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14907APPLICANT TO FILL IN INFORMATION WITHIN RED, LINES - USE BALL POINT PEN ONLY r UI LDI NG PROJECT I DENTI FIC TION "' APPLICATION &PERMIT BUILDING tELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER - 14907 BUILDING{ ADDRESS Q p IR, a / OWNER'S -II/ NAME ''1, 1^. I. -1q,t� ry(.1xRSj PHONE ITI SS OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION ' NAMERAcrORs UTLETS-SWITCHES-RECEP 10.00/1.00 '1 LIC. No. LIGHTING FIXTURES 10.00/1,00 ' r-DrvTRAcroR's ((Gp - C_^rLa TZ9 Urm. ADOREss APPLIANCES 4.00 PANELS 10.00 DATE OF APPLICATION.' ARCHITECT OR. e�l1l{a{�{LE ENGINEER �,,,puPc ^ �A r(� `/vwsrclM ET>NV� LIC. NO, PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 1 ARCH. OR ENG. ADDRESS •3793 VO LAC12AA7-C VD SPECIALCIRCUIT 5.00 PERMIT VALIDATION' - TEMP. METER OR POLE INS. 20.00 APPLICANT MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 ' U G1/a qlL(�� ' ( /.+ LICENSED CON TRACTORS DECLARATION ? I hereby affirm that I am licensed under provisions of Chapter 9' PAJQUANCE DATE ' (commencing with.Sccti.D 7000) of Division 3 of the Business and PIOCeBaIO'a COIIC, afld Iny IIeIL-n9e Is Ill VIII Cnre nsI [y'e�1 Licensses� Clays Lic. Number I4'xg(Q Date v -I • G� Contractor OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Sec, 7031.5, 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 ofthe Business and Professions Code) or that he is exempt therefrom and - B DG. ELECT. PLG. MECH. qq/'1I�v�A BUILDING PERMIT - �QkT10N L A ION S/FT. ,.,%Cl�r�) `"" -/ OOO MISC. - REFER TO ORD PERMIT ISSUANCE 10.00 r0 ELEC. CONTR. LIC. 0. _ ELEC. �sp TOTAL" PERMIT TO /^ QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. the basisforthe alleged exemption. Anyviolation ofSeclion7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): ' ALTER -DRAIN -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 br offered for sale (Sec. 7044, Business and Professions Code.'The Contractors License Law does not apply to an owner at property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improve- mentsare not intended orol Cared for sale. ll', however, the building FIXTURES - PER TRAP 5.00 SO. FT. FLOOR AREA /.� A/ ( ro r TOTAL ACREAGE - GAS - EA. SYSTEM -1 INC. 4 OUTLETS 6,00 or hnprovemenl 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.).INDUSTRIAL ❑`' I, as owner of the properly, am.exclusively 'con Rucling with GAS - EA. SYSTEM -OVER 4 IEA.) 2.00 BUILDING USE RES ,IND CON Pe Otha, & Cl ❑ ❑ ❑ WASTE INTER. - 30.00 licensed bommetors to construct the project (Sec. 7044, Business and Professmns Code: The Contractors 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 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. .- Q / contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA, 200ft/10.00 TRACT N0, PARCEL NO. ❑'l am exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO, WATER TREATING EQUIP. 5.00 WORKERS'COMPFNSAI'ION DECLARATION 1 hereby affirm that I have acertil'icate of consent to self-inslue, ora certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE NO. copy thereof(Sec. 3800, Lab.C. 1. Policy No. Company- FIRE SPR INK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ ❑ Certified copy is hereby ]or 1 tied. ,k.Ln ❑ Cur 'tied. c p 's Iled wi h the city inspecimn division pppBcant I MISC. - REFER TO ORD. PERMIT ISSUANCE d0{iO CERTIFICATE OF EXEMPTION FROM WORKERS' FLOOD ZONE A.L.U.C. COMPENSATION INSURANCE (This .section need not be completed it the permit is for one PLG. CONTR. LIC. NO. I.G.P TOTAL - YC] ,''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, 1 shall not employ any person in any manner so as In GTV. MECHANICAL PERMIT FEE FEE SUMMARY BUILDING r V---.SAData a become subject to the Workers' Compensation Laws of California. Applicant ALTER OR ADD TO MECH. 5.00 NOTICE O APPLICANT: 11, after making this Certificate of rix- T APPLIANCE 5.00 AIR HANDLING UNIT (TO 10000C.F.M.) 4.00 PLAN CHECK FEE emplicn, you should become subject m the Workers'Compensalion provisions of the. Labor Code, you must forthwith comply with such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(OVER I0,000C.F.M.) 6.00 SEISMIC FEE �0'd CONSTRUCTION LENDING AGENCY I hereby affirm that there iso construction Icuding 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.) 6.00 Lender's Name H EATI NG U N IT (OVER 100,000 B.T.U.) 9.50 - ELECTRIC Lender's Address I certify that I have read this application and saute that the above VENTILATION FAN (SINGLE) 4.00 information is correct. Lagree to comply with .I1 city and county - rdinances and state laws relating to building construction, and PLUMBING BOILER -COMP 13 H.P. or 100,000 B.T.U.) 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH, MECHANICAL CONST. TAX 1'ereby authorize representatives of this city to enter upon the 9 -ave -mentioned petty for inspection purposes. (We), agree t c, indemnify and keep harmless the City of Cupertino agalns I' birdies, judgments, costs and expenses which in n a w Frac geinst said City in consequence of the r�Ig(of his It. l �JI A MISC. - REFER TO ORD. PERMIT ISSUANCE -10:00' -Oa MECH. CONT. LIC. NO. MECH. TOTAL wft TOTAL n/ IaCi Ignature of Applicant/Contractor Date _ OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING, CITY. OF MURTINO = INSPECTION DIVISION JOB INSPECTION RECORD q JOB ADDRESS N I-5OM UNIT# _LOT# OWNER 14-%J , ,r,/ 6- CONTRACTOR ls�M/N ,, denmlT NUMBER 14907 PERMIT EXPIRATION ' PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE, OR 180 DAYS FROM 'LASTCALLED INSPECTION. y;, INSPECTION DATE I INSPECTOR INSPECTION RECORD FOUNDATION - NOTE: ALL GRADING AND ORAINAGE'SHALL BE INSTALLED COMPLY WITH THEAPPROVEO PLANS AND CITY OF CUPERTINO STANDARDS. LIFER - PREGUNITETO ' PERMIT VALIDATION ✓ + ' "=• �' c'' �.`' ISSUANCE DATE GARAGE SLABS .'FOUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB F ,ND({Z ,o U. Firs i -An EU on. 035-9111," c.paotin+15t�I-bF1aM_ PLUMBING _Z— w, 0 F 1 - — il p Y�i „p C ELECTRICAL - MECHANICAL' ' \-L. •- Gc t5'O �'b'Di'Uj ` �Haz�emtiQlWv QP' ELUc ELecr ❑ ❑ •PLG. MecR. m,❑ p DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ;L�y �:_ �p�ppyu BUILDING P RMIT INFORMA ON' VALUATION SIFT. /�� WOOD FLOOR PLUMBING �' _ _/f �f �P�O,A�1 pgOh, e h 1.G,�- �� Q MECHANICAL `://- ELECTRICAL FRAMING- INSULATION STORIES "A TYPE CONSTR. b 'ND G►rf rA=N�wF< LyHFL y~p L•tL NOTE: NO FINAL INSP, SHALL BE MADE BE O V N�EQg2releWU¢k, 1�ial."jU S �is_�. OCC,GROUP RES. UNITS ; P.L'ACE NO SU BFLOOR UNTIL ABOVE HAS BEEN SIGNED ' - ROOF SO, FT FLOOR ANSA TOrALACREAGE , ;DIAPHRAGM ROOF SHEATHING BUILDING USE RES IND CON PB oRl.„, © ❑ ❑ ❑ 0 'APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED PINALS DATE INSP. ROUGH SANA ASSESSORS PARCEL NO PLUMBING1 ,T ELECT. ENERGYro TUBS 8 SHOWER AN /7 PLUMBING ENERGY TRACT NO! PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE- ACC. FILE NO. FRAMING ELECT. FINAL TEST .INSULATION � .� b PLUMBING D%2�FFi ZONING ENG, SITE NO. GAS TEST •' GAS WCC t 3 274 MECHANICAL FIRE sPRINK Y [:]N E] ENERGY T 2 IN COVER NO WORK UNTIL ABOVE HAS BEEN -SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y ❑ N❑ ALUC Y ❑ Nq. INTERIOR SHEAR FIRE DEPT. .. SHEETROCK GRADE 1 FEE SUMMARY EXTERIOR LATH _ Q BUILDING BUILDING 0/ - INTERIOR LATH - tk3o TEMPORAR APP OV $ SCRATCH SCRATCH COAT' ELECTRIC PLAN CHECK. FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE �J OCCUPANCY OE.BIJILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY P=252-4505 w ONE WORKING DAY'BEFORE REQ PLEASE GIVE JOB ADDRESS WHE PERMIT FOR EXPIRAMECHANICAL ELECTRIC ,Z PLUMBING dSEE CONST. TAX % '�1 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY OFFICE CITY OF CUPERTINO _ COPY GAS SERVICE NOTICE ,19 To You are hereby authorized to.connect the GAS Iservice for Owner or Tenant f Y 1 C 1<i i� L4^C915J4 Ar New Service No. of Meters Reconnect + r No. of Add. Meters Move Service Move Meter PLUMBING INSPECTOR�j L 1 i CITY OF CUPERTINO INSPECTION DIVISION i d H H H z O z m Ll O D 9 0 p m N;r y y 2 2 y µ 1a 3 S2 O 2 2= m D m m v<i y Z 2 2 D[ rn T `GO D v O aD O D a t m O m g yy)� p w T y y O C CC p a O H m m D r r f y y m a Z m r C am O y m . K 2 m r V fi S D O y Z y y Z 3 n n m m D m m a O fA ; 2 O C y. a c y m O = m va 8 m p n 2 m m EQQ� Z o 2 0 tmi C i p 0 z< 2 v ti y Cf r _ m m m A LLnJl y n 9 s m m D 9 2 ~ m m n m m y ; D m m m C f rn W M m * 10m m ujl m - .' V o ; v m s Q Z m mr D A D mn O { r•� ❑ ] O O m Z O m m cc to' �fld y z m E < D r D r m m O m < rV I O \ 9 c Y S 1 I i d H H H z • CITY OF CUPERTINO INSPECTION DIVISION O m O m o G m S m S m m x y D a D r y m r rnn 2 ll O m D y i y (/1 y 1 r i d Gy ~ p. mN o n W 2 Z D O x ti D Oy 3 m O O O z v r 0 n C r 9 r Z 2 C D m m m m D y m m C r2 a < O N N m -xl r u. T c 2 Z Z 0 ZS ZS m D m m y D Z 2 Z r(n H y `2 D v 2 m 2 to T y �' 9 m .4>• v 9 b D O y Z Z D 2 3 D 9 m m D m 3 m m0 @ Z O C m m C C A ^ Q O in 9 F 4 3 j m Gy y y m O D O (m] Z 2 O O y 9 1 p$ n C m O O Z< Z y O r m m tmii O 1 a m g g 4 C o O 2 m v Z H a< 3 mD n m m 9 n a y 9 m D v 9 Z Z ti m o m O m♦ 9 a O m< 1 m~ y m'< m D$ r O m a m o y C m N D _ O D n m r � D rw n O m ❑ 3 c m m y m my m C 7rc mj z o ❑ y> 1 n L1 n m m m �� al n Cc 0 z 1 � ` z ❑ z POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTAO INSPECTION DIVISION JOB INSPECTION RECORD JOB ADDRESS LU! �� ���'F}�lU !C I Iy) U/NIT# _LOT# �4,f OWNER zz %L_ �. Ar�,��'g-- CONTRACTOR � (� INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION LIFER PREGUNITE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING L MECHANICAL L ELECTRICAL FRAMING INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROOF DIAPHRAGM ROOF SHEATHING NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. - ^ -A k t0_0 - x4-) 7T -g � G�qD� B�iS vo( s PERMIT NUMBER 14906 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. PERMIT VALInATin Ni NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID SSS ANCE DATE B fj TPLG. 1:1 1:1 BUILDING PERMI INFORMATION VALUATION PERMIT TO S�',/7 w STORIES TYPE C OCC. GROUP RFS I SO. FT. FLOOR AREA TOTAL ACR ,_ i_34 BUILDING USE RES IND CON PB APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ROUGHSAN.# ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY 33%—o/ TUBS & SHOWER PAN TRACT NO PARCEL :■ AGE m -25 1 ✓/3 PLUMBING ENERGY FIRE SPRINK Y ❑ N ❑ ENERGY T24 Y ❑ N❑ MECHANICAL MECH.ENERGY EXTERIOR SHEAR ELECTRICAL RELEASE ELECTRICAL BUILDING ENERGY ACC DATE ACC. FILE NO. FRAMING ELECT. FINAL TEST INSULATION PLUMBING ZONING ENG SITE NO. GAS TEST GAS ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 4 �j z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY MECHANICAL FIRE SPRINK Y ❑ N ❑ ENERGY T24 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE ILOOD ZONE Y ❑ N❑ ALUC. v ❑ N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING �. INTERIOR LATH `Z TEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCYOFBUILDINGISNOTPERMITTEDUNTILBUILDINGFINALISSIGNEDBYBUILDINGINSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 4 �j z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST. TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY k er-• O ZZ P=o - li LU g_ CL Z) Z 0 U- U Ow >- a a- CID Z U APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT BUILDING — ELECTRICAL— PLUMBING — MECHANICAL -PERMIT NUMBER - A ,r�� 4 9 u BUILDING ADDRESS ©-% ,/ nAn® � , ° ` 1�`-TY�� OWNER'S "AMEM{'h _ WL WOktrq PHONE 0 QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION CONTRACTOR'S NAME �( 2 I ti s D LIC. NO. 1A 27 OUTLETS -SWITCHES- RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S p ADDRESS APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 PHONE 1ET DATE OF APPLICATION OR /[ ^ �kl „ ENGINEER' �l1f�M1'I (40❑C. NO. t4gtrARCH. PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 OR ENG.SPECIAL ADDRESS S�/(jJ�� �{ i� � L�CW� 'gLi✓P. zip CIRCUIT rj,QQ PERMIT VALIDATION EMP. METER OR POLE INS. 20.00 APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 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 foyge ole , License lass Lin. Number - � MASSUANCE DATE L ELECT. PLG. MECH. El 1:1 Date 'z� Contractor Xl BUILDING PERMIT OWNER -BUILDER DECLARATION I 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 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 INFORMATION MISC. — REFER TO ORD PERMIT ISSUANCE -10TO0 / r;� VALUATION v w $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL /07, 0 PERMIT TO a� vLl �- 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 ❑ I, 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. DEV ICE 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 u improve- menare not intended or offered for sale. If, however, the building FIXTURES - PER TRAP 5.00 SQ. FT. FLOOR AREA 3� TOTAL ACREAGE GAS - EA, SYSTEM - 1 1 NC. 4 OUTLETS 6.00 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 El 1, GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE E RE S IND CON PB Ocher ❑ 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. 3 S"', — 0 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. SEWER -SAN EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. B.&P.C. for this reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP, 5.00 WORKERS'COMPENSATION DECLARATION I hereby affirm that I 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.C.). Policy No. Companyp—j �rr y ❑ CertUed Is hereby f is ed. ' T" _ 3 J ❑ Cert il!d h tet cl y inspection division. Applicant ,JL. �.r--I y FIRE SPRINK Y [] N ENERGY T-24 Y [:] NE] MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE _10:00 r `?',' FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL r� COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N Y NEI QTY. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($100) or less.) I certify that in the performance of the work for which this per- mit is issued, 1 shall not employ any person in any manner so as to BUILDING -71 je�L7f%t 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)"C.F.M.) 6.00 SEISMIC FEE /S 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 ER100,000B.T.U.)9.50 ELECTRIC 07P Lender's Name Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and VENTILATION FAN (SINGLE) 4.00 PLUMBING r , / BOILER-COMP(3 H.P. or 100,000B.T.U.I 6.00 BOILER -COMP (Over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. - REFER TO ORD. ST. AX CONT (We) agree to save, inde ify and keep harmless the City of Ic4pertino against liabilities, jgments, costs and expenses which y in ay a cr e a ai st said City in consequence of thePERMIT ISSUANCE 16:00 l MECH. CONT. LIC. NO. MECH. TOTAL TOTAL ��;;'9' q I % I r tingr i . cy Signature of Appl ant/Contractor Date OFFICE COPY O ZZ �: O CC- W a. o � Z UO LL U 0W a N Z u APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION &PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL PERMIT NUMBER L+ A 6 y BUILDING 0 rY-or�� O , 1,)DgSs 0C,192 3 T f` OWNER'S :i -e PLAN CHECK VALIDATION NAME PHONE -I `- Cy QTY. ELECTRIC PERMIT FEE co NTRACTOR S - NAME OUTLETS -SWITCHES- RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 LIC. NO. DATE OF APPLICATION CONTRACTOR'S ADDRESS PHONE APPLIANCES -RESIDENTIAL 4.00 PANELS 10.00 ARCHITECT OR ENGINEER LIC. NO. PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS SPECIAL CIRCUIT 5.00 P1 PERMIT VALIDATION 4✓ EMP. METER OR POLE INS. 20.00 ZIP APPLICANT'S MOTORS SEE FEE SCH. ADDRESS SERVICE CHANGE 20.00 per[► /X��i LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 - ISSUANCE DATE (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 BLDG. ❑ ELECT. El PLG. ❑ MECH. ❑ Date Contractor BUILDING PERMIT 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 INFORMATION MISC. - REFER TO OR VALUATION 0 �}-/ 0 +tea / (/ Vz' $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. ELEC. TOTAL PERMIT TO �/,Q-oAf WA -4 -4 - QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 by any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars ($500).): El 1, 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 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, 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 5.90 SQ. FT. FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such improve- ments are not intended or offered for sale. If, however, the building GAS - EA. SYSTEM - 1 I NC. 4 OUTLETS 6.00 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- proyeforpurpose ofsale.). gI, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE El IND CON PB Other ❑ ❑ ❑ El 1:1licensed INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. 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 - OVER 5 (EA.) 1.00 contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ❑ Iexempt under Sec. B.&P.C_ for this WATER HEATER W/VENT 6.00 reason ' Owner 4- nat'' °- �rrYY�� e WORKERS'COMPE$1SATION DECLARATION WATER SYSTEM 5.00 ACC. DATE ACC. FILE N0. WATER TREATING EQUIP. 5.00 hereby affirm that I 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.C.). Policy No. Company FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city inspection division. Applicant MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. PLG. CONTR. LIC. NO. PLG. TOTAL COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y ❑ N ❑ Y ❑ N ❑ QTY. MECHANICAL PERMIT FEE FEE SUMMARY 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 BUILDING Cj ,rte 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. CONSTRUCTION LENDING AGENCY FEE AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00 I AIR HANDLING UNIT(OVER 10)"C.F.M.) 6.00 SEISMIC FEE y 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.). 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.)9.50 ELECTRIC Lender's Name Lender's Address VENTILATION FAN (SINGLE) 4.00 PLUMBING 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and BOILER-CUMP(3 H.P. or 100,000 B.T.U.) 6.00 BOI LER-COMP (over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC. REFER TO ORD. CONST. TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which a� ii any way accrue against said City in consequence of the rafitj(rg f this pe�. PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. TMETCA-9,�g TOTAL fi Uv Si ture of Applic nt/Contractor Date c1,_)C4-Tr OFFICE COPY POST THIS CARD NEAR �.IONT CITY OF CUPERTINO INSPECTION DIVISION JOB INSPECTION /Q 9 4L0/ JOBADDRESS/C7gA`3D ,Kdl-feA,/7ZZ✓ 16 ['�/ OWNER N `L—Li�(j— ®' 't`�.. CONTRACTOR OF BUILDING RECORD p �a � UNIT# _LOT# —acT„u� CL,�1. --- PERMIT NUMBER 16646 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. PERMIT VALIDATION ssuANCE unrE INSPECTION DATE INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICALBLDG I ELECT PLG MECR DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED p 0Xr G� BUILDING PERMIT INFORMATION WOOD FLOOR PLUMBING VALUATION S/FT, MECHANICAL ELECTRICAL PERMIT To FRAMING INSULATION STORI S TYPE CONSTR PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED OCC. GROUP RES. UNITS ROOFSO NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID FT FLOORAREA TOTALACREAGE DIAPHRAGM ROOF SHEATHING BUILDING USE HES IND CON PB Other ❑ ❑ ❑ ❑ ❑ APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ROUGHSAN.# ASSESSORS PARCEL NO PLUMBING ELECT. ENERGY TUBS &SHOWER PAN PLUMBING ENERGY TRACT NO PARCEL NO MECHANICAL MECH.ENERGY ELECTRICAL BUILDING ENERGY ACC DATE ACC FILE NO FRAMING ELECT. FINAL TEST INSULATION PLUMBING zoNlNc ENG. SITE No. GAS TEST GAS MECHANICAL FIRE SPR'NK Y ❑ N ❑ ENERGY T-24 Y ❑ N❑ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE Y [:]N❑ A L U C. Y L__1N❑ INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATHTEMPORARY APPROVALS SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS / 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 o� ONE WORKING DAY BEFORE REQUIRED INSPECTION. z PLEASE GIVE JOB ADDRESS WHEN PHONING. -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY 7' O 2! Z% �: O OC - LU > ao � Z UO LL U OW } a N )- Z LS o1OPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION APPLICATION & PERMIT ]BUILDING - ELECTRICAL- PLUMBING - MECHANICAL -PERMIT NUMBER 6 6 4 6 BUILDING Lo-rs $ Mt iCiN�j R� I OWNER'S NAME �l PHONE QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION DATE OF APPLICATION PLAN CHECK FEE CONTRACTOR'S NAME r� / �7l-rAIWI DFMAd' LIC. NO. 4Z%. OUTLETS -SWITCHES- RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 CONTRACTOR'S c ADDRESS ',b J <APQT,, De G MC)e61kT J 611 CA PHONE'j%S 15!54 ARCHITECT OR ENGINEER LIC. NO. APPLIANCES - RESIDENTIAL 4.00 PANELS 10.00 PANELS (OVER 200 AMP) 20.00 SIGNS TRANS. 3.00 ARCH. OR ENG. ADDRESS ZIP SPECIAL CIRCUIT 5,00 PERMIT VALIDATION IS DAN��CE DATE EMP. METER OR POLE INS. �' APPLICANT'S ADDRESS MOTORS SEE FEE SCF, SERVICE CHANGE 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 Professions Code d my license is in full fo GG a def License Class Lic. Numbe 1Z,� 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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 1, 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- prove for purpose of sale.). 13I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, BusinessLAWN 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 the Contractor's License Law. Elnl am exempt under Sec. B.&P.C. for this re �\ BLDG. O ia MECH. ❑ o� BUILD NG PERMIT INFORMATION MISC. - REFER TO ORD PERMIT ISSUANCE VALUATION $/FT. ELEC. CONTR. LIC. NO. ELEC. TOTAL .- PERMIT TO i �= �-J Z i L QTY. PLUMBING PERMIT FEE STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.00 BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 F IXTUR ES - PER TRAP 5.00 SO. FT. FLOOR AREA TOTAL ACREAGE GAS - EA. SYSTEM - 1 I NC. 4 OUTLETS 6.00 GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Other INDUSTRIAL WASTE INTER. 30.00 SPRINKLERS - 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.) 1.00 SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 Owner 7Datc WORKERS'COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.C.). Policy No. Company WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 ZONING ENG. SITE NO. ❑ Cert ifi cop is heRu nishe ❑ Certifie 'S le it city inspection division. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 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 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. LENDING AGENCY 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. I 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 Cupertino against bilities, judgments, costs and expenses which gr n y w a r eQ a�gainst said City in consequence of the row -fu U - MECH. I Signature of Applicant/Contractor Date FIRE SPRINK Y ❑ N ENERGY T-24 v NQ MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE Y ❑ N ❑ A.L.U.C. Y [:] NEI PLG. CONTR. LIC. NO. PLG - TOTAL QTY. MECHANICAL PERMIT FEE FEE SUMMARY G ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 ECK F AIR HANDLING UNIT (TO 10,000C.F.M.) 4.00CONSTRUCTION AIR HANDLINGUNIT(OVER10)"C.F.M.) 6.00 FEE EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UN IT (OVER 100,000 B.T.U.) 9.50 ELECTRIC i VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -COMPO 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 CONT. LIC. NO. MECH. TOTAL TOTAL OFFICE COPY