20269 PUS] I HIS CA HU NEAR FRON I OF BUILUING
CITY.OF CUPERTINO rlsRMrr Nn.
ROILDING DIVISION 20269
1, F BUILDING PROJECr IDENTIFICATION
IJ I LOW;A PDR[INS SANIIAIO NO. AITILICAHON SIA11,1111AL DAH
l: I, I
No-mel!�7_eA_L
NER S NAME ♦ I-IIONII..
A CONI RAIl RN NA
NIC (ON'I Ru1.N
0
III'I R-1 WNGINITR LICNO, AWREW,
T>csL BUILDINC.1117RNII I*INFO
INSPECTIONS DATE INSPEC. EJ C...,.ftant Fees Paid by Applicant(Initial) III 1)(; 171 PIA Am Nilir 11
El El 13
FOUNDMION/PIERS/H.D.S. INSPECTION RECORD
UFFR GROUND NOTE: ALL GRADING AND DRAINAGE RLSIDI- JOB DESCRIPTION
,MFIAI,,
PAD/SETBACK-CERT' SHALL BE INSTALLED TO COMPLY WrrR 0 SPOKI. F1 KI I CHIN it[
THE APPROVED PLANS AND CITY OF DAODIIION
GARAGE SLABSIPREGUNITI: CUPERTINO STANDARDS. nNflI1:H-IINlI ElsiRlICHIRAL
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED MODIFICAIJOIS
TO ARRANGE INSPECTION DINI17,I Octown REPAIR
# UNDERGROUNDISLABCALL AFTERNOONS (1:00 I'M - 4:31) I-MF) IMPROVENII.N1 E]SWININIINGIN)OIN
-i BAI 11 REN100HARLIVAIR 01)1:mf)l,lllON
PLUMBING 777-3228 MONDAYTO FRIDAY 24 HOURS [I E. GonuaR
FLECTRICAL FORE REQUIRED INSPFCTION. JOB ADDRESS
AND PF RM IT#A BE NEE DFI)WI I EN PI]ON I NG.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED CQAI&IIII,�RCIAI_
PLUMBING XrTENTION CONTRACTORS: EINIAV131,11GIADDIlioN Gin-1,101,11ION
MVCHANICAL NO PERSON(S)SHALL PERFORM WORK ON 0!17NANI
THIS JOB SITE WITHOUT 13FING IN COM- INII'RO%I:Nll,Nl
ELECTRICAL PLIANCE WITH WORKERS'COMPENSANON oollllzR
FRAMING VENTS INSURANCE REQUIREMENTS.
INSUI,AriON
INSPECrION SPECIAL INSPECTION REQUIRED ❑ DA I F INSII
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SIIHATH/DIAPHRAM
PLUMBING - — —:?7- 01*
TUBS&SHOWERPAN
ECIIANICAI,
WIP LECTRICAL/POOL BONI)
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION
COVER NO WORK UNTIL ABOVE I AS BEEN SIGNED
FXTERIAL SHEAR/HOLD DOWN
INTERIOR SHFAR/HOLD DOWN
SIIELrWROCK/SIIFF`I'ROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LAI H
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRNI,cI I CONI
SEWFR/WATER
TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
FINALS
GAS TEST
GRADE
FIRE P A 1 9
HANDICAP
ELECTRICAL JUL 0 7 ANq,ji
..ddikrLUMBINC,
7FICHANICAL
FNERGY
VISUAL
I CERTIFICATE OF OCCUPANCY El
AL ONLY
ISUAL FIN
BUILDING IMPORTANT: ISSUANCE I),Vj I;
OCCUPANCY OF BUILDING IS NOT PERMITTED PLEASE READ REVERSE' SIDE BEFORE
UNTILIL
NTIL BUILDING FINAL IS SIGNED BY BUILDING
'S CALLING FOR FINAL INSPECTION!!
INSPECTOR.
ox.
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
PCITYOFUPERTINO BUILDING-MECH NICA PERMITNO.
APPLICATION/IaERMtT (BUILDING-MECTRI ALC.DIVISION S0001 0269BUILDING i'ROJI?CT IDEN"IIfll'ATIONDRESS: SAN I'1'ARY NO. APPLICATION SOUMI"UIAL DA
Ko MeS d Roe l
WNER'S NAME: _ /� PFLONE: CONTRACTOR'S NAME: IC NO'.
1 Ctrl l:pg1/)fS� ��IO rIi Aq e X L A7 NIC C'ONTRIILk
CHITECT/ENGI EER: 1 `9 4LIIU NO: • A D .S :O e/W Y-(4 �C/ -4OF N ❑
'ONfAC`P PRONE: 0 e Y BUILDING PERMIT INFO
/ � � �a��O ❑ Consultant FCCS Paid by Applicant(Initial) 6L❑IlG ELIiCfj 1'LU❑A1B ME❑C1!
LICENSED CONTRACT K'S DECLARATION V QTY. ELECTRIC PERMIT FEE IrtGf
1 hereby affirm Ihxt 1 am licensed under provisions of Chapter 9 kammcncing JOB DESCRIPTION
Qd'Z Ih Sedinn]00 of of risionJof the Busintss un P .es' ns J ylicense is '� RESIDENTIAL,
WOO sum 1 PERMH'ISSUANCIi
F lyr m full rosea and el a.�d Q ❑SFDWI. (3 KITCHEN RF.h10DE1
aVU LittnseC s. ' LIL.M AI'1'LIANCES-RF,SIDENTIAI. ❑AUUI'I'ION [I PLUMBING RIi-I'IPIi
hGL D:ac Contactor
ARCHITECTS DECLARATION ❑MDI TI"UNIT ❑STRUCI'URAI
-
Z O y Z I understand my plans shall Be itsed a. mi lu,records PANELS MODIFICATION
OZ—0 UI'T02(p AMPS 1I INTERIOR El CHIMNEY REPAIR
F�Fw Licensed Professional 201-1003AMPS IMPROVEMENT C]SWIMMING POOLS
7s1=-j
OWNER-BUILDER DECLARATION OVER 111(10 AMPS ❑BATH REMODEUREPAIR 0DEMOLITION
C 6 I hereby aRmm Thal I am exempt from the Contractor's License Law!or the
X
36 V following reaum.(Section 7031.5.Business and Pmfcsinm Code Any city or county SIGNS ELECTRICAL ❑OTHER _
ul
UL!t which requires a Permit to construct,altar,improve,demolish,or repair any suucma
F 0—
prior)vi—min,e..1-or,mare,Its aPPiicant li—tal,permit 1.file.aignedsuunnent SPECIAL CIRCUDUMISC.
}•.1 Ik t he is licensed pursuant)the pmvisiens of the Contractor's License law(Chapter 9 '
W g'OD teninmencingwilh Section]INN))n(DivisinnJol the lAiaincne anJ Ymfexsinns CudaJnr TEMP.METER OR POLE INST. COMMERCIAL
a a tl� that he is exempt Nercfrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Xmu- Sell 0031S by any applund hfr.permit siby,etsdo,apilicamm a civil penally of POWER DEVICES
W1 w ❑TENANT ❑FOOD SERVICE
t mare than live hundred dollars 1851X11.
- ZF IMPROVEMENT
_< �ldo the work.the pr.perry.rnmyemntended withwogesaatalei(See 0af4.Bsiness SWIMMING POOL ELECTRIC J
ad will Re the wons and e:The chureCont is not intended Law doved s not apply to an,Rosiness ❑OTHER
ti 3 m and cmy who
Code:The Contractor's License law does not apply m an owner of OUTLETS-SWITCHES-PIXTURF.S N ^
his o ny emp builds or impnmvth thereon,i send who doents such work himself or through
his own employeese provided that such improvement are not intended or platted for NEN'RESIDENTIAL ELECfR SQ FT
rsale.If,own,huwev will
hvethingar o.f, oto issoldha
ithino Wild ofcompletian,the SQ.FT.FLOOR AREA $ISQ.PTo
pwner-FuiWer will have the buNen n!proving That he did not buil)ser improve for pur-
vofwlo).
as owner of the property,am exclusively contacting with licensed contractors to TOTAL: O
ouseurs the project(Sec.](Nn.Business and Professions Code:)The Cormsere's Li. Pl A I D
cause Law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE r P4
who contracts for such projects with a contractors)licensed pursu ch to the ConeractoYs
License am Law.law. ttPERMIT ISSUANCE JUL 0 7 ANS.
❑lundcrg . ,B&PCfnr Nis..,in
hate ALTER-DRAIN&VENT-WATER(EA) VALUATION /l
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE VII Y Ur lour Cti i,aiU'
1 hereby affirm under penalty of pc jury one of the following declarations:
have and will maintain a Cerrifcate of Consent toxelf-insure for Workcr.,Compco- DRAINS-FLOOR,ROOF.AREA,GOND. STORIES 'TYPE CONSTRGG❑(
workax provided far by Seniors 37M of the Labor Code,lin me Pe,f side n e of me
for which Nis maid is issued, FIXTURES-PER TRAP
C3 1 have and will reunion Work—Cnmpenmfon In...mor.as required by Section
3]0(1 of LaMn cede.fonhe�pee^rnarmaarwe oflhe wnrkkffoorrwwhi�chibis permit is issued. GAS-EA.SYSTEM-1 INC.40UT1.El'S OCC.GROUT' AIN
Myierty r8L Y4W vPol cy NoNj.. _/.GI�S3Y�9 CAS-EA.SYSTEhI"OVERJIEAI
Carritr"' ""tg/l/1 k
CERTII9CATI?Oh EM
EXPIIONFROMWORKE S'
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTER
(This section need a.,hecomplcled iflhe pmmil is Borne hundred dollars 16100) BUILDING DIVISION FEES
or less.) GREASE FRAP
PLANCH CK FEE '
Ioyany that in manyhe fmmancco(the)bek for)mesuhjech thispmmitisi,sued,I s'Conshad SEWER-SANITARY-S'IOIXM EA.21X1 FT.
not rsnploy nnY I>LTson many manner sit us m become suhjunn the Workers Compen- ENERGY TLE
Z an..lawsof Califon..Date
z � Amlicam 1 WATER IIWTEk W/VENT/EhECfR
I P GRADING PL'E
z/l NOTami APPLICANT:IL after making Nis Certificate,of Exemption,you should WATER gVSTGM/TRGATING
ai hcamrse me suhjulto,,,he Wozkcr'. i,mpcnsmiis pmanshal ofthe rned rCade,you must SOILS FEE
� forthwith comply with tach provisions onhis permit shall be deanranked. WATER SF.RVICF.
0
U0 CONS
attherRUCTION Ltion lending agency
NEW RESIDENTIAL PLMB. SQ.FT I'AIU
L) p k for
rwhich rm that there iso issued
len ding agency far the performance of Date RccciplM
� �+ the work ins which this permit is issued(Sec.3119],Civ,CJ
0 C Lender's Name TOTAL:
Lenders Adm... TOYTAU
1 certify that I have seat this application and state that the.bare information is BUILDING FEE
F" N anted l agree in comply wimall city and county ordinance,and some laws refiling l,, QTY. MECHANICAL PERMIT FEE
C)IK building cnmwction,and hemhymothorizerepresentatives ofthiscity toenmrurym the SEISMIC FEE
dire-mono mod prnpcny for inspersion p rouses.
(We) give la save,indemnity and keep ludulm's the City ofCupcninnygainPERMIT ISSUANCE /
IiL[CTRIC FEE
into-equenc "I the o,sitind
expcnssmit. mmmyin any..,.,.a against said City ALTER OR ADD'TO M HCH.
nisequcnu nl'the gitmiing of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI'TITOI0.000CFMI
SOURCE REGULATIONS. MECHANICAL PER
AIR HANDLING UNIT(OVER 10.1100 CPM) CONST RUCHON'PAN
Signature of Applicant/Contractor Data EXHAUSTHOCED(W/DUCI) HOUSING MITIGATION PER
MATERIALS DISCLOSURE
Willmeapplicam mhore building occupant smre.,bundle hrearchm material HEATING UNIT(TO 10D.000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cede,Section 25572(.)! HEATING UNI"1'(OVER III BTU)
Y<s ❑N.
VENTILATION PAN(SINGLE RESIDE PAID
Will the applicant or furore building occupant use equipment or devices which
Data Rurs iplN
iithnzanlous air conmminmiu'os defamed by the Ray Area Air Quulhy Mumgmnenl BOILER-COMP(JI{POR 100,000[11
' ❑Yes � �No BOILER-COMPfOVIiR IIXI,G1(11{'IT)
I have real the harard.ua malasomn ra,mremcri s imder Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
forms Health&Safety Code,Sections 25505.25513 and 255]4.1 understand Nat if the NEW RESIDENTIAL MECH. SQ.ET.
Building does trot currently have a tenant,that it is my responsibility to notify the occupant ,
oft quacerim..Xw�hich 1 u I he mei or 1)1 ametof 9C^Crq 'Occupancy.
"Yet or authon'rcJugent rp_l/ I�/•'/ Date TOTAL: ISSUED BY:
OFFICE