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15204 (4) F TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY - -' t r PROJECT IDENTIFICATION .PERMIT NUMBER aorh NlJ�G, APPLICATION &.PERMIT 15204 � O BUILDING -ELECTRICAL- J PLUMBING-:MECHANICAL ' 0 NER'SPLAN CHECK VALIOA ON NAME �iVtO S+QILYoE DTV.' ELECTRIC PERMIT FEE PHDrvE -o d - fo, cAAM1ERAcroFs 8� UTLETS-SWITCHES-RECEP 10.00/1.00 / c3n4 OIGHTING , FIXTURES 10.00/1.00 coNrRAcrons PPLIANCES-RESIDENTIAL . 4.00 AD J Q _ /�a� NE 3, PANELS 10.00 DATE OF APPLICATION oRCRRECT n,.� PLAN CHECK FEE P.C.NO. OR ;f`r�i PANELS (OVER 200 AMP) 20.00 .. ENGINEER + uC.NO. SIGNS TRANS. 3.00 ARCH.OR NG. _ � - PERMIT VALIDATION AooREss 7f '�! SPECIALCIRCUIT 5.00 Z O✓ CGYItJ/(V zIP EMP.METER OR POLE INS. 20.00 ' APPucarvrs �/NO MOTORS SEE FEE SCH. AUORE55 �'} UI O V/ - SERVICE CHANGE 20.00 / w�i 10 ;/& F o o LICENSED CONTRACTORS LFCLARA'1'[ON ' a u I hereby affirm that 1 am licensed under provisions TChapter 9 ISSUANCE GATE ¢i (commencing with Section 7000)W Division 3 of the Business and G. ELECT. PLG. MECH. r w i Professions C ,anA my license is in full for, f e ❑ ❑ o i m o-� Liccnsc Clas Lia Ni Uatc Comrador_ _ P Y s IBUILDING PERMIT ¢ Q w OWNER-BUILDER LECLARATIO I RMATION E ;LL y '1 hereby atltrm that 1 am exempt front the Contractor's License MISC.- REFER.TO ORD u O ¢ Law for the following reason.(Sec.7031.5,Business and Professions N $/FT. s- _ g PERMIT ISSUANCE 10.00 Code:Any City or county which requires permit to construct,alter, .�..L�. ¢ ¢ 4 Q improve,demolish,or repair any structure,prior to its issuupce,also ELEC.CONTE. LIC.NO. ELEC 7 0 E� v w0, requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO S u he is licensed pursuant to the provisions ol'the Contractor's License > Law(Chapter 9(commencing with Section 7000)of Division3 ofthe N �Qyd 1 i o Business and Professions Code)or(hat he is exempt therefrom and DTV. PLUMBING PERMIT FEE tic 0_ the basis for the allegedexemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. 3 by any applicant for a permitsubjec(s the applicant(.a civil penalty ALTER-DRAIN (EA.) 5.00 �i hip of more than five hundred dollars(myem): ' ❑ Las owner at the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS (heir 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. 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 SQ FT.FLOORAREA TOTALACREAGE himself ar through his own employees provided that such improve. himselfOnts an through hiss or employeeffered for sale.Iided that suhebmlding GAS-EA!SVSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 builder will hove the burden of proving(flat he did not build or art. GAS USE prove for purpose ofsale.). INDUSTRIAL WASTE INTER. 30.00 RE5 IND CON PB Other Cl 1,as owner ol'the property,am exclusively contracting with ❑ F-1 ,❑ ❑ ❑ licensed contractors to construct Nie project(See.71744,Business LAWN'SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:I lie Contractor's License Law does not Imply 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 SEWER-SAN EA.200ft/10.00 the Con(m,toi s License Law. TRACT NO. PARCEL NO. ❑ I am exempt nosey Sec. B.&BC.for thisreason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5,00 ACC.DATE ACC FILE NO. WORK FRS'COMPFNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 haruhy affirm ihat 1 have a certificate of consent In self-insure, �a or a certificate of Workers'Compensation Insurance,or a cerlified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lub.C.). - - Policy No. Company C) ❑ Cerlified copy is hereby furnished, FIRE SPRINK ENERGY T24 Z Z Certif' copy.' If d will the cit in Pection division. Applicant'_,-,�� MISC.- REFER TO ORD. Y � N Y [] NC] CERTIFICATE OI°EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FL00020NE A.L.u.c. LU - COMPENSAT'ION INSURANCE PLG.CONTE. - LIC.NO. PLG m . CL 0 (1 his section peed not be completed if the permit is for one TOTAL Y N V N L) -0 hundred dollnrx(SIO0)or Ivv,J L,L� I certify that in the performance of the work for which this per- GTV. MECHANICAL PERMIT FEE FEE SUMMARY �L) mil is issuede I shall not employ any person in any mommy rh as na U become subject to the Workers'Compcnsalion Laws oC California. G 9 U1 Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING �Qa�� } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- F Z emption,you should become subject in(he Worker'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 deemed revoked AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE Ihereby 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. MICROFILM 3097,Cre.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that I have read(his application and stale that theabove VENTILATION FAN (SINGLE) 4.00 informmion is correct. I agree to comply wish all city and county BOILER-C(Nv1P(3 H.P.Of 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, anti J8hereby hath.,me representatives of this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. above-mentioned property for inspection purpous. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. - Cupertino ag'' liabiltlies,Jud menu, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX ay in a we accrue 'id City in consequence of[he ting ennlL or MECH.CONT. LIC.NO. MECH, TOTAL TOTAL ,7•�0p� SI t plicant/Contra fLate OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15204 INSPECTION DIVISION JOB INSPECTION RECORD,' ` PERMIT EXPIRATION 1601 Saratoga-Sunnyvale +II JOB ADDRESS "UNIT# - _LOT#1. PERMIT EXPIRES IF WORK OWNER Info Bridge CONTRACTOR South Bav Construction. IS NOT. STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION 'ANCE OR.180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER �" ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF, PE TMIT vALmATION CUPERTINO STANDARDS. GARAGE SLABS - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNEDVrLILv UNDERGROUND /SLAB ✓ rt,; .�I PLUMBING ELECTRICAL IssunlvcE(inrE " MECHANICAL - BLDG, ELEC� PLO. MEcR It ❑' ❑�I ❑- ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1� BUILDING PERMIT WOOD FLOOR J INFORMATION PLUMBING. VALUATION SIFT MECHANICAL S . �� j - ELECTRICAL - - PERMTI TL FRAMING i;ry INSULATION - STORIES. TYPE CONSTR. - - - OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO,FT,FLOOR nEC. TOTAL ACREAGE ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM - THE CONSTRUCTION TAX IS PAID . BUILDING USE ROOF SHEATHING RES .IND CON PB mn., ' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP.• ❑ Cl ❑ ❑ ❑ ROUGH SAN.N ASSESSORS PARCEL NO ' PLUMBING ELECT.ENERGY - I TUBS 8 SHOWER PAN ' PLUMBING ENERGY TRACI NO, PARCEL NO MECHANICAL MECH.ENERGY- . E CECTRICALACC,DATE ACCFI LE.NO � BUILDING ENERGY ' FRAMING ELECT.FINAL TEST 20m INC, ENG,SITE NO, INSULATION PLUMBING -� - " GAS TEST' - M. MPORARY FIRE SPRINK - ENERGY T"Z< CAL � ,COVER NO WORK UNTIL ABOVE HAS BEE � • N'❑ -T ❑, N❑.FLOOD ZONE ALUCEXTERIOR SHEARAL RELEASE -Jj= - INTERIOR SHEAR . _1 ❑SHEETROCK FEE SUMMARY EXTERIOR LATH INTERIOR LATH MPORARY APPROVALS BUILDING '-•f ' SCRATCH COAT, ELECTRIC PLAN CHECK GAS FEE ' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE OCCUPANCYOF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. MICROFILM oARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC +l � ONE WORKING DAY BEFORE REQU6RED INSPECTION. PLUMBING Z PLEASE GIVE JOB ADDRESS WHEN PHONING. d' - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX i PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING �--�- FOR FINAL INSPECTION. OFFICE COPY