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3272 (2) APPLICANT TO FILL IN INFORMATION WITH IN'RED LINES - USE BALL POI PEN ONLY BUILDING PROJECT I DENTI FICATION WPEE•4c -APPLICATION &.PERMIT PERMIT NUMBER BUm ILnc ADDRESS '` F^y y f`V�� �] �N V,yl\ '• `� 3Z I' Z .g BUILDING -ELECTRICAL-PLUMBING=MECHA - Owry R'S PLAN CHECK VALIDATION ""ME DTV. ELECTRIC PERMIT FEE ' - P.O.E252 !'AIS c NIRA TORSOUTLETS-SWITCHES-RECEP' 5.00/1.00 `{ AE Mgy2C .Llc.rvo. LIGHTING FIXTURES 5.00/1.00 '7)v J p DDNTRADTOR'S PPLIANCES-RESIDENTIAL • 4 � ,00 ''� C%f 19O ADDRESS Y Of C PHONE PANELS _ 5.00 DATE OF APPL ARCHITECT SIGNS 6.00 PLAN CHECK FEE O: OR ENGINEER LIC,NO. SIGNS TRANS. - 3.00 APDH.GRENc. SPECIAL CIRCUIT rj,QO PERMIT VALIDATION ADDRESS _ •• ZIP. TEMP.METER OR POLE INS. 15.00 •, APPLICANT rvs' _ MOTORS SEE FEE SCH. CH. '. - ADDRESS • + SERVICE CHANGE 10.00 o o LICENSED CONTRACTORS DECLARATION �� a I hereby affirm that I am licensed under provisions of Chaptcr 9 ISSUA CE DATE w a H (commencing.wilh Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. FOR. F n z Professions Code,and my license is in full force and effect. ❑ Z O w - License Class Lie.Number �- ❑ Q z r Date - Contractor < y s BUILDING PERMIT E ¢ w a OWNER-BUILDF-R DECLARAPION INFORMATION w ;LL hereby uffnn that 1 am exempt fens the Cuntructor's License MISC.- REFER TO ORD LL 0 sc Law for the following reason.(Sec.7031.5;Businessand Professions PERMIT ISSUANCE dy VALUATION $/FT. - Code:Any City or county which requiresu permit toconstniCLalter. _ 6.00 - E 2 Q p improve,demolish,or repair any structure,prior to its issuance,also ELEG.CONTR. LIC.NO. ELEC. 0`= iL 0,¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO u w m he is licensed pursuant m the provisions 01 the Contractor's License _^✓ F Z Q Law(Chapter9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and' DTV. PLUMBING PERMIT FEE ¢ t$ the basis forth,alleged exemption.,Any violation of Section 7031.5 STORIES TYPE CONSTR. w. by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(5500).1: ❑ L as owner of lire pm Perry,or it,,employees with wages as BACKFLOW PROTECT.-DEVICE 2.00 OCC.GROUP RES.UNITS their sole compensation,will do the work.and the structure is not - - intended or offered for sale(Sec:7044, Business and Professions' DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does not apply to all owner of - property who builds or improves 0mreon,and who dues such work FIXTURES-PER TRAP 4:00 SO.FT,FLOOR AREA TOTAL ACREAGE himself a of intended own em Pluyces,provided that such ibuildi g meals a re notlnth.his or ofend for Rmh.y"su4.ILed that suhe...pro ng GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 or improvement is sold within one year of completion.the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE builder will have the burden of proving that he did not build or int- prove for purpose of sale.). - INDUSTRIAL WASTE INTER. 20.00 RES IND CONPB ornx, ❑: I,as owner of tire property,am exclusively contracting with ❑ - ❑ ❑ ❑ ❑ licensed contractors Io consvuet the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply ' • 1. to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA:) 1.00 contracts fur such'projecls with a CORtraeturfs)licensed pursuer m the Contractor's License Law. SEWER-SANITARY-STORM EA'.200ft/8.00 TRACT NO. PARCEL NO. ❑ I ant c,ennounder Se,,-.B,&P.C.,fo,this WATER HEATER W/VENT 4.00 reason Date_ .vim owner _ WATER SYSTEM - 4.00' Aee.DnrE ACC.FILE No. wORA1iRs'co>1 PIiN'SA'1'1 Iv DliC1.ARA'l'ION WATER TREATING EQUIP: 4.00 I hereby affirm that I have a Certificate of consent to self-insure. - ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance.or a certified• copy thereof(Sec.3800,Lab.CA ' Policy Na Company - O ❑ Certificdcupyisherebyfunlished.- .FIRE SPRINK ENERGY T 24 Z_ 2 ❑ Certified copy is filed with the city inspection division. MISC.- - REFER TO ORD.' O Applicant - .Y❑ N❑ Y ❑ N❑ F- w " PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C.. � CIi R'I'I PICATIi ENSAX EXEMPTION FROMNCE RIi RS' W 1 need not he com INSURANCE PLG.CONTR. .LIC.NO. PLG. Y❑ N❑ Y ❑ N❑ D. O I'fhis scditin need not he completed if the permit is fol.-or TOTAL :)-Z bu ndred dollar IS 100)or less.) U O 1 certify that in the performance of the work,for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY. LL F mit is issued I shall not cntploy any,person in any manner so as to .. U become subject to theWorkers'Compensation Laws of Cilil'ornia. BUILDING- 0 ED Date -Applicant ALTER OR ADD TO MECH. 4.00 a�' - a } to NO]ICE TO APPLICAN'1':,If;after staking this Certificate of Ev- F2 eiption;you should become subject it)the Workers'Compensation r APPLIANCE - 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply,with FEE U such Provisions or miss pennit shall be Jeumed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE . .� I hereby affirm that there is a construction lending agency lir EXHAUST HOOD (WITH DUCT) 2.00 the peflormance of the work for which this permit is issued .Sec. HEATING UNIT(70MICROFILM 3097:Civ.C.). - - ,100,000 B.T.U.) 4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.17.50 ELECTRIC - Qv Lender's Address I certify thatl have read this application and state that lire above VENTILATION FAN (SINGLE)' 3.00 information is correct. I agree to comply with all city and county BOILER-COMPI3 H.P,or 100,000 B.T.U.) 4.00 PLUMBING hereby as ori stole'laws relating to building construction.,and �. hereby authorize representatives ec this city es enter,upon the BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL shove-mentioned property for inspection purposes . (we) agree to save, indemnity and keep hannlec the City of MISC.- , REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX iP y in any way accrue against s'' City all co Reyuenee t.the granting of Wisp nt it. MECH.CONT. LIC.NO. MECH. TOTAL TOTAL T - S igntureof A ppicanI CoA1,9I ate • OFFICE COPY - ' -- - - -- ---- - -- ------- ---- CITY 01' CUPERT'INO INSPECTIOP RECORD (Office Copy) Umit-A--_ _199D l Olivec34od-.N/S.-Dividera 1pPE11JIIT 110. SANIT'ARY DIST. NO. LOT NO. ADDRPSS Re-klodel Property Services PROJECT OWNER JOB SITE PHONE NO. PER11IT ISSUED Date hLECTRICAL Ruildi_nn _ 5T257-83 Date Insp. Electrical 5/25/83 Power Pole Plumhinr _ Underground --_ - - He.chanica.l Roul,h Uiring 'Temp. Ens/Elect. FIa1.1.s _ Solar Ceiling Fire Sprinkler Fixtures Int/Ext _ Sign Hotors Grounding Hi.sc. Temp. Power _ Other FINAL INSPECTIONS Not Approved _ Date Insp. PLUMBING Electric Date Insp . Plumbing Backflow Mechanical Underground Solar Underfloor _ Pool Partial Roul:h . Gradin , Rough Complete -- I'Lanning Solar Rough Fire Dept. I-later & Insulation _ Health Dept. Main Drain Bui.ldinr R/of/S Drain _ Other Gas _ Other _ BUILDING Not Approved Date Insp. Pad Certi.ficat.ion HLCHANiCAL Foundation Date Insp. Pre-Ganite Underfloor S.H. Slab-Ilembrane Ducts & Insulation Bond Beam Fire Dampers _ Underfloor Girders Fireplace Floor Steel Grease Duct & Hood Tiedowns One (lour Shaft Di.aphrams Condensate Drain _ Seismic Bracing Equipment Anchorage llal.ls-Panels flues & Comb. Air -- Frame Other Lath Not Approved llallboards Int/Ext . Firewalls Other Not Approved BUILDING ELECTRICAL PLUMBING • MECHANICAL MISCELLANEOUS