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10905 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY , Y PERMIT NUMBER BUILDI NG PROJECT 1 DENTI FICATION BOlaol G ,APPLICATION 8i PERMIT , , �' 4mREss ILDING -ELECTRICAL-PLUMBING-MECHANICAL ldw � o I � 10905 X OWNER'S --' DTV. ELECTRIC PLAN CHECK VALIDATION NAME^ PERMIT FEE PHDNrp�IS7 X09 CONTRACTORS _ UTLETS-SWITCHES-RECEP _ 10.00/1.00 NA E Oh h0 Lt..No. LIGHTING FIXTURES 10.00/1.00 - CONTRACTOR'a APPLIANCES-RESIDENTIAL 4.00 ADORESRa , qtp /// V / 4'T YPHOiyE PANELS - 10.00 PATE OF APPLICATION ARCM TECT - PLAN CHECK FEE P.C.NO. 1 on - - PANELS (OVER 200 AMPL 20.00 - ENGINEER UC.NO. SIGNS TRANS. 3.00 - ARCH.OR ENG. PERMIT VALIDATION , ADDRESS - SPECIAL CIRCUIT 5.00 - ZIP EMP.METER OR POLE INS. 20.00 ,f ' ASMOTORS SEE FEE SCH. DREESS ADDR SERVICE CHANGE 20.00 pp 00 LIC17NSED CONTRACTORS DECLARATION l - ¢u u' hereby uffirm lhut•I am licensed under provisions of Chapter 9 r/ '15 Ct DATE w Q u (commencing with Section 7000)of Division 3 of the Business and G. ELECT. PLG. MECH. r 7 z Professions Code,and my license is in full force and effect. ❑ o a W License Class Lie.Number. - B Date Contractor tI 0 ❑ ¢ x 2 d BUILDING PERMIT ¢ ¢ w a OWNER-BUILDER DECLARATION - INFORMATION " MISC.- REF ER TO ORD w ;LL N I hereby afErm that 1 am exempt from the Contractors License VALUATION S/FT. u O a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00' Code:Any city orcounty whichrequiresapermitloconstruct,alter, �d QQ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO 6 W p1 Ile Is lCmacd Pursuant t0 the provisions of the Contractor's License rii Law(Chapter 9(commencing with Section 7000)of Division 3 of the ((��`•!\ 1"L- 4 o Business and Professions.Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE CE f the basis for lhealleged exemption.Any violation of Section7031.5 STORIES TYPE CONSTR. i by any applicant for a permit subjects the applicant to a civil penalty ALTER•DRAIN& VENT-DRAIN of not more than five hundred dollars(5500).1: ❑ I,as owner of the property,nr my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 OCC.CROUP REB.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 does not apply to an owner of - properly who builds or improves thereon,and who docs such work FIXTURES•PER TRAP , 5.00 SQ FT,FLOOR AREA TOTAL ACREAGE himself through his own employees,provided that such improve- memsam rcnot intended or ol'femd for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4 IEA) 200 builder will have the burden of proving that he did not build or im- - . . . BUILDING USE prove for purpose ofsnleJ INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB On., LII,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 - s contracts for such projects with a conlmclors)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200f[/10.00 TRACT NO. 'PARCEL NO. ❑ I am exempt under Sec. ,B&P.C.for flus WATER HEATER W/VENT 6.00 ' reason �r owner D WATER SYSTEM 5.00 ACC.OATE ACC.FILE NO. /1 WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have acertifncale of consini to sel Ginsure, - ZONING ENG.SITE NO. or.a certificate oGWorkers'Compensation,Insurance,or a Certified Copy thereof(Sec.3800,Lah.CJ. - - Policy Nn. Company - ❑ Certified Copy is hereby furnished. FIRESPRINK ENERGY T-24 Z Z ❑' Certified copy is filed with the city inspection division. O Applicant MISC.- REFER TO ORD. r❑ N❑ 'Y❑ N❑ F-' a - - CERT(FICAT'f:OF E%IiMPI'ION IROhI WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE - A.L.L.U.C. Lu > COMPENSATION INSURANCE PLO CONTR. LIC.NO. PLG. .d a (This section need not be completed if the period is for one TOTAL V❑ N❑ - Y ❑ N❑ Z. hundred dollars(S 100)or les.) U O . I 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 so us to U become subject to the Workers'Compensation Laws of California. U y Date Applicant - ALTER OR ADD TO MECH. 5.00 BUILDING f� } N NOTICE TO APPLICANT: IL after making this Certificate of nix- `- Z emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this peimif shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C,F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10000.F.M.) 6.00 SEISMIC FEE y 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,Cie C.). - HEATING UNIT(TO.100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.60 ELECTRIC Lender's Add I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00 1 information is correct. I'agree to comply with all city and county PLUMBING Jordinances and,smte laws relating to building'construction, and BOILER-COMP 13 H.P.or 100,000B.T.U.)`6.00 hereby authorize reirmsenlafives of this city to enter upon the above-mentioned property for inspection purposes. BAILER=COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD: Cupertino against liabilities,judgments, costs and expenses wh.ch .PERMIT ISSUANCE - 10.00 CONST.TAX may in any way accrue,against said City in consequence of the granting of this pe II. MECH.CONT. LIC.NO. MECH. �- TOTAL TOTAL Signature of Applicant/Conlrect Date OFFICECOPY - - POST THISCARD;NEAR FRONT OF BUILDING 'PF,RMIT NUMBER. CITY OF CUPERTINO - 1-0905 INSPECTION DIVISION !.. JOB INSPECTION RECORD PERMIT EXPIRATION, JOB ADDRESS 1111.11-) ;UNIT# LOT*f pERM1T'EXPIRES IF WORK OWNER CONTRACTOR - ISNOT .STARTED WITHIN ' INSPtCTIODATE INSPECTOR INSPECTION RECORD 18a oAVSOF PERMIrJSSU- ANCE OR,180 DAYS FROM FOUNDATION L �1b ?-I�-i[b LkCW6l� STS LAST CALLED INSPECTION. { UFER PREGUNITE 'PERMIT VALIDATION III■•`. "POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ,. , .. ./a•* .� ` UNDERGROUND /SLAB �I PLUMBING - ELECTRICAL - 3.' iSSUANGE DATE MECHANICAL , BLDG, ELECT," PLG. MFEW ❑;- ❑• ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION S./FT. PLUMBING MECHANICAL ELECTRICAL PERMi�To " FRAMING " STORIES TYPE CONSTR. INSULATION ' OCC.GROUP RES,UNITS, j ;TUAC E"NOsSUBFL00R UNTIL ABOVE HAS BEEN SIGNED " ROOF SO.FT"FLOOR AREATOTAL ACREAGE t ' ♦ . .. DIAPHRAGM BUIL USE CON RES ' IND ICON PB OMer Y '4/APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑' ❑ ❑ ❑ ASSESSORSPARCELNO, I ROUGH, ' PLUMBING GAS TEST , r TRACT NO, PARCEL NO, MECHANICAL - - ACC.OATE ACC.FILE NO. ELECTRICAL - FINALS DATE INSP. FRAMING „ SAN INSULATION - PLUMBING ZONING ENO.SITE No. ' GAS'' MECHANICAL - FIRESPRINK 'ENERGY T 24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ NO ` ❑' N❑ LATH-INTERIOR I ELECTRICAL ? FLOOD ZONE- . A.L.U.C. ,; .,, LATH-EXTERIOR FIRE DEPT. " - ' Y❑ .N❑ Y'❑ N❑' SHEETROCK, GRADE FEE SUMMARY f 'SHEAR INTERIOR` „ BUILDING - SHEAR EXTERIOR "" TEMPORARY APPROVALS . BUILDING x I ' FIREWALLS ELECTRIC .. PLAN CHECK FEE. ... ��..�. i NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUFANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT.PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. -,MICROFILM ' ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 1u' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O� PLEASE GIVE.JOB ADDRESS WHEN.PHONING. Z = SEE PERMIT FOR EXPIRATION DATE MECHANICAL } IMPORTANT! CONST.TAX i PLEASE READ REVERSE SIDE BEFORE TOTAL CALLING FOR FINAL INSPECTION:•.' OFFICE COPY- .