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17078 (2) • •, APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION -PERMIT NUMBERq BDu ESS APPLICATION & PERMIT 170 f S ADOREss ILDING -ELECTRICAL-PLUMBING-MECHANICAL a OWNERS PLAN CHECK VALIDATION NAME /' TV. ELECTRIC PERMIT FEE { PHONE croR NAME s UTLETS-SWITCHES-RECER 10.00/1.00 NAME uc.No.CONTRAIGHTING FIXTURES 10.00/1.00 ADORES I{o(� 's APPLIANCES-RESIDENTIAL 4,00 RES !^ A HI LT DATE OF APPLICATION PHONE ISS PANELS 10.00 OR PANELS (OVER 200 AMP) 20.00 ENGINEER PLAN CHECK FEE P.C.NO. AENG. LIC.No. SIGNS TRANS. 3.00 ADDRESS SPECIAL CIRCUIT 5O PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 �, APPLICANT'S ••y�.�, aooRE �11I MOTORS SEE FEE SC H. l'CI- Ph0./U SERVICE CHANGE R 2 20.00 w 1 .02 LICENSED CONTRACTORS.U?iCLA TION �� a v I hereby affirm that I am licensed under provisions of Chapter 9 " y¢n Iconnneneiog=il S`crion]000)of Uivisian 3 of the Nosiness and ISSUANCE DATE - r y z Prafessla'is Co d mlicense is in full l'o to BLD EL CT. , PLG. MECH. Z o w - Llwnse C Lic.Numhor 4 ,Z,r Z Uutc_ ContmCRR_ OWNER BUILDER DIiCLA ATIRATIO BUIL ING PERMIT w3: u H 1 herchy affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD INFORMATION H LL O ¢ Law for the following reason(Sec.7031.5,Business and Professions �p ALUATION $/FT. „ PERMIT ISSUANCE 10.00 YX'J Code:Any city or county which requiresn permit to construct.alter, CO Q 2.0 improve,Demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. CLEC. LL nyuires the applicant for such permit m filo a signed smlemem that TOTAL w 8 he is licensed pursuant m the provisions of the Contractor's License ADO IT TO L, Z< Law(Chapter 9fcommencing with Section 7000)af Division3 of t he r q i D Business and Professions Code)ar that he is exempt therefrom and OTV. PLUMBING PERMIT FEE ¢I-$ 1he basis for the alleged exemptioh.Any violation of Section 7031.5 STOR T NSTR. i3 � by any applicant forapermir subjects the applicant toacivil penalty ALTER-DRAIN- bt not more than flue hundred dollars(5500).1: (EA.) 5.00 ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 (heir sole compensaliaq Will do lhC work,and the structure is Oof OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF.,AREA,COND.' 5.00 Cade:Thu Contractor's License Law does not apply to an owner of properly who builds or improves thereon•and who docs such work FIXTURES-PER TRAP 500 himself or through Ills own employees.Provided that such improve. . SO.FT.FLOOR AREA TOTAL ACREAGE mems are not intended or offered forsale.If.Imwever,the building GAS-EA.SYSTEM-1INC.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(EA.) 2.00 BUILDING USE Prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 30.00 R IND cDN pe Omer O I,as owner of the property,am exclusively contracting with - E a ❑ licensed contractors to construct the project(Sce. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 {urd I'rofessinns Code:The Conlracroi s License Law docs not apply ASSESSORS PARCEL NO. to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER-5(EA.) 1.00 ca,lroca for such projects with a conlmemds)licensed pursuant to the Contractor's License Caw. ❑ SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO. I am exempt under Sec, ,B.&P.C.for this reason WATER HEATER W/VENT 6.00 Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. ' WORKERS'COMPENSATION DECLARATION WATER TREATING EQ U IP. 5.00 I hereby affirm that I have o cercil eato of consent to sel Pinsure, or a certificate of Workers'Compensar1 n Iryn/urunco or a c tined ZONING ENG.SITE NO. Pali m y V O ❑ Cor id cop cr y furnished. Z Z Certified ed I with it a FIRE SPRINK ENERGY T-24 F- O Ip {ant _ MISC.- REFER TO ORD. y El N ElrA.L.U.C.[:] NE H CF TIP AT F -XEMPI'ION FROM WORK. PERMIT ISSUANCE 10.00 d _ FLOOD ZONE O $ATION'INSUNANCE PLG.CONTR. LIC.NO. pLG,(This sectionReed not be completed if the permit is for one Y❑ N0 N 0 :3O hundred dollnrs(SI00)or less.) I certify that in the performance of the work fur which.this per- CITY MECHANICAL PERMIT FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to FEE O W become subject to the Workers Compensation Laws of California. Q. Date APPLICANT: I ALTER OR ADD TO MECH. 5.00 BUILDING �� }.tn NOTICE ptimi,TO APPLICANT: If•after making this Certificate sa Ex- A ? emplion,you should become subject m the Workers'Came comply with APPLIANCE 5.00 PLAN CHECK .* provisions of the Labor Code, you must forthwith comply with FEE �U r Z'� V such provisions or this permit shall he deensoA revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 4,00 CONSTRUCTION rLENDINC AGENCY AIR HANDLING UNIT(OVER 10MC.EM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 MICROFILM the performance of the work I'or which this permit is issued(Sec. 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UNIT(OVER 100,000 B.T.U.I,% ELECTRIC I certify that 1 have read this application and state chat the above VENTILATION FAN (SINGLE) 400 ® information State l CL cI agree to comply with all city and county . PLUMBING ' ordinances and scare laws relating to building construction. and BOILER- AM(3 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned agree to property for inspection purposes. BOILER-COMP IOver 100,000 BTU)SEE FEE$CH. MECHANICAL (We) agree 10 save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00CONST.TAX ' ranting of this permit. MECH.CONT. LIC.NO. MECH. e�11 /}�� StNTOTAL TOTAL nahve of APPlaan[/Contractor Uutc `�lI OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17078 INSPECTION DIVISION 1 . JOB INSPECTION RECORD ir1 PERMIT EXPIRATION JOB .— �„_ '"', PERMIT EXPIRES IF WORK OWNER Tp' 'JyL�(�(,J'U/�. CONTRACTORt,., .� - - j j" IS NOT STARTED WITHIN INSPEC ION GD TE INSPECTOR INS 2 RECO'RD�� 180 DAYS OF PERMIT ISSU- FOUNDATION F - - ANCE OR 180 DAYS FROM ALL GRADING RADING AND DRAINAGE SHALL BE INSTALLED - LASTCALLEDINSPECTION. � - ALL G PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION _ CUPERTINO STANDARDS. , GARAGE SLABS IGr POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING pI�' 'I q 'I(] )(� ELECTRICAL JAN 1 3 1J 7J ISSUANCE DALE ' MECHANICAL - - RLD E ECT. PLG- . MECR Lliy of COpert n ❑ ❑ 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT ' WOOD FLOOR INFORMATION PLUMBING vn LAT1ON C SIFT. MECHANICAL - ELECTRICAL f RmIT TD lA FRAMING INSULATION - STORIM r Pec NSTR, DCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED / ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50.Fl FLOOR ARLA TOTAL ACREAGE DIAPHRAGM' THE CONSTRUCTION TAX IS PAID BUILDING USE i ROOF SHEATHINGICON PB - APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP- ASSESSORS PARCEL NO. ROUGH SAN.N PLUMBING ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO. PARCEL NO MECHANICAL MECH.ENERGY. - ELECTRICALAcc.DATE ACE,PILE NO BUILDING ENERGY FRAMING ELECT.FINAL TEST ' ZONING ENG.SITE NO. INSULATION � PLUMBING GAS TEST GAS ' MECHANICAL FIRE SPRINK ENERGY T.SA, COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y [:] "❑ ° ❑ ' "[ ' . EXTERIOR SHEAR ELECTRICAL RELEASE FLOGumNE AL.0C. INTERIOR SHEAR FIRE DEPT. Y❑ NEJ Y ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH " BUILDING INTERIOR LATH TEMPORARY PPROV LS BUILDING SCRATCH COAT - ELECTRIC PLAN CHECK GAS - FEE- NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY ' SEISMIC FEE ? OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. .MICROFILM Lu ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC j L-� ONE WORKING DAY BEFORE REQUIREDJNSPECTION• PLUMBING, O PLEASE GIVE JOB ADDRESS WHEN PHONING. z - SEE PERMIT FOR EXPIRATION'DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE'BEFORE TOTAL CALLING FOR.FINAL INSPECTION. ' 177. 7 OFFICE COPY