19379APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Building Address:
3 a 6 s Ho �1csT��nn eo _ Cu,.a,0e7
nersName : Phone:
ZZ�eC— Pl SQ[/A,[E a-,$'2
CITY OF CUPERTINO�BUILDING DIVISION
APPLICATION / PERMIT
Contractors Name: Lic. No:
BLTLDING-ELECTRICALPLUMBINGMECHANICAL
Architect/Engineer. Lie. No.
QTY ELECTRIC PERMIT FEE
Address:
PERhUTISSUANCE
LICENSED CONTRACTOR'S DECLARATION
pr 9 c-
I MrebyaffirmionA
MPLIANCIS-RESIDENITAL
aE of ivsionsedhe Busi essannso/Chapter
Ingwith Section force a deffect. ofthe BuslnessandProfemlonaCode,ani my
ionsCo e,and
license Is in Duct force and effect.
PANELS
License Clam LLCM
Date Contractor
701-IODO AMPS
ARCHITECT'S DECLARATION
I understand my plans shall M used as public records.
OVER I000 AMPS
SIGNS ELECTRICAL
Licensed Pmfesstonal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
SPECIAL CIRCN7/MLSC
7EMP.MEFER ORIOLE INST.
followingremora.(Section7ll Businessand ProfemCode:Anycity
countywhich requires. permktotoco.trua, alteu improve,ve, demoLLsh, orrepaitir
anystm=mpriortolta Wuance,alaomqurestheapphantforsuchpermitto
file a signed statement that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9(mmmencing with Section 7000) of Divi-
cion 3 of Business and Profrad os Code)orth.t he is exempt therefrom and
the bash for the alleged exemption. Any violation of Section 7MI.5 by any
applicant fora permit subjectsthe applicant to a civil penalty of not room than
five hundred dollars (SM.
❑ I, as owner of the property, or my employees with wages as their sole
TOWER DEVICES
gWPfMING POOL ELECTRIC
OUTLETSSWITCIiESAXTIIRFS
NEW RESIDENTIAL ELECTR_ SQpT.
compensation, will do the work and the structure Is not intended or offered for
sale (Sec. 7044, Business and Pmfemlons Code: The Cmar d.e. License law
don not apply to an owner of property who builds or improves thereon, and
who does such work himself or through hisown employees, provided that such
improvements are not intended oroffend forsale. If, howevcu thebulldieg or
Improvement issold whhinoneyca..fcomplelic u,theowner-builderwiil have
threlIurden of proving that he did not bulla or improve for purpose ofsals.).
U I, as owner of the property, am exclusively motiaciing with Rommel
to mmtruct the project (Sec 7044, Business aha Profemio. Code:
The Contraaor's License Law does nor apply to an owner of property who
builds -improves thereon, and who contracts for such pSojects with a
t or(a) licensed pursuant to the Contractor's License Law.
I am ex pt under $ares B & P C for this reason
TOTAL:
QTy. PLUMBING PERMIT FEE
PERMIT ISSUANCE
ALTER -DRAIN &VENT- WATER (EN
BAIXFfAW PROTECT. DEVICE
`L
Ow D � 7 /'d' �
DRAINS FLOOR ROOF, AREA, GOND.
pIXNRFS PER acted
GAS EA �,�,� 1 WG4 OUTLETS
WORkt)CtAN E AT10NDECLAR TI �b
❑I M1ereby affirm that ave a certificate 'consent to selfdnsure, or a
ernlfleateofWorkere'Compewtlon Insurance or a certified copy thereof LSec.
3800, Lab C.)
Policy Y
Com any
❑ CeniLed copy is hereby th the city
❑Certified copybfihd with the city inspection division.
GAS EA. SYSTEM -OVER 4(EA)
GREASE/WDUSTRL WASTE INTERCEPTOR
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
( hl.section need not bscocepleted ifthapsrodt isforone hundred dollars
SEWER -SANITARY -STORM EA. "FT.
-
($100) Orissa.)
WATER HP.ATFRW/VFNT/E,ECTR
Icenlfythat inthe perfomunmofthework ferwhich this permit is issued,
I shall not employ any person in any manner so as to become subject to ted
Workers' Compenadion Laws of Cs Rfomda. Date
WATER SYSTEM/TREATING
Applicant
NEW RESIDENTIAL PLMB.__SQyr.
NOTICETOAI'PLICANT:ILafiermak gthls CertUl.teof Exemption,you
should become subject m the Workers' Compensation provide. of the Labor
Codayou must. ith comply with such provisions or this permit shall be
deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perform
ance of the work for which this permit Is Issued (Sec. 3097, Cie. C.)
Lender's Name
TOTAL:
qT'Y, MECHANICAL PERMIT FEE
PERMIT ISSUANCE j
dander's Address
I ocAllythatl have madth6appllation and state thatthe above Information
E; corn'.. I agree to comply with all city and county ordinances and state laws
relating to building censuuetion, and hereby authorize representatives of this
citytoenlerupontMabova riles property for Inspection purposes.
(We) agree to mull, Indemnify an d kreph ors the City of Cupertino
against lubdl ,judgments, a expenses which may in anywayacaue
against sal ty in cons the gr fthls permit.
ALTERORADDTOMECH.
AIR HANDLING UNIT (To lfLXDCFM)
AIR DANDLING MITT (OVER 1 ga00 CFM)
/
nature of Appy/.entractes Dal
H ZARDOUSJr1ATF�R ALSDI5C1.O5U E
Willtheappllca ntor (utureb goavpant store or handle hacardous
material as defined by the Cupertino Municipal Code, Chapter 9.17, and the
health and Safety Code, Seetion 25537(.)7
❑ Yea ❑ No
EXHAUST HOOD(W/DUCT)
HEATING UNIT (TO 100,000 BTU)
HE-ATING UNIT (OVER 100p00 BTU)
Wali the applicant orfuturebuilding occupant use eAl
ordevices
emit haves nims air contaminants as deo ned by ta AirQuality Management DisWct?BOILER-COMP)Yn 4No
have read the haexrTou9 materials requirements uer 6.95 of
Californ la I I.IIh & Safety Code, Sen ions 25505, 255534. Iunderstand that lithe building does nm currently have hat it Ismy
respo.iblll tonaifythe oc ant tM1erryuircmentst hemet
prior to race of a Cert too pa
VENTILATIONn(SINGLEwhich
BOILER-COMPthe
NEW RESIDENTSQ.FT.
ner or awhori' age te
OTAL: 15
OFFICE COPY
CATEGORY
9379
❑ ❑ ❑
AREA
FEE SUMMARY
OUTSIDE F
3ANITARY Y N
RECEIPT p
; i0OL TAX Y _ N
R
'LANCHECK FEE
'AID .t} U
'"(�r/�
Date Recei t# 1�
3NERGYFEE Y N
'AID
Date Receipt#
SUBTOTAL:
:ONSTRUCI'ION TAX
:ONSTRUCfION TAX PAID:
ISSU R 6 TE
. :.0 U t I�nJj
}\ Cit f ^` ^'+-^rtinf)
e
3UED,1
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION - JOB INSPECTION RECORD
JOB ADDRESS hl'rh Alwkaw. UNIT # LOT # _
�F
OWNER CONTRACTOR
PERMITNO.�
9379
a
A A .
CATEGORY
cor r10L -
BUILDING PERMIT INFO
INSPECTION DATE INSPECTOR
INSPECTION E -CORD
NOTE ALL GRADING AND DRAINAGE
SHALL BE INSTALLED TO COMPLY "UH
THE APPROVED PUNS AND CITY OF
CUPERnNOSTANDARDS.
hl_�l PLUMB Mi�H
11 1
FOUNDATION/ PIERS
UFERGROUND
JOB D RIPIION
(�
`
PAD/SETBACK-CERT
GARAGE SLABS 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 ACUZZI BOND
FRAMING/STAIRS
INSULATION /VENTILATION
EMERG. EGRESS
SEWER WATER
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAR
EXTERIOR LATFI/W-SCREEN -
SHOW GR LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
NOTE: NO FINAL INSPECT[ON 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
F7 RE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING IS NOT PLRAIJITED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR PAID
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS 0 'U
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT # ARE NEEDED WHEN PHONING. C& rF ^--dinn
IMPORTANT! —•
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSu DBY:
OFFICE COPY
;z
CITY OF CUPERTINO
•
BUILDING DIVISION Construction
Receipt No.s
�j
PROJECT
CONTROL
n
ADDRESS �0%'7� ��OCi%�,jJ�'L✓�
s7
��
7.
PERMIT Y13 /
OWNER
A.P.N. Y
ARCHITECT
PHONE
SANIT. 8
ADDRESS
BLDG TYPE
CONTRACTOR
PHONE
OCC. CROUP
ADDRESS
REP
S.F.
RESIDENTIAL/SQUARE FOOTAGE
NOTES:
LIVING
GARAGE
DECKS
2t� ^
VAL $ `J 000,
STRUCT. PLAN CK
}}'
BLDG PLAN CK
•
PERMIT FEE �%d• O(>
CAP FEE S
CONST. TAX
ENERGY FEE
PUBLIC WORKS
9
I
OFFICE
CITY OF CUPERTINO COPY
GAS SERVICE NOTICE
,42— e-/— 8`"? 119 -
To
19
To
You are hereby authorized to connect the GAS service for/
Owner or Tenant9'�r"r��`
Ar
% 0
New Service
No. of Meters Reconnects•,
Move Service
No. of Add. Meters
Move Meter
PLUMBING INSPECTOR
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4of �.zss
GD�'�TroAJ,
APPROVED
IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES LAID ORDINANCES
DATE'
SIGNED
This set of pians ::g;i ;pc „tions MUST
be kept on ihr i;+': a ; ,, end it is um
lawful to mc�.e x:v c.;IRFS or aRerations
On same WiiiP.Ij. C( LSn F. n,,M:ssion from
the bn6ding Uept., G;t ca
The stampin, 6i ;;i:s p:.:n nd :specifications
SHALL NO'I be fo d t, P. -,reit or to be an
approval of ti,e vulati,,n of any provisions
of any City Odnance or State Law,
111,11P�i=V
211, t c`
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ECOl1389
1
BLDG. INSPECTION DEPARTMENT
CITY OF CUPERTINO
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