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16708 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FICATI ON .PERMIT NUMBER BUILDING APPLICATION & PERMIT 1 6708_ AooRI/D� 9/� O / BUILDING - ELECTRICAL-PLUMBING -MECHANICAL OWNER'S PLAN CHECK VALIDATION \/ NAME QTY. ELECTRIC PERMIT FEE T' P. E Co TRACTo OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME p LIC NO 2 LIGHTING FIXTURES 10.00/1.00 C,o TRA R U� PPLIANCES-RESIDENTIAL 4.00 GORE • 8l(f �¢/,y 96� 1,24f5PHONE PANELS 1O.CO DATE OF APPLICATION ARCH]TECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER UC,NO. SIGNS TRANS. 3.00 ARCH,OR ENG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANT$ ADDRESS MOTORS SEE FEE SCH. 9 SERVICE CHANGE 20.00 v o o LICENSED CONTRACTORS DECLARATION G a u I hereby affirm that 1 am licensed under Po0visious of Chap ter 9 ISSUANCE DATE ' way (commencing with Section 7000)of Division 3 of the Business and ELLLEEEppp�� PLG. MECH. r H z Professions Code,ay my license is in full force a e ❑ ❑ o i m o License Class Number_ Dale tb Contract.,- ¢ m s /"""f BUILD PERMIT ¢ ¢ w vi OWNER-BUILDER DECLARATION O A D MISC.- REFER TO ORD ATION w43 LL H 1 hereby affirm that I am exempt from the Contractors License L ATION $/FT. H n o J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 Cj Code:Any city or county which requiresa permit to construct,alter, .L1lx IF ¢> improve,demolish,or repair any structure•prior to its issuance,also ELEC. TOTAL CONTH. LIC.NO. ELEC. 0 LL requires the applicant for such permit to file a signed statement that PERMIT TO e w m he is licensed pursuant to the provisions of the Contractor's License Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 oftheb-+L�r,fr a Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ O the basis for the alleged exemption.Any violation of Section 703 1.5 1 STORIES TYPE CONSTR. by any applicant for a permit subjects the applicant ton civil penally ALTER-DRAIN -WATER IEA.) 5.00 of not more than five hundred dollars(55001.)'. ❑ 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 intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONO. 5.00 Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TR AP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE • himself or through his own employees,provided that such improve- GAS-EA.SVSTEM-11NC.4 OUTLETS 6.00 mmre es anot intended or offered for sale.If,however,the building or improvement is sold within one year of completion, • . .) 2.00 the owner- GAS EASYSTEM-OVER 4(EA builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON p9 Omer ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project ISec. 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 contractons)licensed pursuant to SEWER-SANITARY-STORM EA.200tt/10.00 the Contractors License Law. TRACT NO. PARCEL NO. ❑ lam exempt under Sec.-,B&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate ofcunsent to self-insure, ZONING or a certificate of Workers'Campe anon I r nc or a certified ENG.SITE NO. copy thereat ISec 3800,Lab.C.). (/ 4 Policy No. Company O Q Certified copy is hereby furnished. �'� FIRE SPRINK ENERGY T44 Z ZOJ xl lcCertified copy is filed with the city inspection division. MISC.- REFER TO ORD. y N Y N �p 1 ❑ ❑ ❑ ❑ ~ CERTI PIC rn PERMIT ISSUANCE 10.00 FLOOD ZONE A. .U . LU � COMPENSATION OP EXEMPTION FROM WORKERS' L .c W INSURANCE PLG.CONTR. LIC,NO. PLG. Z (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ hundred dollars IS 100)or less.) U O I certify that in the performance of the work for which this per QTY MECHANICAL PERMIT FEE FEE SUMMARY.' . W I- mit is issued,I shall not employ any person in any manner so as to O W become subject to the Workers'Compensation Laws of California. BUILDING it. Dale Applicant ALTER OR ADD TO MECH. 5.00 } to NOTICE TO APPLICANT: IE alter making this Certificate or Ex- I. ? emption,you should became subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you mus[ forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M,) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 109MCF.M.) 6.00 SEISMIC FEE ,SO I hereby affirm that there is a construction lending agency fur EXHAUST HOOD(WITH DUCT) 5.00 the 3097.performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 8.00 MICROFILM Lender's Name Address HEATING UNIT(OV ER 100,000 B.T.U.)Lender's Address ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 • information is te[. I agree to comply with all city and county PLUMBING Ordinances rotasand state laws relating to building construction,and BOILER-DUMP(3 H.P.Or 100,000 B.T.U.) 6.00 hereby authoriLe representatives of this city to enter upon the BOILER-COMP (Over 100,000BTUISEE FEESCH. MECHANICAL above-mentioned properly 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 sail City in consequence o'the ranting this permit �n b MECH.CONT. LIC.NO. MECH. TOTAL TOTAL s-tj�lou Sig azure of Applicant/Contract Dote V OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16708 INSPECTION DIVISION JOB INSPECTION RECORD ,�^J PERMIT EXPIRATION JOB ADOR//E''SS 62,/0 70f��KL! L' UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR % ZU, J' ac. IS NOT STARTED WITHIN INSPECTION DATE - INSPECTOR MSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: UFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION.- PREGUPJITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION CUPERTINO STANDARDS. GARAGE SLABS _ POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED _ . UNDERGROUND /SLAB PLUMBING ELECTRICAL QISSUANCE DATE MECHANICAL ELECT PLG. MECH El El \�NFLI 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED n �C 1 INFORMATION UILDING PERMIT,<i'.w? . WOOD FLOOR G�ty VALUATION SIFT. PLUMBING MECHANICAL �� PERMIT To ELECTRICAL FRAMING "��I INSULATION STORIES TYPE CONSTR. OCC.GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so.IT FLooR ARFA TOTAL ACREAGE • DIAPHRAGM THE CONSTRUCTION TAX IS PAID B W LDI USE ROOF SHEATHING Res IND CON Pe oma. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED,. FINALS , J:, DATE INSP. ❑ 11 El El 11 ASSESSORS PARCEL NO. ROUGH SANK PLUMBING ELECT.ENERGY TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No. MECHANICAL MECH.ENERGY Acc.DATE ACC.FILE No. ELECTRICAL BUILDING ENERGY FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO, INSULATION PLUMBING GAS TEST , GAS FIRE SPRINK ENERGY T 2 MECHANICAL Y ❑ N❑ v ❑ N� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A U INTERIOR SHEAR FIRE DEPT. ND YL NE] SHEETROCK GRADE "FEE SUMMARY.,s,L:.,,,,K EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I SEISMIC FEE _ OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC OONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING • z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL _.. OFFICE COPY