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14086 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALLPOINT PEN ONLY 'BUILDING PROJECT ID TIFICATION PERMIT NUMBER •' aUl Dl G / 5 7 APPLICATION & PERMIT 1086 L (I 4 � ' r ADDRESS BUILDING -ELECTRICAL-PLUMBING-MECHANICAL r OWNER'S PLAN CHECK VALIDATION NAME -Z QTY. ELECTRIC PERMIT FEE PHONE CONTRq\\�'/Ra • OUTLETS-SWITCHES-RECEP 10.00/1.00 NAME V� - • 3S9nd' T ��-aWWrV'[[[-(((-///'jrr-///IIIr LIGHTING FIXTURES 10.00/1.00 uc.ND. CONTRACT 'S PPLIANCES-RESIDENTIAL 4.00 ADORES �// �f � SjL(I PHONE779-1u� PANELS 10.00 DATE OF APPLICATION OR PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. DR ENGINEER LIC.NO. ISIGNS TRANS. 3,00 ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDRESS ZIP EMP.METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. /A�--' ADDRESS SERVICE CHANGE 20.00 w o o LICENSED CON'T'RACTORS DECLARATION `o u I hereby affirm that I am licensed under provisions of Chaplet 9 ISSUANCE DATE y z n (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F =i Professions Col an* lia-nsc is in full 1'or'-a d f - ❑ ❑ ❑ ❑ z o v'A, License Cla s�[.�'L Lia Numher - 9 re H°� Date //_] Contractor x E - C BUILDING PERMIT ¢ a w 4 OWNER-BUILDER DECLA ION INFORMATION E: LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD uoa Law for the following reason. 7031.5,Businessand Professions PERMIT ISSUANCE 10.00 6/�`/ALUQATION $/FT. L. _ Code:Any city or county which requires a permit to construct,alter, V.45SC " rc Q 2 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.• I o M requires the applicant for such permit to file a signed statement thatTOTAL P RMIT T • /1 A w m he is licensed pursuant to the provisions of the Contractor's License ! (x11 V I II Law(Chapter 9(commencing with Section 7000)of Division 3 oft he. a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 STOPIES TYPE CONSTR. by any applicant fora permit subjectsthe applicant toa civil penalty ALTER-DRAIN&VENT-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 F LOW PROTECT. DEV ICE 4.00 OCC.GROUP RES.UN TS 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,AR EA,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 g0.FT.FLOOR AREA TOTAL ACREAGE himself re of intended own employees.provided that such improve- himseiiielfix arenotintended or employees,ffered for prove. ided that sthe mprobuilding GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 . MVor 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 ❑ I,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 contractors)licensed pursuant to ' the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 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 AGE.FILE No. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate of consent to self-insure, - ZONING ENG.SITE NO. or a certificate of Worker,'Compensation Insurance,or a certified copy thereof(See.3800,L.b.C.). Policy No. Company O ❑ Cerilne1 copy S hereby furnished. FIRE SPRINK ENERGY T-24 Z Z Certified Co i. filed yrith t t inspection division. Q cant -r MISC.- REFER TO ORD. Y ❑ N Y ❑ N❑ � y CERTIFI E OIr EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE 'A.L.U.C. LU > OMPF,NSATION INSURANCE PLG.CONTR. LIC.NO. PLG. CIL (This section need not be completed if the permit is for one TOTAL Y❑ N❑ Y ❑ N❑ Zi Z hundred dollars IS 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 f mit is issued,1 shall not employ any person in any manner so as to U become subject to the Workers'Compensation Laws of California U i Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 3 } m NOTICE TO APPLICANT: If,after making this Certificate of F-x- FZ emption,,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 10,OODC.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE ,33 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00mi the Performance of the Work for which this pert is issued(Sce. MICROFILM 3097,Civ.0.): - HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Namc HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address 1 certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 ation 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 0,6 n_nces and state laws relating to building construction, and 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 aid expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in an way accrue t said City 'n consequence of the granting is perm?. MECH.CONT. LIG NO. MECH. �� TOTAL TOTAL Signal of Applicant/Contractor DateOFFICE COPY -.- POST THIS CARD NEAR FRONT OF BUILDING m~'a'ti PERMIT NUMBER ° CITY. OF CUPERTINO40g6 INSPECTION DIVISION wJOB INSPECTION RECORD PERMIT EXPIRATION JOB ADDRESS Lot S F 6, . 7 LEONG UNIT# LOT# PERMIT EXPIRES IF WORK OWNER WOOLWORTH CONTRACTOR SIERRA PRECAST Is NOT STARTED WITHIN. INSPECTION DATE INSPECTOR INSPECTION RECORD 160 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LASTCALLED INSPECTION. UFER - PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEE SIGNED ��- UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL y FLOG. ELECT. PLG. MECH. J ' D D I El DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR, ' �'- l„tTVALUATION $IFT. PLUMBING • �j1 QV1 C� MECHANICAL ELECTRICAL - PERMrt Tp r � FRAMING. - - ' • STORIES TYPE CONSTR. INSULATION OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED I ROOF • '.. $O.FT,FLOOR AREA TOTAL ACREAGE I PHRAGM BUILDING USE Com✓ RES IND CON PB Oow• El 011 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED SE EL ASSESSORS PARCEL NO, ROUGH PLUMBING _ GAS TEST - TRACT NO. PARCEL NO. MECHANICAL - ACC.DATE ACC FILE NO. ELECTRICAL. FINALS DATE INSP. FRAMING SAN n ., ZONING ENG.SITE NO. INSULATION PLUMBING GAS, FIRE SPRINK ENERGY T.Z4 MECHANICAL Y� NF v ❑ No COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I HEATING FLOOD LONE A.LLLC LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. v� N� Y � NE] SHEETROCK GRADE ip FEE SUMMARY SHEAR INTERIOR BUILDING 'CD BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK F GAS EE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE � = OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM LU ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. .1 MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — ��..•-. CONST.TAX IMPORTANT! , PLEASE READ REVERSE SIDE BEFORE TOTAL I%S CALLING FOR FINAL INSPECTION. OFFICE.COPY _ -