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13078 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LD1 NG PROJECT I DENTI FICATI ON PERMIT NUMBER Go tDING APPLICATION & PERMIT 13078 ADDRESS BUILDING - ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME - DTV. ELECTRIC PERMIT FEE JZAKAOS, PHONE CONTRACTORS CS3 NAME UTLETS-SWITCHES-RECEP 10.00/1.00 :BWuc.No LIGHTING FIXTURES 10.00/1.00 CONTRACTORS APPLIANCES-RESIDENTIAL 4.00 ADDRESS I� PHON S,SD PANELS 10.00 DATE OF APPLICATION ARCHITECTPANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.NO. SIGNS TRANS. 3.00 ADDRESS ENG' - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION zu, 7EMP.METER OR POLE INS. 20.00 PAID APPLICANTS MOTORS SEE FEE SCH. ADDRESS SERVICE CHA G 20.00 I\, I O M o LICENSED CONTRACTORS DECLARATION S d', a I hereby affirm that 1 am licensed under provisions of Chapter 9 e- s -a'1 IVA E (tl n0 H G w (commencing with Section 7000)of Division 3 of the Business and JI. BLDG- EL T. PLO. MECH. r o z Professions Co license is in full I'or h f'' o G- LicenuSflas Lic.Numbe o w H ° DateSQL�• Contractor ltd C110QttfnO �_ ©' 0 BUILDING PERMIT ¢ w u OWNER-BUILDGR UECLARATI N INFORMATION w 0 n N 1 hereby affirm that I am exempt from the Contractor's License IMISC.- REFER TO ORD g Businessand Professions VALUATION $/FT. u o¢ Law for the followin reason.(Sec.7031.5, PERMIT ISSUANCE 10.00 y v4 Code: y city or county which requires permit to construct,alter, o-a K Q 0 improve, mulish,or repair any Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. 3 La E e LL requires th pplicanl for such permit to file a signed statement that TOTAL PERMIT TO X $m he is license ursuant to the provisions of the Contractor's License rz > Law(Chapter commencing with Section 7000)of Division 3 of the ¢ Business and Pr ssions Code)or that he is exempt therefrom and DTV. ' ' PLUMBING PERMIT + * FEE at = 0 the basis for the a of exemption.Any violation of$eclion 7031.5 STORIES TYPE CONSTR. a by any applicant for emit subjects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five 1 ndred dollars(S500)J: ❑ I,as owner of the ropeany,or my employees with wages as BACK FLOW PROTECTDEVICE 400 their sole compensation, I do the work,and the structure is not . . OCC.GROUP RES.UNITS J2 intended or Offered for sale Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code:The Contractor's Ucen Law docs not apply to an owner of TAY property who builds or improve thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE 9 himself or through his own emplo es,provided that such improve- GAS 6.00 mentsare not intended oroffered f Sale.If,however,the building or improvement is sold within one y of completion, the owner- - w I builder will have the burden of proving tGAS EA.SYSTEM-OVER 4 (EA.) 2.00at he did not build or or. BUILDING USE prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer ❑ I,as owner of the property,am exc ively contracting with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the Truce Sec. 7044,Business LAWN SPRINKLERSO IPCO2 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License w does not apply to an owner of property who builds or improves reon,and who LAWN SPRINKLERS-'OVER (EA.) 1.00 contracts for such projects with a conlructor(s)licens pursuant to the Contractor's License Law. gEWER-SA NITARY-STORM EA.200f1/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. B.&P. .for this WATER HEATER W/VE'NT 6.00 reason Owner Date WATER SYSTEM V 5.00 PCC.DATE ACC.FILE NO, WORKERS'COMPENSA'fION DECLARATION WATER TREATING LMeiip. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or u certified ENG.SITE NO. copy thereof(Sec.3800,Lab.C�„� _y�Q dD L 0 Policy thereof Company_'-�A 0 ❑ C�tified copy is hereby furnished. FIRE SPRINK ENERGY T 24 [rCery'Cyq rppc fl d .yI it�yps�P�tiO division. Zp Applicant.ffi�-L.- ��lM-f_�b.3_ MISC. REFER TOORD. r ❑ N❑ r ❑ N❑ r� M W CERTIFICATE OF EXEMPTION 17ROM WORKERS' PERMIT ISSUANCE 10.00/0S FLOOD ZONE A.L.U.D. LU �_ COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. L�j) I/ r[3 N C] Y❑ N❑ d 0 (This section need not be completed if the permit is for one TOTAL /C/ 2 hundred (5100)or les') U O I certify that I erformance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY LL 1- mit is issued,1 shall no loy any person in any manner so as to - O become subject m the Workers ensation Laws of California. U y Date Applicant BUILDING / } N NOTICE TO APPLICANT': If,utter making Certificam of F.x- ALTER OR ADD TO MECH. 5.00 Z emption,you should become subject to the work- 'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith Imply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Op000. .M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOVE 10Od0 .F,M.I6.00 SEISMIC FEE /�-- I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT). aC1;55.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L t HEATING UNIT(TO 1 0;000 -.T.U.) 8.00 Lender's NameH EATING UNIT(OVERd00,000 BT�1; ELECTRIC ? Lender's Address J r 1 certify that I have read this application and stole that the above VENTILATION FAN (SIN LEYJ v 4.00 TZI information is correct. 1 agree to comply with all city and county PLUMBING ordinances and state laws relating t0 building construction, and BOILER-COMPI3 H.P.or 10 OO B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP(Over 100,000-TUI SEE FEE SCH. MECHANICAL - ' (We) agree to save, indemnify and keep harm ess the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.001/oCONST.TAX may in any,wit ac{rye against said City in con., of the -_ gran[' g/4 w rSic t MECH.CONT. LIC.N0. MECH. / 1 .671 TOTAL TOTAL gnalure0 Applicant/Contractor CD Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PFRMIT NUMBER 1 CITY OF CUPERTINO 13078 INSPECTION DIVISION JOB INSPECTION RECORD �+yPERMIT EXPIRATION JOB ADDRESS 22468 StdT11RQ Ct. UNIT#t LOT# PERMIT, EXPIRES IF WORK OWNER R.Ramos CONTRACTOR Blue Haven• Pools IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM - UFER LAST CALLED INSPECTION. i PREGUNITE r TyER MIT VALIDATION � IM{ POUR NO CONCRETE UNTIL ABOVE HAS B IGNED I UNDERGROUND /SLAB �,;�, .1 t� t� • PLUMBING -�99 ELECTRICAL .� n . cE DATE MECHANICAL dy �ILD ELECT. I PLG. I MECK A�f DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - BUILDING PERMIT WOOD FLOOR INFORMATION PLUMBING VAWATION SIFT, MECHANICAL ELECTRICAL PERM I,,T/TO FRAMING , My//* INSULATION STORIES. YPE CONSTR. 6u IV/jrg OCC.GROUP RES.UNI TS P,LWACE,•NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT.FT.FLOOR AREA TOTAL ACREAGE ROOF IO�I DIAPHRAGM BUILDING. WLDI USE RES .IND CON PB OR,... APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED 1:1 0 0 0 ROUGH ASSESSORS PAP CE L NO. PLUMBING • GAS TEST TRACT NO, PARCEL NO. MECHANICAL - ACC DATE ACC FILE NO. ELECTRICAL FINALS . DATE INSP. FRAMING SAN # INSULATION PLUMBING, �� ZONING ENG.SITE NO. I GAS - MECHANICAL FIRE SPRINK ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y 0 N0 1 0 ND . LATH-INTERIOR ELECTRICAL FLOOOZONE A.L.0C. LATH-EXTERIOR FIRE DEPT. Y�. N[3 Y❑ No SHEETROCK GRADE - - FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING 'i• -+�.� SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC IONE WORKING DAY BEFORE REQUIRED INSPECT]ON. �-�., PLUMBING Z� PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL - ^ • IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY