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14644 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BU I LDING PROJECT IDENTIFICATION PERMIT NUMBER _ BUILDING APPLICATION & PERMIT A°OResB 6$ (NT 6-rJ 14644 BUILDING— ELECTRICAL—PLUMBING—MECHANICAL OWNER'$ PLAN CHECK VALIDATION NAME ) f� QTY- ELECTRIC PERMIT FEE /1,,I V Ti 7a� NAAMERACTORS OUTLETS=SWITCHES-RECEP 10.00/1.00 u c.N LIGHTING FIXTURES 10.00/1.00 aooeess TOR'S APPLIANCES-RESIDENTIAL 4.00 • OE PHON �' J�J PANELS 10.00 DATE OF APPLICATION OR - RCHIT CT PANELS (OVER 200'AMPI - 20.00 PLAN CHECK FEE P.C.NO, ENGINEER ` _ LIC.NO. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIALCIRCUIT .5.00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 20.00 APPLICANT s MOTORS ADDRESS - SEE FEE SCH. SERVICE CHANGE 20.00 a i 0 00 LICENSED CON TRACTURS DECLARATION !/ Y a v I hereby affirm that 1 on licensed under provisions of Cli.ptc,9 77 ' H 2 w ¢ (commencing with Section 7000)of Division 3 of the Business and ISSUANCE DATE BLDG. ELECT. PLG. MECH. H m i Professions Cc ,54f9y license is in full fo d @'( � ❑ ❑ ❑ o i m W License Class ✓ Lic.Numbe !v w H Dnle Conlmct, BUILDING PERMIT ¢ C w a OWNIi R-BUILDER Df CLARA'TION C A D INFORMATION X a_ 1- _ 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD H LL o j Law for the following reason.(Sea 7031.5.Business and Professions PERMIT ISSUANCE VALUATION $/FT. Code:Anycryorcounty which requires a permit to construct,Act, .10.00 ¢ ¢ o improve,Jenmlisll,or repair any structure,prior to its issuance.also ELEC.CONTE. LIG NO. ELEC. O a, requires the applicant for such permit to file a signed statement That TOTAL PERMIT TO a w m he is licensed Pursuant to the Provisions of lire Contractor's License _6 H Z,a Law(Chapter 9(eommencingwithSection 7000)ol'Division3ofthe 4 L,46: x o Business and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE / ' It r S the basis for the alleged exemption.Any violation of Section 7031,5 STORIES TYPE CONSTR. a g by any applicant fare permit subjects S500).ire licum too civil penalty ALTER-DRAIN VENT-WATER 5.00 of not more than five ire prop dollars(cry employees - ❑ 1,as owner at the property,Or my employees with re is not BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will(S the work,and the structure Professions is not OCC.GROUP RES.UNITS intended or offered for cote (Seca 7044; Business and Professions who DRAINS-FLOOR,ROOF,AREA,COND. 5,00 Code:The Contractor's License Law does not to an owner of property who builds or improves thereon,and wwho docs such work FIXTURES-PER TRAP 5.00 . so.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- Ore.(, cc notorimprovemenntcndedoroNerod yearsale.Ic.mpletinthe building GAS-EA.SYSTEM-11NCA OUTLETS 6A0 or improvement isle b within one year of completion,0m owner- builder will have the burden of proving that he did not buil)or hit- GAS-EA.SVSTEM-OV 2.00 BUILDING USE Prove for purpose ofsa]c-). INDUSTRIAL WASTE N RES' IN CON PB Omer -- 13I,as owner of the properly,ant exclusively contracting with 0:00 licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 1T.Q. `'6.00 AssE55oR5 PARCEL rv0. and Professions Code:']lie Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS- 5(EA.) 1 contracts for such projects with a contractuds)licensed pursuant to lire Contractor's License Law, SEWER-SANITARY-STOR .00 rgger NO. PARCEL No. real ❑sl um exempt under Sec. ,B.&I'.C.file mis " WATER HEATER W/VE 6.00 - Ownclr Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK F,.that I h ve 0 certificate e aco ser, ,, WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a ccrtifiI pi,of consent mself-insve.or a cert ifica t f Worker'Co.pensali Insurance,or a certified ZONING .ENG.SITE NO. capytndy t?ls�o, n.c.). MP�r,fei/ Polity No/ -dp In ny�[Rlr� '^�`1-�_ U ❑ Ce(j�'E Py t-here y furnished. Z Z cc fi opy is fil with the city inspection division. FIRE SPRINK ENERGY T24 F O Aprilicaul MISC.- REFER TO ORD. Y N v.� N� cc y CERTI CATE 01'EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 _ OO FLOOD ZONE A.L.U.C. L COMPENSATION INSURANCE PLG.CONTE. uC.NO. PLG. A IL Cl (This section need not be completed if the permit is for one TOTAL 6V0 Y N� V ry� � Z hundred dollars(S 100)or Ian.) U O I certify 0mt in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE SUMMARY LL U alit is issued, I slmll not employ any person in any manner so as to FEE O W become subject to the Workers'Compcnsal ion Laws of California. 0. Doh. ICANrm 0 ALTER OR ADD TO MECH. 5.00 BUILDING .} N NOTICE TO APPLICANT:: If,after making this CcNificute of F:x- ? (option,you should become subject to lire Workers'Compeasalion APPLIANCE 5.00 PLAN CHECK provisions of tile e Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked, AIR HANDLING UNIT(TO 1Q=C.F.M.1 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNI (OVER IOAOOC.F.M.) 6.00 SEISMIC FEE I hereby affirm trim there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 500 tile . e performance of the work for which this permit is issued(Sec. ' 3097,Civ.C.L HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name - Lender's Address HEATING UNIT(O VER100,000B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that The above VENTILATION FAN (SINGLE) 4.00 Imtilnnation is correct. I agree to comply with all city and county PLUMBING Qa ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00 hereby authorie roprescnlatives of this city to enter upon the above-mentioned roperty for inspection Purposes. BOILER-COMP(Over ioo,000 BTU)SEE FEE SCH. MECHANICAL ' (We) agree In s cc, indemnify and keep harmless the City of MISC.- REFER TO ORD. .. Cupertino against I Ibililics,judgments, costs and expenses which ' r any way a 'rue against said City in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX n[iD ofthi Perm MECH.CONT. LIC.NO. MECH. / TOTAL TOTAL Sign of Applicant/Contractor Date' ` OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING .. PERMIT NUMBER CITY OF CUPERTINO 14644 INSPECTION DIVISION JOB INSPECTION RECORD a. PERMIT EXPIRATION IJOB ADDRESS Z& S TCR'4'7O/✓ L UNIT# _LOT# ^ PERMIT EXPIRES IF WORK. owrvER LJ✓E CONTRACTOR G,-.S g- IS NOT STARTED WITHIN ' INSPECTION DATE INSPECTOR INSPECTION RECORD '' i80 DAYS OF PERMIT'ISSU- FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNI?E TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT IAL.DATION CUPERTINO STANDARDS. GARAGE SLABS - '' POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DA It: MECHANICAL BLDG. ELECT. PLG. MICR , ❑ ❑ 1 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD FLOOR - .INFORMATION PLUMBING VALUATION S/FT. � - MECHANICAL ao ELECTRICALIVr , //' PERMIT TO FRAMING �� d.r,- INSULATION - - p .�joRlEs rvPE CON"R OCC GROUP '.RES UNITS' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF' NOTE:NO FINAL INSP.SHALL BE MADE BEFORE SO.I'V R.DOR AREA TOTAL ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID Q�'ROOF SHEATHING _ RES IND ILUCON UBEPB OV... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ - 1:1 ❑ .❑ 1:1ASSESSORS PARCEL NO _ ROUGH -SAN ft ` PLUMBING, ELECT.ENERGY TUBS 8 SHOWER PAN PLUMBING ENERGY TRACT NO, PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY - ACC DATE ncc.FILE No FRAMING - ELECT.FINAL TEST INSULATION - PLUMBING ZONING ENG SITE NO, GAS TEST - GAS MECHANICAL FIRE SPR IN ENERGv T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ` ❑ N❑ ` ❑ NO EXTERIOR SHEAR ELECTRIC FLOOD ZONE A,LUC INTERIOR SHEAR FIRE DEPT. v❑ N ❑ N❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING - INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC . PLAN CHECK -I GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. PLUMBING /li - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL ff OFFICE COPY