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18295 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION PERMIT NUMBER B"' ,rvG q Orr)n[ ,w ' AOOREss �Oy00 Vlo/3t, 1Qocld BUILDINGELECTRICAL-P �� �� 10 G J J 7 - LUMBING-MECHANICAL '�' OWN 'Sri,ino . OA 91 PLAN CHECK VALIDATION NAME (409 OTY. ELECTRIC PERMIT FEE e 1 uc O PHONE ^////.FYI O CONTRACTOR'S -391% 91 / e N1 /nUTLETS-SWITCHES-RECEP 10.00/1.00 Xv 2 2, uc rva C9 LIGHTING FIXTURES 10.00/1.00 f/^� ` ADDRESS ads APPLIANCES 4.00 �11`va AOOREss 1, (/ PHONE Z PANELS 10.00 DATE K APPLICATION ORRCHDEOT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER _G.ND. SIGNS TRANS. 3.00 ADDRESS era. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION z,P EMP. METER OR POLE INS. 20.00 APPucarvrs.XI Ls.ca MOTORS SEE FEE SCH. ADDRESS S 1 IZlo W. Washlley Ave- Ji3 1 SUpn ie. • CR ,,v, 6 SERVICE CHANGE - " 20.00 � /� �I ( u /( 00 LICENSED CONTRACTORS DECLARATIONl" a is(Hj I hereby affirm that 1 am licensed under provisions of Chapter 9 1 /s ISSUANCE DATE ¢ n (commencing with Section 7000)of Division 3 of the Business and ; BLD ELECT. PLG. MECH. r w i Professions Code,and my litemse is in full buret,and effect z D m - License Class Lie.Number o m t w Date Contractor �j(�w ¢ y E a a Y{` BUILDING PERMIT ¢ c OWNER-BUILDER DECLARATION ¢w O INFORMATION w3 d H I hereby affirm that I am exempt from the Contractor's License I MISC.- REFER TO ORD I. 0 J Law for the full owing reason,(See.7031.$.B usin ess and Professions PERMIT ISSUANCE 10.00 ��{wALUATIOjN S/FT. - Code Any city or county which requiresa permit to construct,alter, ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO` ELEC. ¢ requires the applicant for such permit to file a signed statement That TOTAL PERMIT TO a w lie is is licensed pursuant to the provisions of the Contractor's License H z Law(Ch.pmrs)fconvnencing with Section 7000)ul'Division3ofthe �11'�'�Vl �MMOVE 5 i 4 Business and professions Code)or that he is exempt therefrom andOTV. PLUMBING PERMIT FEE Or H 0 the basis(or The alleged exemption.Any violation of$ection 7031.$ n g a STORIES TYPE CONSTR. $ by any applicant for permit subjects the applicant Toacivil penalty of nut more than live bundled dollars($500T) ALTER-DRAIN&VENT-WATER (EA.) 5.00 ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UNITS their sole conppensation,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 dues not apply to an owner of J x property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.ET.FLOOR AREA TOTAL ACREAGE himself or through his awn employees,provided that such improve- GAS-EA.SYSTEM-11NC.40UTLETS 6.00 mems ore not intended or offered for sale.If,however,the building or improvement is sold within one year of completion, the owner GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have tine burden of proving that he did not build or im- - prove for pmpose of sale.). REB IND CON PB Other ❑ 1,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 30.00 E] ❑ El 0 ❑ licensed contractors to construct The project(Sec. 7044,liminess LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts fctor',License ts Lwith acoptructorts)licensed pursuant SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. The Contaor such License Law. ❑ I am exempt under Sec.-,134P.C.fur this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0. N'ORKERS'CONIPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that 1 have a certificate ofrooster to sell-insure, or a certificate of Workers'Conhpensation Insurance,or a rertil'ied ZONING ENG.SITE NO. copy thereof(Sec.3800.Lah.C.). Policy No. Co pony O �❑4�Certihed oly is crchy n ed FIRE SPRINK ENERGY T24 IIrw(�� c y Z Z O APpI¢anl ificJ lair+k til city usPectiun division. MISC.- REFER TO ORD. YEJ IN Y � N� L CC m CERT INCA 117 OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. W > COMPbNSA'I'ION INSURANCE PLG.CONTR. LIC.NO. PLG. O. 0 1'I'his section need not be completes! if the permit is for one TOTAL Y N Y ry ::) Z hundred doll...IS 100)or Icss.) U O 1 certify tot in tile pi,immancC of the work for which this per. OTY. - MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued.I shall riot employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ma Date Applican' ALTER OR ADD TO MECH. 5.00 BUILDING 67E5 } w NOTICE TO APPLICANT': If,after raking this Certificate of Ex- F'- � emption,you should become Subject to the Workers''Compensa1i0n APPLIANCE 5.00 PLAN CHECK _ provisions of the Labor Code, you must forthwith conhply with FEE U such provisions or this permit shall be decnhed revoked AIR HANDLING UNIT(TO 10=CF.M.) 4.00 CONS'T'RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 6.00 SEISMIC FEE 15 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the pei r oricance of the work for which this permit is issued(See. MICROFILM HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC .A � I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct. I agree m comply with all city.rid county PLUMBING ordinances and state laws relating to building construction, and BOILER-COMP(3H.P.or1OO,000B.T.U.) 6.00 •v hereby authorim represenmtives of this city w enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL ♦s above-mentioned property for inspection purposes. (We) agree to save, indemnify and cep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgme , costs and expenses which CONST.TAX may ain ny s�ry uceose against City in coo'c"lance of the PERMIT ISSUANCE 10.00 ntl0 Of tlh' MECH.CONT. LIC.NO. MECH. TOTAL TOTAL Sig 4r,r, fApply cunt bftrTactor Uum OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF I CUPERTINO 18295 INSPECTION DIVISION St. JOB INSPECTION RECO D _ ') e%• IT q 4 y 7 TMIT EXPIRATION In ( 0U' I/✓d {'{� �` UNIT_# LOT JOB ADDRESS pp�� �j RMIT-EXPIRES IF WORK OWNER [� Cl. cavrRAcroR IS N0�9TAWTED WITHIN INSPECTION DATE INSPECT011%, INSPECTION RECORD 180 DAYS OF PERMIT ISSU" FOUNDATION ANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PEHmn VALUATION PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGREU UNDERGROUND /SLAB PLUMBING 1989 -b/ • ELECTRICAL - ISSUANCE LIATE MECHANICAL IO ot Comm BUTy ELECT PLG. MECH © ❑ ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT I INFORMATION WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL (V PEi+ro+lt TO ELECTRICAL FRAMING STORIES TYPE CONSTR INSULATION OCC GROUP RES UNITS .w. PLACE NO SUBFLOOR UNTIL ABOVE HAS'BEEN SIGNED SO IT PLOpR ARIA roTAI.ACHI.ACE r ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING i RES IND CON PB Om., r I APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ASSESSORS PARCEL NO ROUGH . - SAN.# PLUMBING ELECT.ENERGY THAC1 NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECN.ENERGY ACC GATE ACC.FILE NO ELECTRICAL BUILDING ENERGY ' FRAMING ELECT,FINAL TEST ZONING ENG.SITE NO. INSULATION PLUMBING GAS TESTGAS H MECHANICAL FIRE SPINS ENERGY T-74 ' � Y E] N❑ Y 1:1 NEI NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE A.LUC INTERIOR SHEAR FIRE DEPT. Y ❑ N❑ t ❑ No SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING ' INTERIOR .LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE " GAS 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 i ' Il' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z . MECHANICAL SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX / PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY