22012 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building project Identification PERMIT NO.
Building Address: 22012
07k/ S. 6La0re �v�
c° am. on-. A
meraN on uGN a2 jS� CITY OF CUPERTINO-BUILDING DIVISION
"`n °'• ams: Lie.No: APPLICATION I PERMIT
BUILDINGELECTRICALPLUMBINGMFf_HAMCAL CATEGORY CONTROL N
Architect/Englnrer. Lie.No:
Qn ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addrcn; PERMIT ISSUANCE x ❑ ❑
LICENSED CONTRACTOR'SunderDECn.of Chapter
I�J LL
T hereby ion70that l am licensed under Business and Proeag.ra de toulm APPLIANCES-RESIDENTIAL JOB DE5CREHON
Ingwith1 .fail force of d efeIon3oflhegualnessand Pro/emlonsCade,and my
IcensebIns force end effect. PANELS
License Cbv Lic.X \
-_ U7ate Cont.cior
ARCHITECTS DECLARATION 201-1000 AMPS
,ppW+Owre ZO - I understand my plana shall be used as public remNs. OVER 1000 AMPS SQ.Fr.FLOOR AREA S/SQ.Fr.
E L�j Licensed Professional SIGNS ELECTRICAL
fn 6 • OWNER•BUILDER DECLARATION SPFGIAL CIiCUIT/M15C
7F. g Ihrmbyaf1mrthatl amexempt from the Contractor's License Law for the
following reason.Section 7071.5,Business and Pm(eeelons Code:Any city or TEMP.MEM ORPOLE INST.
p4 O , county which requirwa permittomrotrun,alter,Improve,demolish,orrepair
q' nystmc mpdortolts6wance,alsorequlreetheappfiantforsuchpermitto rNL POWER DEVICES file a pgned statement that he b licensed pursuant to the prova;kag of the
3q� Contnctor'e License low(Chapler9(mmnnncing with Section 7000)of Dlvi-
SWIMMING POOL ELECTRIC
slon3o(the BusinemandIm mimuCWe)orthat hebexempttherefromand OUTLETSSWITCHFSEKTURES VALUATION
x' the basis for the alleged exemption. Any violation of Section 70315 by any s
<$ applicant fora perratsubjects th-applicant to a civil penalty ane!more than 2V�
Cqrd
five hundred delta.ISM, NEW R
❑I,as owner of the property,or my employees with wages as their sole ESIDENTIAL ELECTR SQ.Fr. STORIES 7YPECONSIRIICTION
compson.d.n,will do the work and thearucture is not Intended or offered for
o .1.(Sce.7064,Business and Profession Code:The Contractols License Law
sR does not apply to an owner a property who Wilds or Improves thereon,and OCC.CROUI' RES.UNITS
who does such work Mmselforthrough his own employees,provided that such
4nprovereenb am not Intended oroffered for sale.If,however,the building car TOTAL: \
Improvement bsold within owrarofcompletbn,theowner-bu0derwlll have
tFp*rden of proving that he did net build or Improve for purpose ofukJ. QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
Lf I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to comtmct the project(Sec 7044,Huge.and Pros esslore Code:
The Contmen rf License low does not apply to an owner of property who -
ALTER-DRAIN AVENT-WATER(EA)
bulkls or Improves thereon, and who contracts for such p(ojens with a
��DtTacior(s)licensed pursuant to the Contractors License Law. BAIX FLOW PROTECT.DEVICE FEE SUMMARY
Lf I am exempt under See. B k P C for this region
Owner pais DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y_ N
_ _ RECEIPT If
WORKMAN COMP ENSATION DECLARATION � M SCHOOLTA% Y N
❑1 hereby affirm that I have a certificate of consent to se141neure,ora 'C-I--'i_ RECEIPT X
3800,Uteo(Worken'Compersatlon lrsunna ora certified copythereo((Sec. G EA.SYSTFM-1 INCA OUTL77S PARK FEE Y N
3800,Lab CJ
m RECEIPT
N
PoI1ryM C EA.SYSTEM-OVER4(FA)�
Cam any BUILDING DIVISION FEES
My
copy b herebyturnbhed. GREASE/INDUSTRLW I �. PLANCHE'CK FEE
❑CertBied copy b filed with the city inspection division.
CERTIHCATEOFEKEMPTION FROM' GHFA57RAI' ' PAID ' 1,NN`��
COMPENSATION INSURANCE SEWER.SANITARYSIDRM EA 2MFT Date Recd tif, L-t s
(Thisse.) need not be completed ItM permit bfor one hundred dollen60
(Sl armlythI. WATER HEATER W/VENT/ELI:CTR ENERGY FEE Y N
I rent em t o the person In anf!manner so as to b curhis pertNt is booed, —
I shall not employ any person f any manner ro u to berome subject to the WATER SYSTEM/TREATING G
Workcrs'Compewtbn Laws o(GEomis.Date PAID
O Z Applicant
Z O NOTICE TO APPLICANT.It,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ.FT. Date ReCel t#
Hshould become subject to the Workers'Compenut ion provisions of the Labor TOTAL:
N
Code,you=at forthwith comply wlthsuch provisions orthb permit shall be IN s
j deamad revoked.
LU
O CONSTRUCTION LENDING AGENCY SEISMIC FEE 1-06
= Z m Ihereby affirthat there is a construction lending agency for the perform ELECTRIC ELECTRIC FEE
ar \
, ae of the work for which this permit Is busied(Sec.3097,Civ.C.) PLUMBING FEE
U O Leeader'.Nam
IL 1- lendee.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W I mAifythat l haveread thbappliationand state thattheabove Information
bcarrea.]agree to comply with all city and county ordinances and pate laws PERMITISSUANCE FESS PAID:
} IL a relating to building construction,and hereby authorise representatives of this
F N city to enter upon the above-mentloned property for inspection pu rposes. ALTERORADDTOMECH.
? Mr)agree to save,Indemnlly an d keep harmless the City of Cu proino Dale ReeCIPt#
V aga last Liabilities, caps and exp-noes which may In any wayamue AIR HANDLING UNIT 8010,000 CFM) SUBTOTAL'
aga lmt said City In consequence,of the granting of this permit.
n 0��� 5� AIR HANDLING UNIT(OVER 10,0DOC1M) CONSTRUCTION TAX
Slgnaromid pliIlam+/°Contractor Date EXHAUST HOOD M/DICT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuturebuiding ompant store or handle havNous HEATING UMT(TO IDg0W BTU)
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Reeei t#
I Ieakh and Safety Code Section 75532(a)7 HEATING UNIT(OVER 100,000 BTO) TOTAL: l
R
Yes MN.
Will the applicant orfumm building occupant use equipment ordevkes VENTILATION FAN(SINGLE RESID) - CE DA'Z'E
which emit hanedous air contaminants as defined by the Bay Area Air
Oi�ua Illy Management District? BORER-COMP OHP OR 1W,IXq BTU)
4Yes he �No FOCI)
have read ealth&hazardous materials reons 255nlsundernd 2S5r6.95of BOILER-COMP(OVER 100,DOOBN)
the California Health A Safety Code,Sections 75505,75533 and 75536. I
understand that lithe buildingdoesnot currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.FT.
capon lbility to notify the occupant of the requirements which at be met
prior to Issuance of a Certificate of Occupancy.
t
Owner or authodud agent Data ISSUED BY:
TOTAL:
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING 2P p,IT®n�[�
CITY OF CUPERTINO
INSPECTION DIVISION tw
JOB INSPECTION RECORD
C 1 �` PERMIT EXPIRATION
JOB ADDRESS 1014% �+� �`�r1v'�_f UNIT,'*--LOT#
n PERMIT EXPIRES IF WORK
OWNER O CONTRACTOR Uowwjrp,Q. IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAV F
FOUNDATION -A> '9 7 1 --If TT NOTE: L °Y I T
UFER ALL GRADING AND DRAINAGE SHALL BE INSTALL;
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY' IE r
CUPERTINO STANDARDS.
GARAGE SLABS FEB 12 1993
POUR NO CONCRETE UNTIL ABOVE HAS-BEEN SIGNED !3' -z,=9g
UNDERGROUND /SLAB O S ert� jI6-@_ ✓ pppL�l
PLUMBING , In
ELECTRICAL
BLDG ELECT PLG MECH.
MECHANICAL El
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT-
INFORMATION
INFORMATION
WOOD FLOOR
VALUATION SIFT,
PLUMBING
MECHANICAL
PERMIT To
ELECTRICAL
FRAMING
INSULATION STORIES TYPE CONSTR
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNE
50 FT FLOOR AREA TOTAL ACREAGE
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE
1 • DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING
RES IND CON PB Omer
APPLY.NO ROOFING UNTIL ABOVE HAS BEEN SIGNEDI FINALS DATE INSP. EL El ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SAN.4
PLUMBING ELECT.ENERGY
TRACT NO PARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICALBUILDING ENERGY ACC DATE ACC FILE NO
- j-
FRAMING ELECT.FINAL TEST
zoNlNc ENG SITE No.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T 24
MECHANICAL v ❑ ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD zonE ALuc
INTERIOR SHEAR FIRE DEPT. _y YEj N� v Ll N�
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH 1117 BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED occuPANcv SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
� � ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING '
l 0 PLEASE GIVE JOB ADDRESS WHEN PHONING.
— SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY