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19519 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - - lldingdsd*r.,. /� PERMITNO. Bu • 903 C-Ano 6X/ UQ : �.�� . 19519 _neresass: Phone:" G ),(/ F MA N'A/ ds 3 '3 9 g 7 CITY OF CUPERTINO-BUILDING DIVISION ' Contractor'aName: LIc.N. APPLICATION /PERMIT . Architect/Engineer. Lle.No: BULDINGEL. TRICA4I LUMBINGEC MHANICAL CATEGORY `CONTROL ..� d 6( SGL 'BUILDING PERMIT INFO QTY ELECTRIC PERMIT "FEE Addrcsa: _-. PERhETI55UANCE UrU —�i PLUMB MUCH ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby afffrmthat I am licensed under provisions of Chapter 9(commenc APPLIANCES-RESIDENTIAL )OB DESCRIPTION Ingwith SecHon7000)ofDtvlston3 ofthe Businessand ProfemionsCode,and my If..is in full force and effect. PANELS - - LianseCkeg LIc.11 Data Contractor ARCHITECTS DECLARATION 2(11-1000 AMPS /r' \Y\WYY "`111"' l L fl Ors O I understand my Plane shall be used as Public recon a. OVER 1000 AMPS C -SQ.ET.FLOOR AREA $/SQ.FT. (0 Licensed Professional SIGNS ELECTRICAL. / OWNER-BOLDER DECLARATION ` o❑❑❑y (here afRrenthatlamexamptfrothe Contractor's U License Lawforthe SPECIALCEiCT/MISC 0 2 F following reason. m(Section 7011,5,Business and Professions Code:Any city or - - Fcounty which requires a permit to censtruct,alter,improve,demolish,or repair TEMP.MEEK OR POLE INSF. any s[mcmre prior to Ib Issuance,abo requ Tres the appllant for such perndt to O Ble a signed statement that be lelkenaed pursuant to IM proWeioru of the POWER DEVICES 3µD Contractor's Lkerue Lw(Chap[er9(commencing with&ctbn 7000)of Divi- SWIMMING POOL ELECTRIC 1-, don3 ofthe Businessand Pro(embrc Code)&rtbethebexempttherefremand VALUATION G the basis(or the alleged exemption. Any violation of Section 7LR1.5 re any ^> OUTLETSSWITCHESFIXTURES / [� '7 a 0 0� appBant(ora permit eubjectsthe applicant t&a civil perulty&fnU more than .-3 G-- five hundred dollars($500). �n I,as owner of the property,or my employees with wagn as thetr sole NEW RESIDENTIAL ELECTR SQkT, STORETYPE CONSTRUCTION mmpeneatlon,wllldotheovork and theetructure b not Inlendetl or offered for O sale(Sec 7044,Bueimss and Professieru Cotle:The Contract&,Elsa Law c.�' does not apply to an owner of property who bulMe or improves Nand who doeeeuchworkhimsel(orthrough hlsownemployees,provided thatsuchOCCCROU' RES.UNITS Improvement.are not lManded oroffered fo .k.IL h&wevey thebullding or TOTAL: '�,�Db the nt lsprovemesold within oneyearafcompleli.,the owner-builderwlll have the home.of proving that he did not build or improve for purpose ofsale.). QTy, PLUMBING PERMIT FEE" [I L as owner.of the property,am exclusively contracting with licensed FLOOD ZANE APN contractors to construct the pmject(&c.7044,Buslnessand Pm(rsaions Code: PERMIT ISSUANCE The Contractor's License Law does nut apply to an owner of properly who builds or Improves thereon,and who contracts,for such Eup*ta with a ALTER-DRAIN&VENT-WATER(FA) on [5t licensed pursuant to the Contract&,License Law. FEE SUMMARY -LI I am exempt under Sec B &P C for this reason BACK FLOW PROTECT.DEVICE Owner Date - DRAINS FLOO$ROOF.AREA,COND. - SANITARY. Y_ N_ WORKMAN COMPENSATION DECLARATION" - RECEETp QI herebylafflmr that I have a certificate of consent to opythemc (gue. �e PER TRAP SCHOOL TAX .Y N certificate of Workers'Compematlon Insurana&ra certified cepythereof(Sec. - "RECEE'F M 3800,LbCdr GAS EA.SYS113.1-1 INC.4OUTLETS 0O PARK FEE Y ' N Policy tl 'RECEIPT p Com any - GAS EA,SYSTCM-OVER4(FA) BUILDING DIVISIONFECS �Certlfied copy V hereby(umlehed. Certified mpy le filed with the city Inspection division. GREASE/INDUSIRL WASTE INTERCEPTOR_ PLANCHECK FEE - /vC , CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID •7 � COMPENSATION INSURANCE ' (TNasectlon need ($10not becompleted lithe Permit lsforonshundred dollars SEWER-SANITARY-STORM F.A.200Fr. Date Recei t# 0)or less.) - IcerO(y that in the performance ofthe work for which this permit is issued, WATER I IF.ATFR W/VENT/ELECTR ENERCYFEE Y_ N_ I shall But employ any person In any manner w as to become subject to the Workers'Compem.ti&nlaweof CalKomh. Date WATER SYSTEM/TREATING O Z Applicant PAID Z 0 NOUCETOAPPLICANT;If,after making this Certlfkate of Exemption,you NEWRESIDENTIALPIMB.__SQFT, 'Date Recei t# Fshould beamesubject to the W&rkers'Cbmpewatbn provisiomofthe Labor "FUE LUW Code,you mustf&rthwlth comply MthmchpmW lmuorthisper ishalibe > deemed revoked. BUILDINGa c CONSTRUCTION LENDING AGENCY SEISM7 hereby afRrrnthat there is a construction lending agency for the perform- ELECTZranee of the work(or which this permit is issued(See.3097,Chi.C.) TOTAL:Q I<nder.Name PLUMLL I— Lender'sAddress QTY. MECHANICAL PERMIT FEEOW -IcertltythatlhavereadlhbappBcetlonandYafethatthe above infomutl&n MECHa Isarrect.I agreeto complywith all city and county ordinances and state laws PERMIT ISSUANCE - FEES P} N relating to building corstmeion,and hereby authorize representatives ofthisZcity to enter upon the above-mentioned property for Wpecton purposes. ALTER OR AODTOMECH. 6Ve)agrcc to cove,Irma, an d keep harmless the City of Cupertino against BabNtlea,}adgments,mets and expenses which may in any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: Z against said City in consequence of the granting of this permit. AIR HANDLING UNIT(OVER IfiW0CFM) CONSTRUCTION TAX Sigremreof Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Healthmaterialand defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Recei t# Health and Safety Cod�ction 25532(a)7 HEATING UNIT(OVER 100,000 BTU TOTAL: ❑ Ye No Will the zpplyd..,rr turecont buildingmining as defindby,qulpmenlordeelem VENTILATION FAN(SINGLE RESID) ISSUANCh (� E 'hill eMthazanlous air contaminants as defined by the Bay Area Air - yOI 15A,•, Quality Management Dlel 'ct7 BOILER-COMP OHP tW.WO BTU ❑Yea No ]havereadthehazaPusmateriaisrequiremen,under Chapter6.95of" BOTLER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 25505,25533 and 25534.I understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQn ' responsibility l&no[ifylhe occupant of the requirements which must bemat priorO. nit 1atttlPghlnn lolm anao(a.C_s_rt,lfirca-t-eofOavpancy, �H :i i-l4 �•Ta ///7 3/ rs owner of authorized agent Date - TOTAL: ISSUED OFFICE COPY APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification - - lldingdsd*r.,. /� PERMITNO. Bu • 903 C-Ano 6X/ UQ : �.�� . 19519 _neresass: Phone:" G ),(/ F MA N'A/ ds 3 '3 9 g 7 CITY OF CUPERTINO-BUILDING DIVISION ' Contractor'aName: LIc.N. APPLICATION /PERMIT . Architect/Engineer. Lle.No: BULDINGEL. TRICA4I LUMBINGEC MHANICAL CATEGORY `CONTROL ..� d 6( SGL 'BUILDING PERMIT INFO QTY ELECTRIC PERMIT "FEE Addrcsa: _-. PERhETI55UANCE UrU —�i PLUMB MUCH ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby afffrmthat I am licensed under provisions of Chapter 9(commenc APPLIANCES-RESIDENTIAL )OB DESCRIPTION Ingwith SecHon7000)ofDtvlston3 ofthe Businessand ProfemionsCode,and my If..is in full force and effect. PANELS - - LianseCkeg LIc.11 Data Contractor ARCHITECTS DECLARATION 2(11-1000 AMPS /r' \Y\WYY "`111"' l L fl Ors O I understand my Plane shall be used as Public recon a. OVER 1000 AMPS C -SQ.ET.FLOOR AREA $/SQ.FT. (0 Licensed Professional SIGNS ELECTRICAL. / OWNER-BOLDER DECLARATION ` o❑❑❑y (here afRrenthatlamexamptfrothe Contractor's U License Lawforthe SPECIALCEiCT/MISC 0 2 F following reason. m(Section 7011,5,Business and Professions Code:Any city or - - Fcounty which requires a permit to censtruct,alter,improve,demolish,or repair TEMP.MEEK OR POLE INSF. any s[mcmre prior to Ib Issuance,abo requ Tres the appllant for such perndt to O Ble a signed statement that be lelkenaed pursuant to IM proWeioru of the POWER DEVICES 3µD Contractor's Lkerue Lw(Chap[er9(commencing with&ctbn 7000)of Divi- SWIMMING POOL ELECTRIC 1-, don3 ofthe Businessand Pro(embrc Code)&rtbethebexempttherefremand VALUATION G the basis(or the alleged exemption. Any violation of Section 7LR1.5 re any ^> OUTLETSSWITCHESFIXTURES / [� '7 a 0 0� appBant(ora permit eubjectsthe applicant t&a civil perulty&fnU more than .-3 G-- five hundred dollars($500). �n I,as owner of the property,or my employees with wagn as thetr sole NEW RESIDENTIAL ELECTR SQkT, STORETYPE CONSTRUCTION mmpeneatlon,wllldotheovork and theetructure b not Inlendetl or offered for O sale(Sec 7044,Bueimss and Professieru Cotle:The Contract&,Elsa Law c.�' does not apply to an owner of property who bulMe or improves Nand who doeeeuchworkhimsel(orthrough hlsownemployees,provided thatsuchOCCCROU' RES.UNITS Improvement.are not lManded oroffered fo .k.IL h&wevey thebullding or TOTAL: '�,�Db the nt lsprovemesold within oneyearafcompleli.,the owner-builderwlll have the home.of proving that he did not build or improve for purpose ofsale.). QTy, PLUMBING PERMIT FEE" [I L as owner.of the property,am exclusively contracting with licensed FLOOD ZANE APN contractors to construct the pmject(&c.7044,Buslnessand Pm(rsaions Code: PERMIT ISSUANCE The Contractor's License Law does nut apply to an owner of properly who builds or Improves thereon,and who contracts,for such Eup*ta with a ALTER-DRAIN&VENT-WATER(FA) on [5t licensed pursuant to the Contract&,License Law. FEE SUMMARY -LI I am exempt under Sec B &P C for this reason BACK FLOW PROTECT.DEVICE Owner Date - DRAINS FLOO$ROOF.AREA,COND. - SANITARY. Y_ N_ WORKMAN COMPENSATION DECLARATION" - RECEETp QI herebylafflmr that I have a certificate of consent to opythemc (gue. �e PER TRAP SCHOOL TAX .Y N certificate of Workers'Compematlon Insurana&ra certified cepythereof(Sec. - "RECEE'F M 3800,LbCdr GAS EA.SYS113.1-1 INC.4OUTLETS 0O PARK FEE Y ' N Policy tl 'RECEIPT p Com any - GAS EA,SYSTCM-OVER4(FA) BUILDING DIVISIONFECS �Certlfied copy V hereby(umlehed. Certified mpy le filed with the city Inspection division. GREASE/INDUSIRL WASTE INTERCEPTOR_ PLANCHECK FEE - /vC , CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID •7 � COMPENSATION INSURANCE ' (TNasectlon need ($10not becompleted lithe Permit lsforonshundred dollars SEWER-SANITARY-STORM F.A.200Fr. Date Recei t# 0)or less.) - IcerO(y that in the performance ofthe work for which this permit is issued, WATER I IF.ATFR W/VENT/ELECTR ENERCYFEE Y_ N_ I shall But employ any person In any manner w as to become subject to the Workers'Compem.ti&nlaweof CalKomh. Date WATER SYSTEM/TREATING O Z Applicant PAID Z 0 NOUCETOAPPLICANT;If,after making this Certlfkate of Exemption,you NEWRESIDENTIALPIMB.__SQFT, 'Date Recei t# Fshould beamesubject to the W&rkers'Cbmpewatbn provisiomofthe Labor "FUE LUW Code,you mustf&rthwlth comply MthmchpmW lmuorthisper ishalibe > deemed revoked. BUILDINGa c CONSTRUCTION LENDING AGENCY SEISM7 hereby afRrrnthat there is a construction lending agency for the perform- ELECTZranee of the work(or which this permit is issued(See.3097,Chi.C.) TOTAL:Q I<nder.Name PLUMLL I— Lender'sAddress QTY. MECHANICAL PERMIT FEEOW -IcertltythatlhavereadlhbappBcetlonandYafethatthe above infomutl&n MECHa Isarrect.I agreeto complywith all city and county ordinances and state laws PERMIT ISSUANCE - FEES P} N relating to building corstmeion,and hereby authorize representatives ofthisZcity to enter upon the above-mentioned property for Wpecton purposes. ALTER OR AODTOMECH. 6Ve)agrcc to cove,Irma, an d keep harmless the City of Cupertino against BabNtlea,}adgments,mets and expenses which may in any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: Z against said City in consequence of the granting of this permit. AIR HANDLING UNIT(OVER IfiW0CFM) CONSTRUCTION TAX Sigremreof Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Healthmaterialand defined by the Cupertino Municipal Code,Chapter 9.12,and the Date Recei t# Health and Safety Cod�ction 25532(a)7 HEATING UNIT(OVER 100,000 BTU TOTAL: ❑ Ye No Will the zpplyd..,rr turecont buildingmining as defindby,qulpmenlordeelem VENTILATION FAN(SINGLE RESID) ISSUANCh (� E 'hill eMthazanlous air contaminants as defined by the Bay Area Air - yOI 15A,•, Quality Management Dlel 'ct7 BOILER-COMP OHP tW.WO BTU ❑Yea No ]havereadthehazaPusmateriaisrequiremen,under Chapter6.95of" BOTLER-COMP(OVER 100,000 BTU) the California Health&Safety Code,Sections 25505,25533 and 25534.I understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQn ' responsibility l&no[ifylhe occupant of the requirements which must bemat priorO. nit 1atttlPghlnn lolm anao(a.C_s_rt,lfirca-t-eofOavpancy, �H :i i-l4 �•Ta ///7 3/ rs owner of authorized agent Date - TOTAL: ISSUED OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING PERMIT No19519. CITY OF CUPERTINO A A INSPECTION DIVISION- JOB INSPECTION RECORD r, �7 OB ADDRESS ?`("�V J (ifyti J[ 1-fy�� UNIT'# LOT ri CATEGORY CONTROL N i J OWNER_ N �-,,, /a : '?..psi+,BUILDING".PERMITINFOh�'+;,x,'" 'L CONTRACTOR <<c. n:"uf.».�.x�.� r.�-.c4+•.-:.;:-•s .:",.a-dl'- 'INSP.ECTION°u+'t-"cy3l ; 'g";+211':ti,'j`iz ?firMUM -mrcrr-- DATE INSPECTOR INSPECTION RECORD ❑ FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLY WITI TOB DESCRIPTION PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF CLIPERIINO STANDARDS. GARAGE SLABS PREGUNITE ,P.O UR 5NOT CONCRET E-'UNTI L'ABOVE,HAS aBEENr'S IG NED 51 UNDERGROUND/sus INSPECTION DATE INSPECTOR PLUMBING ELECTRICAL 2f 7 C,f r MECHANICAL `DOINOT-,IPO LIR?FLOOR:LINTIGPA BOVE:HA'S vBEEN;SI GNED: WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL FRAMING/VENTS CLEAR INSULATION SPLA'CE'NOFSLIBFLOOR;UNTIL',A'BOVE HAS�BEENTSIGNED' ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL ACUZZI BOND FRAMING/STAIRS INSULATION/VENTILATION MERG.EGRESS ,EWER WATER OVERWO'WORK!UNTIL',ABO VEiHAS@BEENSIGNED',I)'-4 TERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN SHOWER LATH SCRATCH COAT 5NQ1TA'PE�OR:PLASTER,'UNCIL°ABOV5HAS4BEEN:SIGNED! ?NOTE:;NO'�FINAL'INSPECTION�I SHALLiBEf AL1 DE,}B EFLORE,: :THEr'CONSTRUCTION�TAXAIS-Pt1lD:-i�;z=:d.,t e+ri�}:.:A,:4,, FINALS DATE IINSPECTOR SAN.# ELECT.ENERGY PLUM BING ENERGY MECH.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FIRE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING rOCCLWA'NCYFOF;BUILDINGUS-�NOVPERMITTED,ILUNTILy!-i ISSUANCE DATE LIiLDING&INAL..1SISIGNED.-BYMUIEDING,INSPECTORlf, ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT# ARE NEEDED WHEN PHONING. rc "—T o pIMPORTANT k�'tNaSh.,l �5 a ak`A PLEASE READ REVERSE SIDE BEFORE!CA•LLING.,FOR.FIIVAL INSPECTION'S-,"Jj ISSUBDBv. APPLICANT'S POSTING COPY NOTICE . . . When calling for FINAL INSPECTIONS, the following occurs prior to the release of utilities: The Building Department coordinates the request for final inspection with the following City departments, as required, to assure that the site/building complies with the requirements of these departments. 1. BUILDING: Complies with all building code requirements. 2. ENGINEERING: a. New driveways, sidewalks, curbs, gutters completed. b. Lot fine grading to drain or bond posted. c. New water system in operation. d. New sewer system in operation (Sanitary District). e. New streets paved, with sewer manhole and valve boxes raised to grade. Sewer cleanout at property line to grade. f. New subdivision lot corners set. 3. FIRE: a. Fire hydrants properly installed and operating. b. Fire sprinkler system properly installed and tested. c. Fire alarm systems completed and tested. d. Fire extinguishers installed, dated and tagged. e. No parking signs in required fire lanes. f. Restaurants, hood fire extinguishing systems operating and tested. 4. PLANNING a. Required landscaping and irrigation system installed. b. Paved parking, trash enclosures, exterior light fixtures, etc. c. Documents (CC & Rs, easements, etc.) 5. HEALTH All food handling facilities must meet the requirements of the Santa Clara County Health Department. Upon receipt of approvals in the Inspection Division from all the above departments, gas and electric utilities will be released, and you may then occupy your building. If new owners are attempting to occupy the building for the first time and the utility release has been delayed, check with the contractor who is responsible for meeting all the above requirements of the various departments. BUILDING INSPECTION DIVISION CITY OF CUPERTINO