19599 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
7s'Ifdin Noted Identification - PERMIT NO.
B°°°f°g Address 19 5 9 9
/03s9/� G eco AC,
nerd ante: Phone:
Aa - atSzly4 CITY OF CUPERTINO-BUILDING DIVISION _ 3
C.M�.ct^orN
. ame: _ LIc.No: APPLICATION / PERMIT
e� CSS /Ne/ BUILDING-ELFCnUCALPLUMBING-MF LAICAL CATEGORY CONTROL#
Architect/begin=er. Lie.N. -
/-� — Qn ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Add..�73D .S;gV,(*rSCu � .
PERMIT ISSUANCE El 1:1 71LICENSED CONTRACTOR'S DECLARATION
I herethat under
.pofChaptrr 9o(commenc APPLIANCES-RESIDENTIAL
Ingwhnaction7000)ofisai=3oftheBuinmuse.dProleasion.Cdqend my ]]]QBDFSCY}1R/IxI
'70N
license,b In full and effect. PANELS
Lcs Ch _ Lt.
# 3938Ly
D.te Comrenor
ARCHITECT'S DECLARATION 2014000 AMPS
re00 Iurdrratand my plansshall be used a public records OVER 1000 AMPS SQ.FT.FLOOR AREA $/ .FT.
Limnsed Prof.[..] SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION n SPECLILCIRCUIT/ML9C
2 F,�S Iherebyaffien that I sormempt fromthe Contranori License Law for the
following reawn.(Section 70315,Business ane Professions Code:An n r
O F•� caulrescity TEMP.METER OR POLE INST.
�� ntywhlch requaperrtdt tomnstron,alter,Mprove,demolbh,orrcpair
anystmdum prior to ib lsmance,also requires the applicant for such permit to POWER DEVICES
5 Eke a signed statement that he Is Bussed!pursuant to the provbioru of the
Commences License Law l(Zhapter9(commencing with Section 7000)of Owl-
� 5 SWIMMING IDOL ELECTRIC
sion3 other Business and ProfessionsCode)orthat he is exempt therefromand VALUATION
the bash for the alleged exemption. Any violation of Section 7031.5 by any D 00
applicant for a permit subjectatheapplicanl to a civil penalty of not momthan OUTLEISSVITCHES-FIXTURES O D
five hundred dollars($500). NEW RESIDENTIAL ELECTR
�n
F-11,as owner of the property,or my employees with wages as their sole SQ'r' SIORISS TYPE CONSTRICTION
compensation,will dothe wwk,andthe stm=m boot intended or offered for
does sale snot.apply to alnow and Professions Cade:The C improves Cleve Law
'SS whodolsuch torn owner ofpropertywho nempbuilds orlmproovidedves rcoryand OCC.GROUP RES.UNITS
who does entsam work himself ed orough hlsowne.If,hec rrothe dthatsuor
Improvements intended earofce pleioNthh ner-p deer ldingw TOTAL:
Improvement bwldwithln ovycarofcompinion,theowner-bullderwlll have
tltl�urden of proving that he did not bu0d or Improve for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLOODMNrE APN
u Las owner of the property,am exclusively contracting with licensedmtlLFRMCf ISSUANCE
ntraors to construct project(Sm 7064,Buslnem and ProfessionsCode:
The Contractor's License Law tices not apply to an owner of property who ALTER-DRAIN&VENT-WATER(FA)
Wilds or Improves thereon,and who contracts for such plojects with a
tgatput.K.)lensed pursuant to the Cantranwl L1ense Law. FEE SUMMARY
U I am exempt under Bee B&P C for this moon BACK FLOW PROTECT.DEVICE
DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N_
Owner Date RECEIIT#
WORKMAN COMPENSATION DECLARATION FIXTURE&PER TRAP SCHOOL TAX Y— N_
❑1 hereby affirm that 1 have o Insurance
of consent to copy
the rc,ora RECEIPT#
380,Lab C.Workeri Compensatlonivuranm wa ertlfled copy tM1emof LSrc.
- 3800.Lb C3 GAS EA.SYSTEM-1 BJC.40UTLE[S PARK FEE Y_ N—
P
oliry Y RECEIPT#
Com acts KC�ON GIC t N Hslu( GAS EA.SYSTEM-OVER4 MM BUI LDING DIVISI ON FE ES
Certified copybhercby furnished. - GREASEANDUSRI,WASTE INTERCEPTOR 'PLANCHECKFEE
Certl(Ied copy b filed with the city Ivpenlon division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION hepeINSURANCE SEWER-SANITARY-STORM EA.200FT. Date Recel til
(fhb section need ria W completed I(the permit b Forane hundred dollars
(S1Irttlyth WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
Icomfy that Nthe perioion In ofthe wwksfor wMuhthis permit ishoed, —
1 shall not employ any prawn in any manner se as,to become abkn to the WATER SYSTEM/TREATING
Werkeri C°mpensatlon Law.of Callfomia.Date PAID
PP NEW RESIDENTIAL PCMB. SQFr.
A licant
Z � NODCETOMI'L1CAM:ILafternukinglM.Certlfioleo(Fxempibn,you Date Receipt#
shmid become subject to the Workers'Comperuetion provisions of the Labor TOTAL:
N Code,you mu at fort hwith comply with suU provisions or this permit shall be
> deemed revoked. BUILDING Z , UD
LUG CONSTRUCTION LENDING AGENCY - SEISMIC FEE
I herebyaffirmthat there b a constructionry
lending agency for the perfort
Z anceaf the work(or which thio b Issued(Sec.3097,CIv.Cd TOTAL ELECTRIC FEE
O O I<^eery Name - PLUMBING FEE
IL F Lerar,',Addre.s QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertltythatlhave rcadthbappBcatirnandk.tethattheabovelnformation
6. Iscorren.]agree to comply with all cityand county ordinances and state laws PERMIT ISSUANCE FEES PAID
r N rebting to building coretmni.,and hereby authorize representatives afthls
F. city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH.
Z
_ (We)agree to save,indemnify an d keep harmless the City of Cupertino Date RBCeI til
agaWt liabilities)rdgments,mats and ekpenseswhtch mayln anywayaccme AIR HANDLING UNIT CTO 10,000 CFM) SUBTOTAL: .Z.
ag.l t ItyI ronseyuen f the granting of this permit.
4� / AIR HANDLING UNIT(OVER I a,"CFM) CONSTRUCTION TAX
Signature Al AppB®nt/Contractor-� Data EXHAUST HOOD(W/DICT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuhm,building occupant store or handle hazardous HEATING UNIT(TO IOg000 BM
materials,defined by the Cupertino Municipal Code,Chapter 9.12and the Date Recei til
health and Safety Code,Selben 2553I(a)Y HEATING UNIT(OVER 100,000 BTU) TOTAL: 2_
F�Yn No
111 theapplinnt or forum building occupant use equipment or devices VENTILATION FAN(SINGLE READ) ISSUANCE DATE
which rest hamardous air contandrmm.a.defined by the Bay Area Air
Quality Management D'ul BOILER-COMP OHPOR 100,0(10 BTU)
4 a N
fI have read the haza ous o matenah requlrerrcnb under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the California f Teaith&Safety Code,Sections 25505,25533 and 75534.1
understand that lithe building does notmrrently have a tenant,that it b my NEW RESIDENTIAL MECH. SQ.FT
responsibility to notify the compact of the requirements wh lch must be met
prior to issuance of a Certificate of Occupancy.
Owner or authorized agent Date ISSUED1
TOTAL,
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO. 8599
CITY OF CUPERTINO APPLICAHONSUBMIIIALUAll,
INSPECTION DIVISION- JOB INSPECTION RECORD �� �D
JOB ADDRESS_ D C-1-C UNIT## LOOT 4 CA RY CONTROL M
OWNER CONTRACTOR ll ck:S BUILDING PERMIT INFO
ATION/PIERS CTION RECORD
INSPECTION DATE INSPECTOR
INSPE
FOUN NOTE ALL GRADING.N.DRAINAGE
UFERGROUND - SHALL BE INSTALLED TO COMPLY MRH JOB DESCRIPTION
THE APPROVED PLANS AND CITY OF % •
PAD/SETBACK-CERT CUPERTINO STANDARDS.GARAGE SLABS/PREGUNITE !
IP.OUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB INSPECTION DATE I INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL ,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '
WOOD FLOOR
PLUMBING ,
MECHANICAL
ELECTRICAL
FRAMING/VENTS CLEAR
INSULATION
JPRACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ,
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI BOND
FRAMING STAIRS -
INSULATION/VENTILATION
EMERG.EGRESS -
SEWER WATER
MOVERT NO WORK UNTIL ABOVE HAS BEEN SIGNED
i EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR ,
EXTERIOR LATH/W-SCREEN
SHOWERLATH
SCATCH COAT
f:O1TA PE'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
BUILDING
WCCI'IP,ANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE-DATE
VigPULDING FINAL IS SIGNED BY BUILDING INSPECTOR
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.
' IMPORTANT!
"khEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUED BY.`
OFFICE COPY