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15450IN i O ¢ Z W O O U V Z `W N �� 2 2 H O y F W J 2 Q¢a a O a U LL 0 J N to Q W �2 W ¢ 2 LLXoLL Wmi ~Za f =o ¢moo a3°r O J Z Zi Ir - LU > a❑ Z UO_ LL Ow } a Cn Z i APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 5 4 5 0 BUILDING ADDRES - ,/'� ( //�`(J] OWS �� /-� 7 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALID TION 2 �^ � J DATE OF APPLICATION PLAN CHECK FEE P.C. NO. CON OR'S WzLw-UTLETS f <N M -LIC. NO. 3 - SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 C NTRACTORS ADDRESS - I V S Z2 A/- ft, _. PHONE 5 5 - -SbOV ARCHITECT OR ENGINEER a4z LI PPLIANCES - RESIDENTIAL 4.00 1PANELS 10.00 PANELS (OVER 200 AMP) 20,00 SIGNS TRANS. 3.00 ARCH. OR ENG. A / `J qS­, r SPECIAL CIRCUIT 5.00 PERMIT VALIDATION Z TEMP. METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 % / �/ - / 6-4 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 fSSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and BLDG. ELECT. PLG. MECH. Professions Code, an y license is in full force pie egtU Class Lic. Number 3 V ❑ El 11 Date Contractor BUILDING PERMIT OWNER- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also NFORMATION MISC. - REFER TO ORD E� UATION ��S $ /FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that TOTAL iw PERMIT TO he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 _}� G�G� QTY. PLUMBING PERMIT - FEE ORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): BACK FLOW PROTECT. DEVICE 4.00 orC. GROUP RES. UNITS ❑ I, as owner of the property, or my employees with wages as 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, AREA,COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES - PER TRAP 5.00 SQ FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such ments are not intended or offered for sale. If, however, the building Improve- or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im- prove for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See. 7044, Business GAS EA. SYSTEM OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPR IN KLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code: The Contractor's 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 for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER- SANITARY -STORM EA. 200ft /10.00 TRACT NO- PARCEL NO. WATER HEATER W /VENT 6.00 ❑ 1 am exempt under Sec. B. &P.C. for this reason Owner Date 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 self- insure, or a certificate of Workers' Compensation Insurance. Or a certified ZONING ENG. SITE NO. copy thereof (Sect, . 388000. Lab.C.). , Policy No�AI�C �pany -grguld/y ❑ Certified copy Is hbbreby furnished. ❑ Certified copy is file h the /ci Y Lspection division. \ Applicant - GG FIRE SPRINK Y N ❑ ❑ ENERGY T -24 v N ❑ ❑ MISC. REFER TO ORD. PERMIT ISSUANCE 10.001 FLOOD ZONE A.L.U.C. CERTIFICATE OF EXEMPTION FROM WORKERS' PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y [:3 N ❑ Y 1:1 N 1:1 QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If. after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation BUILDING c 42-0 v L ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10;000 C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10=C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) 9.50 ELECTRIC Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. MISC. - REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL " ranting of this permit. 5- S Signature of pplicant /Contractor Dafe OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION RECORD PERMIT NUMBER 15450 PERMIT EXPIRATION JOB ADDRESS cr 0 J'`r,2:7✓e -,,1s �'L 1/[) UNIT# _ LOT# PERMIT EXPIRES IF WORK OWNER 4 CONTRACTOR U/1i L,r �C-,y 7,Q IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION LIFER PREGUNITE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN UNDER-GROUND/SLAB PLUMBING ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING. MECHANICAL ELECTRICAL FRAMING INSULATION NOTE: ANCE OR 180 DAYS FROM ALL GRADING AND DRAINAGE SHALL BE INSTALLED LAST CALLED INSPECTION. TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. 7 5'-F - / - ISSUANCE DATE BLDG ELECT. I PLG I MECH ❑ I ❑ ❑ ❑ BUILDING PERMIT INFORMATION . VALUATION PERMIT TO STORIES u TYPE CONSTRM PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -- UL-L UHUUY RES UNITS ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SO FT FLOOR AREA TOTALACREAGE DIAPHRAGM ROOF SHEATHING. BUILDING USE RES IND CON PB Ome, ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGH SAN.#i ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY TUBS & SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK Y ❑ N ENERGY T -24 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ❑ N ❑ A.L U Y L7 N [:3 INTERIOR SHEAR SHEETROCK _ _ FIRE DEPT. GRADE Ib � 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 JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNEDBY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252 -4505, o�ONE WORKING DAY BEFORE REQUIRED INSPECTION. Z PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT. .PLEASE READ REVERSE SIDE'BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY"