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14050 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY ,BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 14050 aooR BUILDING- ELECTRICAL-PLUMBING-MECHANICAL PLAN CHECK VALIDATION .�•v`'fg NAME � r t � • ' OTY. ELECTRIC PERMIT FEE V 0 PHONE os CONTRACTORS PJ )OUTLETS-SWITCH S. 10.0011.00 ' NAME 5�/?V �r/ J I //lTic.ND. LIGHTING FIXTURES 10.00/1.00 CONTRACTORS ( PPLIANCES-RESIDENTIAL 4.00 ADDREZ '51.- - - pg a PHONE,3 O' op PANELS 10.00 DATE OF APPLICATION PLAN CH CK FEE NO. ORcnrtacT A_ (OVER 200 AMP) 20.00 OR ENGINEER 3.00 ' LIC.No. SIGNS TRANS. ARCO On ENO SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ADORE55 ( l ZIP EMP.METER OR POLE INS. 20.00 Vib- APPUCAHTs MOTORS SEE FEE SCH.ADDRESS SERVICE CHANGE 20.00 o o LICENSED CONE RACTORS DECLARATION p �(ysSl�� ¢ w H In u' ISSUANCE DATE X O u 1 hereby affirm (hid I am licensed under provisions of Chapter 9 r.I� y G (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. D"4 Professions Cy and m� icense Is in full for f act. ❑ Z O ,� Licenu Clasd Lie.Number ❑ ❑ ❑ 9 H Dale Contractor - a y BUILDING PERMIT ¢ ¢ wOWNER-BUILDER DECLARATION INFORMATION w I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD g PERMIT ISSUANCE 10.00 VALUATION $/FT. F .. o< Law for the following reason.(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter, 3a[. 2 2 < 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. w O ¢ requires the applicant for such permit to Ole a signed statement that TOTAL PERMIT w he is limped 9(commencing ompursuant en the provisions of the )ofDivisi n3of the F z i law(Chapter and Professions Codewith Section is cxemf t Division om the i o Business and Professions Code)or that he u exempt therefrom and OTY. PLUMBING PERMIT FEE ¢ r the basis for Ne alleged exemption.Any violation of Section 7031.5 STORIES Tv CONSTR. n ; _ by any applicant for a permit subjects the applicant toacivil 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.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 docs not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 sa FL FLOOR An EA TOTALACREAGE 0 himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 I NC.4 OUTLETS 6.00 . ments are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE builder will have the burden of proving that he did not build or ire- RES IND CON PB OMn 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 Coale',The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 the Cana ctor',hcene La.. acontractor(s)licensed purwam to SEWER-SANITARY-STORM EA.200ft/10.00 --TRACT_NO. PARCEL NO. the Contractor's License Law. ❑ I am exempt under Sec. ,B.&P.C.for this WATER HEATER ADVENT 6.00 Drawn Owner Date WATER SYSTEM - 5.00 __ACC.DATE ACC.FILE NO. WORKERS-COMPItNSATION DECLARATION WATER TREATING EQUIP. 5.00 1 hereby affirm that 1 have a cenif¢ate ofcoment to self-insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certirwd copy thereof(Sec.3800,Lab.C.)-�AEmai (MOEMtIa Policy No. COntpuny O ❑ Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24 Z Z Certified copy B filed with the city inspection division. MISC.- RE7RT ORD. Y❑ N❑ Y ❑ N❑F 'Itppllcanl� y CIiRf1E1CAfIi OF EXCAIPTION PROM WORKERS' PERMIT ISSUANCE 10.00 FLDOD20NE A.L.U.C. LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. GY❑ N❑ Y❑ N❑0 (This section need not he completed if the permit is for one TAL Z hundred dollars IS 100)or less.) U 0 1 certify that in the perfurmunce 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 OW become subject to the Workers'Compensation Laws of California. BUILDING Date Applicant ALTER OR ADD TO MECH. 5.00 } ai NOTICE. '1'0 APPLICANT: If,after making this Certificate of ER- F Z emptian,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the tabor 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 10=1C.F.M.) 6.00 SEISMIC FEE �"(J I 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,Cv.C). ) HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Address _ I certify that I 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 PLUMBING ordinances and state laws relating to building construction. and BOILER-CONP(3 H.P.or 100,0008.T.U.) 6.00 hereby authorize representatives of this city to enter upon the BOILER-COMP Io.r100,00DBTUISEEFEESCH. MECHANICAL .Y above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilitin,Judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue agairut said City in consequence of the gra lin fill permit. !`' MECH.CONT. LIC.NO. MEC TOTAL TOTAL -D 4- 66e� Signalturcol'AppcifinfiCbmtractor D e OFFICE COPY POST THIS CARD NEAR-FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO • JAS) 9 (� INSPECTION DIVISION 14050 yl `(I JOB INSPECTION RECORD PERMIT EXPIRATION �. 923 S. TANTAU JOB ADDRESS UNIT# LOT# PERMIT EXPIRES IF WORK OWNER "BUDROW r CONTRACTOR FRED SMITH TERMITE IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD - 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM ' UFER LASTCALLED INSPECTION. - PREG UNITE' - PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED- UNDERGROUND /SLAB, IGNEDUNDERGROUND /SLAB, PLUMBING C ` �� . / • ELECTRICAL h ISSUANIcEDAYE MECHANICAL �„T,. •`. IaLDW' ELECT. PLG. j MECH. ❑ ❑ E ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S/ET. PLUMBING 4/ 300. MECHANICAL ELECTRICAL - PERMIT To FRAMING STORIES TYPE CONSTR. INSULATION OCC-GROUP RES.UNITS • PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO `L<IOOR AREP TOTAL ACREAGE ROOF DIAPHRAGM BUILDING USE .�� . RES IND CON PR ONer APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ El ❑ ❑ ROUGH A5 SSORS PARCEL NO. • PLUMBING GAS TESTTRACT NO. PARCEL NO. - ' MECHANICAL ELECTRICAL - FINALS DATE INSP. ACC.DATE ACC.FILE NO. FRAMING SAN 0 ZONING ENG.SITE NO. INSULATION PLUMBING GAS FIRE SPRINK ENERGY T 74 MECHANICAL Y ❑ r [] Y ❑ N[j COVER NO WORK UNTIL ABOVE HAS BEEN SI ED HEATING FLOOD ZONE a,I.U,C.. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. C-1 N❑ SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING SHEAR EXTERIOR TEMPORARY APPROVA S BUILDING FIREWALLS ' ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDINGINSPECTOR. MICROFILM 1 uj ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC •� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING PLEASE GIVE JOB ADDRESS WHEN PHONING. 1 Z F MECHANICAL - SEE PERMIT FOR EXPIRATION DATE - IMPORTANT! CONST.TAX I PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION. OFFICECOPY