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8895 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY " BU LD1 NG PROJECT IDENTIFICATION P RMIT NUMBER •r�� AoEss /��3 SMS c`.�u D.E' APPLICATION & PERMIT G✓/ ��/✓0 C (� O�� BUILDING -ELECTRICAL-PLUMBING -MECHANICAL 8895 OWNER'S "AME PLAN CHECK VALIDATION QTY. ELECTRIC PERMIT FEE ! 7~ NI 5A4D ViI PHONE ys6 � ps_ NAIVE CONTRACTOR'S NAME 7747"1 OUTLETS-SWITCHES-RECEP 10.00/1.00 uc.No. LIGHTING FIXTURES 10.00/1.00 ADDRESSToq's PPLIANCES-RESIDENTIAL PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE P.C.NO. OR PANELS (OVER 200 AMP) 20.00 ENGINEER LIC.No. SIGNS TRANS. 3.00 ARCH,OR ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 PAID ADDRESS Ts MOTORS SEE FEE SCH. AA SERVICE CHANGE 20.00 ` � 1S�U woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 a o U 1 hereby affirm that I am licensed under provisions of Chapter 9 1�y Of Cq DATE a, <y (commencing with Section 7000)of Division 3 of the Business and _ EJ T, PLG. M H. H H z Professions Code,and my license is in full force and effect. ❑ o0m W License ClassLic.Number is r Date Contractor ¢ - f S, w a OWNFR-BUILDFR DECLARATION BUIL ING PERMIT o A r' INF RMATION F ; LL I- 1 hereby affirm that 1 am exempt from the Contractor's License MISC.- REFER TO ORD u o j Law for the following reason.(See.7031.5,Business and Professions VALUATION S/FT. y w PERMIT ISSUANCE 10.00 ) � Code:Any city or county which requires a permit to construct, K a O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. o M requires the applicant for such permit to file a signed statement that TOTAL a w m y he Is licensed pursuant to the provisions of the Contractor's License ERMIT TO r z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 o Business and Professions Code)or that he is Lac nhpt therefrom and DTV. PLUMBING PERMIT FEE I- m the basis for the alleged exemption.Any violation of Section en LS STORIE TYPE CON A .- by any applicant for apermit subjects the 0).)applicant macivil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not mon than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the sl ruct,i.is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 5.00 Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sD. .FLoaR AREA TOTAL ACREAGE himself re through his own employees. le.If,ed that such improve- or nts improvemennot t mid or within red one or yeaale.If, tilebuildingoGAS-EA.SYSTEM-1 1NC.O OUTLETS 6.00 or lder will is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove forsimpose owner of the.)' INDUSTRIAL WASTE INTER. 30.00 E IND CON PB Other ❑ L as owner of the property,ha.e exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions property Contractor's License Law does not apply to t owner of property who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 concocts for such projects with a contractor(s)licensed pursuant to the Contact 's l.icemp Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ 1.. Rept n der Sec ,B.&P.C.for this WATER HEATER W/VENT 6.00 i reason Owner KERS'COMPENSATION DECLARDate / WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. ATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconscot to self-insure. ora certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab C.). Policy No. Company O ❑ Cenifhed copy is hereby furnished. FIRE SPgINK ENERGY T24 Z z O Certified copy is fled with the city inspection division. f- p Applicant MISC.- REFER TO ORD. Y ❑ N[] Y ❑ N[-] CC W CERTIFICATE OF EXEMPTION PROM WORK ERS' PERMIT ISSUANCE 10.00 FLOOD-ZONE A.L.U.C. W COMPIiNSAfION INSURANCE PLG.CONTR. LIC.NO. PLG. CL p (This section need not be completed if the permit is for one TOTAL Y❑ N Y[] N :) Z hundred dollars(S 100)or less.) U O 1 certify that in the performance of file work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H mit is issued,I shall not employ any person io any manner so as to O W become subject to the Workers'Compensation Laws of California. C. Dam ApplicantUILOING >_ N NOTICE TO APPLICANT: If,after making this Cerlificme of lix- ALTER OR ADD TO MECH. 5.00 l�1 F Z emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK U provisions of the Labor Code, you must forthwith conhply with FEE such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNITIOVER 10=C.F.M.) 6.00 SEISMIC FEE 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. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC I certify 11,411 have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 Information n estate . I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws representatives to building construction, and hereby entioed ropertyforins of on city es enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) agree to save• indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities, i,fligments, costs and expenses which may in any way com List sat it in consequence of CONST.TAX the PERMIT ISSUANCE 10.00 genii of this mil. /J,rIL/ MECH.CONT. LIC.NO. MECH. ,p IJ Sib 41 o Ap /Confracinr 1196, TOTAL TOTAL Dec OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PERMIT NUMBER •1 { INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# PERMIT EXPIRESAF,WORK OWNER CONTRACTOR _ IS NOT-STARTED WITHIN INS ECTION DATE INSPE TOR I IN CTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - d ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE - 7-944 V✓ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MAY UNDERGROUND /SLAB PLUMBING .City Of COPBrtIDO ELECTRICAL ISSUANCE DATE MECHANICAL - BLDG. E T. PLG. mecR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED / BUILDING PER WOOD FLOOR INFORMATI N VALUATION S/FT. PLUMBING MECHANICAL �� / .•" ELECTRICAL ERMIT TO i FRAMING � • INSULATION STORIES TYPE CONST . OCG-GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF $O.F T,FLOOR ARE A TOTAL ACREAGE DIAPHRAGM I +I BUILDING U5E RES INp CON P9 Olney APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED Q4 ❑ ❑ ❑ ❑ ROUGH 'JASSESSORS PARCEL NO. PLUMBING ! ' GAS TESTTRACT NO, PARCEL NO. D` MECHANICAL ELECTRICAL — FINALS. DATE INSP. Acc.DATE ACG FILE NO. FRAMING SAN # INSULATION PLUMBINGZONING ENG.SITE NO. — 254) GAS MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING 2. Y ❑ N❑ V ❑ N❑ LATH—INTERIORELECTRICAL FLOOD ZONE A.L.U.C. -z � LATH—EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING U SHEAR EXTERIORTEMPORARY APPROVALSBUILDING 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 ISSIGNEDBY BUILDING INSPECTOR. MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.ONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY '