who builds or improves thereon,and who does such work 'z- FIXTURES-PERTRAP 5.00 O SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00 mems are not intended or offered for Sale.If,however,the building 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 m. GAS IND CON ve Otner prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ .❑ ❑ ]iconsed contractors ID construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 6.00 ASSESSORS PARCEL NO. and.Professions Code:The Contractor's License Law does not apply . to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS-O A.) 1.00 contracts for such projects with a contractors)licensed pursuant to the Contmcmr's License Law. SEWER-SANITARY-STORME 0 0 - TRACT NO. PARCEL NO. C1I am exempt under Sec. ,B.&P.C.for this WATER HEATER W/jILV 6.00 reason Owner Dale WATER SYSTEM e ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EO J 5.00 I hereby affirm that I have a certificate ofcon sent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or u certified copy thereof(Sec.3800,Lab.C.), I /� ` Policy No. Company�T�l�e- rZV M.l O' O Certified copy is hereby fumishad. FIRE SPRINK ENERGY T 24 Z Z li Certif, copy is file with the IY i peclion division. O Appl¢an��� - �--- MISC.- REFER TO ORD. ,y 1:1 N❑ Y ❑ N❑ y PERMIT ISSUANCE 10.00 Q FLOOD ZONE A.LU.C. . Cr CF: TI' ATF:PE EXEMPTION FROM WORKERS' W � COMPENSATION INSURANCE - PLG.CONTR. LIC.NO. PLG. 1 a (This section need not be completed if the Introit is for one TOTAL CXqq (]. Y❑ N Y❑ N❑ 0 Z hundred dollars IS 100)Br less.) U O I certify that in the performance of the work for Which this Par- QTY. MECHANICAL PERMIT FEE FEE SUMMARY W F- mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers Compensation Laws of California. 0- Dale Applicant BUILDING 3,P Sd a ALTER OR ADD TO MECH. 5.00 �- } N NOTICE TO shouldAPPLICANT: become If,after making this Certificate of Ex- F Z eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions the Labor Code, you must forthwith comply "'ills FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10 .M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVE 1 C.FJA. 00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH 5.00 the performance of 11 w k for which this permit is issue)(Sre. MICROFILM 3097,Civ.C.). �X' HEATING UNIT(TO 1 B.T.U.)' Lender's Name, H EATI NG UNIT 100,00 . 9.50 ELECTRIC �Q �_ Lender's ss Ad I certify that I have read this application and state that the above VENTILATION FAN (SIN4 4.00 information is correct. I agree to comply with all city and countyPLUMBING ordinances and state laws relating to building construction, and BOILER-OOMPI3H.P.ol-100,MICIRT.U.I 6.00 . hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTUI 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,judgments, costs and expenses which CONST.TAX may in any way accrue against mid City in consequence of the PERMIT ISSUANCE 10.00 Q grant f This permit. MECH.CONT. LIC.NO.3 MECH. Z 8.,6 TOTAL Ov TOTAL 0 °b main of Applicant/Contractor ate OFFICE COPY