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18392 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY B0 LDING PROJECT I DENTI FICATION ,PERMIT NUMBER (� BUILDING APPLICATION & PERMIT 8392 � ADDRESS ��:.� / BUILDING - ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION OWNER'$ A. QTY. ELECTRIC PERMIT FEE ;4 A./ p/ ADQ r CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 et NAME LIC.NO.ek LIGHTING FIXTURES 10.00/1.00 f-pNTRAOTORs APPLIANCES-RESIDENTIAL 4.00 AooREss vHON r PANELS 10.00 DATE OF APPLICATION ARCRiTEO PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER SIGNS TRANS. 3.00 LIC.NO. PERMIT VAU DATION ADDR,SS ENG. SPECIAL CIRCUIT 5.00 ADDRESS ziF EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 &DATE ro0 LICF;NSIiU CONiRACTORS UF.CLARATIONW I hereby affirm that I am licensed under provisions of Chapter y 15SUAN w Z (commencing with Section 7000)of Division 3 oi'the Business and (,, V ,l BLD . ELECT 21 ceiProfessions Coda licenseis in full fu/ry�,�_�jG��yyI�,/�� it o - License Class Lia Number _ / _ o F w Date contractor- BUILDING PERMIT w IMNI R-BUILDER DIeCLA RATION INFORMATION w 3 LL N 1 hereby affirm that I am exempt from the Conlmcloh Liceme MISC.- REFER TO ORD LU ATION $/FT. u o a Law for the following reason.(Sea 7031.5,Businessand Professions PERMIT ISSUANCE Code:Any city or county which requires permit to construct,alter, P O G E improve,demolish,or repair any strmture,prior to its i...mime,also ELEC.CONTR. LIQ NO. ELEC, w a O 0 requires the applicant for such permit to file a signed statement that TOTAL pERrytIT TO wm he is licensed pursuant to the provisions of the Contractor,License -er-'/V�rpOFAr•- rzi Law(Chapter 9(emomencingwith Section 7000),fDivisiun 3 oftbe F a Business and PlurLsmwu,Code)or phut he is exmnpt lhurefrom and QTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. F >$ byany applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 A of not more(Iron five hundred dollars(5500).): ❑ I,as owner of me prupurty,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 000.GROUP RES.UNITS their sole compensation.will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Pmfic„ion, DRAINS-FLOOR,ROOF,AREA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property whr builds or Improves thereon,and who does Such work FIXTURES-PER TRAP S.OD 50.FT.FLOOR AREA TOTAL ACREAGE h1m,eif or lhrrugh his owuempl,yces,provided that such improve- GAS-EA.SYSTEM-IINC.40UTLETS 6.00 mems arc not intended or offered for sale H.however,the building or improrement is sold 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 int- RES IND CON PB Other prove for purpose ofsulc.). INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ I,as owner of Ore property,mo exclusively contracting with licensed contractors to construct (he project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:'Ihe Contractor's License Law does not apply to an owner of Properly who builds or improves Heroin.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for suclip,mcet,with a contraclons)licensed Dormant to SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. the Contractor's License Law. ❑ l amexempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00 ' reason Owner [)are WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. ,rORKERS'COSIPENSA'I'I0N DFCLARAI'ION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure. ZONING ENG.SITE NO. certificate,(Worker,'Campensation Insurance,n u cerlitied _ copy lhereo Sec.3800.1-ab.C.). r Policy No Company Q O til Led copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z E r, ified copy is Bled with the city inspection division. MISC.- REFER TO ORD. y ❑ N❑ Y ❑ No HyApp icon( PERMIT ISSUANCE 1A�0/ FLOOD ZONE A.L.uc. CC Lo CERTIFICATE OFEXEMPTIONIONNS FROM WORKERS' 11J > COMI^IiNSAT10N INSURANCE PLG.CONTR. LIC.rv0. PLG. y❑ N❑ Y ❑ N❑ 0- ❑ OTAL (this union need of be completed if the permit is fill area Z) Z hundred dollars IS 100)or less.) FEE SUMMARY U O 1 certify that in he performance of the work for which this per- QTV, MECHANICAL PERMIT FEE lL H it is issued,I shall not employ any person in any manner so m'm Ow become subject to We Workers'Conmeosaliun Laws Ll California. im pate Applicml ALTER OR ADD TO MECH. 5.00 } W NOTICE TO APPLICANT: If,after making this Certificate of Ex- 5.00 F Z aRmHon,you should become subject to the Workers'Compensation APPLIANCE povision, of lite Labor Code, you must torthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.000NSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER IOJ=C.F.M.) 6.00 Ihereby affirm that there is a construction lending agency fnr EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this perntil is issued(SeeHEATING UNIT(TO 100,000 B.T.U.) 8.00 3097,Civ.C.).Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 Leander',Addres, I certify that l have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 �. information is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100.000 B.T.U.1 6.00 ordinances and ,tree lows relating to building construction, and hereby authorize repre,entatives of this city to enter upon the BOILER-COMP(Over10000OBTU)SEEFEESCH. MECHANICAL above-mentioned property forin,pecUon plIT06Cs. (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 C' in consequence of the ranting of this permit. H.CONT. LIC.NO. MECH. r,0. `O TOTAL TOTAL r J pp ctor OFFICE COPY - POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER `5 CITY OF CUPERTINO 18392 INSPECTION DIVISION JOB INSPECTION RECORD I. / O�� O� ,J zl• r ER IIT tP RATION,/ JOB ADDRESS �/�F—h ,, lI /�- UNIT# �fi _LOT #_ PE MIT EXPIRES IF WORK owrvER ��4 �*,QCONTRACTOR a" C O�I/S IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION - ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED' TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIfIATION PREGUNITE - CUPERTINO STANDARDS. GARAGE SLABS '/� y __ - / POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ��U�TI d��O L➢ /// �]J7G/�{�_'/`y7/ UNDERGROUND /SLAB a— Is--f32 L PLUMBING ELECTRICAL ISSUAry CuATI MECHANICAL RLOf;' ELEc PLG MEC. a ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VAT.UATION S/FT. PLUMBING , 11•j U j z/ � zs MECHANICAL '+ T•E•�'` �• ELECTRICAL pµ d ERM FRAMING TO FRAMING - Y�8 4` STORIES fVPE CONSTN INSULATION UCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN I NEO _ 50 [i,fLOOf1 ARE< TOTAL ACREAGE ROOF E:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM TH ONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING I+Es IND CON PB Om.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO ROUGH SANA PLUMBING ELECT.ENERGY N CIN PARCEL NO TUBS&SHOWER PAN - PLUMBING ENE GY MECHANICAL MECH.ENERGY DATE ACC FILE No ELECTRICAL BUILDING ENERGY T� C FRAMING ELECT,FINAL TEST _ A zoNIN ENG SITE NO. INSULATION PLUMBING , GAS TEST GAS FIRE SPRINK ENERGY i.za MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ N[-] v E] E] FLOOD ZONE ALu,c. EXTERIOR SHEAR ELECTRICAL RELEASE u ❑ N❑ ❑ N❑ INTERIOR SHEAR FIRE DEPT. I Iq. SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH BUILDINGp� BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC FEE 1E q`G GAS r . .. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE -,rQ OCCUPANCY OF BUILDING ISNOTPERMITTED UNTILBOILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX {� PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY