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15530 ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ^ Z' BL11 LDING PROJECT IDENTIFICATION PERMIT NUMBER ^ SoILDING - APPLICATION & PERMIT 1 [[ O ADDRESS -Z4!! ' _5,,r�te y C-/< I J�J 5; S'TE Sr C . ' BUILDING -ELECTRICAL-PLUMBING-MECHANICAL OWNER'S NAME / f�?./r�u.4 ' 'V,,jl�s PLAN CHECK VALIDATION �,• 7� H/ '/"'x' °-N+''Z -l"1000 O� DTV. ELECTRIC PERMIT FEE 7 'Ke n 1 'J "�Tr• CONTRACTOR UTLETS-SWITCHES-RECEP 10.00/1.00 / CQ &J gcgic. Uc.ND.1(9 90G 8 LIGHTING FIXTURES 10.00/1.00 ' CONTRACTORS PA APPLIANCES-RESIDENTIAL 4.00 (}� R�/1/IlVr//r 5/ PHONEts3 0J6�i PANELS 10.00 DATE OF APPLICATION. I ARCHITECT 7#Z-7 , /eCq` PLAN CHECK FEE P.C.NO. OR IrPL /'1/�L-`//T•EG7URAZ-�� C•CI PANELS (OVER 200 AMP) 20.00 ENGINEER LIC,Na(i/2 /0 SIGNS TRANS. 3.00 ARCH.OR ENG. 72-0 ' u fA /x PERMIT VALIDATION \ / All HE R lAV/V /�I� SPECIAL CIRCUIT 5.00 'C le`i L_o /4,f-&70 TEMP.METER OR POLE INS. 20.00 i- APPacaNrs ADDRMOTORS SEE FEE SCH. ESS - SERVICE CHANGE 20.00 o¢= 0 o o LICENSED CONTRACTORS DECLARATION : .Q isI hereby all that 1 ant licensed under provisions of Chapter 9 NCE DATE to a m (commencing with Section 7000)of Division 3 of the Business and B CT. PLG. MECH. F N z Processions Code, I my license is in(all fore• 4•�t. 1 ❑ ❑ ❑ z o mi- License Class Lic.Number s I 9 L Due_wa j_� Contactor tl6J j6 Kr Y s BUILDING PERMIT ¢ ¢ w a OWNER-BUILDI>R DECLARATION a a INFORMATION E: 3,LL w 1 hereby affirm that I am exempt from the Contractor's License C.- REFER TO ORD u o sc Law for the following reason.(Sec.703).5,Business mad Professions VALUATION $/FT. I- N,n PERMIT,ISSUANCE 10.00 Code:Any city or county whiny structure, permit toconsuance,lter,also Q ¢ Q O improve;demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. / ¢ requires the applicant for such permit to lite a signed statement that TOTAL n w m u- he is licensed purmmpt to the provisions of the Contractors License PERMIT TO Q Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe �� " i o Businesa and Professions Code)or that Ile is exempt therefrom and QTY. PLUMBING PERMIT FEE >� ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. 2 hyany applicant for a permit subjects the applicant tea civil penalty ALTER-DRAIN -WATER (EA.) 5,00 of not more Than five hundred dollars 5500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 their sole compensation,will do file work,and the structure is not OCC.GROUP RES.UNITS- their 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 Its property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.Fr.FLOOR AREA rorAl ACREAGE rr himself or through his own employees,provided that such improve- (, mems are not intended or offered for sale.ll,however,the building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 Boa or improvement is sold within one year of completion,the owner- GAS EASYSTEM OVER 4(EA.) 2.00 builder will have the burden of proving that he d - . - . BUILDING USEid not build or im- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec. 7044,BusinessLAWN SPRINKLERS- 1 INC 5 VB600 ASSESSORS PARCEL NO, and Professions Code:The Contractor's License Law does not apply V.8. . to an owner of property who builds or improves there.,,.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with it contructmos)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the Contractors License Law. TRACT NO, PARCEL NO. ❑ I am exempt under Sea ',B.AP.C.lin this WATER HEATER W/VENT 6.00 reason Owner Dam WATER SYSTEM _ 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have acerlificale ofconsent toselGinsure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy Ther• '(Sac.38 0,Lab.C.). - - _r - Policy No ompeny /,f(�(d '�y�/(�- ❑ Cetlifedcopyisherebyfurnislmd. FIRESPRINK ENERGYT-24 Z Z ?it CertiI •d opy fila, withhe t .city inspection division. Appncam i; - rJeAxf-t^-'' MISC.- '.'REFER TO ORD. Y [] NE] I Y [:] NE] 0 N CERTIFICATE OI'EXEMPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTE. LIC.NO. PLG. d O (This section need not.be completed if da permit is Tor one TOTAL Y❑ N 0 Y❑ NEI Z hundred daltons IS 100)or less,I 0 O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY LL F mit is issued,1 shall not employ any person in any manner so as to O ED becnnm suhject to the Workers'Compenwtion Luws of California. p• Date Applicant BUILDING } to NOTICE TO APPLICAN'1: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 5.00 7L5- F 2 e nipion,you slmuld become subject to tire Workers'Compensation APPLIANCE 5.00 ,PLAN CHECK provisions of the labor Code, you.must forthwith comply with FEE CJ such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION L17NDING AGENCY AIR HANDLING UNIT(OVER I0=C.F.M.) 6.00 SEISMIC FEE 6� I hereby sffirn that there is a construction lending agency for 'EXHAUST HOOD(WITH DUCT) 5.00 the perlormance 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(OVER 100,000 B.T.U.)9.50 Lender's Address ELECT" IC 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE)' 4.00 v rn'" information is correct.,) agree to comply with all city and county 'BOILER-CCMAP(3 H.P.Or 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 lover 100,000 erul SEE FEE SCE. MECHANICAL '1 above-mentioneU properly for inspection purposes. �-+yY (We) agree to save, indemnify and keep harmless the Ciy of MISC.-. REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX 17 may in any way accrue against said City in consequence of the PERMIT ISSUANCE - 10.00 / ranting of 111 permit - MECH.CONT. LIC.NO. MECH. G • 0/7 TOTAL TOTAL 37� �P Signatureo Applicant/Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 15530 INSPECTION DIVISION JOB INSPECTION RECORD /� PERMIT EXPIRATION JOB ADDRESS C��S-1�Sr� Lr�'r U� IT It _LOT it— `,' - PERMIT EXPIRES IF WORK v11 L�/C Tim/w,/L To-/ 'y.0/Li% CONTR•CTOR fC�p- G IS NOT STARTED WITHIN UWN[N -y INSPECTION DATE I INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VAEIUATIUN PRE GUN I TE CUPERTINO STANDARDS. GARAGE SLABS tEl POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I=OV OT_ i«N IFOLr7'E1xtS �u1� UNDERGROUND/SLAB PLUMBING ELECTRICAL ISSOANCt DATE MLU(. ELECT LG '6"MECHANICAL ❑ El 00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING FERMI pO INFOR TION WOOD FLOOR vALUA III. snT PLUMBING MECHANICAL / ru(xTI u ELECTRICAL FRAMING 'T� w'rvv cul vuNl s LP[cosTN INSULATION (X.l UHOUv N!5 UNIT$ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED AL I.,n ILouN nNe• u •we•oL ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAXIS PAID "UCO.-USE ROOF SHEATHING .,IS INO CON R UL.. APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. O ❑ I] ❑ O nSSk55UN •NOEL NU ROUGH SANK PLUMBING ELECT.ENERGY , TNnCT NU ANCtL NO TUBS d SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY PCC DATE ACC TILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING ENG SITE NO INSULATION PLUMBING GAS TEST GAS iINF SPRINR FN[NGr T). MECHANICAL rp NE] ro No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR j-L_(�_g� ELECTRICAL RELEASE - _ (171 FLUUU1ONE Luc INTERIOR SHEAR FIRE DEPT. r[:] N� :L Cl No SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING y� BUILDING INTERIOR LATH TEMPORARY APPROVALS / ,r RATCH COAT -1 ELECTRIC PLAN CHECK GAS FEE V NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252.4505, ELECTRIC H ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL —SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX D� PLEASE READ REVERSE SIDE BEFORE E fs TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY