S 2799 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY CW CUPERTINO BUILDING-ELECTRICAL. PERMI
BUILDING.IIIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL (N n (](J
' BUILDING PROJECT IDENTIFICATION J G J J
13111LDING ADD^RESS: SANITARY NO. APPLICATION SUBMITTAL DATI
o/i/ -28
WN ;S NAME: / PHONE: CONTRACTOR'S NAME. LIC NO:
SC NIC CONTROL%
RC TEC'I'IENGI L' LICNO: _ f ADDRESS: ❑
CONTACT. PHONE: - BUILD GPERMIT INFO
❑ Consultand Fucs Paid by Applicant(initial) BLDG
ELECT PLUMB MUCH
u
LICENSED Co ACTSDhC1 AHAlION
QTY. y 1 ELECTRICPERMIT FEE
JOB DESCRIPTION
1 herby a8nm tht l I' dunder
3 w rho Section AI00)of D - 3oftheBus adP nfetsmf Code,aedm eg IAL:
Iy,� � � y�yense i.0 PERMIT ISSUANCE "D-WL ❑KITCHEN REMODEL
FFy� -n full force and ellen Off/
dVZ0 license Class Lie If - TG Doto TS mi APPLIANCESRESIDENIAL
r- El ADDITION ❑PLUMBING RE-PIPE
m 6
ARCHITECTS DECLARATION - PgryliLS ❑MULTI-UNIT El STRUCTURAL
y0y l understand myplans shall beuseaspubl'mreeords MODIFICATION
OZ4g 11P'f0200AMPS ❑iNTER10R El CHIMNEY REPAIR
F 11F W Licensed I'm e,irm0 201-1000 AMPS - IMPROVEMENT El SWIMMING
X ,'Jj OWNER-BUILDBR DECLARATION OVER 1000AMPS El BATA REMODEUREPAIR El DEMOLITION OLS
C W Q I hereby affirm that I am exemptm
from the Corvcmr'e License Law for the
W a11 U fnllnwing rayon.(Section]031.5,Businees and Pndessirm Cnde:Any city or erunlY SIGNS ELECTRICAL ❑OTHER
a•h which requires a permit o construct,all,improve,demolish,or nindr any structure
�y prior to its issuance,also requires the cold and for such permit to Ela a signed aWlement SPF,OI A I.C I RCUIT/MISC.
<� that he is l censer Internet to the provisions of the Contractor'a License Low(Chapter 9
x.. 0 (commending with Section 7000)or Division 3 of the Busi nessond Prof L;
sons Code) TEMP.METER OR POLE I COMMERCIAL'
dy p, that he is exempt therefrom and the hleeis for the already exmnptfon.Any violation of
iC�as NEW BLOC/ADDITION El DEMOLITION
Section any applicant Fire subjects Os applicant In acivil Penalty of POWER DEVICES TENANT ❑FOOD SERVICE
F � not moo than five hundred dollers($500).
I narwneraf the IMPROVEMENT
❑ pm"actur my not withwuaesoside(ace 044,Booness SWIMMING M)OL P,hP.CfItIC
F will Jathewrrk.nndlheatnmmmo iaternhmden Law dosfor otl sandy
Baseness ,HER
end Pmfoesiona Cnde:'1 he Cnntmclora Lledme Law Jxe not apply m an owner of WTLLTS-SWITCHBS-FlXTUHES
4i pmpeny wM10 lurid.ar lntpmvev Werenn,and who docs snob workam ref nrthmugh
his own employees.Provide that sail.In.ITrrvements are net incurred or offered fnr NEW RESIDENTIAL ELEC!'R SQ Ff.
,old.If,however,the mightier re man is sold walmatine ycm.1t cont,imirnthe SQ FT,FLOOR AREA $/S@FI'.
eoticilder will have the harden of Proving that he did not bold or improve for pea'-
Poseafsola)-
:1 1,m own of the poccurry, a ohnnedun,with cC crntmdrrs m TO
//V
constructd p j t(Sea7044,B :irc,.,to iC Jc:)The
_ Contractor's L' ,
causeLa d I apply to fp pity n builds aimproves.heard,and QTY PLUMBING PERMIT FEE 6A
who .acts fnranchTowards tlacmmertr(Jlmnsed pursuanmthe Chace,,,
License Law. PERMIT ISSU 'E
❑ I can exempt under Seo. ,B&P C bahia ration
r Dole ALTER-D E T-WA'fEli([:A)
VALUATION
rte WORKER'S COM PENSAI'I ON DECLARATION BACK FLOWPR CE
1hereby of ran under penally of pe jury one of the following declarations:
I haveend wit l maintain a CanlGeate of Gtnsenl to sel f-insure for Worker's Colorado. DRAINS-FLOOR,ROO, OND. STORIP.fi T ECONS'BUCTION
sadon,as provided for by Section 3700 of the Labor Code,tot the pe ro mince of the _
work lin which this permit is issued. FIXTURES-PER TRAP 1 1
❑ 1 have and will normori Worker's Compensation histamine,as required by Section '•IV/
3700ofthe Labor Code,for the parfcamuccof the work for which this Pemdl is issued, GAS- ^ OCC.Caputo, �yJ Ptd
My Wa.r / ncecutrieay
Carrer / � / LPolicy Nor
0at7? GAS A 'YSTE 1IVti (HA)
CERHFICATEOFEXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE GRED' 1 DUSTRL WASTE INI'EHCEPTOR BIIILDIyO�IVIS[ON IYfS$,
a s `
or lessall,. man,need not be complete iflMpcomi,prince hundred dollars($1(0) GREA APF1PR 1 9D v
LANCHI C
I cern fy that in the performance of the work for which this permit is issued.I shall _
nm employ any person In may manner sr as m become subject,,the Wnrkcrs'Compen- SHWE SANITARY-STcM"UA.mail,. ENEH V "•f T
Q Z scion Law,of Colifcniv,Data WATP. h rA'IY?R W/VENT2LP.CTR /'CJ
zO Applicant G rjy13E
ti r�jt NOTICE TO APPLICANT:11,one,nuking this Cghfi,hc of Exemption,yon ahonld WAGE
a become subjem to the Wrrkera Grmpenmtion provisions nl'the Labor Code,you nmol f -nA
SOLI FEE
W forthwith comply with such provisions or this Permit shell be deemed revoked. WATER SERVICE
Q Q
CONSTRUCTION LENDlNG AGENCY NEW RESIDF,NTIAI.PLMB. SQ,FI'. PAI
V I for
rwhichrm dam thaoiasued( ectirmlending agency for the performance of 'm Receipt#
w U Thework f which this p fl . :nue(Se 3097Civ.C.)
Q Lender,Plain, T J1
Lead AddressTOl L. e C)
On I n eto co h ell Induction J el ce Farthest, 1 ti nn 13111E G an C)
rn
correct I a ply ten city authorize q d d i t 1 1 a g m QTY. MECHANICAL.PERMIT ! FEE'
U abovebuildina onedaroe d forebyrchalprepresentatives of this citymcncr upon the STSMI
abovca(WO a ed Property for emnify an purposes. PERMIT ISSDANCE
(Wc)cera to cove,indemnify and keep hvmtlecs the City of Cupertino vaginal BLP. C PGE
liabilitics,judgments,coatsand e,pah,ra whugaidynt any way accrue against said City ALTER OR ADD TO MECIL
a consequence of the granting of this permit. PLO ING FEE
PLICANT UN RS'IANDS AND WILL.COMPLY WITH Ahl.NON-POINT AIR HANDLING ON['1'(TO IILIHI)CPM)
S MGCHA CALNEE
AIR HANDLING UNIT(OVER I0,110NI CFM) CONSTRUCTION"[AX
SignamrcofAppliant/Contractor 'Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATI NPEE
HAZARDOUS MA' .RIALS DISCLOSURE. 1
Will the opplieartor future buildfna occupem,nore of handle hazardous material HEATING ONI'ITO 100,0011 BTU)
as defined by the Cupertino Mummi ed Code,Chapter 9.12,and the Hedlh and Safety
Code,Section 25532(a)'! ,c.� HEATING UNI I(OVER 100,000 BT UI
El Yes L�wu PAID�'r
VENTILATION FAN(SINGLE RESID) pale Be dA
Will the applicant or future building occupant use equipment or devices which
III haealloue sit contaminants is definrA by the Be,Area Air Qmality Menagemem BOILER-COMP(3HP OR IIX1,000 BTIl)
vow,I AE
❑Vex WNW- BOIhP.R-COMP(OVF.R 100,0008'IV)
I have iced the hmmdoua materinlsrerequirements under Chapterfi95 of the Orli- AIR CONDI'f10NER ISSUANCE.DATE
quveme
tomiu Health&Safely C Se lions 25565.25533 and 25534,I understand that ifthe NEW RESIDENTIAL.MICH. SQ.Cr
indr,pl dpc eWa..pthud it is my responalhilily lr notify lboomuPant
of the t 'ren �s tact per
isauan ,face m O
Owner of concreted agent it, CDale O
/ ISSUED BY:
OFFICE
FROrt-: CLP'ERTINO CONSTRUCTION, INC. FAX NO. . : 408 253 6609 Dec. 13 2000 02: 19PM P2
POSTTHIS CARD NEAR FRONT OF BUILDING
CITY OF Ci1Pp:RTINO - _ - .. .. - -. ..-rI) 'Nn w.'.�I�,'Q�
OUILDIN6 DIVISION Zi H�
BDILDINI:PRAIECT IDENTIFICATION `` i i v
BUB DING oUURESS: - .
/ SAN!Tn Y NO. APP TIUN SI!NMEA
x+ S �:// r- �� q 1 �3 n��yC CONTKM:IVK$NAME:
R Wil',HN N LIC N0: AMINESS: ❑
''• BUILDING PERMTT•)NFO
INS S__; DATR INSPECT. ❑ Cunxnitant Feex Vnw by 4ppiium(Ininep _�— Hyq,�U
❑ o
FOUNDATION(PIERS/H.U.S. INSPECTION RECORD
,308 DESCRIPTION
UFER 'ROUND NOTE: ALJ. GRADING AND DRAINAGE•
AD/SET BACK•GERT •.�• : SHALL BE INSTALLED TO COMPLY WITH - spDwL U KITCHEN REMODRI
HL• APPROVED PLANS AND CITY OF UADDITION ❑PL(IMBINO RE.PIPR
CARACE SLAES/PRFOUMTE CUPHRTINO STANDARDS. LJ MUCII-UNI' U.STKUCI'URAL
MODIFICATION
:P[)l,)R NO CONCRETE;UN T1i sAEOVg'iiAS BE[IIN`;S1G138u, TO ARRANGE INSPECTION VIMRRIOK UCHIMNHY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PM - 4e30 PM) IMPROVEMENT ❑Sw'IMMINr.POOLS
PlAWSING 777-3228 MONDAY TO FRIDAY 2a HOURS BE- r7 BATH RBMnnF.I,rREpntR ueMounary
t1 mxeR
ELECTRICAL FORD, RFiQU1RED INSPECTION.1OR ADDRESS
AND PERMIT#ARE NEEDED WHEN PHONING.
D¢}IYOT,P,QUR"FLOOR UNTT,fs>�OVEdir�M BCLN�fiTG COMMERC)AI_:
PLUMBING yy. ATTENTION CONTRACTORS: 0NEW BLMIADDiTION ❑nEMOUTION
MECHANICAL NO PERSON(S)SHALL PF-RFORM WORK ON OTENANT 0POOD SERVICE
"1 '9 .._ THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
P.LHf:T'Ri('Ai.. PL.IANCE WITH WORKERS'COMPENSATION ponlDR
FRAMING VF,N'TS y--qq INSURANCE REQUIREMENTS. -""
INSULATION J INSPECTION SPECIAL INSPECTION REQUIRED E..] DATE INSE
i¢1;ASJ3NOSftIiFL00R;UNTILAIIOVE J3E NIti7CPNF]i,.',�
_ Fr .
ROOF SHEATH/DIAPHRAM _
PLUMBING
TUBS&SHOWER PAN T
3CHANICAL
ECTRICAL/POOL BOND
U —
FRAMJNG/STALR$/E.EGRESS
INSULATION/VTiNTILATION
,DOVER NDN!;ORk U1y'171pw90v$HASB„ SI ,:..:'r{!,%„ _
=- -RIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN -._...,.._--
SHL•ETWROCK/SHEETROCK SHE
EXTERIOR LATH/WSCREED ..,.,_...._,._.._
SHOWER LATH
;NOTAP80RPLw�UNTpL'AB V$Hi5.9EE'Ii,SICyNPp;:
SCRATCH,JCOAT --T I'•
WB ATER .L ..�.......� n 1'-.,.� IT•"!
ORpR9G'gPPROVAIS; .,, d sw EI, Lj! i.
OCCUPANCYI
ELECTRICAL
GAS 7 JJ
.,' ..�:•-moi:=.
ii�t�L$x�, :,;±?.:ibC!Ifl.£ifi�:li'�iSo��i!°u�V�STi'✓Rro1�i�J6i .ia a+ "!!/[:�
GAS'I'EST -'
--fit OIL
GRADE /S' CID -__.........._......_
FIRE
HANDICAP
EL£CI7t1CAL ... / 4q """�'"-
71—
MHA
MDING
ECHANICAL _ /
4' ENERGY . .�
VISUAL FINAL uNLY f F.TtTTI'(.4TF. QF QC-1C LTP,ANCY❑ _
BUILDING / S OJ IMPORTANTI i 1 ISSIrNr.R DATF.
roGr�UpaNO, �1,p yI IM TrS Y PLEASE READ RRVF,RSF, SIDE BEFORE _7
Nw,{¢,W— CALLING FOR FINAL INSPECTION!!
s),ISI,SFR Prir+ iVlyuA n:�)iyd�'4ris Po illy rclil xlil). ,, I ISSUED BY.