26561 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
PERMIT NO.
CITY OF CUPERTINO PLUMBING-MECHANICAL
BUILDING DIVISION APPLICATION/PERMIT
.BUILDING PROJECT IDENTIFICATION 26561
BUILDING ADDRESS: -�L SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT# IAT# G
7,RING�lNlu
PHONE: CON��R' NAM `' (ys'}pVy� (C'NO.J6 N/C CONTROL#
• - LIC NO: ADDRESS S ❑ .
/T U G Shy 0
PHONE: S:a�3.. 'f'* w^� �"' " ' BUILDING PERMIT INFO
Q'ffYq y't+', ELE(ril'RICPERMIT '--FEE
�/� r"I �re x'A^'Is'�F BLDG ELECT PLUMB MECH
1 A. 1D 'Y LY PERMIT ISSUANCEmthatiSEDCONTRACfOR'SDECLARATION pppL1ANCES-RESIDENTIAL �N
Qy.Z IM1ueby affirmCNS mliCONT uACTOR'S DECLARATION
ter9(commenaingwiN
FE 00 Section]000)of Division 3 of the Business and Professions Code,and my license is in PANELS
N full foree and effect.
6Z License Class Co.#.� IIP TO200 AMPS
F N� Data /y A Cliff
Dr ARATION OVER
-1 I RAMS SQ.PT.FLOOR AREA $/SQ.FT.
I understand my plans shall be used u Public records. OVER IOW AMPS / p p�
�0�� SIGNS ELECTRICAL I � y„ II f D
4yyyLicensed Professional L�•• f a
yy�f�6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. V11 P, n
O a U 1 hereby afrom that 1 am exempt from Ne Contractor's License Low for the 'II�.YII
3 W rFjr following reason.(Section]031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST., JIII(�_
ER
J O; which requires a permit to com0uct,mar,improve,demolish,or repair any swctwe
y� poor to its ismance,also requires the applicant for such permit to file asi,thdsmtemem POWER DEVICES DA DDD
pl0.4 pC that he is licensed pursuant m the Provisions of the Contractor's License Law(Chapter _
axaLL 9(ummencing with Section 9000)of Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATUIF
W_y ar that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
Section 90315 by any applicant fora permit subjects the applicant a civil penalty of
not more than live hundred dollars($50p).
p NEWRESIDENTIALELECTR _SQ,FT. ,STORIES TYPECONS'TRUCHON
❑ othewrk,anheestracy,ormyempinyeeswoffendsasthei(sole compensation,
p,
will dothewons anile:no tommncesot License
Lmv does of applWe y to an Business
and Professions Cade:The Convaaor's License Isw rices not apply to m owner of '
propetrywhobuildsorimprovesthereon,and who does such workhimselforthroughbis OCC.GROUP E�S.0own employees,provided thatsuchimprovementsarenotimemed moffered forsale.If,however,the building or improvement is sold within one yearofcompletion,theawnery TOTAL:
builder will have the burden ofproving that he did not build or improve for purpose ofsale. x ;s FLOOD ZONE
❑ I,asownerofthepropeny,amexclusivelycontmctingwiulicensedconvamonto QTY's. ;PLUMHING PERMIT FEE
onswct the project(Sec.0044,Business and Professions Code:)The Contractors PERMIT ISSUANCE
License Law does not apply m an owner of property who builds or improves Hereon,and
whocontractsforsuchprojects with aeamractons)liceneed pursuant to the Contmntm's ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
License Law.
❑ I am exempt under Sec. ,B&P C for this mansion BACK FLOW PROTECT.DEVICEO T ID FEES
SANITARYY N
Owner Dare DRAINS-FLOOR,ROOF,AREA,COND. RECEIPTq
WORKMAN COMPENSATION DECLARATION SCHOOL'TAX YN_
❑ RECEIPfp
Ihereby off that l have a certificate om certificate fconsent self4romm,or a of FIXTURES-PER TRAP
• Workers Compensation Insurance ora certified copy thereof(Seo.3800,Lab C.which PARK FEE RECBIPf# N
covers all employee's un altpe
os rfnit. y 9 3 GAS-EA.SYSTEM-1 INC.4 OUTLETS
Policy N �� 42 SPP BUILDING DIVISION FEES
Company 25*0 4'F F=Ih N11, GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cardfled copy is hereby founded.
�cnified copy is filed with the city inspection division. GREASIVINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION PROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This sachonneed native completed H da,Permit is formebarmied dollen S lif, SEWER-SANITARY-STORM EA.201 ENERGY FEE
oris.,.)
I unify that in Ne performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECTR
not employ any person in any manner so as to become subject to the Workers PAID
Compensation Lewsof Califmnia. Date WATER SYSTEM/TREATING Date Reedit#
Q zApplicant
/'. NOTICE TO APPLICANT:If,after cruising this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FC TOTAL:
G y become subject to the Workers Compensation Provisions of the Labor Code,you mos[ BUILDING FEE
fonhaval comply with such provisions or this permit shall be demand revoked. oi�
LTa (] CONSTRUCTION LENDING AGENCY SEISMIC FEE
rz Ihereby effimt Net there ra a conetrucnon lending agency for Ne performers f TOTAL: ELECTRIC FEE
O the work for which this permit is issued(Sec 3099,Civ.C.)
Lenders Name '1 a4 t s c
u' F Conder.Address
`y'MECHANICAI:PERMIT" ' PSE z PLUMBING FE8
L) I cerOf that I have read this application and slate that the above information u ' a f"-("` t
Lkl Y PP MECHANICAL FEE
correngconsectocomply withall ysadvand counryordinancesmd stat slawsr upon the PERMIT ISSUANCE
U bbove-gcotioned ropers herebspectin purposes.pivesof Niscity to enrer upon the CONSTRUCTTON TAX
above-mentioned property for inspection keeph ALTER OR ADD TO MECH.
(We)agree m save,indemnify and keep hertnless the City of CLpertino against
Iiabilities,judgmems,costsandex ensu wbich me;t any a mteagainstsaid Ciry AIR HANDLING UNIT TO 10,000 CFM)
inconsequence the ntin this pemn. /
AIR HANDLING UNIT(OVER 10,000 CFM)
rgnature A nt/ ontmct to EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dete Receipt#
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,000 BTU) T
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cade,Section 25532(e)9 VENTILATION PAN(SINGLE RESID) a
❑Yes ❑No ISSUANCE DATE
Will the applicanmrfuturebvilding occupant umequiprrwnmrdeviceswhichemit BOILER-COMP(3HP OR 100,000 BTU) gY p I '
• ho"wous air comeminents its defined by the Bay Ares Air Quality Mmegemem BOILER-COME(OVER 100,000 BTU) r
Dis cR
11Yes ElNo NEW RESIDENTIAL MECH. SQ.FT' 'JUN.14
1 have read the hazmdous materials requirements under Cbapler 6.95 of the ryy
California Health&Safety Code,Sections 25505,25533 and 25534. (understand that - /s�l l Ur
ifthe building does not currently have a tenmt.I as onsibility to notify the V l/UY—h I IIVU,
occupant of the requirements win must be cc ofa Cm'mete of
Occupancy.
Owner am oriaed agent m TOTAL: ISSUED BY:
OFFICE
POST THIS CARD NEAR FRONT OF BUILDING PERMIT N23346
CITY OF CUPERTINO
INSPECTION DIVISION- JOB INSPECTION RECORD
' JOB ADDRESS c q2 � KS�y UNIT# ,,•• NN ``�LOT
# CATEGORY CONTROL 9
OWNER ' CONTRACTOR BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR INSPECTION RECORD
FOUNDATION PIERS NOTEALLCRADING ANDDRU IAGE
UFERGROUND SHALL RE INSTALLED TO COMPLY WITH JOB DESCRIPTION
PAD SET BACK-CERT THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS 'B
GARAGE SLAAS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION
EM ERG.EGRESS
• SEWER WATER
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
13UILDING IISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL
. BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN PAI J)
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND FEB
2
PERMIT# ARE NEEDED WHEN PHONING. 199 .;
IMPORTANT! �o,
CITY-4J vyrc��I,I�y
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION +ss
APPLICANT'S POSTING COPY x (f