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15169 (2) 'APPLICANT TO,FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY ; 1'UU I L DING PROJECT IDENTI FICATION ` 1 'PERMIT NUMBER ' all;LDING ' . APPLICATION&'PERMIT .V�'ti �(� '�j. rIDORE55 - J I OS�3 . JJ W� - e✓,p_. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL . 51J OWNER'S - VALIOATION rvnA^IIG I_. �j'/�/� ?,-s TV. ELECTRIC PERMIT FEE PLAN CHECKair I„ -PHONE J�v `7 CONTRACTOR 5 - 0 NAME' �- UTLETST SWITCHES-RECEP 18.90/1.00 ((II . . _ 'gin: e- �l-lir- arc:No. p �I��� LIGHTING FIXTURES 1Bc00'11.00 -. CONTRACTORSPPLIANCES RESIDENTIAL - !4[- _ o//pPR ss SSX. Z A - , /�z_ A tip- ;PHONE' • �p)> .�PANELS y '' 10.00 DATE OF APPLICATION.T' ARCHITECT e - - - - PLAN CHECK FEE P.C.NO. OR- Q�-y PANELS (OVER 200'AMP) .20.00 EN- GINEER 4• /�/LL uc.No.' Q SIGNS TRANS. 3.00 ARCH.OR ENG. .• ,n 1 pERMIT.VALIOATION� ADDRESS ,l q SPECIAL CIRCUIT 5.00 '-' EMP.METER OR POLE INS. 20.00 y A -. - Z MOTORS SEE FEE SCH. ADDRESS ooREss _ So(/� Kw- - S •S- 937.1 SERVICE CHANGE 20.00 �/31 / woo " LICENSED CON'FRACI'ORS DECLARATION - (/ < I hereby affum that I am IiccOwd under provisions of Chapter'( ISSUANCE DATE Z,w (commencing with Section 7000)of Division 3 of the Business and< w - BLDG. ELECT.. PLG.]. MECH. r o z To Cod A my license is in full force a fepg!-9// - i H - License Class Con Number L - G m�� UmeS"f Cnntmc[or w ¢ .` ` OWNI:R-BUII.DI:R DECLARA'T'ION 11LDING PERMIT w ;LL r •1 hereby affirm dial I am exempt treat the Contractmr,,License MISC.= REFER TO ORD "NFORMATION LLOa Law for The hollowing reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE VALUATION $/FT. r - Code:Any city or county which requires a permit to construct,alter, � n�_ _ a p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. - LIC.NO. ELEC. �� (�'�-'Q ' O ¢ requires the applicanl for such perin it to file a signed'Statement that '' TOTAL o. s, m" he is licensed pursuant to the provisions of the Contractor's License ,,,EEf PERMIT TO m F z < Law(Chapter 9(comcncingwlth Section 7000)of Division 3of(hc - [ µ�•/'/ 7/ 61%1 z O Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE - 11 the basis for the allegcJ exemption.Any violation of$ection 703L5 STORIES TYPE CONSTR. a'; by any opplicunl for a panni(suhjects the applicant toucivil penalty -� " Of not more than five hundred dollrrs15500).1: ALTER-DRAIN&VENT-WATER (EA.) - ' ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS - their sole compensation,will do the work,and the structure is not r 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 loon owner of property who builds or improves thereon•and who docs such work `; FIXTURES-PER TRAP . 5.00 Sa FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve. ments a re not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 6.00 or,Improvement is sold within one year of completion, the owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or air. . - RES IND CON PB Omarprove-for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ '❑ licensed contractors to construct lire project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The'Contramar's License Law does not apply - to an owner ol`properly who builds or improves thereon,and who - LAWN SPRINKLERS-OVER 5 IEA.) 1.00 contracts lorsuch projectswith a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law: TRACT NO. PARCEL NO. ❑ l am exempt under Sec. ,B.&P.C.for this Person WATER HEATER W/VENT' - 6.00 Owner Dee WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE N0. or a certificate of Workers'Compensation Iasumne ,or u eertifieJ co /Q�ol'fSec.3800,I:ab.C.), r 1•0l eT'✓n CnmponY.p7�1asG1�N - Ua Q Cerlilied copYi hereby rnished. ^ _ FIRE SPRINK ENERGY T 2 Z Z ❑ Certified cap w,i}�n 1pe� Iuy irepection division. P: p Applicantlfe�-- MISC.- e REFER TO ORD..D. Y ❑ �N❑ ❑ ❑v � N cc: L5 CER'IIFICATI>OI'F.XIiMPI'IONI:ROMWORKERS' PERMIT ISSUANCE 1.9:86 , FLOOD ZONE A.L.LI.C. W > - COINPENSWION INSURANCE PLG.CONTR. LIC.NO. PLC. � Z (This section rued not be completed it the permit is for one _ TOTAL �p Y❑ N❑ Y ❑ .. N❑ hundred dollars IS 100)oP less.) U O I certify that in the performance of the work for which this per CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL t- mit is issued„I shall not employ any person in any manner so as to Q w become subject to the Workers'Compensation Laws of California. Date ApplicantEK- f BUILDING } N NOTICE: 'r0 APPLICANT: If,after making this Certificate of ALTER OR ADD TO MECH. Ji.00 - ♦- ? CMdb n,you should become subject to the Workers'Cornpcnsution _ APPLIANCE,, 5.00 PLAN CHECK provisions of the Labor Code, you must lorthwith comply with FEE U such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONS'[RUCr10N LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC,FEE 3 a� I hereby affirm that there is r construction lending,cre,for EXHAUST HOOD(WITH DUCT)•. 5.00 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 Lender,AddressHEATING UNIT(OVER 100,000 B.T.U.)9.50 ' ELECTRIC ` ' " 1.certify(hut 1 have read this applicationW state that urn above VENTILATION FAN (SINGLE) 4.00 ordinances and state laws relating t0 building construction, and a 6 information is correct. I agree to comply Willi all city and county PLUMBING BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby rnflune a representatives ins of this city s. enter upon the •BOILER-COMP (Ovar 100,000 BTU)SEE FEE SCH. MECHANICAL hereby multo ize property for inspection purposes. - (We) agree to save, indemnify and keep harmless the City of MISC:- REFER TO ORD. upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE gg.gp CONST.TAX 49'ray in any ay accrue against said City in consequence of thss �anting of MECH,CONT. LIC.NO. TMECH OTAL y' °2�� TOTAL lgnatefyof Applicant/Contractor _ Date OFFICE COPY TI r POST THIS CARD NEAR FRONT-OF BUILDING - ,� • - PERMIT NUMB ER CITY OF CUPERTINO INSPECTION DIVISION, - 15169 I :JOB INSPECTIQN,RECOND .s 7 4 c PERMIT EXPIR�A �ON • JOB ADDRESS >10553' ,JOhn WayUNIT# r - _SLOT.# •�'.( j , - - PERMIT EXPIRES IF WORK OWNER Mike Gaf f ev CONTRACTOR. IS NOT STARTED WITHIN. INSPECTION DATE INSPECTOR -INSPECTION RECORD 180'DAYS OF.PERMIT MSU-:1E FOUNDATION - - - ANCE OR.180 DAYS:FROM NOTE: - - LASTCALLEDINSPECTION.-! r. UFER _ - ALL GRADING�AND DRAINAGE SHALL-BE INSTALLED . �.;, 'TO COMPLY WITH THE APPROVED,PLANS AND CITY OF PERMITvnLmnnUN -. 'PR EGUN ITE CUPERTINO STANDARDS. - . POUR NO CONCRETE UNTIL ABOVE HAS BEEN S Dov✓ -( . .v-etvIEo ve - - • w ` UNDERGROUND /SLAB ' ' - AlUMBING �1� - VI t �' f X4`71 ELECTRICAL . '•{, - - ISSUANCE DATE ° MECHANICAL t 1 - , BLuc[ ELEcr PLC: . .�MeyH, DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING _ , . MECHANICAL. e Qj1�Y-,A1 ELECTRICAL- ,PERNIIT Tow FRAMING ' STOHII{S - IYPE CONSTH. INSULATIONcj OCG GROUP RES UNITS NPLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROOF NOTE:NO FINAL INSP.-SHALL BE MADE BEFORE so.FT.aooR AREA rorAL ACRI ACE., DIAPHRAGM r - THE CONSTRUCTION TAX IS PAID• a. BUILDING USE ROOF SHEATHING RES IND - CON PB Ude., APPLY NO ROOFING,UNTILABOVE HAS BEEN SIGNED FINALS DATE INSP. CD 0 0 E]' ❑ ROUGH - "SAN.p T - - nssessoas PAHceL NG, PLUMBING`. Y•.ff ELECT.ENERGY . TUBS&SHOWER PA TRACT NOPARCEL - � PLUMBING.ENERGY T , . NO ,17- MECHANICAL , poO_ MECH.ENERGY - ELECTRICAL �•d BUILDING ENERGY - L\ - Acc DATE Acc P1LC No. FRAMING_� ,fsy. ELECT.FINAL TEST INSULATION PLUMBING zGNINc ENG SITE No. IF \. GAS TEST ` GAS . '.. - MECHANICAL "+i. rl.. EIRE SPHwK. - eNERerT-za COVER NO WORK UNTIL ABOVE HAS BEEN SIG ED HEATING %\ "v ❑ "❑ Y 0 "�: ' FLOOD ZONE. A U.G EXTERIOR SHEAR ELECTRICAL RELEASE r\. , .. INTERIOR,SHEAR - FIRE DEPT.`.- _ 'Y'El "❑ Y ❑ "Of SHEETROCK - GRADE - FEE SUMMARY EXTERIOR ,LATH - BUILDING . INTERIOR LATH - TEMPORARY APPROV LS .•BUILDING %,C/�'y"� ' SCRATCH COAT - ELECTRIC '• - PLAN CHECK , GAS .FEE'. NO TAPE OR PLASTER UNTIL A80VE HAS BEEN SIGNED VUUUPANCY. SEISMIC-FEE ' „ OCCUPANCY OF BUILDING IS NOT P ER MITT EDUNTILBUILDI NG FINA LIS SIGNED BY BUILDING INSPECTOR. .MICROFILM ARRANGEFOR INSPECTION BY PHONING 252-4505, ELECTRIC 1. o , ONEVVORKLNGDAY:BEFORE'REQUIRED'INSPECTION PLUMBING �G PLEASE GIVE JOB ADDRESS WHEN PHONING. Z = SEE PERMIT FOR EXPIRATION DATE - MECHANICAL - } IMPORTANT! CONST:-TAX PLEASE READ REVERSES IDE.EIEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY