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13633 (2) A9PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION _ PERMIT NUMBER -7( auILmNG APPLICATION & PERMIT A°eSS o/ s��A�� -f ,►,�ig� RD13633 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL / OWNER'S PLAN CHECK VALIDATION �f N 4 OTY. ELECTRIC PERMIT FEE S'�AfERJ fSTcXReNE-5�S=2�2 . CONTRACTOR'S UTLETS-SWITCHES-RECEP 10.00/1.00 NAME JV ,/ wI it L LIC.NO. :71- ILIGHTING FIXTURES 10.00/1.00 CONTR C APPLIANCES-RESID ADDRENTIAL 4.00 ' Ess PHONE/1•L& PANELS 10.00 DATE OF APPLICATION P.C.NO, ARCHITECT PLAN CHECK FEE OR - PANELS (OVER 200 AMPI 20.00 ENG pE�(rl. NO. k0B SIGNS TRANS. 3.00 AARCH.OR DDRESS ENG. '��y SPECIAL CIRCUIT 5,00 PERMIT VALIDATION # /q G�`E'� xIP EMP. METER OR POLE INS. 20.00 - AMOTORS SEE FEE SCH. DRESS ADDDRESS / SERVICE CHANGE 20.00 w 0 2 LICENSED CONTRACTORS DECLARATION a u u I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE+GATE. H¢ w (commencing with Section 7000)of Division 3 of the Business and - B DG. ELECT. 'PLG. )MECH. H 7 z Professions Code, y license is in full force ay)iyfja:Fj„ [ v O ❑ z o v�- License Class Le.Number_ 0 m f w DareContractor ' et m sa - BUILDING PERMIT le Q w a O NER-BUILDER DECLARATION INFORMATION KD u MISC.- REFER TO ORD g n N I hereby affirm that I am exempt from the Contractor's License VALUATION t LL 04 Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00 $/FT. Code:Any city or county which requires a permit to construct,alter, rt rt a * improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. �J G u requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO, A w m he is licensed pursuant to the provisions of the Contractor's License FZ > Law(Chapter 9(Commencing with Section 7000)of Division 3 ofthe 4 business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r the basis for the alleged exemption.Any violation of Section 7031.5 i(MIES TY E CONSTR. a. by any applicant for a permit subjects the applicant loacivil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ 1,as owner of the property,or my employees will,wages as BACK FLOW PROTECT.DEVICE 4,00 OCC.GROUP RES.UNITS their sole compensation,will do tire e work,and the structure is not 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 to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve GAS-EA.SYSTEM-11NC.40UTLETS 6.00 ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of Completion,the owner. GAS EASYSTEM OVER 4 (EA) 200 " builder will have the burden of proving that h - . - . . e did not build or am- BUILDING USE prove for perp Aoofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Otne, ❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑- ❑ ❑ licensed contractors to construct tire'project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 600 ASSESSORS PARCEL NO. and Professions Code:The Contractors License Law does 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 contrxcloolo licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. ,B.&1•.C.for this WATER HEATER W/VENT 6.00 roaster Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO, WORKFRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsenl to self-insure, ZONING ENG.SITE N0. or a certificate of Workers Compensation Insurance,or a certified copy fhereof(See.3800,Lab.C.L Policyr Con Q ❑ edlfiedcopy ishemrebpayy_funtished. FIRE SPRINK ENERGY T-24 Z Z /certified o fit ItlI Ole city 'n,spy�tion division. AI hcant . .�1�U%� Gam.) l MISC.- REFER TO ORD. v❑ N❑ v ❑ N❑ I- W e- � � � 2 PERMIT ISSUANCE - 10.00 cc CERTIFICATE OF EXEN PTION PROM WORK: FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL ❑ (This section need not be completed if the permit is lar one TOTAL Y❑ N❑ Y❑ IN ::) Z hundred dollars IS 100)or less.) U O 1 certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,I shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING l:56 Z } W NOTICE TO APPLICANT: If,after making this Cer il'icate of Ex- Z emplion,you should become subject to the Workurs'Compensation APPLIANCE5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply will FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER l0,000C.EM.) 6.00 SEISMIC FEE I 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 f5ec. MICROFILM 3097,Civ.C.L - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATI NG UNIT(OV ER 100,000 B.T.U.)9,50 Lender's Address ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree to comply with all city and county g01LER-COMP(3 H.P.Of 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the BOILER-COMP over 100,G10BTUISEE FEESCH. 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 consequence of the Stealing of this permit MECH.CONT. LIC.NO. MECH. y TOTAL TOTAL �T7� ig lure fApplicanl/C for Da OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY 'OF CUPERTINO 13633 INSPECTION DIVISION tA'- JOB INSPECTION RECORD ! - PERMIT EXPIRATION -�R' JOB ADDRESS 1601 SARATOGA—SUNNYVALE RO4QIT4tP Lor# cc(�( • PERMIT EXPIRES IF WORK OWNER CALIF. STATE AUTO AY'l9 "CTOR DINWIDDIE COAST IS NOT STARTED WITHIN IL' INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM UFER LASTCALLED INSPECTION. PREGUNITE POPERMIT,VALIDATION � � UR NO WHAS CONCRETE UNTIL ABOVE BE-EN SIGNED: 'I � UNDERGROUND /SLAB PLUMBING ' ELECTRICAL ISSUANCE Dnrn MECHANICAL BL ELECT. PLG. MECR. 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION SIFT. � .'`�� MECHANICAL ELECTRICAL PERMIT TO 'i FRAMING INSULATION - STORIES TYPE CONSTR. • OCC GROUP RES.UNITS IP•LACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF- DIAPHRAGM FLOOH AREA TOTAL ACREA[iG DIAPHRAGM BUILDING USE ' RES IND CON PR . 00', VAPPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 0 El 0 El ' � ASSESSORS PARCEL NO, ROUGH PLUMBING GAS TEST TRACT NO, PARCEL NO. MECHANICAL ELECTRICAL FINALS . DATE INSP. ACC.DATE ACC.FILE NO. .' FRAMING SAN # ZONING ENG.SITE No. INSULATION PLUMBING GAS MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E] N❑ Y ❑ N❑ .LU. LATH—INTERIOR ELECTRICAL 'FLOOD ZONEC. A LATH—EXTERIOR FIRE DEPT. Y❑, N❑ v ❑ N❑ SHEETROCK - GRADE - FEE SUMMARY 1 SHEAR INTERIOR BUILDING BUILDING ,�) ' SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK . i2 GCCAS FEE IND TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OUPANCY SEISMIC FEE 150 OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o'� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE TOTAL 1I - CALLING FOR FINAL INSPECTION. OFFICECOPY