31042 APPLICANT TO FILL IN INFORMATION WITHIN RED,LINES-OSE BALL POINT PEN'O'NLY
CITY OF.CUPERTINO BUILDING-ELECTRICAL PIIRMI I NO
BUILDING DIVISION APPLICATIONITERMIT PLUNIBING-AIECII, 31042
BUILDING ADDRESS: BUILDING PROJECT IDENTHI'lexrioN
SANITARY NO APPLICXI ION SUBMITTAL DATE
10 tic) ic-L—ReD
Az
JOWNER'S NAME THOSE'
;-TA K)le-r—mm_k Ci�- NOC CONTROL 0
'_�R&TrEff"GNEER LIC NO. AILE)DRESS,
CONTACT. PHONE:' BUILDING PERMIT INFO
Consultant Fees Paid by Applicant(Initial) BLDG FLECI P[V MECH
LIC17NS12I)CO�RAMORSI)ECI,ARATION QTY ELECTRIC PERMIT FEE
a8ZI inachy aff'71"that I ma licensed uru&,Provisions of Chapter 9(commencing JOB DESCRIPTION
is lit"�num 7prin" own.not the Imone,,and pool a,,a i, "u an or, al
0 S03
I- in LEE home and effect PERMIT ISSUANCE RESIDENTIAL,
0 SFDWL HEN IiEMODE
v4 I.,U License I Lic. !VP
'��w Den. Continuator t--iqj 1, 1 joki-mob- APPLIANCES-RESIDENTIAL OADDITION 0 PLUMBING RE-PIPF
E�D�� ARCHEFE�CTS DECLARATION []MULTI-UNIT []STRUCTURAL
Z0�7 I.nde.... PANELS MODIFICATION
1 024 a UPTO 200 AMPS El INTERIOR 0 CHIMNEY REPAIR
r4tw Licensed Pooficaawnil 1201-1000ANIPS
�j " - OWNER-BUILDER DECLARATION I ROVEMENT
W< I minis,affinnom,I a.�,Lan,,,from ],a Contractors License L., In,me I OVER IOCOAMPS ZATH RENIODELIREPAIR C3 DEMOLITION
OAI�Iuu'onclano tSIL'a 703 1.5,Humnevs and P fi,,,uvu,C CIOTHER.1
11,omstrun: ihonaluilbod. Any`oly,-'om2
W which ro,tiunciri limmus arvEaur. vuerem. SIGNS ELECTRICAL
prior to its issuance,also requires the applicant for ineh pernunt UI,.Eiltn�,��oi� SPECIALCHICUITIMISC.
ce w
:")T�iiiencingwiihSectit)�7NX))oI loor THMP.NTE114,R OR POLL INS U COMMERCIAL,
ta. In.,hen,asmoint davo,frourand Ill.hat...farde,alle,a] onourplum An, mhuamof [j NEW BUDGIADDITION 0 DEMOLITION
�ectum 70315 by any applicant tor a Permit subjects the applicant to a civil Penalty of P
not more han five hundred dollars Win)) �S OTENANT 0FDOOSERVICH
OWES DB
El Las wh,,.ftkEmamy......ILI,.with duormA,,ompars.'U., SWIMNUN E RIC IMPROVEMENT
2 I'D it,)the walk.and Ohn,,nournum n,rictuntomod mofnon!fir,110(Sea 70a,LB.,ouvw E)OTHER
W and Professions Code:no Contractor's License Law drics nor apply to an owner of o_oo_F7m_&Ts�ffHCx]TRES /A 7h
propeny who bonds or unproves thereon.and who does sudi work hirh�lf or through
his n.o cantiloym,p....dvd he,...IS inninow,omod,am OI�f'c'rod NEW RESIDENT6�tt�R
valf, .cdp,.," SQ F-r. SQ.F-L WGOZAIIJ;F�' $/SQ FT
avvwvlhoddi�ILI]I'me On,hand,noPnovol,demhedud in,
pn'nf.le.)
Ol,asown�r�)?�epro�hy,ainexclu%lvelyci)ntiacting,v TOTAL
commect the protect(Sec.7044,Business and Professions Code:)no C.."come,Ij- MR.,- 7 REC.'a
acneve Law don�an,apply 1. it owner of property.no hold,.,impro,i,,,than..,tend
,he sunnes,61 It protons with a ounhou,nan) nomwd Em, I QTY. PLUMBING PERM IT 17EE
License Llw. tem,to the C.nt,.an.,', CII I V r '�Urrh I INC
E3 In."nontal under See. k
11 C to,'his"'eur FRESH I Is A�
u,ne, A LTER-DRY41slj^E NT-WATER(EA)
goo I VALUATION
WORKERS COMPENSAI ION DECLARATION BACK FLOW PROTZ_PTEVICE
I hereby Mr. ndin-Earmll,afileem,ma fine fiafl..oa,dfaA.annma,
ker,Cupolne -3.
I a- DRAINS-FIO��RUOAI, RE ONO STORIES TYPE CONSTRUCTION
namne�peavubM for by Sontrat 37M of the Labor Code,for me penformarove of I,
work for which this ELL,...ill I,i,,.,d. TTFIXTURES-P NIAP.,,'
[] I have and w in neontain Worker's Compensation Insurance,as required by Sea I
37M.1 the Later Code.nothe pedurrism. fim, .,it for abullu this ponnot is imed A S-E A.s Y s-m NE,�ii Nl I L-E I.k
Nlywo' 'C ndPoln,, ilk,0,141 OCC GROUP ARN
Carth,'., t tgg�al "on"Policy GAS-EA SYSTIN-OVEIR 4pil
CERI MIMI'r,"N.EMPTION FROM.WORKERS' GUEASMNDUSTRL WASTE HST�l R
COMPENSATION INSURANCE I
(The,walmo.v,d]net ta,�uo,qehai it the numall)s Orono hundred notice,S IOU) BUILDING DIVISION FE
or hes'.)I ceftify that in the 1. 1 1 GREASE.IR�P PLANCRECK ITE
Performance unhe work for which this portion is issued,I shall
Z not employ an,Eaoroo anynamt,,,v,a, ,,ke...avadva,u,he"Wier,'Coul SFWER-SANITARY STORM EA 200 FT ENERGY PER
0 'ahan hits'nfahmem.,Date WATER HEATER W/VENTULECTR
z 0 Applicant GRADING Firm.
NOTICE TO APPLICANT If, fair nookun,this Cmhfi�mlc of E,nonnim,you should WATER SYSTCMffREAI ING
t,ecome subject t�the Worker's Compensation provisions of me Latour Code.you mus, SOILS PIPE
tonlewith comply with Stich pro,knumi,this pornaushAl he dicarml re...ved. WATE R S 17 RV I C E
z CONS HRUCTIONILRNDINGAGPN�Y N17W RESIDENTIAL PLIM. SQ.hT PAID
U 0 1 In.,ch,liffirm 11mOVre it.imouturnover krafin,none,to,he enfimaxiu,,of Date Receipt
'he-.Lk Jor which in oil(See,3W)7.Civ C i I -
I.,it BDTAL.
0 U a
o------- "so TOTAL
I cloudy Ohm I Innocoad On—E,Ukat a Lou]amac,lanflno base of mat or, BUILDING FEE
(Z) Correct.I agnetocomply wolualivity and county oredulancesand Slide law%oflulong to 33
U Z �QT Y MECHANICAL PERMIT FEE SPISMIC FEE,
ulano'c-imoun.ruol prolem,far inspection Exurprev, I PERMIT ISSUANCE. ELECTIOC FEE
(we'agree to save.indemnify and keep harmless(tic City of Cupertino against iL:1 j
luildhoes,,.netionno,costs and eSpenses wh ich may in any way acome against said AUTER OR ADD TO MECIT Je/ .6
in c of the ..run,�f this .it. PLUMBING FEE
OILICANT U ERSTANDS AND WILL COST WITH ALL NONPC AIR HANDLING UNIT(TO 10,000 Chid)
ERROLL IT
2 NIECE IANICAL FEE
I.AIR HANDLING UNIT(OVER (1,000 CFNU
'com, IKE Data HXHAUSTHOODOV/DUCTI -ONSrRUCLONTAX
HAZARDOESMATERTALS DISCLOS HOUSING,MH IGATION FEE
us definto]by the C.,mon.Miminivol ColI,:Chute,9 V2.
Will the...human m far..henhung ov,mianst,t000irliandh,meteadme,-.long HEATING UNIT CFO 100,0010 BTU)
he Brodd an',Sale,
Code,Section 25532fa)? H RATING UNIT(OVER 100.000 BTU)
#' C)Yea ' VENTILATION FAN(SINGLE BESIDE PAID
-ill e applicant or future building occupant use equipment a'it"' which Due, IOnocim La
Irlectoa=1.11 o.ufiunmuarr�as defined by tile Buy Area At t Quality Sau`�'Rm,cu, BOILER-COMP(.1 HP OR 100,000 BTU)
B
Lis in, TOTAL
6yis O<N. BOILER-COMP(OVER IDO,OOOBTU)
4
,a,6 AIR CONDITIONER ISSUANCE D
,14 L rely Cud�'Sc�aam,25501.25.533 Laid 21534.1 undeoland that it the NEWRESIDENHALMILCH SQ.vT
at,
aS
'a gd dos, ma� a any e a tenant.that it is my m%Earmarbiliny to notify the wropeam
I ur
if Z�k�orwhjch must la,me?prior to issuance of a Certificate of occupancy,
0 I)atc
0,-.F, r.admoical allc.W� 31 Y TOTAL ISSUED or
OFFICE
PLMNII I No
NIIILI)ING DIVISION BUILDING PROJECT IDENTIFICATION:
BUILDING ADDRI SS
IlUtlk]711ALDA�
C(,�I`RACTOR��NAME LIC NO
�QW!NERSNAME HONE
N/C LUNI RDJ�,ft,
7
L_Pc� r AL I
I I ITE Y-NGINHER LIC NO ADDRESS ❑
hL�.�l
IaN INSPECTIONS. ❑ Consultant Fees Paid by Applicant(Initial) I FILM ELECT PLUMB�7
MECH
El.
FOUNDATIONIPIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
UFFR GROUND I NOTE: ALL GRADING AND DRAINAGE RE CID .NT I,
PAD/SET BACK-CERT SHALL BE INSTALLED TO COMPLY WITH D SFDWL U46/TCHPN REMODEj.
THE APPROVED PLANS AND CITY OF ❑ADDITION 0 PLUMBINC RE-PIPE
GARAGE SLABSIPREGUNJTF I CUPERTINO STANDARDS. ❑MULTIUNIT El STRUCTURAI,
,f:.POUPINO,CONCRETE UNTIL ABOVE RA:S'13E- MODIFICATION
TO ARRANGE INSPECTION ❑INTERIOR ❑C14IMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (12:30 PM - 4:00 PM) U71TH RE ROVEMENT
MODEUREPAIR El DEMOLITION
III PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑0THER
ELECTRICAL FORE REQUIRED INSPECTION.JOB ADDRESS
l DO NOT POUR FLOOR UNTIL HAS BEEMSIGNEDI AND PERMIT#ARE NEEDED WHEN PHONING.
. .1. .1 1 1 1 .111, � j COMMERCIAL
PLUMBING ATTENTION CONTRACTORS: D NEW BLDG/ADDITION 0 DEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT 0 FOOD SERVICE
1p d THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
ELECTRICAL c7 rD I PLIANCE WITH WORKERS'COMPENSATION EJOTHER
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION SPECTION SPECIAL INSPECTION REQUIRED El DATE INSP
'PLACE NO SUBFLOOR UNTIL ABOVE HAS BFEN,SIGNE6,
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
0 ELECTRICAUPOOL BOND MAR -7 REPTI
-FRAMING/STAIRS/E.EGRESS
Cu v INSULATION/VENTILATION s,
I.COVER NO WORK UNTILABOVE HAS BEEN SIGNED
EXTERIAL SHEARMOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEFTWROCK/SHEETROCK SHEAR
EXTERIOR L
SHOWER LATH
NO TAPE OR PLASTER UNTIU`ABOVE'HAs.BEEN SIGNED_ft
SCRATCH COAT
SEWER/WATER
jR,TEI PDRARY'�d,PPIZOVALS"�' "A
. I'll 1- �'. .. ,11" , .�', s;
OCCUPANCY
ELECTRICAL
GAS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL PLUMBING 42-2- 1 r0 2 -17
� no
PLUMBING 2
MECHANICAL
I
'IWENERGY I VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY El
BUILDING IMPORTANT: ISSUANCE DATPI
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPE
S
ISSUED B1
APPLICANT'S POSTIN(-, cnpy