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11382 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ` BU I LDING PROJECT I DENTIFICATI ON PERMIT NUMBER BUILDING APPLICATION & PERMIT 11382 ADDRESS RA& t BUILDING- ELECTRICAL-PLUMBING-MECHANICAL OWNERS' PLAN CHECK VALIDATION NAME ELECTRIC PERMIT FEE 17 S ON � CONTRACTOR'S NAME - OUTLETS-SWITCHES-RECEP 10.00/1.00 ^ 7I L /� LIC.NO, LIGHTING FIXTURES 10.00/1.00 e7, CONTRACTOR PPLIANCES-RESIDENTIAL 4.00 PRON !' PANELS 10.00 DATE OF APPLICATION ORCMITE T aj_ A L �S y PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEE T Kms/ vG LIC.NO, SIGNS TRANS. 3.00 noo'Ess ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zIP EMP.METER OR POLE INS. 20.00 AE MOTORS SEE FEE SCH. ADDRDDRESSS tf` SERVICE CHANGE 20.00 wo LICENSED CONTRA -I' a i w hereby affirm that I am licensed under Provisions of Chapter 9 t DATE a `w (commencing with Section 7000)of Division 3 of the Business and B O ELECT. PLG. MECN. w z Professions or and y license is in 1111 ti f z o m - License Cl.. Lia Nun y f�p ffl® 0 H )ate CONrBc se y E J M 4 OWNER-BUILDERD- LA BUILDING PERMIT iL M a D INFORMATION X g a- n I hereby atfrm that I am exempt fru lie Contractor's License MISC.- REFER TO ORD to u o J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT. Code:Any city or county which requiresa permit to construct.alter, rta,Q O improve,demolish,or repair any St ruct Lire,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. G a requires the applicant for such permit to file a signed statement that TOTAL PER TO n w m he is licensed pursuant to the provisions of the Contractor's License D F Z Q Law(ess and,9(Cosmos Code)or Section is exempt therefrom and N Business and Professions Code)or That he is exempt therefrom and QTY. PLUMBING PERMIT FEE te F m the basis for the alleged exemption.Any violation of Section 7031.5 / STORIES- TYPE CONSTR. dam _ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(55001.): ❑ 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 structure is not OCC.GROUP RES.UNITS 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 F IXTUR ES-PERT AP 5.00 SD�R AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- ments an not intended or offend for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one-year of completion,the owner- builder will have the burden of proving that he did not build or im- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 s IND CON P8 Omer ❑ 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 ASSE55ORS FARCE L NO. El 13 13 F-1 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ l am exempt under Sec..,B.&P.C.for this WATER HEATER W/VENT reason 6.00 Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE N0. WORKF-RS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers Compensation Inssuuurranc�e,,.or a certified ZONING ENG.SITE NO. F PY 0 au'r f�.CPJIwI-J a.[.2 ❑ CeRi red C s hereby furmine z O-Certift 'o y is filed vi the `Ir U e liar division. FIRE SPRINK ENERGY T 24 F O Applicant MISC.- REFER TO ORD. Y❑ N Y ❑ N� Cr N CER1'IFICA OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.UC. W � C MPENSATION INSURANCE PLG.CONTR. LIC.NO. CL O PLG. = Z ('Phis section need not be completed if the permit is for one TOTAL Y N Y ry � O hundmA dollars(SI00)or less.) I certify that in the performance of the work for which this per-LEATING MECHANICAL PERMIT FEE FEE SUMMARY LL U 'mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. i Date Applicant BUILDING } N NOTICE TO APPLICANT: IL after making this Certificate of Ex- OR ADD TO MECH. 5.00 t5 b F ? emption,you should become subject to the Workers'CompensationANCE 5.00 PLAN CHECK provisions of the Labor Code, you nmst forthwith comply with FEE U such provisions or this permit shall be deemed revoked. NDLING UNIT(TO 10MC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY NDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency forUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). NG UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address NG UNIT(OVER l00,0006.T.U.)9.50 ELECTflIC I eerily thm I have readthis application and state that the aboveLATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply will,all city and countyPLUMBING ordinances and state lws relating to building construction, and -COMM H.P.or 100,000 B.T.U.) 6.00hereby authorize representatives of this city to enter upon theR-COMP (Over 100,too BTU)SEE FEE SCH. abuve-mentioned property for inspection purposes. MECHANICAL (We) agree to ve, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino aga rhabilifics,judgments, cos d expenses which CONST.TAX may in an at, accrue against said City s c sequen of he PERMIT ISSUANCE 10.00 granlln this permit MECH.CONT. LIC.NO. MECN, 7 TOTAL TOTAL ,5-7ignalure of plicant/Contractor D e OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PER„ITND„RER INSPECTION DIVISION 11382 JOB INSPECTION RECORD �I- PERMIT EXPIRATION - JOBADDRESS �IP� �' �J'a-�e5 UNIT# LOT# 7 PERMIT EXPIRES IF WORK OWNER 0,0 MD bed I CONTRACTOR Silva On IS NOT STARTED WITHIN INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU FOUNDATIONANCE OR 180 DAYS FROM LIFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING I ELECTRICAL ISSUANCE DATE MECHANICAL eL9G. ELECT. PLG. MECH. © ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. MECHANICAL - ELECTRICAL PERMIT TO FRAMING - o T IN) STORIES TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS _ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED w� ROOF SO,FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM � BUILDING USE yE5 IND CON PB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED IT] ❑ ❑ ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICALFINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING �b SAN OF INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL 52, 2.re FIRE SPRINK ENERGY T-1d COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NIf FLOOD ZONE A.LUC. LATH-INTERIOR ELECTRICALLATH-EXTERIORFIRE DEPT. Y❑ N❑ Yo N❑SHEETROCK GRADEFEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCv SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505; ELECTRIC o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. 4,. PLUMBING ZMECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. ' OFFICE COPY