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B0659 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL 160PERMIT xo. APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING DIVISION �^�y BUILDING PROJECT IDENTIFICATION `l BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DA 1c376(-) e:::)fz A T� w�}: Z �� OWNER'S NAME: PHONE: CONTRACTOR'S NAME: / LIC NO: :�• Z 2 T 2 —d4-'7�- - W N/C CONTROL# _Rt,HITECTBNGINEER: LIC NO: ADDRESS: ❑ 13_V. CONTACT: PHONE: BUILDING PERMIT INFO r�_ �� 3� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ct LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION a a z with Section 7000)of Division 3 of the Business and Professions Code,and my license is E TIAL W 0 O PERMIT ISSUANCE H W F in full force and effect. FDWL El KITCHEN REMODEL Uz U License Class Lic.# H Q W Date Contractor APPLIANCES-RESIDENTIAL ❑ ADDITION PLUMBING RE-PIPE F ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL L4 O ria I understand my plans shall be used as public records MODIFICATION Z4 A UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR 4t� Licensed Professional 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS � OWNER-BUILDER#)ECLARAT[ON OVER 1000 AMPS El BATH REMODEL/REPAIR El DEMOLITION I hereby affirm that I am exempt from the Contractor's License Law for the 0W U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER O F. which requires a permit to construct,alter,improve,demolish,or repair any structure h a prior to its issuance,also requires the applicant for such permit to file a signed statement SPECIAL CIRCUIT/MISC. that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 A (commencing with Section 7000)of Division 3 of the Business and Professions Code)or TEMP.METER OR POLE INST. OMMERCM: p n y that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION W h Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE F >. not more than five hundred dollars($500). IMPROVEMENT x .< Fl I,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC [r Ao will do the work,and the structure is not intended or offered for sale(Sec.7044,Business ❑OTHER ,4 oo and Professions Code:The Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES 4 property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL EL.ECTR SQ FT. sale.If,however,the building or improvement is sold within one year of completion,the SQ.FT.FLOOR AREA $/SQ.FT. owner-builder will have the burden of proving that he did not build or improve for pur- pose n e.). owner of the property,am exclusively contracting with licensed contractors to TOTAL: construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE who contracts for such projects with a contractor(s)licensed pursuant to the Contractors Q 3Z License Law. PERMIT ISSUANCE 't I v ❑I am exempt under Sec. ,B&P C for this reason r Owner - Date ^ ALTER-DRAIN&VENT-WATER(EA) VALUATION 14 WORKER'S COMP SATO ECLARATION BACK FLOW PROTECT.DEVICE I hereby affirm under penalty of perjury op9of the following declarations: O O ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTIO sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. FIXTURES-PER TRAP `Ti,_ F-1I have and will maintain Workers Compensation Insurance,as required by Section e�L 3700 of the Labor Code,for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN My Workers Compensation Insurance carrier and Policy number are: Carrier. Policy No.: GAS-EA.SYSTEM-OVER 4 MA) �7tj' 4-6-157 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR BU NO DIVISION FEES (Ibis section need not be completed if the pemrit is for one hundred dollars($100) GREASE TRAP or less.) I PLANCHECK I certify that in the performance of the work for which this permit is issued,I shall SEWER-SANITARY-STORM EA.200 FT. 7 not employ any person in any manner so as to become subject to the Workers'Compen- ENE G z,Z sation Laws of California.Date WATER HEATER W/VENT/ELECTR r C) Applicant G E H tj NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM/TREATING become subject to the Workers Compensation provisions of the Labor Code,you must SOMVEE W forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE UA CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.Fr. Z I hereby arm that there is a construction lending agency for the performance of P Date Receipt# U O affirm the work for which this permit is issued(Sec.3097,Civ.C.) w E"t Lenders Name T !�,,,V Lenders Address TOTAL: l F'W I certify that I have read this application and state that the above information is BUILDING ! L�O correct.I agree to comply with all city and county ordinances and state laws relating to Ql y, MECHANICAL PERMIT FEE V 4 building construction,and hereby authorize representatives of this city to enter upon the SEI MICnE above-mentioned property for inspection purposes. PERMIT ISSUANCE (We)agree to save,indemnify and keep harmless the City of Cupertino against ELE E m liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. PL G FEE 2 U in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) GtJ SOURCE REGULATIONS. MEC ICAL FEE � AIR HANDLING UNIT(OVER 10,000 CFM) CONS UCTTON TAX ignature of Applic t/Contmctor Date EXHAUST HOOD(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSINMITIGATION FEE Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) E]Yes F-1 No PAID VENTILATION FAN(SINGLE RESID) Date Receipt# Will the applicant or future building occupant use equipment or devices which e - , BOILER COMP(3HP OR 100000 BTU) mit hazardous air contaminants as defined by the Bay Area Air Quality Management TOTAL: District? BOILER-COMP(OVER 100,000 BTU) ❑Yes ❑No - I have read the hazardous materials requirements under Chapter 6.95 of the Cali- ALR CONDITIONER /// ISSUANCE forma Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the NEW RESIDENTIAL MECH. SQ.FT. building does not currently have a tenant,that it is my responsibility to notify the occupant of the ments w A mustbe met prior t issuance of a Certificate of Occupancy. . .20 pp O er or authorize agen Date F TOTAL I ISSUED BY: nFFICE POSTzTHIS CARD NEA fOF BUILDING_ CITY OF CUPERTINO PERMIT No. BUILDING DIVISION --- �.6i;_4 BUILDING PROJECT IDENTIFICA' BUILDING ADDRESS: ��t S N ARY NO. APPLICATION SUBMITTAL DA PHO ONTRACTQR'S NAME: LIC NO: N� 0 .a ..OWirIER'S NP.IYIE. i-'�'t. ' f^ N/C CONTROL/#� C ECI'/EN INEE LIC NO: , ADDRESS: ❑ BUILDING PERMIT INFO INSPECTIONS DATE INSPEC. ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ ❑ ❑ FOUNDATION/PIERS/H.D.S. _Olc.�, INSPECTION RECORD JOB DESCRIPTION UFER GROUND �`jC7 NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL: V SHALL BE INSTALLED TO COMPLY WITH LJlDWL ❑KITCHEN REMODEL PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF El ADDITION ❑PLUMBING RE-PIPE GARAGESLABS/PREGUNIT Q(, CUPERTINO STANDARDS. ❑MULTI-UNIT ❑STRUCTURAL MODIFICATION,- POURNO CONCRETE UNTIL ABOVE HAS BEEN IGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR C i A�TFRNOONS (1 nn PM - 4 30-ElYt) IMPROVEMEN) E]SWIMMING POOLS UNDERGROUND/SLAB —� –< ❑BATH REMODEL/REPAIR ❑DEMOLITION PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑GTHER ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AND PERMIT#ARE NEEDED WHEN PHONING. COMMERCIAL: PLUMBING ATTENTION CONTRACTORS: ❑NEW BL-DG/ADDITION ❑DEMOLITION MECHANICAL ��O NO PERSON(S)SHALL PERFORM WORK ON ❑TFN oVEl FOOD SERVICE THIS JOB SITE WITHOUT BEING IN COM- [:1IEMENT RO ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION FRAMING VENTS —496 j>&uRANCE REQUIREMENTS. INSULATION r/ O SPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP. PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN IGNED ROOF SHEATH/DIAPHRAM PLUMBING TUBS&SHOWER PAN G _U o ?�P MECHANICAL 16 ELECTRICAL/POOLBOND U _w .� FRAMING/STAIRS/E.EGRESV/9-1 •r s-" INS ULATIONNENTILATION / - eel/ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIAL SHEAR/HOLD DOW0_7,9,e� .E'-� INTERIOR SHEAR/HOLD DOWNSHEETWROCK/SHEETROCK SHEEXTERIOR LATH/W-SCREED SHOWER LATH NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIG SCRATCH COAT SEWER/WATER U J TEMPORARY APPROVALS OCCUPANCY ELECTRICAL GAS FINALS GAS TEST �. GRADE 01 FIRE HANDICAP ELECTRICAL PLUMBING —Q I MECHANICAL - _-p ENERGY CERTIFICATE OF OCCUPANCY ❑ VISUAL FINAL ONLY BUILDING IMPORTANT: ISSUANCE DATE -, OCCUPANCY OF BUILDING IS NOT PERMITTED PLEASE READ REVERSE SIDE BEFORE UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!! `- INSPECTOR. I ISSUED BY: APPLICANT'S POSTING COPY