26980 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING-F.LEUI'Rli.'AL PERMIT NO,
APPLICATION/PERMIT PLUMBING-MF,CIIANICAL 2 6 9 8 0
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION
BUILD�I}NG AIN�N/I//FS/_S: ,(/�,� SANITARY NO. APPLICATION SUBMDT'AL DATE
/`� /W 40vflliv ONITO LOT#
OWNERS NAMI7: PHONE: CO LTOR'S NAME �y LIC NO: NpC CONTROLM
4.'ti /ros L/ �/u 17 .6 7JS
RCHITE GINEER: LIC NO: ADD ❑
CONTACT: PHONE QTY. ELECT RIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MELD
PERMUISSUANCE ❑ 11
LICENSED CONTRACTOR DECLARATION APPLIANCES-RESIDFM L
I Mrebyaffinn del l am lk<racl stab isiomor Ch.pl«9(mrwnencingwilh JOB DESCRIPDO
60
F Section
force and eofIX vivam J of the Busirra W Rofeaian Cock,std my liemLS
e is in PANE
I..,Zw U.Clan I.ic.# UPT02MAMN
N<y Due Cmtrrr« 201-1000 AMPS
'LOvV'.Z ARC]IMTIECTS DECLARATION OVER IOW AMPS SQ.FT. AREA f/SQ.IT.
_OZ_p Iuerstud myplm.NellMusedupublk rends.
FyFJ Licenser]l4afasimW SIGNS ELECTRICAL
QyEJ
e�eQ OWNER-BUII.DIM DECLARATION SPECIAL CIRCUIT/MISC.
jc 06 V I hereby affirm that 1 am exempt from be Commcar's Liccme Lxw for IM
W 3LLy following ret,m.(Scnlon 71131.5,Buslncax and Pmfaeiom CMc:Any city m cmmy TENIP.METER OR POLB INS].
which reyuhcs a permit m cun4rucl,alter,imianve,dereollN,or repair any sWnure
>� prior mib'iuuame,arca reyuirexled nlmlicam ke,och permit la file asigured sutmwl POWER DEVICES
a0 thai Mis LcenrtdpurwuntmlhepnavieimenflMContreneisilceme Law(Chapler
aX 9(commeming with SeqInn700thofDivisim JoflM Businrsend Pmfevinns Cak) SWIMMINGPOOL P.IJ9CIRIC VALUATION
—y m liv he it exempt lhvo,rixn end the be am lm led al leseJ exemption.Any vbluion of OUTLHTS-SW ITCIIPS-FIXTURI3
Sanofi 70315 Mnny upplicwlFern pnmtlt eublects the applicant lo•rnil pcnnhya
ort Imre then Five hualrtd dollen Will
� $ ❑ I,mnwnernflMpmpeny,amyemployenwithwaguas deirwkcmtpensuion, NEW RESIDENTIAL ELI;CfR .IT. STORIES PE CONSTRUCflO
a3— will do[M'l.Calde he Coomwir ,1,Li nrawckfmsal apply Tart a.of cad Rvfeslom Cale:The Cmtmctar'n I.ieemc Law dau rwr apply In w owner of '
pwpeny woo builds m inaTmn'u IMrevn,W wMJonwchwak timulfa Jwugh his
emploYces.Povi or ihmasucnimpravanwabin rwimeMN«offcrtd the coa.lf, OCC.GROUP RFS, TIS
however,the iris line r impo crmmmoving
Is hatJ within one Year of c prove for porpoise
ownm-
b le_). 11 have ted burJen of proving Nat M did ort build a improve for puryose or
k). ^
❑ t the,aaecI(Scpany,I.Birsi�ral mofeso gwlN cle:)Td,Concaaaw QTY. PLUMBING PERMIT yj FLOOD ZONE APN
coM1 the pmjcm(Sec.]094.B of aril Proreasiau Coder:)The,Co ,arcs L
Iharcox for rid 1pplytowownvofpropmy wMbuiWa tto th,comm,ud PERMIT ISSUANCE ,)
UMco Law.fawch pwjeav wish.cwtnrlor(Olimvei pluawnOo III�Convacmis
U.Law. ALTER-DRAIN h VENT-WATER(FA) FEE SUMMARY
❑ I un exempt uakr Sec. ,B&P C for This reason
BACK FLOW PROTECT.DEVICE OUTSIDE
SANITARY Y N
Owrsr Due DRAINS-FLOOR,ROOF,AREA,COND. REMPT.
WORKMAN COMPENSATION DECLARATION SCIIOOLTAX YN
OD]hvebylffinc tlhnve.anificne ofcomanlo rclf-imurc,«a eertif tom RECEIPT#
Worker;Canpcmuicn Imurwea•cW fled PICTURES-PER TRAP
wPY HereoflSee.3g00.1�b C.)which O PARK FEE YN
7 coven all mployce's miler this permit. GAS-EA.SYSTEM-]INC.40lfH.BIS RF,CEIYT#
Policy♦ BUILDING OI VISION FEES
Canpemy GAS-P.S.SYSTEM-0VIM 4(EA) PIANC IECK FEE
❑ Certified espy is MrcbyfmisMtl.
❑ CmifiW copy is fled with Ne my impeetion Jivisiw. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP SOILS FEE
COMPENSATION INSURANCE
(ThixrcmimlreNag M<umpleted;Fide prnnil is lar mcM1ludred dullan(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or Icor.)
I emfylhw in the pcdomam,oflM work fawhich this perm;[k issued,I shall WATER HEATEJt W/V[If[I.F.CII
not employ any pawn in wy roamer w as In becorm subject to the WmkaxPAID
C.,itsminnlnweoi Cdifaniu Dnlc WATER SYSTEM/IRFATING Dere Receipa
O z Applicum
z0 NOTICE TO APPLICANT:I[e@,meting this CenlEcemof E.aemption,you should NEWRESIUENfIALPLMB. SQ.IU'. TOTAL
r+ Vl F¢oor—mbjal to the Wm4cr's Cnmpen.wtiunpro,kim,nflbe labor Code,you must
fmrhwith cmply with xmb pnrvl.vinm a this pmoril shall he tlamerl hvoked. BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I Mrehy dBml Nat there iso const mo Icnding aecrscy for the,ptnfamsrce of
the work fawhich this pcmdt II Ixaued(Sec.309'/,Civ.C.) A ELECTRIC FEE
O Tearer,Nm - PLUMBING FEE
Emden Aesa AJQTY. MECHANICAL PERMIT FEE
1 enify that 1 have real his applicmlw and stun tort the Ibovc information it
gi7 career. [agree mav[ply with dl city end enunry mdhra sands•,-laws relating to PERMIT ISSUANCE MECHMTCAL FEB
F' Cn building construction.seal Mrtbyamhoriu repesenwive of Nis city to cora upon the CONSTRUCTION TAX
() z Ibove-rmllimrvl property for impaction puura
rpALTER OR ADD TO MECIi.
(We)ape b save,indcrmiry ami keep ban the City Of Cupertim Igeinst
r liabitiries,ludlipmch epylnanyway.,iiiraseid Gry AM HANDLING UNIT(TO 10.0110 CFM)
in cm�crcc opry ofwsu Ni /�
// a�s
AIR HANDLING UNIT(OVER I0,000 CFM)
Sigrwu of Appli t/Cm Due EXHAUST HOOD(W/DUCT)
PAM
IIAZSRDOUSMATERIAISDISCLOSURE HFATINGUNIT(TO100IM01IM Dab RcaifnN
Will be applicant m future WWmg mevinnt store or hantlie Mwdous mueriJ HEATING UNIT(OVFJtIW,WOB
n defined by tle Cutem.MwicifW Code,Chapter 9.11 artd the Hcehh anal Safety TG1
Cade.Section VENTILATION FAN(SINGLE RFSID)
❑yet,
❑No
Will the, tafmmebuidin «mrpwtueec ui BOLLFR-COMP(JIrP OR IW,000 BlU) �.
ISSUANCE DATE
IPWtr•" g 9 Pmwlmdevles which mil
havrdws au cmbminwb as defined by IM Bey Area Au Quality M.S. BOILER-COW(OVER IMMO BTU) - o
i
District?
❑ RFSA .
Yee ❑No NEW IDFMMS
IALCI{. SQ.FT. •[OI/ go .—
IM mpta � .
I have ree] nwanloue materinle rtyuireman under,Cl6.95 of tie Y
(alcbxnhElwllox Safety Cu me 25505.25533 y rx,ar4. lily In
dW ;�/
;Fide buiklln Jaslla c.el y errs terlBlll,the it is my reyvmibili[y to nmify Ne /f V�'
acupm the quire ich t M mel prior In iuueruc fir a Cenifimte of la{�/
chvncra au0vla gent Date TOTAL: ISSUED BY:
OFFICE
I
POST THIS CARD NEAR FRONT OF BUILDING "
CITY :OF CUPERTINO RM,i"Uh,BER
10 INSPECTION D6VISION. i
1 T. sI " JOB INSPECTION-RECORID
Io/j.,/��� /� u PERMIT EXPIRATION
O JOB ADDRESS ,J ' /WQ//1)WA) ON T# LOT# " ;
/
OWNER PERMIT. EXPIRES IF WORK
r 5 - CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION 4. ANCE OR 180 DAYS FROM
LASTCALLED INSPECTION.
U FER '� � 'y '
PREGUNITE - - PEHMIT VALI DATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
-UNDERGROUND /SLAB 'III D V
PLUMBING ,
h
ELECTRICAL suANCE DATE
MECHANICAL • BZ ELECT. PLG: MECH:
u ❑ ❑ ' ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED y BUILDING PERMIT
. WOOD FLOOR INFORMATION
PLUMBING VALUATION
MECHANICAL .(� -
ELECTRICAL - ".PERMIT TO
:l
FRAMING '
INSULATION 6 STORIES T PE CDNSTR.
. - OCL GROUP RES�UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.FT,FLOORAREA .TOTALACPEAGE
,•
ROOF '
DIAPHRAGM
r
RV,
USE
/•w' , HEs .IND ,CON Po �O,n.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED - - ❑ ❑' ❑ . ❑''
ROUGH ASSESSORS PARCEL NO.
-
PLUMBING ' - - a
GAS TEST
TRACT NO. PARCEL NO.
' � -
MECHANICAL
ELECTRICALACC.OATE ACL FILE NO.
WW' FINALS ' DATE INSP. .
FRAMING - -$7 SAN # r -
INSULATION - PLUMBING r ' ZONING ENG.SITE NO.
GAS
'
MECHANICAL- FIRE SPRINK ENERGVT-2A
- � '
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ? - - ❑ NE] •y ❑ •"❑ 1
LATH-INTERIOR ELECTRICAL FLOOD ZONE A,L U.C.
LATH-EXTERIOR. �/ ,FIRE DEPT. �❑ ,N❑ r ° ❑ 'NJ
SHEETROCK GRADE,'. FEE SUMMARY
SHEAR INTERIOR BUILDING
TEMPORARY APPROVALS. BUILDING' -
SHEAR EXTERIOR - � � - -
FIREWALLS ELECTRIC .PLAN CHECK
FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE .
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505j
ELECTRIC
IW-�' ONE WORKING DAY BEFORE REQUIRED INSPECTION.-
-PLUMBING
z PLEASE GIVE JOB ADDRESS WHEN PHONING. w
- SEE PERMIT FOR EXPIRATION DATE.- MECHANICAL „
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE - �'•��'
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY -