99110141 CITY OF CUPERTINO
[WILDING DIVISIDN PERMIT "'CON'TRACTOR,INFORMATION:.:
BUILDING ADDRESS: PERMIT
.OWNER'S NAME: APPLICATION SUR DATE
NONE: SANITARY NO CONTROL ROL
WFARCHITEC"DENGUNRER: PHONE# BUILDING PERMIT INFO
BLDG ELECT PLUNIB MECH
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fl 'o
INSPECTIONS, I SPEC' JOB DESCRIPTION
c, TO ARRANGE INSPECTION
P Z 1.t Sl CALL 777-322S MONDAY-FRIDAY 24 HOURS RESIDENTIAL
�<N REQUIRED INSPECTION.JOB ADDRESS
�Z BEFORE R
FOUNDATIONJPIFRS/H.D.S. Cl SFDIL El KITCHEN REMODEL
o iAND PERMIT#ARE NEEDED WHEN PHONING, El ADDITION C]PLUMBING RE-PIPE
UFER GROUND
El MULTI-UNIT STRUCTURAL
PAD/SET BACK-CERT RESIDENTIAL COMMERCIAL MODIFICATION
OTHER
B: GARAGE SLABSfPREGUNITE ;N I tKIUK 1i CHIMNEY REPAIR
E"o a'��OijRZ14(DrCdPiCR��ijt�Tl&'���OVE!ffXS BEEN I SiGNED.'�� r, HAZARDO S FIRE AREA
IMPROVEMENT ❑ SWIMMING POOLS
0 BATH REMODEUREPAIR F3 DEMOLITION
11 YES If,,-I ucd.,I.ud mut,Gull A il IcLtuircd.
UNDERGROUND/SLAB
ID OTHER
'to PLUMBING C1 NO Initi.1 I.C.B.O.It
�Ro ELECTRICAL
NrR' CONI IERCIAL-
�!DUNOMPOUR FLOORJUNTH]ABOVE HASREEN STGFE�& EXIS ING ROOF COVERING
PLUMBING O
0 NEW BLDG/ADDITION 0 DEMOLITION
MECHANICAL Numbtr.f existing coverings El TENANT L� FOODSERVICE
IMPROVEMENT
ELECTRICAL T.ba removed To be,,mined Ej OTHER
FRAMING VENTS -ou
INSULATION -w
i;PbItCE-Nb'sbdFL66k.ENTIL ABOEr
HA'S BEEWSIGW96';.' TYPE OF ROOF COVERING
ROOF SHF.ATH[DIAPHRAM EXISTING, PROPOSED:
PLUMBING 0 Built-Up Roof El Built-Up Roof
TUBS&SHOWER PAN 11 Asphalt Shingle, D Asphalt Shingles
MECHANICAL C1 Wood Shakes 0 Wood Shakes
ELECTRICAL/POOL El Wood Shingles EI Wend Shingles
F—FMING/STAIRS/E.EGRESS El Other(Specify)_ -1 Other(Specify)
-AN&7SULATION/VENTILATION III—// Provide I.C.B.O.Report Na.
`COVER NOWORK-UNTIL ABOVE HAS BEEN I
NEEf�nj Provide Mfgr.histaliation Specs,
XTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHFETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED FE DATE INSP
EXTERIOR LATHIW-SCREED
.72
SHOWER LATH � F�Sol- r/1;Foe
C75�1-)� W
�,:NO,,TAOEORPL`AStER`,fJNftlI;-ABOVEHAS,BEEN,S[6 D•;�i�l'j;i
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
D
.jFTNALSP,;
z PLANNING 777-3308
Iq
z GAS TEST
-e
GRAIDE(P.W.777-3354)
FIRE
Z) z
PLANNING
C-� 0 ELECTRICAL
iw PLUMBING
rl
>, MECHANIC=ALSoi
ENERGY
VISUAL FINAL ONLY
BUILDING
l�.,OCCUPANCYOF BUILDINBOIS ISNOT PERMITTED
"
N I`G,F.].'`6SS' L
IGNED BY BUILDING
'S5' ","I,
,�l SPE
CERTIFICATE OF OCCUPANCY[I
PRE-INSPECTION: PLYWOOD IN-PROGRESS
INSP._ DATE_ INSP. DATE_ INSP.— DATE
TEAR OFF INSPECTION BATTENS FINAL:
INSP. DATE---_ [NSP.— DATE_ INSP DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
APPLICANT'S POSTING COPY
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING{SI})I{h$;.1 FINCH AVENUE PERMIT N99110141 -
OWNER'S NAME
NA�M�E:F� APPLICATION SUIT DME
AKABORI 11/22/1999
PHONE: SANITARY NO. CONTROL NO.
RCIIITEC,ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
' a
S LICENSED CONTRACT'OR'S DECLARATION Job Description
Q =C I hereby affirm ohs'I am Icensed under provisions of Chapter J Immmencing
F°'tai wan Semon 7(Ilxp oromisioa3ortne Basiness and rmfessfona tale.and my tato 769. 8'' CONDITIONED 413. 07 GARAGE
a� , ,,in full force and effect. r_
11 Ou=U Date Clnsn LiCnContractoraContractorContractor
11 3 V a. .
ARCHITECT'S DECLARATION
I-a O 1 understand myphotostat
li M used public record,
po Lmcn.ad PrnEv Evil' - .
OWNER-BUILDER 1117CLARNI'[ON
er 1 hereby affirm Nat I as exempt from the Contractor's License Law for the
following reason.(Section 0031.5.Business and Pmfespions Code:Any city or County
SdFF O which requires a Permit to conswcr,alter,improve,demolish,or repair any,doctor.
Adm pnorlo its iswunre.uho requireslhc upplicnm rot such permi'mfilaysignul smremcm
mathehsncensmrnrsaantionic provjinn.nnneenmmemr,ue<n,eLaw(enaptero Sq. Ft. Floor Area Valuation
(cmnn,anaing with Sredon 7(w 1)of Disish,n 3 onhe Bw heats aad Pnnesslons Codel S 83293
or that he is exempt themmen and the basin for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permitsubjects the applicant to a civil penally
of nor Tome than rive handled dollars($500). APN Number .'Occupancy Type
U L as nwacrid the property.or my employee,.ith wages as met sloe clumemotion. 37505021.00
will do the work,and the saucture is not intended or offered for sale(Sec.71Hy —
Business and Pmfio
ez. ns Code:The Comments',License Lew dom n stn apply an Required Inspections
..rvr of property Who builds or improves thereon,and who does such work himself 101 FOUNDATION
ttmugh his own un,ployec.,presided Thal such impravo rents me nal intended or
offered to,sale.If,bnwevac the baddine or improvement is old within ono Carol 102 — PIERS
completion,the owner-balwill have the homes of proving flout he did not build or
improverorparposemade.). 103 — UFER
01,as owner of the property.ntuexclusively contracting atilt icaasadcon'ramorslo 104 — REBAR
......tract the project(Sec.7494,Business and Professions Codc)'hu Contractor's
ureas,Law does not apply to an owner of PmlKrtr who naafis or improves tnereo... 105 — ANCHOR BOLTS
.it ctorse rWaprnj 'x with a.o..v a)licensed pursuant,..t, Lice� mthe .1.06 — SEWER R WATER
❑I ale Csmnp'undar 5oe. ,B d'P C on lms rea6O° 202 — UNDERFLOOR PLUMBING - -
Owner Date 203 — UNDERFLOOR MECHANICAL
WORKER'S COMPENSA'T'ION DECLARATION t-
I hereby mrnn coderpe,,airy„r pmjmy ore of the ndowinc declarations: 204 — UNDERFLOOR FRAME
❑ 1 have and will maintain a Certificate of Consent m self-insure for Worker's 205 — UNDERFLOOR INSULATION
[lie as provided for by Section 37W of ,e labor Code, for the 301 — ROUGH PLUMBING
rformvnce of the work for which this permit is issued. -
❑I nava.,of d will ImWolkar's Cotws:nsadon msamaae,as ecgnhed by Semi..n 302 — TUB &- OR -SHOWER
3700 of the Labor Code for the perrolooloe of the work for which this perm)is 303 — ROUGH MECHANICAL
L3,700
My Worker's Compereation Invamnce carrier and Policy number arc:
Carrier) Policy No.; 304 — ROUGH ELECTRICAL.
CUKIpiCATION Or EXGMPI'IONI7ROM WORKERS' 305 — FRAME
COMPENSATION INSURANC17
This section need ambeCompleted ithe fiction isfor onenotarial dollars 306 — HOLDOWNS
(slmn,nrea) 307 — 'INSULATION
1 certify that in the fictional of the work for which this pCmat is issued 1 308 — SHEET ROCK
shall not employ any person in any manner so as to become subject to the Workers'
Compensation Laws of Cmimirma.Dae 309 — EXTERIOR LATH
-
NO]I
NaileCr:E
To nrrl.IcnNT:I anal making misamfie:ott or rsea,pnan,you should .310 — INTERIOR LATH ,
hate .ubjecno the Warkeex Campensalnn pooos utthe Labor Code....mu.' -
O C d forthwith Comply asithsuch pro,isionsorthis Peron haBnedeemedrevoked.
311 — SCRATCH COAT
. EN CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL
I to rehy union'hot theta is a Connlmetion lending agency far the p:rfam elle
m
of he work for whichthopC,nllisi...to(Sol.3097.Civ.C) 501. — FINAL ELECTRICAL ENERGY
y p Lente me
Add. 502 — FINAL PLUMBING ENERGY
Na
emcr's
UC 1Cnifythat Iha4creadthis ad ' dnlate bar heanoveinformation'1, 503 — FINAL MECHANICAL ENERGY
rr ied coo and
W. correct, a cmemCmnplywisheball eanioncrprcoonly omimmesoandstatetowsrelai ng
erupon 504 — FINAL BUILDING ENERGY
Q f,J to building ctnswai..n,and hereby amh..rirc representatives of this city to enter upon '
>, m the alo o-meneased property far inspection parpases. 505 — FINAL ELECTRICAL
f.. g (We)vgrtemslo C.indemnify mad keep harmless the City of Cureuino.,.in,,
f-I h liabilities,mdgmen's,Costs and expenses which m4.ay in any way acme ogvin..t.aid 506 GAS TE T
V
SOURCE REGULATIONS.
UNDERSTANDS
N ERSTA, fAND WILL CO —
SOURCANTUNDF.RSTANDSANOW p COMPLY Issued by: 507 — FINR PEtQhIBING Dale (�
Signature mAppEcantleoatmnor [)are Re-roofs '
HAZARDOUS MATERIAIN DISCLOSURE509 '- FINAL GRADE
Will the apple.,or fall,.building aeapma slam,or handle nnr.,raotis material Type of Root
ardelined by'he Cupertino MuNcipal Cole.Chapter 9.12.and the health and Safety 510 — FINAL PLANNING
Code.Section 25532(a)^
°Y°s ON. All roofs shafilb4 imTeEtllti*Kor WUB)_I$NinWl®li? &I being installed.
Will the applicant ornature building occupant Use egoiplwarncar desloeswhlab If a roof is installed without first obtaining an inspection, I agree to remove
mit hoa:udous air conmminams as defined by the Bay Area Air Quality Management
Districn all new materials for inspection. Applicant understands and will comply with
Oyes ❑No all non-point source regulations.
I toot mad the herwho,man,nnls mquiramca'.under Chapter 6.95 of the -
alifufniu Health&Satety Calc,Sections 25505,25533 and 25534.1 underimnd that
if the building does oat currently have a tenant,that it is my respoasibiliry m notify the -
acupam of the requirements which mus'W Ise'prior to issuance of a Certificate of
Occupancy.
Signature of Applicant Date
Owner or authorized agent Use All roof coverings to be Class "B"or better