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10777 (2) +� APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT I DENTIFI CATION. PERMIT NUMBER BUILDING APPLICATION & PERMIT �• AZZ,7 4epw045 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 10777 DWNER'5 PLAN CHECK VALIDATION NNAf.M�E �J CITY. ELECTRIC PERMIT FEE // \) /, tf"T{ I tP•�+. I'T� PRONE -�1 W / / CONTRACTOR'S NAME �j �� (p OUTLETS-SWITCHES 10.00/1.00 v/O�` 1` L I'C❑ �1)� �GI.Ic.no. 2 LIGHTING FIXTURES 10.00/1.00 /` COY On RAcrons PPLIANCES-RESIDENTIAL 4.00 - ADDne55 SSI &X0-P-{ VE. 5.J,PHONE :31Fj 7 PANELS 10.00 DATE OF APPLICATION ARCHITECT0. PLAN(OVER 200 AMP) 20.00 PLAN CHECK FEE C.No. ENGINEER ise-i c.No. ISIGNS TRANS. � 3.00 AT H. ENG' SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 PAD• APPLICANTS MOTORS SEE FEE SCH. FF - ADDRESS B .10 SERVICE CHANGE 20.00 19 woo LICENSED CONTRACTORS DECLARATION /�Of �" a u v 1 hereby affirm that I am licensed under provisions of Chapter 9 TE Haw (commencing with Section 7000)of Division 3 of the Business and BLDG. E PLG. ECH. F m z 1'mfessions Cd reit y license is in full for c an Wff t. i i w o Licelve Clan Lic.Number o w H Uma Contractor - st y -c- BUILDING PERMIT a a a OWNER-BUILDER DECLARATION a w v INFORMATION wA w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD R .. o g Law for the following reason.(Sce.7031,5,Buslnessand Professions PERMIT ISSUANCE 1000 VALUATION S/FT. E r'0P Code:Any city or county which requiresa permit to construct,alter, M ac a O improve,demolish,m repair any Mmetere,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. in D ic requires the app Ucant for such permit to lilt a signed statement that TOTAL PERMIT TO w 9 w he is licensed pursuant to the provisions of the Contractor's License I z r Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe 4 o Buslne.v and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE a r the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(551)07.): IF- ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 ocC.GROUP REB.UNITS Their sole compensation,will do the work,and the structure is not _ intended or offered for sale (Sec. 7044, Business and Profcviuns DRAINS-FLOOR,ROOF,AREA,COND. 5.00 a' Code:The Contractor's License law does not apply to an owner of '.a property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 - 5O,FT.FLOOR AREA TOTAL ACREAGE F himself or through his own employees,provided that such improve- ' mems are not intended or offered for sale.if however,the building GAS-EA.SYSTEM-1 INC-40UTLETS 6.00 '"M 'or improvement is sold within one year of completion,the owner- '.y' builder will have the burden of proving that be did not build or int- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. RES IND CON PB Otlnr 30.00 ❑ .❑ 1:1 El 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 ASSESSORSPARCELNO. and Professions Code:The Contractors 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 v contractort s)licensed pursbanT To the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt Under Sec. ,B.&P.C.for This WATER HEATER W/VENT 6.00 reason Owner Date _ WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPITNSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified - _20NING ENG.SITE NO. Policy NySyf(Sc�:.3 A,Lab 'Y P. O ❑ Certified copy is herehy fu fished. RE SPRINK ENERGYTZ4 Z ❑ Cersl Ic oty Ic ITI the�)Ty spection division. IJ� CIU. MISC.- REFER TO ORD. APPIiCanl � y ❑ ry❑ y ❑ ry❑ F- rn Cr - G1iR1'1 1FICA 117 OF EI T10N FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.C. W CO � COMPENSATION INSURANCE PLG.CONTR. ❑C.NO. PLc. d,0 (This section need not be completed if The permit is for one TOTAL Y❑ N❑, Y ❑ N❑ ::) Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTV 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 } DD TO MECH. 5.00 to NOTICE TO APPLICANT: If,after nsa king this Certificate of Ex- ALTER OR A F Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the tabor Code, you most forthwith comply with FEE J U such provisions or this permit shall bc deemed revoked. AIR HANDLING UNIT(TO 10=C.F.NL) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F. .) 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 pennit 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.)Lenders Address ELECTRIC 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby enlhoed roperty for ins of this city to enter upon the BOILER-COMP (Oxer 100,000 BTU)SEE FEE SCH. MECHANICAL also e-mentioned property for inspection purposes. (We) uphe: to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino ag st Babi lines,jud cots, costs and expenses which' CONST.TAX may in y y accrue against id City in consequence of the PERMIT ISSUANCE 10.00 Y flfd j - MECH.CONT. LIC.NO. MECH. / TOT TOTAL TOTAL Qrlatum of Appli nt/Con act Date / OFFICE COPY ' (Z. POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 10777 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS_I Dlvlp7 f-I IhF�N'� UNIT# LOT# pERM1T EXPIRES IF WORK OWNER CONTRACTOR Nl_ _AjIS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION R CO D 180 DAYS OF PERMIT ISSU. FOUNDATION-+ —Z wtXAI� y7 .AN E OR 180 DAYS FROM - LIFER ' LASTCALLEDINSPECTION. PREGUNITE , PERMIT PA35 N POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - _ FEB 10 1�� UNDERGROUND /SLAB {, PLUMBING . Cit Of CUPert1no ELECTRICAL _ ISSUANCE DATE MECHANICAL BLDG. EL PLG. I MCR. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT INFORMATION.S. WOOD FLOOR VALUATION /FT. PLUMBING MECHANICAL .� ELECTRICAL _ PER WJT To , FRAMING - I I INSULATION STORIES ;TYPE CONSTFt. OCC.GROUP RES.UNITS r` PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED saFr. 00BAREA roTALACBEAee 'ay1 ROOF a ( J// DIAPHRAGM e aOlNc usE ` Y' I RESI CON PB OIBn APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 11 ❑ ❑ ASSESSORS ROUGH PARCEL NO. - , PLUMBING - - GAS TEST - TRACT NO, PARCEL NO. � ' MECHANICAL _ cZ. ��y�� ACC.GATE ACG FILE NO, ELECTRICAL FINALS DATE INSP. FRAMING SAN # ZONING ENG,SITE NO. INSULATIONPLUMBING , GAS MECHANICAL FIRE SPRINK ENERGY T-24 - COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] N[:) Y [3 NEI • LATH—INTERIOR ELECTRICAL FLOOD,ZONE A.L.U.c. LATH—EXTERIOR FIRE DEPT. ' Y❑ N❑ Y0 N❑ SHEETROCK �j�, GRADE FEE SUMMARY SHEAR INTERIOR BUILDING _ SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLSELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE i OCCUPANCY OFBUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR: MICROFILM �..� ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN.PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — CONST.TAX ' IMPORTANT! -- / PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY