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8717 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT lDENTIFICATION PERMIT NUMBER APPLICATION & PERMIT eutLotNc ^ / 8 7 1 7 ADORES, /,/� --r BUILDING - ELECTRICAL-PLUMBING-MECHANICAL svN ER'S PLAN CHECK VALIDATION NAME• QTY. ELECTRIC PERMIT FEE PHONE S NAME UTLETS-SWITCHES-RECEP 10.00/1.00 Lc.NO. ILIGHTING FIXTURES 10.00/1.00 CONTRACTORS TRAC oe•s OPPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 10.00 DATE OF APPLICATION ,n ogcHlTEcr PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO. ENGINEER LIC.No. SIGNS TRANS. 3.00 ARC".OR ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADDZIP TEMP. METER OR POLE INS. 20.00 ADORESMOTORS SEE FEE SCH. ADORE5S SERVICE CHANGE 20.00 ' L w+m0 o LICENSED CONTRACTORS DECLARATION TEMP. POLE 30.00 • S� iwiz I hereby affirm that 1 am licensed mule,provisions of Ch.,Ic,9 ISSUa N'/CE^GATE m Q aa- •(Commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. r G z Professions Code,and my license is in full force and effect. ❑ ❑ ❑ ❑ ' 0. - 0.- License Class Lic.Number Dale Contractor Q Y J o BUILDING PERMIT mer OWNER-BUILDER DECLARATION S IS ra U INFORMATION w ;LL , 1 hereby alfirnt that Iran cxcntpt train tire Contractor's License MISC.- REFER TO ORD / LL O j Law for the follrtwing reason.(Sec.7031.5.Bv,ine,sand Poin..sion, VALUATION $/FT. r - PERMIT ISSUANCE 10.00 Code:Any my or county which,Metrespermit to construct,,alter, < 40 improve,demolish,or repair any,In¢[ure,prior to its issuancuanc e,also ELEC.CONTR. LIC.N0. ELEC, O a, requires the applicant for such permit to file a signed statement that TOTAL w m U.w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO rz > Law(Chapter 9(commencing with Section 7000)of Division 3 oflhe �� 0 t < Business and Professions Code)or that h / a e is exempt therefrom nd QTY. PLUMBING PERMIT FEE /� .� c. (c the basis for rhe alleged exemption.Any viol,tion of Section 7031.5 STORIES TYPE CONSTR, a by any applicant for a permit subjects the applicant too civil penalty ALTER-DRAIN -WATER (EA.) 5.00 of not more titan five hundred dollars(8500).): ❑ 1,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEV ICE 4.00 Oce GROUP RES.uNlTS 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,CON D. 5.00 Code:The Contractor's Licensc Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 5.00 SQ.FT.FLOOR AREA TOTALACREAGE . hints...act hde Or offered fors. ic,If,howevd thatruch improve- GAS-EA.SYSTEM-I INC.4 OUTLETS 6.00 mems are nal intended Orofferedon formic,If,completion the building or lder ill have is sold within one year of he did ion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 builder will hove the burden of proving that he Aid not build or ins- BUILDING USE prove for purpose of sale.). INDUSTRIACWASTE INTER. 30.00 RES IND CON PB Dune, jy 1,as owner of the property,am exclusively contraming with ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sea 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 on owner of perry who builds or improv,,Ommon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ro rmcts furs h projects with a contrierm(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00 the utract s License Law. TRACT NO. PARCEL NO. ❑ m emptunder Se ,BAP.C.for this WATER HEATER W/VENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC,DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARA'NON WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have u certificate of consent to sell-inure, or a Certificate of Workers Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sce.3800,Lab.CJ. Policy No. Company O ❑ Certified copy is hereby famished. FIRE SPRtNK ENERGY T 24 Z Z ❑ Certified copy is filed with the city inspection division MISC.- REFER TO ORD.F O Applicant Y ❑ N❑ Y ❑ N❑ N CERI'1171CA IT:OF FXEMPItON FROM WORKERS' -_PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. .I LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PL , CL O (This section need not be completed if the permit is for one TOGTAL Y❑ N❑ Y❑ N❑ ::) 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 1- mit is issued, I shall not employ any person in any manner su as to O w become subject to the Workers'Compensation Laws of California. y Dal, Applicant ALTER OR ADD TO MECH. 5.00 BUILDING } W NOTICE TO APPLICANT'. IC after making this Cerliticate of Ex- H Z emption,you should become subject to the Workeri 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=C.F.M.) 4.00 CONS'TRUCT'ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 tire Performance of the work lot which this pe rinit is issued(Sec. MICROFILM 3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Nume HEATING UNIT(OVER 100,000 B.T.U.) Lender's Address ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information n coater.I agree to comply with all city and county BOILER-OOMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING ordinances and state laws relating to building construction, and hereby amtlmrim representatives of this city to enter ,on the BOILER-COMP (Over t00,0008TU15EE FEE SCH. MECHANICAL above inentloned property]or inspection purposes, (We) agree save, indemnify and keep harmless the City of MISC.- REFER TO ORD. upertino a mat liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX in a way accrue against said City in consequence of the gra 'ng this permitMECH.CONT. ❑C.NO. MECH. -?� - TOTAL TOTAL lure ofA licamt/ A rtt Duty INSPECTOR COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO PER,IT%IVHER INSPECTION DIVISION 37117 JOB INSPECTION RECORD / �',,� /��y PERMIT EXPIRATION JOB ADDRESS Z00404* G.J'T�11' FhIE� CitIC UNIT# LOT# ._ PERMIT EXPIRES IF WORK OWNER t6 CONTRACTOR -tpw_LF_ IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR I INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. UFER PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB qo- � 9 PLUMBING 91 ELECTRICAL ISSUANCE DATE MECHANICAL BLDG. 1,5LECT. M5CHL ❑ 11 ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT PAID INFORMATION WOOD FLOOR VALUATION S/FT. PLUMBING MECHANICAL MAY 2 ^. lu"-, ELECTRICAL PERM1 O FRAMING City or Cuperti sroalEs INSULATION • rvPE corvs R. OCC GROUP RES.UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF SO FT FLOOR AREA TOTAL ACREAGE DIAPHRAGM BUILDING USE HES IND CON PB OMw APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ Q ❑ ROUGH Lam- --C a 1--d ASSESSORS PARCEL NO hoar o PLUMBING l YC SL GAS TEST Od 'e cj.O f) 'j TRACT rvo. PARCEL NO, MECHANICAL ELECTRICAL FINALS DATE INSP. ACCDATE ACC,FILE NO. FRAMING SAN * INSULATION PLUMBING ZONING ENG.SITE NO. GAS MECHANICAL FIRE SPRINK ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING YL] No Y [] No LATH—INTERIOR ELECTRICAL FLOOD ZONE A.Luc. LATH—EXTERIOR FIRE DEPT. Y❑ NC] Yo No SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS BUILDING FIREWALLS ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING k PLEASE GIVE JOB ADDRESS WHEN PHONING. Z MECHANICAL — SEE PERMIT FOR EXPIRATION DATE — IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICE COPY