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11519. POST THIS' --'RD NEAR FRONT OF BUILDING 1 c / PERMIT NUMBER Cil, OF CUPERTINO INSPECTION DIVISION 1.1519 JOB INSPECTION RECORD PERMIT EXPIRATION 11 10625 CORDOVA JOB ADDRESS UNIT# -LOT# EDWARDS PERMIT EXPIRES IF WORK OWNER � CONTRACTOR � � IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- FOUNDATION ANCE OR 180 DAYS FROM LIFER LAST CALLED INSPECTION. PREGUNITE PERMIT VALIDATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. _- ISUANC ADATE7 UNDERGROUND/SLAB PLUMBING SAN * ELECTRICAL MECHANICAL INSULATION BLDG. C- ELECT. 0 PLG. MECH t ENERGY T-24 v ❑ NE] DO NOT POUR FLOOR UNTK ABOVE HAS BEEN SIGNED MECHANICAL BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION `^ $/FT. PLUMBING ELECTRICAL MECHANICAL ELECTRICAL SHEETROCK /PERMIT To FRAMING INSULATION - STORIES TYPE CONSTR. SHEAR EXTERIOR - FIREWALLS OCC: GROUP RES: UNITS\ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF GAS SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM BUILDING USE RES IND CON PB Other APPLY -NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ASSESSORS PARCEL NO. ' _ - - ROUGH PLUMBING GAS TEST _ - . TRACT NO. PA1tCEL NNO. MECHANICAL ELECTRICAL FINALS DATE INSP. ACC. DATE ACC. FILE NO. FRAMING SAN * ZONING ENG. SITE NO. INSULATION PLUMBING GAS FIRE SPRINK v N.� ENERGY T-24 v ❑ NE] MECHANICAL COVERA WORK UNTIL -ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE A.L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY SHEAR INTERIOR BUILDING BUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK F EE ' GAS SEISMIC FEE _. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ELECTRIC ARRANGE FOR INSPECTION BY PHONING 252-4505, " �1 0� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING J PLEASE GIVE JOB ADDRESS WHEN PHONING. _- Z - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. OFFICE COPY TOTAL J� ;• _APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LD1 NG PROJECT I DENTI FII )N PERMIT NUMBER BUILDING -. , APPLICATION & P ` A/Slows �o,e���A 2Z. � 11 51.9 BUILDING - ELECTRICAL- PLUMBING -- %4ECHANICAL __A]NAME ,V ' CONTRACTOR'S NAME O CC Z Foo F Z w Q NZ Z O N 2 y H W a0wta� X 3 LL N F LL O J W w ¢ o M X o LL W W 0 �Za H_ o Lu 3 m CONTRACTOR'S ADDRESS PHONE ` 73 NO, PHONE ARCHITECT ���� OR ENGINEER 6� LIC. NO. ARCH. OR ENGGI.. /y'+ ADDRESS �' APPLICANT'S • r ADDRESS ice/ Gy� u efAC�_ LICENSED CONTRA SDC RAT ON I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for .permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ , I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License, Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or im- p r for purpose of sale.). I as owner of the property, am exclusively contracting with li n d contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contra r(s) licensed pursuant to the CoI iia gpicense Law. ❑ 1 am ptund0e, B.&P.C. for this reason Owner WORKERS' COMPEXSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). Policy No. Company O ❑ Certified copy is hereby furnished. Z Z ❑ Certified copy is filed with the city inspection division. I" ' 0 Applicant CC y CERTIFICATE OF EXEMPTION FROM WORKERS' Y.'-", :, ELECTRIC PE-RMIT FEE OUTLETS - SWITCHES -RECEP 10.00/1.00 Ot D LIGHTING FIXTURES 10.00/1.00C_` APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 °�' PANELS (OVER 200 AMP) 20.00 SIGNS TRANS, 3.00 SPECIAL CIRCUIT 5.00 EMP- METER OR POLE INS. - 20.00 d u OTORS EE'SCH. SERVICE CHANGE 20.00 HEATING UNIT (_(0`1A0,000 B.T.ylf-k0b.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 MISC. -- REFER TO ORD COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant PERMIT ISSUANCE 10.00 d ,ONTR. LIC. NO. ELEC. TOTAL U °- � P4UlVIBIN•G PERMIT �_' FEE," ALTER -DRAIN & VENT -WATER (EA.) 5.00 emption, you should become subject to the Workers' Compensation BACK FLOW PROTECT. DEVICE 4.00 provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. DRAINS -FLOOR, ROOF,,AREA,COND. 5.00 A.L.U.C. FIXTURES - PER TRAP 5.00 AIR HANDLING UNITYOVERV10=C.F.M.) 6.0( GAS - EA. SYSTEM -11NC. 4OUTLETS 6.00 GAS - EA. SYSTEM - OVER 4 (EA:) 2.00 INDUSTRIAL WASTE INTER. 30.00 HEATING UNIT (_(0`1A0,000 B.T.ylf-k0b.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 Lender's Name Lender's Address I certify that I have read this application and state that the above LAWN SPRINKLERS - OVER 5 (EA.) 1.00 3. VENTILATION FAN (SINGLE) 4.0( SEWER -SAN ITARY-STORM"EA.200ft/10.00 Q WATER HEATER W%VENTr d 6.00 WATER SYSTEM n�. '�� �' 5.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH WATER TREATIOT(JU(0. -.--5.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD'. PERMIT ISSUANCE 10.00 W > Z U O LL 1- U a >_U) COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant PLG. CONTR. LIC. NO. PLG. TOTAL OTY MECHANICAL PERMIT - ALTER OR ADD TO MECH. 5.0( NOTICE TO APPLICANT: If, after making this Certificate of Ex - APPLIANCE 5.0( Z emption, you should become subject to the Workers' Compensation U provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (,TOj_1Q,000C.F.M.) 4.0( A.L.U.C. CONSTRUCTION LENDING AGENCY AIR HANDLING UNITYOVERV10=C.F.M.) 6.0( EXHAUST HOOD (WITH DUICT) 5.0( 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). HEATING UNIT (_(0`1A0,000 B.T.ylf-k0b.00 r- Lender's Name Lender's Address I certify that I have read this application and state that the above i- HEATING UNIT (OVER 100;000'b.T.U.)9.5( 3. VENTILATION FAN (SINGLE) 4.0( I information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and BOILERCOMP (3 H.P, or 100,000 B.T.U.) 6.0C BOILER -COMP (Over 100,000 BTU) SEE FEE SCH hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD (We) agree to save, indemnify and keep harmless the City of, Cupertino against liabilities, judgments osts and -expenses which' may m way a rue a nst ty m nsequence of the g[ant p f to it.� 72Z -14 /l{7 pERMI f ISSUANCE 10.0 MECH. CONT. LIC- NO. METH. TOTAL OFFICE COPY PLAN CHECK VALIDATION a (p 7 / J, �� _ �� ate... CJ `J DATE OF APPLICATION PLAN CHECK FEE $g C. NO. . rpi. IT VALIDATIOWI �I Xno BLDG. ELECT. PLG. MLCH. Z1 BUILDING,PERMIT` _ INFORMATION( /�, I" PERMIT TO WL STORIES TYPES CONSTR. CV OCC. GROUP RES. UNITS SO. FT. FLOOR AREA TOTAL ACREAGE BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ ASSESSORS PARCEL NO. -TRACT NO. PARCEL NO. ACC. DATE ACC. FILE NO. ZONING ENG. SITE NO. FIRE SPRINK' ENERGY T-24 Y ❑ N ❑ Y ❑ N❑ FLOOD ZONE A.L.U.C. Y ❑ N❑ Y ❑ N❑ FEE FEE SUi BUILDING PLAN CHECK FEE SEISMIC FEE �N MICROFILM ELECTRIC PLUMBING MECHANICAL 0 d 36--" CONST. TAX TOTAL / 0S -7a - w 5; oD a O ZZ F qtr C W _ CL Uo LL U Ow } a CL I— A APPLICANT TO FILL IN INFORTOATION WITHIN RED LINES — USE BALL POINT PEN OiNLY BUILDING PROJECT IDENTIFICATION - APPLICATION & PERMIT BUILDING — ELECTRICAL—,PLUMBING — MECHANICAL PERMIT NUMBER 1 �+ C+ �+ I u p u BUILDING- ADDRESS 5-- OwNE 'S NAME % v `I\ SCS PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION .. , ... - .. .. . ..- .. ' CONTRACTOR'S [ NAME Lt C. NO. OUTLETS -SWITCHES - RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S' ADDRESS —APPLIANCES RESIDENTIAL 4.00 PANELS 10.00 • Q' r PHON r DATE OF APPLICATION ARCHITECT OR ENGINEER . LIC. NO.' PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADARDCH.ENG. SPECIAL CIRCUIT •' 5.00 PERMIT VALIDATION EMP. METER OR POLE INS. .')C) r) p ZIP ✓r APPLICANT'S ADDRESS MOTORS SEE FEE SCH. y '1l L SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATIO 1 hereby affirm that I am licensed under provisions of Chapter 9_XXT&UANCE (commencing with Section 7000) of Division 3 of the Business and License CI ic. Numb Professions Code nd y license is in full fore I e��k' DATE ELECT. PLG. MECH. Date — Contractor SJ BUILDING PERMIT INFORMATION OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and MISC. — REFER TO ORD '� VALUATION$/FT. '- 7 PERMIT ISSUANCE �.2 ELEC. CONTR. LIC. NO. ELEC. TOTALPERMIT TO QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ALTER -DRAIN &VENT -WATER (EA.) 5.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA /_ TOTAL ACREAGE or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im prove for purpose of sale.). I, as owner of the property, am exclusively contracting with GAS EA, SYSTEM OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other 1:1 El El1-1❑ INDUSTRIAL WASTE INTER. 30.00 licensed contractors to construct the project (Sec. 7044, Business 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 - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. -A-. 10.00 200ftSTORM EA SEWER / SANIT RY TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. B.&P.C. for this WATER HEATER W/V ENT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATINGEQUIP. 5.00 . WORK ERS'COMPFNSATION DECLARATION 1 hereby affirm that 1 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, Lab.0 ) Q� Policy No. Company A•%rCfCzKo42 FIRE SPRINK Y ❑ N _ ENERGY T•24 Y ❑ N� ❑ Certified copy is hereby furnished. OF Certifie p filed tit the city inspection division. ppphcant,, MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. d'Q TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y N Y ❑ N hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to OTY. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- APPLIANCE 5.00 PLAN CHECK — emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10)000C.F.M.) 4,00 AIR HANDLING UNIT (OVER 10.000C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY 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. 3097,Civ.C.). MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OV ER 100,000 B.T.U.) 9.50 ELECTRIC 01 (1�� Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all e(ty,and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. VENTILATION FAN (SINGLE) 4.00 PLUMBING O l BOILER -COMP (3 H.P. or 100,000 B:T.U.) 6.00 BOILER COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. (We) agree .to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which' may in any way accrue against said City in consequence of the CONST. TAX PERMIT ISSUANCE granting o tlti permit. �Si, alure Applican ontraetor Date TOTAL a' / �` ECH. CONT. LIC. NO. MECH. TOTAL POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16661 INSPECTION DIVISION JOB INSPECTION RECORD / / 7 PERMIT EXPIRATION d6 -)C r •I 010,23} UNIT# _LOT# JOB ADDRESS V' PERMIT EXPIRES IF WORK OWNER /y/ CONTRACTOR - `s- IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LIFER PREGUNITE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGN UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL.ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING MECHANICAL ��r? ELECTRICAL FRAMING INSULATION NOTE: LASTCA'LLED INSPECTION. ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VALIDATION CUPERTINO STANDARDS. ISSUANCE DATE BLDG ELECT.PLG. MECI o o a 6.UILDING PERMIT !pil(�1n INFORMATION " VALUATION S/FT. PERMIT TO ZrG7, AS& A` . PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN'SIGNED SCJ. FT FLOOR AREA TOTAL ACREAGE ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING HES IND CON PB 011ier APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 0 0 0 0 ASSESSORS PARCEL NO. ROUGH SAN.#i ' PLUMBING ELECT. ENERGY TRACT NO. PARCEL NO TUBS & SHOWER PAN PLUMBING ENERGY MECHANICAL MECH. ENERGY ELECTRICAL BUILDING ENERGY ACC. DATE ACC. FILE NO. ENG. SITE NO. ENERGY T-24 Y N[ A.L O.C. Y ❑ N[ FRAMING ELECT. FINAL TEST ZONING INSULATION PLUMBING GAS TEST GAS FIRE SPRINK Y N� MECHANICAL 7 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING �$ EXTERIOR SHEAR ELECTRICAL RELEASE 5.Sri FLOOD ZONE Y [1] NE] INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY' EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FiNALISSIGNED BY BUILDING INSPECTOR. 14'"r I'F ; ^; i Ik, MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, F--• ONE WORKING DAY BEFORE REQUIRED INSPECTION. O PLEASE GIVE JOB ADDRESS WHEN PHONING.al Z —SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING (IL 7 7 (� MECHANICAL CONST. TAX `7 . IMPORTANT! PLEASE READ REVERSE SIDE BEFORE v CALLING FINAL. INSPECTION. TOTAL OFFICE COPY w 5: m a z zN O CC LU _ CL ❑ Z) Z UO LL U LU 0. >- In ME k APPLICANT TO FILL IIV INFORMATION VVITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION 'APPLICATION & PERMIT ILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER 14 414 IBUILDING ADDRESS i12x6 OWNER NAME PHONE TY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION -- DATE OF APPLICATION ONTRNAME ACTOR'S 'LIC. NO. 3 'i UTLETS -SWITCHES- RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 r, N RACTOfl'S ADDRESS d J3 PHON - ! S APPLIANCES - RESIDENTIAL 4.00 P PANELS 10.00 CHITECT GINEER rRLIC. No. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ADDRESS ENG. ZIP SPECIAL CIRCUIT 5.00 PERMIT VALIDATION //////JJJ (////111 j�" C`JZ / �/ led ISSUANCE DATE TEMP. METER OR POLE INS. 20.00 APPLICANT'S' ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Picensel ode, nd my license is in full force of e r License Class - Lic. Number Date Contractor _ OWNER -BUILDER DECLARATIONpp1INFORMATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that lie is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for [he alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars (5500).): O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of ptopKrty who builds or improves (hereon, and who does such work himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that h e did not build or im_ prove for purpose ol'sale.). O 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to tile Co the Contractor's License Law. ❑ 1 am exempt under Sec. B.&P.C. for this reason BLDG. ELECT. ❑ PLG. ❑ MECH. ❑ ILDING PERMIT AOINFORMATION MISC. - REFER TO ORD VAth�u TION CCL�n� $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL + PERMIT TO QTY. PLUMBING PERMIT.FEE STORIES cis TYPE CONSTR. ALTER - DRAIN &VENT WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 1 F IXTUR ES - PER TRAP 5.00 SO. FT. FLOOR AREA 67 � TOTAL ACREAGE GAS - EA. SYSTEM - 1 I NC. 4 OUTLETS 6.00 . . GAS EASYSTEM OVER 4 IEA) 200 - . BUILDING USE RES IND CON PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. Z 5- ✓ LAWN SPRINKLERS -OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA200ft/ . 10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner Date WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy [hgrepf�Sc - tn1 ) Policy (��ly[`o on{p:y{y ❑ r[Ified copy is hereby furnished. ❑ Certified is i ed�� ith citeinspection division. Applicant N CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ N ❑ A.L.U.C. Y ❑ N ❑ PLG. CONTR. LIC. NO. PLG. TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY �,{ L BUI) DING < ALTER OR ADD TO MECH. 5.00 NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. . CQNSTRUCTlPN LENDING,A.Q,QNqY . I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of iCupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in conscyuence of the granting his peon, {�j/%% �_ry/ 3) 1!4 47-31-32 Si la ure of App eau t( ontrictor Date J (�,� APPLIANCE 5.00 PLAN CHECK FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLINGUNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE I� EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.) ELECTRIC VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER- COMP (3 H.P. or 100,000 B.T.U.) 6.00 BOI LER-COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL i ncclrc rr%0Nr POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER I... CITY- OF INSPECTION DIVISION INSREC'TIOIV RECORD JOB ADDRESS OG �.S �O'Q �� �� ^��UNIT# _ LOT# r OWNER v G ' Z% CONTRACTOR 1-1e� �Q.s o ...... PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INSPECTIONEIRTEINSPECTOR INSPECTION RECORD FOUNDATION V NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS, UFERZvi PR EGUN I TE PERMIT VALIDATION i , ISSUANCEDATE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ee ce 1p �t UNDERGROUND IISLAB PLUMBING Orl CO{1:bipa ELECTRICAL MECHANICAL, rel e I, PLG. MECH El❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED G-'L�^'�= ' �� 1ING PERMIT,,, u�FORMATION " WOOD FLOOR VALUATION SIFT. PLUMBING MECHANICAL ' ELECTRICAL - PERMIT TO'_ ­ FRAMING INSULATION STORIES TYPE CONSTR. OCC. GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SO. FT. FLOOR AREA TOTAL ACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB otmr ❑ ❑ ❑ 0 APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS 'DATE INSP. ROUGH SAN.# ASSESSORS PARCEL NO. PLUMBING ELECT. ENERGY TUBS & SHOWER PAN - PLUMBING ENERGY TRACT N0. PARCEL NO. MECHANICAL MECH.ENERGY ELECTRICAL i BUILDING ENERGY ACC. DATE ACC. FILE NO FRAMING ELECT. FINAL TEST 40• INSULATION PLUMBING ZONING ENG. SITE NO. GAS TEST GAS MECHANICAL FIRE SPRINK Y [] N❑ ENERGY T.24 Y Ej N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ^� `� L ELECTRICAL RELEASE v+ FLOOD ZONE Y[:] N❑YL A.L. U.C. NEI INTERIOR SHEAR _ Z FIRE DEPT. SHEETROCK, GRADE FEE SUMMARY EXTERIOR LATH _ BUILDING BUILDINGL_ "� U�• INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT ,. , ELECTRIC.500 PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE ' OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. i� I . a MICROFILM uJ ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION.i 00� PLEASE GIVE JOB ADDRESS WHEN PHONING. — SEE PERMIT FOR EXPIRATION DATE — ELECTRIC PLUMBING MECHANICAL CONST. TAX. IMPORTANT! PLEASE READ REVERSH SIDE BEFORE CALLING FOR FILIAL INSPECTION. TOTAL ^ - 5==�'y� r OFFICE COPY