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12943 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER ADSG APPLICATION & PERMIT 12943 -�' ADDRESS BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION • NAME-. QTY. ELECTRIC PERMIT FEE Q C, PH CONTRACTORS UTLETS-SWITCHES-RECEP 10.00/1.00 p T- LIC.NO. y LIGHTING FIXTURES 10.00/1.00 r. TRAc7o - PPLIANCES-RESIDENTIAL 4.00 Ess O I PHONE PANELS 10.00 DATE OF APPLICATION ARCHITECT PANELS (OVP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. ISIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL I S.00 PERMIT VALIDATION -- ZIP EMP.ME OR POLE I 20.00 ADDRESNra MOTORS SEE FEE SCH. �l�y1'f-/✓' AOORE55 SERVICE CHANGE 20.00 y HO o LICENSED CONTRACTORS DECLARATION l7/�//r Fi W I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. H m z Professions Cod 'an I my license is in full for, alhd e 1 cj.� Z, i w G Licen las Coo Numb V_11�y. 1 ❑ ❑ •❑ 9 Dale Coo ° a x BUILDING PERMIT w OWNER-BUILDER DECLARATION INFORMATION it. ;a H I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD Hu°o J Law for the followingmason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION Cods:Any City or County which req uires a permit to construct,alter, QQ¢0 Improve,demolish,or repair any structure,prior to Its issuance,also E C. NTTR/fes LID.NQ ELEG , requires the applicant for Such ea U. permit to file a signed statement that L�/ y/// TOTAL PERMIT TO n w w he is licensed pursuant to the provisions of the Contractor's License H > Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe s i o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE �' G• the basis for the alleged exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. u 3 .- by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 of not more than Ove hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW 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 FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsarenotintended or offered forsale.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 (EA.) 2.00 BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CDN PB Omer C11,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 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO, PARCEL NO. ❑ 1 an,exempt under Sec. B.&P.C.for this reason �'-' WATER HEATER W/VENT 6.00 Owner ore WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsent to self-insure, or a certificate of Workers'Compensalion In uranee,or a cert i(ied ZONING ENG.SITE N0. copy thereof(Sea 3800,Lab.C. . Policy No. Compunyg. U ❑ Certified Copy is hereby furnished. ZZ •❑ Certified copy is Olcd with the city inspection division. FO Applicant MISC.- REFER TO ORD. Y❑ NE] Y ❑ N� it CERTIFICA'F17 OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COWIP1iNSAI'ION INSURANCE PLG.CONTR, LIC.N0. PLG. 9L O (This section need not be Completed if the permit is for one TOTAL Y N Y� N � Z hundred dollars IS 100) oless.) U O I certify that in the performance of the work for which this per= QTY. MECHANICAL PERMIT FEE FI=EaSUMMA"RY •*'+• LL F mit is issued, I shall not employ any person in any manner so as to O W becomesubject to the Workers'Compensation Laws of California. CL Date-Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } to NOTICE TO APPLICANT: IL after making this Certificate of lix- f- ? emption;you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this Permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) ,4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0MC.F.M.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sea MICROFILM s 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name / Lender's Add HEATING UNIT(OVER 100,000 B.T.U.)9,50 ELECTRIC • I Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4,00 information is correct. I 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 authorize representatives of this city to enter upon the BOILER-COMP (Over 1100,00OBTU)SEE FEE SCH. above-mentioned property for inspection purposes. MECHANICAL (We) • to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ape 'n agm t liabilities, 6 t nts, costs and expenses which CONST.TAX may in ny , accrue a ust aid y in consequence of the PERMIT ISSUANCE 10.00 granti fthi permit - MECH.CONT. LIC.NO. MECH, TOTAL TOTAL are a pelican[ t ctor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER CITY OF CUPERTINO 12943 INSPECTION DIVISION • JOB INSPECTION RECORD p PERMIT EXPIRATION .IOBADDR�S'9 Hunterston PI UNIT# LOT# PERMIT EXPIRES IF WORK OWNER Jamesrev CONTRACTOR ne - IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER ' LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED . UNDERGROUND /SLAB �,.Jf PLUMBING ELECTRICAL ISSUANCE DATE, MECHANICAL BLDG. ELECT. P,LG. MECH. ❑ D ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VALUATION $/FT. MECHANICAL ELECTRICAL PERMITTO FRAMING 4' / INSULATION STORIES TYPE CONSTR. OCC,GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED • ROOF - SO.FT.FLOORAREA TOTAL ACREAGE DIAPHRAGM BUILDING USE / HES INCON PB Omer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑' ❑ ❑ ROUGH ASSESSORS PARCEL NO. PLUMBING GAS TEST TRACT NO. PARCEL NO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN #.. INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY L24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - Y ❑ N❑ Y ❑. N❑ LATH-INTERIOR ELECTRICAL -�,�� FLOOD ZONE A.L.U.C. LATH-EXTERIOR FIRE DEPT. Y❑ N❑ Y ❑ N❑ SHEETROCK GRADE - - -- - SHEAR INTERIOR FEE SUMMARY BUILDING SHEAR EXTERIOR TEMPORA RY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC M OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFIARRANGE FOR INSPECTION BY PHONING 252-4505ELECTRIoONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINZ PLEASE GIVE JOB ADDRESS WHEN PHONING. SEE PERMIT FOR EXPIRATION DATE - MECHANIIMPORTANT! CONST.TPLEASE READ REVERSE SIDE BEFORE TOTA CALLING FOR FINAL INSPECTION. OFFICE COPY