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13918 (2) MAKLICANT TO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER HULDING '- ?jr-terry APPLICATION & PERMIT 13918 ADDRESS / &//4BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK yyy{{(��LIGATION NAME ETV. ELECTRIC PERMIT FEE G 1. n (/ /a HDNE ��OiI7/J'-F� CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 NRME d Neu/$ �O LIc.NO. ,� LIGHTING FIXTURES 10.00/1. . ADORE 's APPLIANCES-RESIDENTIAL 4.00 r ONE i PANELS 10.00 GATE OF APPLICATION RCHrtacT PANELS (OVER 200 AMP) 20.00 PLAN-CHECK P.C.No. O - DR "'IN fE C/ C LIC.NO. SIGNS TRANS. 3.00 ARCH.oR fNc' SPECIAL CIRCUIT 5.00 PERNoAV VQAtT10N ADDRESS ([+ ld nr EMP.METER OR POLE INS. 20.00 APPLICANT'$ I MOTORS SEE FEE SCH.T. I I y ADDRESS �- �:QW� SERVICE CHANGE 120.00 / p ,a. rs¢o LICENSED CONTRACTORS DECLARATION /�1u1•� ( 6��1' 14IQQ �' I hereby affirm that I am licensed under provisions of Chapter 9 / ISS A 4,2 ISSUANCE DATE (Commencing With Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. n i Professions Code, d my license is in full fore d z o License Class _ Lie.Number y7 /7 rri f ❑ ❑ g r Date_. Contractor_ _�r .Xf ¢ Y¢ ¢ OWNER-BUILDER DECLARATION i ��PI f;Q QFt98Sfl.�Q BUILDING PERMIT _ ¢ w O INFORMATION MISC.- REFER TO ORD a`xr 'H 1 hereby affirm that I am exempt from the Contractor's License VALUATION $/FT. a- o e Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 r WC 0J Code:Anycityorcounty which requires a permit to construct,alter, l.` /s/�/IT 2 ¢¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ''JJ�s l.J i y O¢ requires the applicant for such permit to file a signed statement that TOTALd d PERMIT TO x 9-1 he is licensed pursuant to the provisions of the Contractor's License w W > Law(ChapterProfessions Codeng )or Section 7000)ofctherefromion 3 the Ic iio Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE ¢;H the the boats portae alleged exemption.Any violation Section malty STO IES ,TYPE CONSTR. by any applicant forapermit subjects the applicantt oacivil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 �A J of not more than five hundred dollars($500)): ❑ 1,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 null EOCC. UP RES.UNITS intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREACOND. 5.00 Code:The Contractor's License Law does not apply to an owner ofproperly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 R 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-i INC.4 OUTLETS 6.00 or improvement is Said within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Omer prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the properly,am exclusively contracting with - ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 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 contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec._,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Dam WATER SYSTEM 5.00 ACC.DATE ACC,FILE NO, WORKF.RS'COMPENSAI ION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that l have a certificate of consent to self-insure, ZONING ENG.SITE NO. . or a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company Q ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-Z4 Z Z ❑ Certified copy is filed with the city inspection division. MISC.- REFER TO ORD. y ❑ N❑ y ❑ No Applicant F PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.u.c. LU CERTIFICATE EXEMPTION FROM WORKERS' W COMPENSATION INSURANCE I.G.CONTR. LIC.N0.]�a�;?A4 PLG. ❑ ❑ 1 (This section need not be completed if the permit is for one 1f- TOTAL V N V ❑ "❑ D Z hundred dollars IS 100)or leas) U O I certify that in the performance of the work for which this pe CITY. MECHANICAL PERMIT FEE FEE SUMMARY I- mit is issued,1 shall not employ any person in any manner so as LL U become jectt the WOrkers'Com pSnsmion ws of California. BUILDING Date Applicant /rte tf../ 115" O y r ALTER OR ADD MECH. } N NOTICE TO APPLICANT: If,after making this Ceroticale of hx- _ Z emphon,you should become subject to the Workers'Compensation APPLIANCE GtCS " 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE (� such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,-F.M.) 4.00 % CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER t0,00DC.RM.) 6.00 SEISMIC FEE OS yaffirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.001 - 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 HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Q Lender's;Address- Icertifythatlhavereadthisapplicationandstatethattheabove VENTILATION FAN (SINGLE) 4.00 Information is correct.I agree to comply with all city and county - PLUMBING lordinances end state laws relating to building construction, and BOILER-COMP I3 H.P.or 100,000 B.T.U.) 6.00 ,hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 10o,0DOBTU)SEE FEE SCH. MECHANICAL 'L above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 l) `t' CONST.TAX may in any way acem against said City in consequence of the grantin [hi erat MECH.CONT. LIC.NO. MECH. ' �/7/ -S-7 TOTAL /�tTZ TOTAL Si atureof Ap caul/Contractor Date ^+ OFFICE COPY POSTTHISCARD NEAR FRONT OF BUILDING " NUMBER PERMIT 3918 CITY OF CUPERTINO ' / - INSPECTION DIVISION JOB,INSPECTION RECORD I 'PERMIT EXPIRATION 7634 HOLLANDERRY "JOB ADDR ESS UNIT# LOT# - - PERMIT EXPIRES IF WORK OWNER LEROY WILKONSON CONTRACTOR GOOD NEWS CONSTRUC. IS' NOT STARTED WITHIN INSPECTION DATE INSP CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- - ANCE OR 180 DAYS FROM FOUNDATION D - LASTCALLEDIN ,ECTION.' UFER PERMIT VALIOA ION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING �-c '�" 1. •i �`i •( + ELECTRICAL 0.J\ _ ISSUANCE DATE BO 1 ELECT, PLG, MECH, P7 MECHANICAL C0'i CVI �AX[] 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1•) BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION $/FT., PLUMBINGr( , MECHANICAL '~~ W PERMIT TO , ELECTRICAL FRAMING STORIES - TYPE CONSTR. INSULATION OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.FT,FLOOR AREA TOTAL ACREAGE ROOF DIAPHRAGM eu..DING USE / HES IND CON PB 01he, El E:l El El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED EL ASSESSORSPARC EL NO, ROUGH PLUMBING TRACT NO. PARCEL NO. r GAS TEST - MECHANICAL ACC.OATE ACC,FILE N0. ELECTRICAL , - �- FINALS DATE INSP. FRAMING _ SAN # ZONING ENG.SITE NO, INSULATION 1PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T24 _ .3-I' ' v � N❑ v � N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A,L.U.c. LATH-INTERIOR ELECTRICALS •c LATH-EXTERIOR FIRE DEPT. Y❑ NE] - Y O No SHEETROCK - '��1 GRADE FEE SUMMARY SHEAR INTERIOR - BUILDING -( C, UILDING SHEAR EXTERIOR TEMPORARY APPROVALS ELECTRIC PLAN CHECK FIREWALLS --FEE �-Z.'S GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOT,PERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM r 1 ARRANGE FOR IN BY PHONING 252-4505, ELECTRIC i7 w ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING Ol� 'PLEASE GIVE JOB ADDRESSWHENPHONING. Z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAXI IMPORTANT! • PLEASE READ REVERSE SIDE BEFORE i" " TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY I -