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8298 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LOI NG PROJECT I DENTI FI CATION PERMIT NUMBER BUILDING APPLICATION & PERMIT ADDRESS ^/1 J4-+ 14i +!} '1 BUILDING,- ELECTRICAL-PLUMBING-MECHANICAL ux G/ lI8 OAN8 S Coli//� 'PJ PLAN CHECK VALIDATION l•• '� _ QTY- ELECTRIC PERMIT FEE 1 / A'-11 1 �'I F� 9 PHONE CONTRACTOR S Nom/E OUTLETS-SWITCHES-RECEP 1000/1.00 1��. G/ /IIS J / ,uc.No. ; LIGHTING FIXTURES 10.00/1.00 �- rNN ADDRESSNTRAT+D•RS PP LI ANCES-RESIDENTIAL 4,00 l rj h i PHONES I(J PANELS 10.00 DATE OF APPLICATION ORRCHITECT PANELS (OVER 200 AMP) 20,00 ENGINEEfl PLAN CHECK FEE D.C.NO. LIC,rvo. SIGNS TRANS. 3.00 ADD ESS ENG. PERMIT CIRCUIT 5.00 PERMIT VALIDATION zm TEMP. METER OR POLE INS. 20.00 ^ ASMOTORS SEE FEE SCH. J ADDRESS SERVICE CHANGE 20.00 D ¢ z 7/c� _02 LICIiNS1iD CONTRACTORS DECLARATION TEMP.POLE; 30.00 �/G c u 1 hereby affirm that I in licensed under provisions of Chapter 9q ISSUANCE DATE H G (commencing with Section 7000)of Division 3 of the Busire"and ^� D zH Professions Code,and my license is in full force and effect. ^I,J ❑BLDG. El ElELECT. PLG. MECH. o I El 0 w o License Class Lia Number 1 m F Date Contractor < Y BUILDING PERMIT ¢ Be w u OWNER-BUILDER DECLARATION INFORMATION X ;LL w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD u O j Law for the following r,aio n.(Sec.7031.5,Businessand Professions VALUATION $/FT. - PERMIT ISSUANCE .].0.0 rF�. ca Code:Any mulish coo my whiny ng acre p prior to consuan",also O F Be Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NQ ELEC. 5ze �/�� O O¢ relishes the applicant for Such permit to file a signed statement that TOTAL V Vi / PERMIT TO a w$ he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 7000)o'Division 3 ofthe Q Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE f i o ¢ r $ the basis for the alleged exemption.Any violation of Section]031.$ STORIES TYPE CONSTR. d ; _ by any applirnt toy a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(5500).): ❑ I,as ownerof 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 struetua s 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 S.00 SO.FT.FLOOR AREA TOTAL ACREAGE himself or through his own coni loyees,provided that such improve. menti are not intended or offered for sale.If,however,the building - GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 or improvement is sold within one year of completion,tiro owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2!00 builder will have the burden of proving that he did not build or int- BUILDING USE pr for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Omer 1,as owner of the property,am exclusively contracting with ElEl El F-1li n sed 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 comouclons)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. Cl. lamuxenlptunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00 reason / / Owner WATER SYSTEM 5 t - . .00 ACC.DATE ACC.FILE NO. % WORK Ii R S'COMPIi NSATION 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(Sec,3800,Labc.). _ 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. F Q Applicant MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ G: CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 1 .00 „ I° FLOOD ZONE A.L.II.C. -LU > COAIPENSA'60N INSURANCE PLG.CONTR. LIC.NO. LGCL. 0 . � 2 ('Phis syedilo need not be completed if the puvnit is for one PTOTAL �� r Y❑ N[_] v 1:1 LG U O hundred dollars(SI00)or less) I certify that in the perfoNnance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY LL I- mit is issued,I slmll not employ any person in any manner so as to LJ become subject to the Workers'Cumpcnsalma Laws of Califurnia. a Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT: IL after making this Certificate of Es- 2 elliptical,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you most forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MOCFJAU 4.00 CONST RUCTION LENDING AGENCY' AIR HANDLING UNIT(OVER 10MC.F.M.) 6.00 SEISMIC FEE c/C� 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� I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 imurnlattnn is correct I agree to unnply with all city and county PLUMBING G'Z ordinances and state laws relating to building construction. and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL (we) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any sway accrue against said City in consequence of the grant in gotthe permit. �j 1 MECH.CONT, LIC.NO. MECH. /dial Ad ��<_ P� OTAL TOTAL Signature of Apphcan t/Contractor Date - / R, INSPECTOR COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY By'1L-DING PROJECT I DENTIFICATI ON ERMITN PER B DOREgLOING APPLICATION & PERMIT - g55 (� (� BUILDING-ELECTRICAL—PLUMBING—MECHANICAL - G J9}V{ V- N NEBS Qin �, PLAN CHECK VALIDATION vHarvE _?5S__?5S_ I, QTY. ELECTRIC PERMIT FEE L] �y ! rRACTORs OUTLETS-SWITCHES-'RECEP_70;0011.00 VLyD ,e, C( Q LICNO. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ADDRESSfes_ PPLIANCES-RESIDENTIAL 4.00 / 653S e 4_46 PHONE ass-oyl PANELS 10.00 DATE OF APPLICATION OR RCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C.NO. ENGINEER ARC 08 LIC,NO. SIGNS TRANS. 3.00 ADDRESS ENG SPECIALCIRCUIT 5,00 PERMIT VALIDATION zip EMP.METER OR POLE INS. 20.00 ADDRESNT'S ' ADDRESS MOTORS SEE FEE SCH. ///VVV"'➢➢➢--- SERVICE CHANGE 20.00 �y'✓ w o LICENSED CONTRACTORS DECLARATION TEMP,POLE 30.00 Q W I hereby affirm that I am licensed under provisions of Chapter 9r4] F� ISSUANCE(DATE (commencing with Section 7000)of Division 3 of the Business and E. 3 Professions Code,and my license a in full ford and effect. BLDG. ELECT. PLG. MECH. ❑ n❑ri\ El El o 1J', License Class Llc.Number P o N o Date on Ctractor APR N G 2 '1 St Q y i i M w 4 OWNER-BUILDER DECLARATION BUILDING PERMIT ca n-1 N FORMATI ON U. I hereby affirm that 1 am exempt from the Contractor's License MISC.— REF.ER TO'ORD F u O Law for the following reason.(Sec.7031.5,Business and Pr etions . - 'VALUATION' . - $/FT. f "ig Code An cit or count which re r PERMIT ISSUANCE O V Y Y Y y 031.5,Busines con Pr t ullcN ^^/ (A�'J` re er ¢ p Improve.demolish,or repair any stricture,prior 10 Its issuance,abw ELEC.CONTE. LIC.NO. ELEQ �� Wr/nr�t t'1'n �` ID O u requires the applicant for such Permit to Tile a signed statement that TOTAL PERMIT TO ' W he is licensed pursuant to the provisions of the Contractor's License H a Law(Chapter 9(commencing with Section 7000)of Division 3 fthe ndvi 7� 4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE ? +\/ s- the basis for the alleged exemption.Any violation of$cclion 7031.5 STORIES TYPE CONSTR. n . by any applicant for fora permit subjects the ePPlicanoecivil 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 PROTECTDEVICE 400 their sole compensation,will do the work,and the structure is not . . OCC.GROUP RES.UNITS intended or offered for sale(Sec. 7044, Business and Profc... on' DRAINS-FLOOR,ROOF,AREA,GOND, 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 TRAP5.00 SD,PT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- Rentsarcnotintended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- GAS EASYSTEM-OVER 4 (EA.) 2.00 builder wdl have the burden of Proving that he did not build or im- - . BUILDING USE P't'J for purpose of sale.). INDUSTRIAL WASTE INTER. 30,00 RES IND CON PB Omar B&1,as..Her of the property,am exclusively contracting with d contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORSPARCEL NO. - 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 commeturls)licensed pursuant to the Contmctori License Law. SEWER-SANITARY-STORM EA:200ft/10.00 T RACT . PARCEL NO. re❑sons am exempt under Sec. ,B.&P.C.for this WATER HEAT ,1WNENTa 1J 6.00 Owner Date WATER SYSTEM :n 5,00 E ACG FILE NO. WORK F.RS'COMPF-NSATION DECLARATION WATER TREATING.EQUIPPN`r 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 ENG.SITE NO. copy thereof(Sce.3800,Iab.C.). Policy No. Company. O ❑ Cer if d copy is hereby furnished. NK ENERGY TZ Z ❑ Certified copy is fled with the city inspection division. - ]4 O Applicant MISC.- REFER TO ORD. N❑ v NCIS RTI FICAT Ii OF EX EM PTION P ROM WOR K E RS' PERMIT ISSUANCE -19cB0 NE A.LU,C LU COMPENSATION INSURANCIi PLG.CONTE. LIC.NO. PLGCL 0 (This section need not be completed if the permil is for one TOTAL ` N❑ Y❑ NU O h Hertel do l tars 15100)ur less.)I certify that in Ibe performance of the work fur which this per- OTY MECHANICAL PERMIT FEEE SUMMARY LL U mit is issued,1 shall not employ any person in any manner so as to Owbemmesubject to theWorkers'Compewtion Laws ofCalifornia. �00 Dam Applicant ALTER OR ADD TO MECH. 5,00W NOID.te Ii TO APPI-(CANT: If,vOcr making this Califcare of lix- emption,you Should become subject to the WorkeriCompensation APPLIANCE - 5.00 CK provisions of the labor Code, you must forthwith comply with U such provisions or this Permit shall h deemed revoked. AIR HANDLING UNIT(TO 10,000GF.RI 4.00 FEE CONSTRUCTION LI:NDING AGENCY AIR HANDLING UNIT(OVER 10pODGEM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the perfomlance of fire work for which this permit is issued(Sec. 3097, .C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00 - MICROFILM LendernderName Lender;AddressHEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC 1 certify that I have read this application and stale that the above VENTI LATION FAN (SINGLE) 4.00 mfonances u correct. I agree tog to b with all city and coolly PLUMBING /,f7 ordinances and state laws relating to building l ityand co and BOILER-OOIJP(3 H.P.or 100,0008.T.U.1 6.00 � hereby authorize representatives of this city to enter upon the above mentioned property for inspcation purposes.. BOILER-COMP Over IOO,ODO BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Estrin, ertino a alnst liabilities,judgments, costs and uxpenscs which CONST.TAX i t rnalaue vgvnst City in comic eryof the PERMIT ISSUANCE 10,00 way (r� MECH.CONT. LIC.NO. MECH. TOTAL TOTAL y) of Applicant/Contractor Date �`� OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING 1 , _ - PFRNPT NUMB ER CITY OF CUP.ERTINO INSPECTION DIVISION 06298 ' JOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS ;J NIT# LOT# PERMIT•EXPIRES IF WORK OWNER CONT CTO IS NOT STARTED WITHIN INSPECTION ATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU. FOUNDATION /1/_� - ANCE OR '180 DAYS FROM. UFER LASTCALLED INSPECTION. PREGUNITE PERMIT VALIDATION . S—7—n- POUR NO CONCRETE UNTIL ABOVE HAS BEEN GNED �; n UNDERGROUND /SLAB PLUMBING �r ELECTRICAL ' f IssuA E DATE MECHANICAL BLDG. T. PLO. MECH. ❑ ❑ ❑ DO,NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT WOOD-FLOOR INFORMATION PLUMBING 9 VALUATION "_$/FT. /4- MECHANICAL ELECTRICALP}ERRMIT To FRAMING L) - 1v Q INSULATION - STORIES TYPE CONSTR. ,OCC.GROUP RES,UNI TS n PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED 6 ROOF 'y - 5U.Fi.TLOOR AREA TOTAL FCREAGE• DIAPHRAGM . BUILDING USE r RES INU BUILDING PR' Olnei �' APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ' ❑ ❑ ASSESSORS PARCEL NO. ROUGH .. PLUMBIN oZ���fJ• } GAS TEST TRACT NO. PARCEL NO. r MECHANICAL I ELECTRICAL _ FINALS DATE INSP. - ACC"DATE•)-r ACC.FILE NO: FRAMING ,.yj— SAN r ' INSULATION 1.e_ a PLUMBING ZONING END.SITE NO .r GAS _ MEOHANOAL '. FIRE SPRINK ENERGY T 2 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ';Y ❑ ry❑ Y ❑' N❑ LATH—INTERIOR ELECTRICAL a- • oaD ZONE a.L.0 c. -I2- FJ LATH—EXTERIOR ,_2�.yY FIRE DEPT. - Y❑ N❑ Y ❑ , N❑ SHEETROCK GRADE "FEE SUMMARY SHEAR INTERIOR BUILDING _ SHEAR EXTERIORTEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC - PLAN CHECK GAS FEE' NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE _ I UCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY'PHONING 252-4505JN. ELECTRIC -f,, ONE WORKING DAY BEFORE REQUIRED INSPECTIPLUMBING. z PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORETOTAL:. CALLING FOR FINAL INSPECTION. ' OFFICE COPY '