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17444 (2) APPLICANT TO FILL IN INFORMATION WITHIN'RED LINES -.USE BALL POINT PEN ONLY ' - - UILDING PROJECT IDENTIFICATION -PERMITNUMBER. . APPLICATION & PERMIT,. 1 �] /� A , BUILDING f f LF f.` ADDRESS 1 MOSa P. BUILDING=ELECTRICAL-PLUMBING-MECHANICAL '"W_ NAME OWNER'S 'y,I -/, PLAN CHECK VALIDATION OTV. ELECTRIC PERMIT FEE aro,_ PHDNE ,a�3- CONTRACTOR /109 'S , c ��y 3 NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 .23,0Z3 LICNO, Z ZLIGHTING FIXTURES 10.00/1.00 /BY pct.nooeessTOR's APPLIANCES-RESIDENTIAL 4.00 ' PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PLAN CHECK FEE PCNO. on PANELS (OVER 200 AMP) 20.00 P.C._. ENGINEER �JIj /1 Ul El ,dfC.rvo.C'617090SIGNS TRANS. 3.00 ARCH,OR ADDRESS ENG SPECIAL CIRCUIT 5.60 PERMIT VALIDATION t ZIP TEMP.METER OR POLE INS. 20.00 ADDDRESS AORE MOTORS SEE FEE SCH. p p / 1 / gQf ti &e, ISERVICE CHANGE 20.00 � Do - ,LICENSED CONTRACTORS DECLARATION a u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE I" (commencing with Section 7000)of Division 3 of the Business and ELECT. PLG. MECH. In¢ y r H z Professions Code,and Ivy license is in full force and effect. BLDG. U Z i _ D License Class " Lia Number '-'- Date.Contractor Y E BUILDING PERMIT w ¢ ¢ w u OWNER-BUILDER DECLARATION INFORMATION;LL y I hereby infirm that I am exempt from the Contractor's License MISC.-- REFER TO ORD u o¢ Law for lite following reason.(Sce.703 LS,Bmanessand Professions 11 VALUATION $/FT. •� - PERMIT ISSUANCE 10.00, • p Code:Any city or county which requires a permit to construct,alter, DDD 2 rt Q improve,-d6molish,or«pair any structure,prior to its issuance,also FLED.CONTR. LIC.N0. ELEQ a D i O ¢ requires the applicant for such permit to file a signed statement that TOTAL 6 T[ he is licensed pursuant t0 the provisions Of the COntrnctor s License ' ° PERMIT TO z a Law(Chapter9(commencing with Section 7000)of Division 3 of the 4 o Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT' FEE It r$ the basis for the alleged exemption.Any violation of Section 7031.5I STORIES TYPE CONSTR. a- by any applicant for a permit subjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00 s V of not more than five hundred dolbus($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS ` intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 1 Code:The Contractor'sLicense Law does not apply to an owner of property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 5.00 .0 SD,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- _ ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4 OUTLETS 6.00 or improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2:00 BUILDING USE 1.'},f ! builder will have the burden of proving that he did not build or im- RES IND CON PB Otner prove for purpose of sale.), - INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ CO � . �( I,as owner of the property,am exclusively"contracting with - lied contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. a d Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1-.00 contracts for such projects with a conlmctorfs)licensed pursuant to the�yCContract.,',License Law. SEWER-SANITARY-STORM EA.200ft/10.00 . TRACT NO. PARCEL NO. I rea4Lnlu rider Sec. ,B.&BC.for this WATER HEATER W/VENT 6.00 „QU Owner Date WATER SYSTEM 5.06 ACG DATE ACG FILE NO. WORKERS'COMPF.NSATION DECLARATION WATER TREATING EQUIP. - 5.00 ' 1 hereby affirm that I have a certificate of consent to self-insure, - or a certificate of Workers,Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.). , ' Policy No. Company 0 ❑ Certified copy is hereby furnished FIRE$PRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. 0 Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N[- CC [CC w CERTI FICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 �VVFLOOD ZONE .A.L.U.C. W > - COMPENSATION INSURANCE - PLG.CDNTH. LIC.NO. PLG. 0' (This section need not be completed if the permit is for one TOTAL V D V N Y NF] Z hundred dollars($100)or less.) V O I certify that in the performance of the work for which this per;, OTV. MECHANICAL PERMIT " FEE LL 1- mit is issued,1 shall not employ any person in any manner so as to FEE SUMMARY O U become subject to the Workers'Compensation Laws of California. nn y Date Applicant r DO (BUILDING 5GL •� } W, NOTICE TO APPLICANT: If,after making this Certificate of E-- ALTER OR ADD TO MECH. 5.00 )- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C-F.M.) 4.00 Q CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE Fj, IS I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 hi the performance of.the work for which this permit is issued(Sec.' yo ^ 3097,Civ.C.h I HEATING UNIT(TO 100,000 B.T.U.) 8.00 p V Lender's Name - - HEATING UNIT(OVER 100,000 B.T.U.)9.50 q Lender's Address � ELECTRIC Q• =iM� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 a I) - information is correct. I agree to comply with all city and county PLUMBING 34 U 0 ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. aMECHANICAL y r above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. uperfino-against Imbilit,es,judgments, co s and expenses which CONST.TAX may y�way aeome against said CIt consoqucnee oC the PERMIT ISSUANCE - ; 10.00 r p r [his permit �/f / MECH.CONT. LIC.N0. MECH. X /�L�� /; OTA u SST TOTAL 6 St natureofA Leant n[mctor Date I OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PE R.MIT NUMBER r CITY OF -CUPERTINO 17444 INSPECTION'DIVISION ' JOB INSPECTION RECORD I � {//-�/' PERMIT EXPIRATION JOB ADDRESS�1 g6 / ;--r AAO4 C{ UNITtt LOT# /�- PERMITTT EXPIRES IF.WORK OWNER 1 l� C� p t- roR IS NOT STARTED WITHIN INSPECTION DATE INSPEC R INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION - ACE OR 180 DAYS FROM NOTE: LIFER. ALL GRADING AND DRAINAGE SHALL BE INSTALLED LASTCAL LED INSPECTION. PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. ` ' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL B� 2 LDDG. ELECT PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION $/F T. PLUMBING VALUATION, MECHANICAL - �,o D p ELECTRICAL - - /�1 TPErRnin ro FRAMING - - - - �I Il D INSULATION STORIES TY PE CONSTR OCC GROUP HES UNITS + PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFSU FT.FLOUH a+EA TOTAL ACREAGEORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID. BUILDING USE ROOF SHEATHING HES IND . CON PB 0', APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ nSSESSORSPARCELNO ROUGH SAN.a PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN - 'PLUMBING ENERGY MECHANICAL- MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE No FRAMING .' - ELECT.FINALTEST ZONING- ENG SITE NO. INSULATION PLUMBING GAS TEST- GAS MECHANICAL FIRE SPHINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ Y ❑ N❑ FLOOD20NE A.L U.C. EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. Y❑ N❑ Y.❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING �2Z-• � INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .. OCCUPANCY OF BUILDING IS NOT P ERMITTED UNTI L BUI LDING F INAL IS SIGN E D BY BU I LDING INSPECTOR. MICROFILM �— ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGLU (� O� PLEASE GIVE JOB ADDRESS WHEN PHONING. 1 Z - - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL <4 IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL _ 7Bl0�' CALLING FOR FINAL INSPECTION. OFFICE COPY. e