20647 / APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.0 6 4 7
BulldingIAddress. 42 5 IkV .
CITY OF CUPERTINO-BUILDING DIVISION
ce/Rractml are: 1L .No« APPLICATION I PERMIT L
y S 1 os APPLICATION
MCAL CATFGORY CONTROL#'
Architect/Engineer. Llc.No:
/� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
_ 1 Address: PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION E] EJ
I hereby affirm that lam licensed under provlalmsof Chapter 9(commem. AP JOB i JOBnDES`CRIPTION y'
ingwith Section 70M)ooff�DDivislm3 ofthe BuslneseanciProfessions Code,and my PANELS rj-s�-0.lt (��1N OL /-
Lmnsaetsinfulllgxq"ILdce». �}e Lr�It ,,f( ^S ,,. 'I,
Date iI I Contractor J O II �1- I(I �+I WL4 QIl
•••/// ARCHITEe usedDECLARATION OVER IOAMI'^'
0 CpC ]understand my plan eMR be used ae public records. OVER IOW AMPS SQ.FC.FLOOR AREA g/�.Ff.
iL U Licensed Professional SIGNSELECRICAL
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC
2s, 1 herebyaffirmtlut I am exempt fromthe Contractor's License Law for the _
oo following reason.(Section 7031.5,Business and Professions Code:Any city or
O 2 H f�
TEMP prior
.METER OR
POLE INST.
county which regermlto ph,orre
anyatmduim tolmIaalso rmquiresthealicamforsuctto POWER DEVICES
file a signed statement that he Is licensed pursuant to the provisions of the
3w
Contractor.Lt..La.(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC VALUATION
shot 3 ofthe Buelneas and Professions,Code)orthat he is exempttherefrocrand -
Gthe basis for the alleged exemption. Any violation of Section 7031.5 by any I �1 •�
O applicant fora permit subjects the applicant to a civil penalty of not ndfithan OUTLETSSWITCHESHXT[1RE5 /LT t
flue hundred dollars($500). NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION
j m pe as owner of the property,or my employees is with wages r offereir d
for
compensation,will d Business
ando the work,and toes Code:
ha not intended License Law
O sale(Sec.7044,Buelneas and Professlom Code:The Contractols License Law
�$ does not apply to an owner of property who builds or Improves thereon,and OCC.GROUP RFS.UNITS
who doessuchworkhlmaelorthrough hisownemployees,provided thatsuch
improvements are not intended oroffered forsale.If,however,thebuilding or TOTAL:
improvementbsold withlnoneyearofccmpletlon,the owner-buaderwfli have
III rden of proving that he did not build or hmpecve for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE -APN
�I,as owner of the property,am exclusively=trading with llmnsed PERMIT ISSUANCE
contractors to construct the project(Sec.7D44,Business and Professions Code:
TTM Contractor's Limns.Law does not apply to an..or of property who ALTER-DRAIN&VENT-WATER BEA)
builds or Improves thereon,and who contracts for such pUojects with a FEB SUMMARY
cq¢[facmr(e)Brenaed pursuant to the Contractor's License Law. I g PRO D
LJ I am exempt under S.c. B&P C for this reasonV OUTSIDE FEES
D'NS HDOIR ROOF,AREA;CbMJ. SANITARY Y_ N
Owner Date RECEIPT#
WORKMAN COMPENSATION DECLARATION e
I]I hereby affirm that I have a cortlfirate of consent to.elfAmo re,or a S PER I-RAP' u SCHOOL TA% Y N
ormificate
Workers'Compensatlonlnsurance oraceratted copytherm,iti c. RECEIPT#
3800 GAS SY -1 PARK FEE Y N
• Policy# 01 `W�1 Ii+I -1GT -9 — RECEIPT#
Com any
�S i,O.i'tOi BUILDING DIVISION FEES
ffCcrtlticdkp whereby futo1 ed. CREASE/1NDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
�rtlfied mpy b filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 200FI Date RCCeI t#
-(Thissectl.n need not be completed If the permit tsfor one hundred dollars
($100)or less.) WATER HEATER W/VENT/E.ECTR ENERGY FEE Y_ N_
I mrtifythat In the performance of thework forwhlch this permit to Issued,
I shall not employ any person In any manner m as to become subject to the WATERSYSTEM/TREATING
Workers'Compensation Laws of California. Date PAID
ZZ Applicant NEW RESIDENTIAL PLMBSQ.FT. .Date Recei t#
Q NOTICE TO APPLICANT.If,after mak .malting this Certificate of Exemption, .
should become,subject to the Workers'Comperuatlon provisions of the Labor TOTAL:
F N Cade,you most forthwith comply with such provbhom or this permit shall he
W j deemed revoked, BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL Iherebyaffirm that there b a construction lending agency for the perform- ELECTRIC FEE
D ZO ante of the workfor which this permit is Issued(Sec.3097,CIv.C.) TOTAL:
V _ fenders Name PLUMBING FEE
LL f Lenacr'.address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW I certilythatl have readtM1bappliwtionand atstethattheabove Information - qq
1 is correct.I agree to comply with all city and county ordinances and elate law. PERMIT ISSUANCE F� S
relating tobuilding construction,and hereby authorize representatives alibis
he above-mentioned property for Inspection purposes. ER ALTOR ADD TO MECH.
Z city to enter upon tDate' Receipt#
(We)agree to save,indemnify an d keep harmless the City of Cupertino
V against llabl fles,Judgments,mita and expenses whichmayfnan ova accue AIR HANDLING UNIT HO 10,000CFM) SUBTOTAL:
against tial Ci rl nscqu ceo the granting of this permit
z AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of Applhcent/Contractor a EXHAUST HOOD MI DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or M ndle haeardous HEATING UNIT(TO 100,000 BTU) Date Recei t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Flealth and SafetyCode Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
f1 Yes MN.
Will the applicant or future buildingoaupant use equipment mdevices VWITLATION PAN(SINGLE REBID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air y�,p,p
�ality Management Distrhct7 BORER-COMP GHPOR 100,000 BTU) RJUD
u Yes n No
IM1ave read the hazai3Ous materials requirements underChapter 6.95 of BOILER-COMP(OVER 100,000 BTU) Un �p�J
the California Health&Safety Code,Sections 25505,75533 and 25534.1 JUL P J
understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQFT.
responsibility to notify the occupant of the requirements which must be met
priorto issuance of a Certificate of Occupancy. ins Of Cu Ino
Owner or authorized agent Date ISSUEDBY:✓ e7 ��
TOTAL:
OFFICE COPY
PFRMITNO.
POST THIS CARD NEAR FRONT OF BUILDING 20647
CITY OF CUPERTINO A A
INSPECTION DIVISION- JOB INSPECTION RECORD 7- -2---`f(7
n
B ADDRESS rI �/ II l UNIT# / LfOT^# CONTROL#
CATEGORY
ER
�u - �•CONTRACTOR \ G1l /oC C BUILDING PERMIT INFO
IN
DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIERS NOIE ALL GRADING AND DRAINAGE El 1:1
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH IOB DEBCRIPDON
PAD SET BACK-CERT CTHE UPER APPROVED
NOY IANDARDS. OF k7rgl/ ; X
GARAGE SLABS PREGUNITE f ..S�P�• I
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION DATE INSPECTOR
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
(v4\ MECHANICAL
ELECTRICAL
FRAMING/VENTS/CLEAR
INSULATION
/ PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI-BOND
FRAMING/STAIRS
INSULATION/VENTILATION
EMERG.EGRESS
SEWER WATER
^OVER.NO WORK UNTIL ABOVE HAS BEEN SIGNED
TERIORSHEAR HOLD DOWN
TERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
NO TAPE OR PIASTERUNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFOP,E
THE CONSTRUCTION TAX/S PAID `
FINALS DATE INSPECTOR
SAN.#
ELECF.ENERGY
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUM13ING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING ISNOT TED U L AAT�
BUILDING FINAL 19 SIGNED BY BUILDING INSPE R P ''N�
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN JUL 0`: 1�3y
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT# ARE NEEDED WHEN PHONING. F Cenert!nn
IMPORTANT! �� 9G([C f I
PLEASE READ.REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED BY.
I
APPLICANT'S POSTING COPY ��