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13168 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER AUGoRssAPPLICATION & PERMIT ^ ^ ios/] 4 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL I b OWNER'S _l - PLAN CHECK VALIDATI NAME {//� mf QTY. ELECTRIC PERMIT FEE mr`. 2s. p ossC PHONE [- +/ 2- CONTNAME TORS NAME OUTLETS-SWITCHES-RECEP 10.00/1.00 L) ^ \/ l LAID Nn6r CO, LID NO.v4/4,a-7o -Z_ LIGHTING FIXTURES 10.00/1.00 p� CONTRACTOR S APPLIANCES-RESIDENTIAL 4.00 AOnORE55 ��''11 �t {/� ��pp ��EE••��11 O/ 3e.� ul-M LE PHONEO O-_7Q�%l PANELS 10.00 DATE OF APPLICATION ARCm!ECTPANELS (OVER 200 AMP) 20.00 'PLAN CHECK FEE P.C.NO. OR ENGINEER ' LIC,No. SIGNS TRANS. 3.00 ARCH.OR ENG. SPECIAL CIRCUIT S.00 PERMIT VALIDATION ADDRESS ZIP TEMP. METER OR POLE INS. 20.00 1,P ID APPLICANT'S - MOTORS Ad1rSEE FEE SCH. �-- Qa(/ � ADDRESS SERVICECHANGE ,n_7 20.00 ) rf t� ) Foo LICENSED CON T'RACT1.7 'ORS DECLARATION t 111 (a 1,�J Ie u v I hereby affirm that I am licensed under provisions of Chapter 9 J v a Z w (commencin with Section 7000)of Division 3 of the Business and 11 +� _.. ISSVANCFOAhI 10 rt - g 1aY ,• BLDG 1�E0ECT9 LG. MECH. -HOZ Professions Code' d my license is in full for m, eft•c p:hl Z 0 r_- License Cls Lic.Number "• ' ®- L1� o Z H o Date_(e Lr Contract. a u s - BUILDING PERMIT w ¢ OWNER-BUILDER DECLARATION INFORMATION A o a. 0 REFER TO ORD X 3. r I hereby at that I am exempt from the Contractor's License MISC.- .. Oa Lawfor the following reason.(See.7031.5.Business and Professions PERMIT ISSUANCE 10.00 (J .� VALUATION $/FT. � - I Code:Any city or county which requires a permit to construct,alter, a <Q improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. at 0 s requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO n w m he is licensed pursuant to the provisions of the Contractor's License i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe /T�L/T/Q� Z < Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Atemthe basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. _ 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(S500).): ❑ 1,as owner of the property,or my employees with wages as ggCK F LOW PROTECT. DEVICE 4.00 OCC GROUP RES.UNITS their sole compensation,will do the work,and the structure is not - _ intended or offered for It (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 - properly who builds or improves thereon,and who does such work 3 FIXTURES-PER TRAP 5.00 �� gp,IT.FLOOR AREA 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 INCA 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 Omer 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.S. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to in owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractors)licensed pursuant to SEWER-SANITARY-STORM EA,200ft/10.00 TRACT N0. PARCEL N0. the Contractor's License Law. ❑ I am exempt under Sec ,B.&P.C.for this WATER HEATER W/,VENT, 6.00 reason Owner .Dale WATER SYSTEM tt •„�•�� 5.00 ACC.DATE ACC.FILE NO, W'ORKERS'COAIPENSATION DECLARATION WATER-TREATING EQUIP[ J� 5.00 I hereby affirm that 1 have a certificate of consent to self-insure, s,.. y no ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified p _ copy thereof(Sea 3800,Lab C.IF,*p m0n T ux"o, , Policy No. Company rll/K- O ❑ CxHilied copy is hereby famished. ,+Ly _ FIRE SPRINK ENERGY T24 Z Z ❑ c copy city inspection division. MISC.- - REFER TO OR . ❑ ❑ ❑ ❑ p'�( Applicant L1. Y N Y N I-- rn CERTTI FICATEEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.LU.C. LU > E DJ COMPENSATION INSURANCE PLG.CONTR. LIC.N0. 1PLG. [:] N❑ Y❑ N❑ CL O (This section need not be completed if the permit is for one TOTAL ::) Z hundred dollars IS 100)or Iess.) U O I certify that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY UT I- Mir is issued,I shall not employ any person in any manner an as to ;O W become subject to the Workers'Compensation Laws ofCalifornia. BUILDING t•-y� A Date Applicant I ALTER OR ADD TO MECH' 5.00 x N1 v - to TO APPLICANT: If,after making this Certificate of 1!x - F ? emplion,YOU should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, youFEEforthwith comply will, FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER,1(,A)C.F.M.)'6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(W ITH'DUCTI,r � 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.L t HEATING UNIT (TO 100,000.ELT:U.) 8.00 Lender's Name HEATING UNIT(OVER1d 00,000 B.T.U:I 9:50 ELECTRIC 30 Lender's Address (OVER\1 -'• lmrlify that lhavercad this application and slam that the above VENTILATION FAN (SINGLE) VtlY 4.00 • information is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100;000 B.T.U.) 6.00 . PLUMBING ordinances and slate 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 10.00 gteolei �I, of this pe 1 il. MECH.CONT. LIC.NO. MECH. _ a,7lirrllil L/1/o 1?7 TOTAL �S!f' TOTAL ignalure of Appl cant/Contractor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER !,'1- CITY OF CUPERTINO 139 6$ INSPECTION DIVISION JOB INSPECTION RECORD.. L _ 10699 LARRY WAY PERMIT EXPIRATION JOB ADDRESS UNIT# LOT# ' PERMIT EXPIRES IF WORK OWNER 'PROSSER• CONTRACTOR ALPAH CONSTRUC IS NOT�STARTED WITHIN INSPECTION DATE I INSP CTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- , FOUNDATION . h.C. vd * ANCE OR 180 DAYS FROM LAST CALLED INSPECTION: UFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAG PLUMBING p I ELECTRICAL - T\\\ I ISSUANCE DATE MECHANICAL �•y }} BLDG ELECT PLG. MECH DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION SIFT. ,PLUMBING MECHANICAL - - ELECTRICAL - P R1MIT rot FRAMING �/ ( �1 D STORIES TYPE CONSTR: / INSULATION / OCC.GROUP RES.UNITS _ A PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' SO.FT.FLOOR AREA TOTAL ACREAGE .� ROOF DIAPHRAGM - BUILDING USE _ - RES IND ; CON .PB Olney APPLY NO ROOFING UNTIL ABOVE HAS BEN SIGNED - ❑ ❑' ❑ ❑ ❑ ASSESSORS PARCEL NO. • ROUGH , PLUMBING f- -1 IF TRACT NO. PARCEL NO. GAS TEST _ D'%$7 J n/L MECHANICAL /,J'!/X4 ELECTRICAL I p-(�- �", FINALS DATE INSP. Acc.DATE AccfILE No. FRAMING _ `� SAN:*, 'ZONING ENG.SITE NO. INSULATION /0-747, PLUMBING ' .j S t•2 -Jd'-{�C GAS /.387 - ' MECHANICAL FIRE SPgINK ENERGY h]< COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.UC LATH-INTERIOR - ELECTRICALRW LATH-EXTERIOR' .FIRE DEPT. y Y❑ N❑ Y ❑ N❑ SHEETROCK . -I GRADE FEESUMMARY SHEAR INTERIOR BUILDING Nkvi' SHEAR EXTERIOR TEMPORARY APPROVALS - ,.BUILDING - FIREWALLS ELECTRICPLAN CHECK FEE GAS - NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY I I I - 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 � F 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 BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY - -