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17662 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION -PERMIT NUMBER BUILDINGC ,_ APPLICATION & PERMIT 4 17662 A^DR�S 1 ��� BUILDING-ELECTRICAL-PLUMBING-MECHANICAL OWNER'S PLAN CHECK VALIDATION NAME QTY. ELECTRIC PERMIT FEE ''e o lsot PHONE CONTRACTOR'S NAMEOUTLETS-SWITCHES-RECEP 10.00/1.00 HAMS` LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S ADDRESS APPLIANCES-RESIDENTIAL 4.00 /yr a,� ,5',yHONEO /"3j W PANELS 10.00 DATE OF APPLICATION " ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. OR ENGINEER / r-(v (,(f�'/r dD•�LIC No. ISIGNS TRANS. 3.00 AENG. PERMIT VALIDATION ADDRESS �G�W��� SPECIAL CIRCUIT 5.00 3 10 7 UUP zIP4y6 EMP.METER OR POLE INS. 20.00 APPLICANT'S 17MOTORS SEE FEE SCH. yam, ADDRESS At CO- SERVICE CHANGE 20.00 W o o LICENSED CO TRACTORS DECLARATION-V'r-03 j ¢ I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE Na a (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. z Professions Cod and my license is in full forc a ffye ❑ Z o N- License ass ( Lic.Number AJ I IJVJ g w w Date - Contractor Cuper��no Y � Ci �{,'il BUILDING PERMIT ¢ ¢ w< OWNER-BUILDER DECLARATION INFORMATION X o I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD z+ LL N VALUATION $/FT. LL o¢ Law for the following reason.(Sec.703 1.5,Business and Professions PERMIT ISSUANCE 10.00 ~ h N � Code:Any city or county which requires a permit to construct,alter, Q Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. ©v a a o¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO x C he is licensed pursuant to the provisions of the Contractor's License Z> Law(Chapter 9(commencing with Section 7000)of Division 3 of the ��;; =o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE '- Aa - the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. a 3 m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT WATER (EA.) 5.00 of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees 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,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 F IXTUR ES-PER TRAP 5.00 SQ.FT.FLOOR AREAJ TOTAL ACREAGE himself or through his own employees,provided that such improve- ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or im- RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 ❑ 1,as owner of the property,am exclusively contracting with licensed 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 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 SEWER-SAN ITARY-STORM EA.200ft/10.00 the Contractor's License Law. TRACT NO. PARCEL NO. ❑ I am exempt under Sec. B.&P.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I 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(Sec.3800,Lab.C.). Policy No. Company 0 ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z Z ❑ Certified copy is filed with the city inspection division. MISC. REFER TO ORD. O Applicant Y[] N Y [] N CCPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. � CERTIFICATE OF EXEMPTION FROM WORKERS' LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CL Z (This section need not be completed if the permit is for one TOTAL Y❑ N Y ❑ E]N hundred dollars($100)or less.) U O 1 certify that in the performance of the work for 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 V become subject Q the Worker, �,y�pensatioP haws of California. (y O a Date�.L�Applicanr -�'3 2js��rl ALTER OR ADD TO MECH. .�.gg BUILDING } to NOTICE TO APPLICANT. �f after making this Certificate of Ex- Z 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 shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MIC.F.M.) 6.00 SEISMIC FEE O 1 hereby affirm that there is a construction 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(OVER 100,000 B.T.U.)Lender's Address ELECTRIC 1 certify that 1 have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct.I agree to comply with all city and county BOILER COMP(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 (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. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE +BbO 1,z.pp grMantif this permit. MECH.CONT. LIC.NO. MECH. � 1., ,.A2AAeA� h�-C) TOTAL TOTAL go a ure of Applicant/Contractor Date /,(^Jb /LID OFFICE COPY j ` POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 17662 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS � �- UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER CONTRACTOR .� IS NOT STARTED WITHIN 80 INSPECTION DATE INSPECTOR INSPECTION RECORD N DAYS OF PERMIT I CE 180 DAYS FROM FOUNDATION '� G NOTE: LASTCALL D INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION PREGUNITE CUPERTINO STANDARDS. GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SI AB 0_7 10 PLUMBING ELECTRICAL21 1299ISSUANCE DATE BLDG ELECT PLG MECH MECHANICALX1 El j( DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED Bof UILDING PERMIT INFORMATION WOOD FLOOR VALTATION7 SIFT PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR INSULATION OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLOOR AREA TOTAL ACREAGE ROOF NOTE:NO FINAL INSP,SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING RES IND CON PB Omer El 0 El 0 El APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS&SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING _ tG ELECT.FINAL TEST ZONING ENG SITE NO INSULATION PLUMBING GAS TEST GAS FIRE SPRINK ENERGY T 24 MECHANICAL Y EJ No ,. ❑ N[] COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A L U C EXTERIOR SHEAR ELECTRICAL RELEASE N❑ INTERIOR SHEAR FIRE DEPT. ` N❑ v ❑ SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING -^ INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK ,r FEE . GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC "' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. z MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - CONST.TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORETOTAL CALLING FOR FINAL INSPECTION. r OFFICE COPY