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18535 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT NTIFICATIO PERMIT NUMBER no'lia1N V u APPLICATION & PERMIT 8535 /Cy �I BUILDING-ELECTRICAL-PLUMBING-MECHANICAL of J OWNER'S �/A�-. /'/ PLAN CHECK VALIDATION NAME / r�� 2S2"4:SSS DTV. ELECTRIC PERMIT FEE PRONE cDNTRAc Rs � OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME T p LIC 00 j' �� / LIGHTING FIXTURES 10.00/1.00 CONTRACTORS PPLIANCES-RESIDENTIAL 4.00 ADDR ESE �F��^/�� r A PH/OxNE �9 f PANELS 10.00 DATE OF APPLICATION ARCRI ECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.NO. SIGNS TRANS. 3.00 AAll H.OR DDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ��jjj ZIP TEMP.METER OR POLE INS. 20.00 ADORESsTs ��/q G�`�C S/� MOTORS SEE FEE SCH. ( l 1 ti e SERVICE CHANGE 20.00 To Vt VG GI o o LICENSED CONI'RAC'I'ORS DECLARATION / /x��y a U u I hereby affirm that 1 run licensed un der provisions of Chapter 9 ^P"ImL ISSUANCE DATE v, O, (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.' w-w z I'rol'essions Colli cm my license is in full Vo d f t �./ i O w- Liccmy Cloy CmuM trur SfK� �v�t� ❑ IYY-xl ❑ ❑ O L wf Date/%9'/V Conlmator SEP a y E BUILDING PERMIT ¢ I[ w OWNER-BUILDER DECLARATION INFORMATION X 3 LL y I hereby affirm that I am exempt from the Contractor's License MISC.- CJtORD LL o ¢ Law for the following reason.(Sec.7031.5.Business and Polls"ams pERMIT ISSUANCE 10.00 VALUATION $/FT. r - -' Code Any city or county which requires a permit to construct,alter, W¢¢ improve•demolish,or repair any structure,prior to its issuance,alw ELEC.CONTE. LIC.NO, ELEC. 0= rellalres the applicant for such pefroo to IIIc a signed statement that TOTAL PERMIT TO a w m" he is licensed pursuant to the provisions of the Contractor's License y� rii Law(Chapter 9(cmnmencing with Section 7000)offivision 3 of the L �p��1i z o Business and Professions Code)or that Ile is exempt therefrom and DTV. PLUMBING PERMIT FEE i-� l ¢ moo lire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a; w by any applicant fora permit subjects the applicant toacivilpenulty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ 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 file structure is not OCC.GROUP RES.UNITS intended or offered for sale (Sec. 7044, Business and Profcssioos DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 Code:'file Contractor's License Law does not apply to an owner of property who milds Or improves thereon,and who docs such work FIXTURES-PER TRAP S.00 50.FT.FLOOR AREA TOTAL ACREAGE himself ents re through his own aered for s provided leve such improve- mmselfo not U911 his orofferloycesale.lf,ed that such building GAS-EA.SYSTEM-1 1 NC.4 OUTLETS 6.00 or improvement is suld 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 Orner prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct lilt project(See 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law docs 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 Contrxmors License Law. SEWER-SAN ITARV-STORM EA.200f1/10.00 TRACT NO. PARCEL NO. ❑ I an,exempt un der Sec.-,B.&.P.C.for this WATER HEATER W/VENT 6.00 reason Owner Dare WATER SYSTEM 5.00 ACC.DATE ACC.FILE No. WORK ERS'COMPHNSA'IION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO. or a certificate of W ork ers' 'C mPensatmn lhnur sarre,or a cert" d copy policy /C'CfmpanY I-��1� O ❑ Cerlil�,Fl pyVIENS!�TION furnished. FIRE SPRIrvK ENERGY T24 Z Z �fC Cerlifo 'Ih lie city inspection division. O AhPhcanI MISC.- REFER TO ORD. y❑ N❑ Y ❑ N❑ ~ m PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > C. A' Nt FINS FRN WORK BES'W Cl INSURANCE PLG.CONTE. LIC.NO. PLG. d O ('Phis section need not be completed if the permit ie for one TOTAL Y❑ N❑ v❑ N[:J Z hhmdreddollars($IIX or IessJ U O 1 certify that in the performance of the work for which this per, OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mil is issued.I shall not employ any person in any mannerso as to U become subject to the Workers'Compensation Laws of California. O w Cate_Applicant BUILDING ly ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: If,after making this Certificate of Z Ex- eruption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be dee nhed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.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(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM 3097,Civ.C.). Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC O - I.endcr's Address I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ordinances n cerate. 1 agree t0 comply with all city and county PLUMBING information and state Iowa rel ming to comply building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorise representatives of this city to enter upon the BOILER-COMP(Over 100,0008TU)SEE FEE SCH. MECHANICAL 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 CONST.TAX may in any way accrue against said City in conseq ucn ce of the ran( gof is ere . MECH.CONT. LIC.NO. MECH. TOTAL TOTAL D Si Lure of APP( 1/Conlmctor l Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 18535 INSPECTION DIVISION JOB INSPECTIpN RECORD sT•LT u v. �� p� � PERMIT EXPIRATION JOB ADDRESS / 1 �V ` ` VL��—{J--i UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER O I CONTRACTOR J- e,i qslc L, IS NOT STARTED WITHIN IN PE TION DATE INSPECTOR INSPECTION RECORD 1,80 DAYS OF PERMIT ISSU. FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. PfAD I GARAGE SLABS {'1 - f - < _I POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED SEP 11989 UNDERGROUND /SLAB _ r .4• P, r v, C % ! PLUMBING c4iu1I1 wm Of A..w/l ELECTRICAL ww ISSUANCE DATE MECHANICAL FLOG ELECT 11.13. MECH ❑ 111.13.❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ELECTRICAL PEFMIi TD FRAMING STORIES TYPE CON 1R INSULATION OCC GHOUP Hes UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO.rt rLaoa ANCA TOTAL Acvf:ACE ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HEs CON Pe DE O ., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. iN ❑ ASSESSORS PARCEL NO ROUGH - SAN.N PLUMBING ELECT.ENERGY 1HACi NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY ' MECHANICAL- MECH.ENERGY ACL DATE ACL FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ervc SITE No. INSULATION PLUMBING GAS TEST GAS FINE SPRINK ENERGY i-20 MECHANICAL Y ❑ N[—] Y ❑ NEj COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LI '�-2R-3'o A Y [:] N� � N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK. GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK , F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDMG FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 11' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 00 PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE `/— READ REVERSE SIDE BEFORE TOTAL CA LING FOR FINAL INSPECTION. OFFICE COPY r