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14431 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — LISE.BALL POINT PEN ONLY- BU I NLY-BUI LDI NG PROJECT I DENTI FICATI ON PERMIT NUMBER - DESG APPLICATION & PERMIT A ., A �� ADDRESS 4 BUILDING - ELECTRICAL-PLUMBING-MECHANICAL O 's PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE 74 C&,te:t z i 777ZC NOMERAcroRs OUTLETS-SWITCHES-RECEP 10.00/1.00 S6liao LIC.NO, ItsLIGHTING FIXTURES 10.00/1.00 r-OADDREss NTRACTOR'S APPLIANCES-RESIDENTIAL 4,00 J110S,JJpJJ: PHONE PANELS 10.00 — DATE OF APPLICATION,. ORRcertscT PANELS (OVER 200 AMPI 20.00 PLAN CHECK FEE P.C.N0. ENGINEER let) ASSC4 LIC.rvor_ B SIGNS TRANS. 3.00 - ADDREssEND ' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP rrEMP.METER OR POLE INS. 20.00 , APPLICANTS MOTORS SEE FEE SCH. ADDRESS � SERVICE CHANGE 20.00 F 02 LICENSED CONTRACTORS DECLARATION - < u 1 hereby of firm that I am licensed under provisions of Chapter 9 ISSUANCE DATE H a"' BLDG. ELECT.(commencing with Section 7000)of Division 3 ol'the Business and " PLG. MECH. D 1O Professions Code,and m license is in full for�v-4.1410.1y{t ❑ ❑ ❑ z o= License Cass_ /_�Lic.Number_y_YZ _E-!I n oN r w Dti e1,]/X9 8'�___Conlractor=$SILh$_-¢en.f-r• ¢ w a ---777 OWNER-BUILDER DECLARATION V BUILDING PERMIT A O > U INFORMATION w g vHi 1 hereby affirm that I and exempt from the Contractor's License MISC.- REFER TO ORD LL o ¢ Law for the following reason.(Sec.7031.5,Businassund Professions PERMIT ISSUANCE 10 00 �Q VALUATION $/FT. � - 0 Code:Any city orrounty whichrequiresapermit to construct,alter, ¢ ar < improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC NO ELEC. �/ a w m 2 requires the applicant for such permit to file a Signed Statement that TOTAL IS PERMIT TO he is licensed pursuant to the provisions of the Contractor's License z a Law(Chapter 9(commencing with Section 7000)ofl1ivision 3 offm 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ F $ Deblois for the alleged exemption.Any violation of Section 7031,$ STORIES TYPE CONSTR. by any applicant fora permit Subjects the applicant toacivil penally ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than fve hundred dollars(55001.1'. ❑ I,as owner of the property,or my em..loyces 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,AR EA,COND. 5.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and wlmdoessuch work FIXTURES,PER TRAP 5.00 SG.FT,FLOORAREA TOTALACREAGE himself or through his own employees,provided that such improve. _ mems are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I INC.AOUTLETS 6.00 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 he d - . - . . id riot build or im. BUILDING USE prove for purpose of sale.). RES IND CON PB Other WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See 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 looks or improves thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00 contracts for such projects wfit,:,contracmd,r)licensed pursuant to SEWER-SAN V-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. ,IL&P.C,for this WATER HEATER W/VENT 6.00 reason Owner Duto WATER SYSTEM - 5.00 ACC.OATE ACC.FILE NO. WORKERS'COMPENSAT ION DECLARA'I'[ON WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thc1rj�J$ye..-3,,�00,Lub.CJ. �J �+ Policy NnjM�fWKnapany—rr ds 7 - '� ❑ Ceftilic' sllereby lar hcd FIRE SPRINK ENERGY T-24 Z 2 ❑ 'C J o is fie a cry inspect ion division. H AP ant MISC.- _ REFER TO ORD. y ❑ N❑ Y ❑ N❑ � - CERTTFICATFOFRXEAIPTIONFROM WORKERS' PERMIT ISSUANCE. 10.00 FLOOD ZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. d'Q II his section neednot be completed if the permit is for one TOTAL v❑ N❑ Y❑ N❑ Z) Zhundred dollars IS 100)or les.) U 01 certify Omt in the performance of the work I'or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL H 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. t Dale Applicant ALTER OR ADD TO MECH. 5,00 BUILDING >_ m NOTICE TO APPLICANT: IL after making this Certificate of Ex- F ? emption,you Should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U Such provisions or this permit shallm be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 ` CONSTRUCT ION LENDING AG17NCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I hereby affirm that there is aconstruction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work lot which this permit is issued(Sec. - MICROFILM 3097,Civ.C.). 'HEATING UNIT(TO 100,000 B.T.U.) 8.00 ' Lender's Name - HEATI NG UN IT E R 100,000 B.T.U.)9.50 Lender's Address ELECTRIC ( certify tis correct: rand agree application and all c that the above VENTILATION FAN (SINGLE) 4.00 '- colmanfo ntion n estatetr laws rel to comply with all city uction, n d BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING ' ove ordinances and a re laws representatives to building canter cion, ante hereby authorize representatives ec this city to enter upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes, (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. ' upertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10,00 CONST.TAX' may in any way -ecru against said City in Consequence of the r, of this perm' .. MECH.CONT. LIC.NO. MECH. ' _0211- TOTAL TOTAL Signature of Applicant/Contractor Leap, OFFICE a - OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER' CITY ' OF CUPERTINO 14431 ' INSPECTION DIVISION JOB.INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS 20375 STEVENS CREEK BLVD ' UNIT# LOT#' ' PERMIT EXPIRES IF WORK OWNER SANTA' CLARA LAND TI�&NFIiIACTOR JERICHO ELECTRICIS NOT STARTED WITHIN' INSPECTION DATE INSPECTOR INSPECTION RECORD '180 DAYS OF PERMIT ISSU- FOUNDATION , ANCE,OR 180 DAYS,FROM NOTE: UFER � � ALL GRADING AND.DRAINAGE SHALL BE INSTALLED LASTCALLED INSPECTION. PREGUNITE - TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION GARAGE SLABS CUPERTINO STANDARDS. POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED X -8$ F` ,*_4—L-caL Pe�-o (4S� (: . UNDERGROUND/SLAB st - PLUMBING - I ELECTRICAL ISSUANCE DATE MECHANICAL - ay�{.—DG�. ,LLIT. PLG. �MECH L�1 0 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED lolc-IIJ-0 BUILDING PERMIT WOOD FLOOR - • INFORMATION V ALUAiION - SIFT. PLUMBING - MECHANICAL ELECTRICAL • PERMIT TO FRAMING INSULATION STORIES TYPE CONSTR. ' -, - - . OCC.GROUP RES,UNITS PLACE NG SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE 50IT FLCOR RHEA TOTAL-ACREAGE. DIAPHRAGM THE CONSTRUCTION TAX IS PAID ' BUILDING USE ROOFSHEATHING - FIT, IrvD CON PB 0", APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - '.FINALS. DATE INSP. ❑ ❑ ❑ - ' ROUGH SAN.k A55E55OR5 PARCEL NO. - � � • PLUMBING ELECT.ENERGY _ TRACT NO PARCEL NO TUBS&SHOWER PAN - � PLUMBING ENERGY I f - MECHANICAL MECH.ENERGY ELECTRICALOL— BUILDING ENERGY ACC DA ACC FILE NO � � t FRAMING - ELECT,FINAL TEST - ZONING ENG,SITE N0. , - INSULATION' PLUMBING - GAS TEST GAS MECHANICAL FIRE SPRINK ENERGY T;2a' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y E N Y N� EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUs. INTERIOR SHEAR - FIRE DEPT. Y❑ "❑ ° ❑ N❑, SHEETROCK - GRADE FEE SUMMARY EXTERIOR LATH - BUILDING ' INTERIOR LATH - TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC. PLAN CHECK GAS - FEE. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505 ELECTRIC ` o� ONE 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 TOTAL CALLING FOR FINAL INSPECTION. _ OFFICE COPY