00010104 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 'OU D 1 O/ Q
CITY OF CUPERTINO BUILDING-ELECTRICAL P
'BUILDING DIVISION APPLICATION/PERMiT PLUMBING-MECIIANICAI.
a i ' :•;BUILDING
�JPRIOJB(RJDFATIFICATIONI+- .',
SANITARY NO. APPLICATION SUBMITTA
L DAT
Q // V O �rJo-jUILUIfADE
SS
OI - E
WNER:SN ME: ^MONIjn C NTRACIOR:S NAME: LIC NO:
��-tJL-/ilL'-J NIC CONTROL Mw
IV ARCHITL LIC NO: ADDRESS: ❑
CONTACT: PHONE: ti,i"+ihr;1 BUILDING PERMIT INFO," '
6n, &02 �^ �r ❑ Consultant Fees Paid by Applicant(Initial) BLS ELECT_ pLUMB� MEC({,
LICENSED37r
COMRACIORS DECLARATION I + -y LJ LrJ! IrJJ/
QTY
'. GLECTRICPERMIT'•', •)r/IZF "
I herehy amrm mall r n Iodep ' f Comm,9 mntnmene g ,' : 1 r 4 ,rr rr JOB DESCRIPTION
OaO wim SeclonAgglool DO' rofthc Bus'ncvsond Pr Coast cccccc�y tdaryleenx
PDO 's� a' PERMIT ISSUANCE
Fa�F Tull lone wW df cl SFDWL O KITCHEN REMODEL
Q,UU License Cl' s 1Jak pPP1,lANCES-RESIDENTIAL ❑AUUI'UON OPLUMBING RE-PIPE
rF 2 Dam Contractor
ARCt{ITEC'("S DECLA ❑MBIJII-UNIT ❑STRUCTURAL
tn
1 understand my pPANELS MODIFICATION
O m Z lans shell M'.axed us publ Ic tcwmx
7 Z•N•,Q UY T02UTAMPS ❑INTERIOR [I CHIMNEY REPAIR
mFW Licensed Precminnal 201-IUWAMPS IMPROVEMENT EJSWIMMING POOLS
W ,C-� OWNER-BUILDER DECLARATION ElBATH REMODFURF.PAIR ❑D17MOLITION
Q I herehy affirm that I in exempt fnsm the Contractor's License Law for the OVER UM)AMPS ❑QIHER
K3 L Um following reaeoa(Section]0315,Business and Professions Code:Any city or county SIGNS ELLCT0.1CA1,
which reyaires u permit m constrain,aIle,,improve,denadi.h,nr reps
air any juncture
prior unit'sissuance,rRorryuirexiheuppllcmn bonsai permit,,file asinudnlatcment SPECIAL CIRCUIT/MISC.
F. y
that he is liecowd,ursuum n,nhe,imsounsof the Comrucmr's License Law(Chapter Y
cU (.......nosing withSection 7000)of Division 3 ofthe Business and Professions Code)or TEMP ME'i ER OR POLE INST. COMMERCIAL
a a
that he is exempt therefrom and the basis for the alleged exemption.Any violation or ❑NEW BLDG/ADDITION ❑DEMOLITION
^NSection]03L5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE
vat more than five hundred dollars(5510). IMPROVEMENT
ESQ ❑I,uownernf the propeny.nr my onploycexwith wages uslhcirsolcttmmpcortins, SWIMMING POLL ELECTRIC ❑OTHER
E. will Jo the work.and thes¢uourc is not imm�dcJ nr of(eted for sale(Sec](kW,Business
mand Pot...ions Code:The Commaors License law does not apply to an owner of OU'i'I-E'I'S—SWITCHES—F RBS
.,it
who lumidx or hurrnvex thereon,and who does such work himself...through
his own employees,provided that such improvements are not intended or offered lot NEW RESIDENTIAL EI Q 1' .
sale.If,however the building or impmvcmcm issold within one ye
emnpItion,the SQ.FE.FLOOR AREA E/SQ.PT
two
me-bride,will have the burden Of proving that he did nut b.F;or improve for pur-
n 1..,ale,) 3 3 kS
1,ac owner of oho pngmny,sin exclusively emvaming with licensed cnmraciors w I OTAI-'
,orsonic,hh p ,,,1t(Site WWJ B J Profession,Cod,The Contracture L /, r + 1, +t •1�.
Law does rtN,pl,m anavortarefiampart,who b Id imp...a,thereon.and QTY ', ( PLUMBINCPFRMIT,,;
h contractsf hp j is with a cotaelrls)licensed puttam to the Contractor, -
• u Law. PERMI I ISSUANCE a
Inual exempt under Svc ,B&P C for the mason
Owner Date ALTER DRAIN TER(EA) VAMATKIN
WORKERS COh1PE4SATION nF:CLAR,, T.
win, BACK FLOW PROTECDF.
1 heresffirstitle,y ampe
nalty m perjury one of the following dmfurm Co
(] ,,have prrowill for F,naurn icamol'Ce Labor odeftre.. Wo,ke...Gmrpea- DRAINS-FLOOR,R 4C STORIES TYPECONSTRUCTION
satins, r hick this
civ by Santos 3]011 OI'hhe taro,Code for for the performance of the
work forwhichmus land is issued.' FIXT'URFS—PER'1'RAP
I hireand will mainwin Worker's Com •nsmion Insurvnce,as mor,4 Section
3pm)oOhe La har C< o;1,m-;fonn d, ad,forwhich this
per suet. GAS—EA.SYS'IEhI-I IN C.4 OUTLETS OCC.GROUP APN
My Workers Co a I P
Camcc Virl GAS—EA.SYSTEM-OVER 4(EA)
CEEI'IFICNDU Op EVZ )N < KS'
COMPENSA O GREASIVINDUSTRL WASTE INTERCEPTOR -
(ThissmtionneednohhecompR difthe permit is 0nonehundreJ dollars(5100) BUILDING DIVISION_FEES,
less) GREASE TRAP PLANCHECK FEE
I cerily that in the performancaut the work forwhich mispunniO,i...vLldmII SEWER—SAN]EARY—S'FORM EA,200 FE.
not employ any Person in any manner so as h)bet,,nme subject w the Workers'Compen_ ENERGY TEL'.
oZ moon laws of CulilontvDate WATER IIEAT17R W/VENI'/ELECBWL
GRADING EEE
7 O Applicant
G"-t NOTICE TO APPLICANT::IL after making his Certificate of Exemption,you should WATER SYSTEhf TREATING
a ; become.cbjw m the Worker's Corn,saw ti,,n provisions of the labor Cole,you muss SOILS FEE
forthwith comply with such provisions or of,permit shall:ate deemed revoked. WATER SERVICE
:D Q �.
CONS usihinRUCT'IONLENDINGAGENCY NEW RESIDENTIAL PLMU. SQ.4T PAID
UQ ibcn'by ufilnn ihenhcre Let cansirctian lendingagency for the Derfonnance of nt 1Dam) ReceipiM
the work our which this permit is issued(Sec.NN7.Civ.CJL.vndcry Name ;t DIAL:
O ULenders Address Q[' a I rift that 11 a mad this applicationand state that the M1 ( i 4. .jy r rr ..( ry,. VIPW IEE1 '�i,
IFF-""" rp erred I Sreeh plYw dm oddity anAv ry d J rh l i gt ,,QTY ,�,- . MECHANICA PERMIT' 1t °id 1 -
UZ building construction,and hereby authurze repre laves of Dix city m enter upan the w ,. t". SEISMIC FEF,
ab,,vo-mendoned,m,.rY for hillecaon I powl. PERMIT ISSUANCE
(We)spite r,cave,save,indemnify keep hmmlese me City of Cupertino agvincl ELLC'ERIC FEL�+'
liabilities.judgments,costs and expenses which may in any way amore agai nst said CRY ALIT;It OR ADD TOM lick I.
in mineyue eofine gr tona,sAthmspeman. NTNG FEE
APPLICA UNDERSTANDS AN WILL COMPLY WITH ALL (ON-P INT AIR HANDLING UNIT TO IBM)CFM) py// MECHANICAL FEE
SOURC I F ULATIONS.
AIR HANDLING UNIT(OVER 10.00007M) CONSTRUCTION TAX
Signe m ppllcvnVCumr Dute EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEF,
HAZARDOUS MATERIALS DISCLOSURE
Will davit"I"min or dative building occupm
mtsrc or handle ln¢alloua material HEATING ON IT(To 10RUR ITT U)
cEned by tile Caper nu Munivipal Cade.Chapter 9.12"and the Health and Safely
o,Section 255321:0' ((EATING UNEP'(OVER 1110,000 BTU)
E]Yeb ' VENULATIONIAN(SINGLERLSID) PAID Date n
Will the applicant or raw a building Ocaupnnl Use ulaipnmm Or devices wmeh• 1{OIUIR—CAMP(3HP OR 11X1000 BTU)emit ha'rachust air come Mame—us deired by the Bay Arca At,Quality Management TOTAL:
Doubt! BOILER—COMP(OVER M.00011TU)
❑rex Nn
/ I5115
hmr 'viii AIR CONDI'fONFt
h 'i Chaplin'6J5 that C.F.
ISSUANCE DATE Iv t Safely C1, 5115,2553 'a1553) Iunderstand mat if the NEW RESIDENTIAL MICHSQ.FI 21s only occuramg
O
ahial y e 'at no'cariare of.Ccrt IcY
Owner Old hori<cd ager I I Data TOTAL: ISSUED BY..
OFFICE
-. �....�...... ,.�_•..,.ru �r.snw�i na-o fVUL.. 1'IV.U."i
Ift Kopp FaWk ;
6ngbaora • Surytyorr � P4naon
AyAli7,9000 �.
Sp No.04OW40
)Ifr.CAYoh Rohconbor8ar
O'llriap Qfaup
9001 Wlw=d Way,Salm 2w.
gao MIMM,CA 94404
Sal�aai: OWc Ya0y-Ifonad40op V'aiRoot .
Oar CbMok,.
oAAPw UA of 1w ym%o parforatad a field fwroy of the 1004Ga of tbo fawWmloa f=for dm bu•.Mop
being 9ontWWWI 0o Lou 3-01,34 343 6o4 3.07 of tbo Oak VUlay prgjact to Cuportitw.
1Lo raenlm of"hat ` '
pawy clatrly show dNt tlu looadon of tbo fouodatioa tofmr oro aootiwot 04 is
• aoatortaaooa with tho do►lgo lcaoioa c t tho baildiage,at aai4 looatlaae aro sham an MA platy propatm by our
rin:I.
This kw 4 wadded m pmvldc you with dta varifttttdca of thoeo aaiu pot OWJaroy. if&M 4M toy otha
4W"rd GOAMola;than logttloat plowo do not bedlam to C41.
BU4X"NW POITLIC
7 BiAOIkYA 81L80 �'
� . gtlt d/81/0Y
tadJau40 PL 3.6141... .: RLMQ
SUFM popttweat
5W No#Avow• RWw*City,CA x4063 .150GI Qj4�OG o fM IB601 A6Y 63aB
6EP•2i�DD 16:D6 FraI:NAR2A ENCINECRINii COWPANY • OAK�ANO 5106262111 T•Ili P•DU02 I00'21D
• nI01�/I� �'iQfllfiAAJ� N+•11�OD�w. .. �rJ..... or..+
426 no"Way 2601 Maing=Qun T4 Gpf"In LOM,BuNa 206 �rloisa►'
OaNYnd.GA pleXt M6yrN<r0.GA 84643 Sa,CA
4S6 8160 ww uw . .
OWS
PK(610)666", Pnj691
FX: 66161
FX:13101608�X17f � >46owr MUMAM
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PRINT N"V.
OWIW11 W7G ORIWNK i
t Oak valley, Cupertino .
01WHERWHO WaaT'MC.
OBSERVATION CHART
OAK VALLEY DEVELOPMENT CUPERTINO.CA. PAGE 4 OF 4
I WW2000
F s [a1
-42 -2000 -5132000 09117/2000 09108@000- _t 0 1000 �
3—'-"'2'-' `3B _ � 452000 28.132000 W.L 2000- 6-29-2000 1425100" 00127/2000. "'
3----- -3- --2A' 531-2000 8-152000 &i S20D0 10231110^ 8.252000
3 4 4A 3CAR 4252000 7-2000 57.2000 8.252000
3 5 11E 3CAR/BON 412-2000 526• 7-31-2000 7-31-4000 to do 152000
3 e 3CAR 412-2000 2000 1411/2000 l0 d0 141812000
3 7 rZOLO412-2000 5152000 0912912000
3 8 BMR 521-2000 slab 141212000 td1?iz000 tDo 14 000
3 9 BMR D18o DBto �o n.a 11 1200D
10
10 412-2000 752000 1d1B12000 1 514
1 - ON 412-2000 510.21100 7-25 7-252000 3
3 12 10 3CAR 41 -2000 5102000 7- 2000 7-20.200- 530.2 1- 2000
3 13 7C 527-2000 83200014231'1000 10/23x2000
_ 3 14 2D 527-2000 8320D3 10!3012000 11101/2000 1110to Onbh 111031'1000
3 15 3C 3CARIBON 527-2000 552000 11103x2000 117 to do
3 18 BC BONUS 77 5152000
3 /7 3E 3CAR 527.2000 5152000 111D32000 p
3 18 BMR
3 19 BMR OSt?!2000 �0 7-20.2000
3 20 1B 84-2000
3 21 3A 330.2000 510.2000 3000 7-20.2000
3 22 to 7.20- 520 7-20
3 23 4E; 3CAR 7-20-2000 52D-2000
• 3 24 3B 3CARIBON 7-20 5292000
3 25 8891-
3 28 2C 3CAR 7-204000 91-
3 27 BMR 7.20.2000 NA
3 B BMR 7-20.2000 NA
3 1 29 78 7-2020110 91-2000
3 1 30 5A BONUS
3 31 28 SCAR
3 32
3 1 33
31 34
3 35
3 38
3 37
38
3 39
3 40
3 41
3 42
[a] pill Wp no 1erHfad ane da0bla 85 PaW
r
0-90-��N
SO 'd OLSI 96E 804 1.53M JNI2133NION3 d£Z = ZO 0
wuS I_IHGS GAHU NtiAK rEIONT OF BUILDING j C'j 64
.9
CITY OF CUPERTINO
BUILDING DIVISION
.1 4 F. ,'_ BUILDING PROJECT IDENTIFIC,
1)4NG A[DRFS.. SANITARY NO APPLICATION SUBM A DATE
0+Old
•
WNER A P
HOP ONIRACTURS NAME LIC NO:
cif '�j . It NIC CONTROL#
ITE -R: LIC NO'. ADDRESS:
JK n
. .......... r+vA,',�,:Ctisuuwma PERmrrINFO
Consultant Fees Paid by Applicant(initial)
INSPECTIONS
INS?E.C.�, BLDG ELECT PLUMB IECII
fl En_ P
FOUNDATION/PIERS/H.D.S. C-t-L-Iap INSPECTION RECORD
UFER GROUND JOB DESCRIPTION
NOTE: ALL GRADING AND DRAINAGE RESIDEN IAL
PAD/SET BACK-CERT SHALL BE INSTALLED TO COMPLY WITH In SFDWL 0 KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF DADDITION EDPLUMBINGRE.PJPE�
C
GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. 11 MULTi.UNIT E)STRUCTURAL
N
POUR NO CONCRETE,UNTIL ABOVE HAA;BEE SIGNED; MODIFICATION
'N , TO ARRANGE INSPECTION DINTERIOR 0 CHIMNEY REPAIR
UNDERGROUND/SLAB- IMPROVEMENT C]SWIMMING POOLS
T CALL AFTERNOONS (1:00 PM - 4:30 PM) C1 BATH REMODEUREPAIR 0 DEMOLITION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- 0 OTHER
• ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
I AND PERMIT#ARE NEEDED WHEN PHONING.
,DO NOTFOUR FLOqKUNTIL ABOVE HAS,BEgN7SIGNBD, CONH ERCIAL
PLUMBING ATTENTION CONTRACTORS: EINEWBLDO/ADDITION C3 DEMOLITION
NO PERSON(S)SHALL PERFORM WORK ON CITENANT 0 FOOD SERVICE
MECHANICAL 0�5 THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION DOTHER
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATIONb INSPECTION SPECIAL INSPECTION REQUIRED ED DATE INSP.
;PL:ACE,NO SUBFLGOJRUNT1LABOVE HAS�,BEENt§19NEP�
ROOF SHEATH/DIAPHRAM
PLUMBING
IMS&SHOWER PAN
7MCHANICAL
ELECTRICAUPOOL BOND
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION
7 A
POYERNQ,:WqRK.UNT1C- BA: §I ,O V RAEEN-91
R
EXTERIAL SHEAR/HOLD DOWN
INTERIOR SHEARMOLD DOWN
SHEETWROCK/SHEETROCK SFIME
EXTERIOR LATH[W-SCREED
SHOWER LATH (11A
NOTAPE,9,R,PLASTE UNTTLAR)V SIGNEM
SCRATCH COAT
SEWER/WATER
'TEMPORARYsAPPROVALS`
OCCUPANCY
ELECTRICAL
GAS (k) 1 1947
GAS TEST
GRADE
FIRE
HANDICAP
CTRICAL
MBING
MECHANICAL
ENERGY
VISUAL FINAL ONLY
TICERTIFICATE OF OCCUPANCY�
a )nnn
BUILDING k"M CSU 09-1 IMPORTANT: 'ISSUANCE DX' 1,
I
NO RPR* PLEASE READ REVERSE SI
m5w
i'OC 'T DE BEFORE
'vN CALLING FOR FINAL INSPECTIONN
IS 6 v'f;9 Y':......
SA NE MANY'll,WYUR .14"
APPI IrA MT`Ocz Pr)qTH,1r r1r1MV
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1
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t wtA11Y1IAi IYuu�ur N1 AAAUUTAI1MIIh Na lanelao o'' •' 1 '
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Wom WPA Na p/l lq opplroN11 dowfAI U1
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ISTALLATION CERTIFICATE (page 1 of 4) — CF-6R
Site Address Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required;however,use of this form to provide the information is optional.) After
completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at
occupancy,per Section 10-103(b).
HVAHVA�MS,
Heating Equipment
Equip. Y of Efficiency Duct Duct or Heating Heating
Type(pkg. CEC Certified Mfr Name Identical (AFUE,etc.)' Location Piping Load Capacity
heat um and Model Number Systems F-IR value (attic,etc. R-value (Btu/hr) Btu/hr
EE
Cooling Equipment
Equip. CEC Certified Compressor Y of Efficiency Duct Cooling Cooling
Type(pkg. Unit Mir Name and Identical (SEER,etc.)t . Location Duct Load Capacity
heat um-) Model Number System CF-IR valuel (onto,etc, R-value tu/hr tutu
SI uwrylaG ..,
ND 4ja/.7' 39Ck!eo3o ie e22Q AMir C ��0
.1. >_reads greater than or equal to.
1, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2)equivalent to or more
efficient than that specified in the certificate of compliance(Form CF-IR)submitted for compliance with the Energy
Efficiency Standards for residential buildings,and 3)equipment that meets or exceeds the appropriate requirements for
manufactured devices(from the Appliance Efficiency Regulations or Part.6),where applicable.
�clG��//� �.�� .y:Z7-99 �f.f�41D.rJJ' f�E1�M�r/U�• � A�C�
Signature,Date Installing Subcontractor(Co.Name)
OR General Contractor(Co.Name)OR Owner
WATER HEATING SYSTEMS:
Distribution IfRecir. Dor Rated' Tank Effi- External
Heater CEC Certified Mfr Type(Sid, aviation, Identical Input(kW Volume ciency' Standby' Insuladon
Type Name&Model Number PointoGUse) Control Type Systems or Btu/hr) (gallons) (EF,RE) Loss I%) R-value
2 For small gas storage(rated input of less than or equal to 75,000 Btulhr),electric resistance and heat pump water heaters,list Energy Factor.
For large gas storage water heaters(rated Input of greater than 75,000 Btumr),list Recovery Efficiency,Standby Loss and Rated Input
For lastantancous gas water heaters,list Recovery Efficiency and Rated Input
Faucets&Shower Heads:
All faucets and showerheads installed are certified to the Commission,pursuant to Title 24,Part 6,Subchapter 2, Section
1, the undersigned, verify that equipment listed above my signature: 1) is the actual equipment installed;2) is equivalent
• to or more efficient than that specified in the certificate of compliance(Form CF-IR) submitted for compliance with the
Energy Efficiency Standards for residential buildings;and 3)the equipment meets or exceeds the appropriate requirements
for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable.
Signature, Date Installing Subcontractor(Co.Name)OR
General Contractor(Co.Name)OR Owner
COPY TO: Building Department
Building Owner at Occupancy
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