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17326 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY , BUI LOI NG PROJECT I DENTI FICAT16N PERMIT NUMBER aDILpING - APPLICATION & PERMIT ADDRESS 1,7326 qqo S• S-T-�LL`/II - t7- BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S • - - /C PLAN•CHECK VALIDATION' NAMFQEEmEit E •^ . pTV. ELECTRIC PERMIT FEERe � • "1 eC CONTRACTORS OUTLETS-SWITCHES-RECEP 10.00/1.00 + .' 4 6 . 7 6 y} i �� - - "LIC.NO. - LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S APPLIANCES-RESIDENTIAL 4.00 AODR ESS `-_ PHONE PANELS - 10.00 DATE OF APPLICATION ARCHITECT - PLAN CHECK.FEE P.C.NO, OR PANELS (OVER 200 AMP) 20.00 - --. ENGINEER LIC NO. . SIGNS TRANS. 3.00 - ARC Ess ENG , SPECIAL CIRCUIT 5.00 PERMIT VALI.CATION 1 ZIP EMP.METER OR POLE INS. ,20.00 APPLICANT'S - MOTORS - SEE FEE SCH: ApOfl E55 - .. SI S �J SERVICE CHANGE 20.00 p /{,I, �I/ I nl o o LICENSED CONTRACTORS DECLARATION I (,;. [-f K�t�V'vv-�-( Pr v I hereby affirm that I am licensed under provisions of Chapter 9MAR 1 )�. ISSUANCE DATE W (commencing with Section 7000)Of Division 3 of the Business and -- BLDG.- ELECTPLG. MECH. Gy .z Professions Code,and my license is in full force and effect Zo 0 Ino License Class Lic.Number civ 0 Upe Q - Data Contract., _ BUILDING PERMIT rc o or sv OWNER-BUILDER DECLARATION INFORMATION w3 W I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD VALUATION B/ET. HWO.J Law for the followingrcason.(Sec.7031.5,Business Professions PERMITISSUANCE `� 10.00 12;,0 Code:Any city or county which requites a permit to construct,alter, ¢ a ¢ o - improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D D- W LL requires the applicant fp(such permit to file a signed statement that TOTAL PERMIT TO - w m he Is licensed pursuant to the provisions Of the Contractor's Liam. - H z i Law(Chapter9(commancingwith Section 7000)of Division 3 o fill, e Business and Professions Code)or[hal he i9 exempt therefrom and OTV. PLUMBING PERMIT FEE -M r o the basis For the alleged exemption.Any violation of Section 7031.5 1 - STORIES TYPE CONSTR. ec by any applicant for a permit subjects the applicant l0 a civil penalty ALTER-DRAIN&VENT-WATER IEA.) 6.00 of not more than five hundrd edollars(5500).). - ❑ I,as owner of the property,Or my employees with wages as BACKFLOW PROTECT. DEVICE. 4.00 OCC.GROUP REB.UNITS their sole compensation,will do the work,and the structure i9 not _- intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 5.00 Code The Contractor's License Law does not apply to an owner of _ + property who builds or improves theoon,and who does such work FIXTURES-PER TRAP 5.00 t O SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. GAS-EA.SVSTEM-11NC.40UTLETS 6.00 Y meats are not intended or offered for sale.If,however,the building or Improvement is sold within one Year of completion,the owner- 1 builder will have the burden Of proving that he did not build or it.- GAS-EA.SYSTEM-OVER 4_(EA.) 2.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Omar -__ INDUSTRIAL WASTE INTER30.00 011,as owner of the property,am exclusively contracting with . 1:1 ' ❑ El El Elliccen`sed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply _ r _ to on owner of properly 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 Contractor's License Law. TRACT NO. PARCEL NO. Irvin exempt under Sec.' ,B.&P.C.for this WATER'HEATERW/VENT 6.00 - r ason Owne Date .f 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 of consent to relf-insore: t e or n certificate of Workers'Compensation Insurance,or a certified ZONING - ENG.,SITE NO. copy thereof(Sec.3500,Lob.C.). - Policy No. -Company + O ❑ Certified copy is hereby furnished. FIRE SP_RINK ENERGY T-24 Z Z ❑ -Certified ropy Is Bled with the city inspection division.pMISC.- REFER TO ORD. C) Applicant .Y ❑ NE] Y-❑ •N❑ _y ISSUANCE 10,00 0 LU COM CfiRTIFIC - EXEMPTION FROM WORKERS' P -PERMIT IANE Z FLOOD ZONE - A.L.UL. Wim. 1. COMPENSATION INSURANCE; PLG.CONTR. LIC.NO.,, PLG. - CL 0( This section need not be completed If H ' ie permit Is for one _ - TOTAL 6-�0- Y'❑ N❑ ,V❑ N❑ hundred dollars($100)or Iessr U O � I certify that in the performance of the work for which this per- OTY MECHANICAL PERMIT - FEE FEE SUMMARY LL b- mil is issued,I Shall not employ any person in'any matte',so as to - O W become subject to the Workers'Compensation Laws of California. ' Data A Meant 'BUILDING } y NOTICE TO APPLICANT, If,after makins this Certificate of Ex- ALTER OR ADD TO MECH. 5,00 - F Z ellption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions Of the Labor Code, you,must forthwith comply with FEE C„) such provisions or this permit she]]be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 . -q CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000GRM.) 6.00 SEISMIC FEE I hereby affirm that there is a'conslnmtion lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the Performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 -• - Lenlleri Address ELECTRIC •SD I cattily that l have read this application and dintithat the above VENTILATION FAN (SINGLE) 4.00 ♦ - Information i9 Slider 1 agree tog to b with all city and county PLUMBING- 9- U D / information and slate laws relating t0 building construction, and BOILER•CUMP(3 H.P.or 100,000 B.T.U.) 6.00 Hereby authorize representatives OP this city to enter upon ilia BOILER-COMP lover 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for m,pectlon purposes., (We)°agree t0 save, indemnify and keep harmless the City at MISC.- _ REFER TO ORD. _ upertmo against liabilities,Judgments, costs andaxpensea which CONST.TAX •- . :y -- may in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 �, rant Oft is nn MECH.CONT. LIGNO. MECH. TOTAL erg S TOTAL -� iglIatureof,Applicant/Contractor Yale Is OFFICE COPY I POST THIS CARD.NEAR FRONT OF BUILDING PERMIT NUMBER• CITY OF CUPERTINO INSPECTION DIVISION 17326 " JOB INSPECTION 4REECORD JOB ADDRESS ^`E UNIT# _LOT# [ I�PERMI,T PyFtATI N a + EX 1 ��h�.. IUI PERMIT EXPIRES I WORK. (OWNER +C..LJ If e6 ACTOR �— 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 PERMIT VALIDATION CUPERTINO STANDARDS. ' GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED t-� j!— •7 UNDERGROUND /SLAB MAR PLUMBING " { �.G ` J �}�•(�� ELECTRICAL city \•1 `ISSUANCE DATE MECHANICAL - RLUG• FIL('I[,�C��T EEGG. MCCH io �4 ., W DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATIONsiPr. PLUMBING - - - i '• t)Q, MECHANICAL ELECTRICAL - PERM I TTO FRAMING IT, •`"�` 'Q INSULATION STORILS TYPE CONSTR, 'UCG GROUPRES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOFNOTE:NO FINAL INSP.SHALL BE MADE BEFORE so ET FLOOR AREA 'TOTA�ACREAGE DIAPHRAGM THE CONSTRUCTION TAX IS PAID .� BUILDING USE ROOF SHEATHING "Es iNu CON PB. Oln., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ 0 1] El ❑ ASSESSORS PARCF.I.NO, ROUGH SAN.n PLUMBING' . ELECT.ENERGY . - TUBS&SHOWER PAN , PLUMBING ENERGY IHACI NOPARCEL NO MECHANICAL MECH,ENERGY ELECTRICALBUILDING ENERGY ACC.DATE- ACC FILE NO FRAMING - ELECT.FINAL TEST - ZONING ENG.SITE No. INSULATION PLUMBING ' -rG( , GAS TEST _ GAS " _ FIRE SPRINK ENERGY T-24 . MECHANICAL Y ❑ N� r �' . "� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Ll1 XTERIOR SHEAR ELECTRICAL RELEASE - 7 '� FFOOD ZONE AC, . O NTERIOR SHEAR' � FIRE DEPT. 'YNE] YL No HEETROCK GRADE FEE SUMMARY XTERIOR LATH . BUILDING — NTERIOR LATHTEMPORARYAPPROVALS 'BUILDING <Dd S RATCH COAT ELECTRIC PLAN CHECK GAS FEE F. O'TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE !wa t CCUPANCY OF BUILDING ISNOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM . u ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ,F ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING; 0v PLEASE GIVE JOB ADDRESS WHEN PHONING. MECHANICAL = SEE PERMIT FOR EXPIRATION DATE -' IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR.FINAL INSPECTION. OFFICE COPY