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22205 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Project Identification IPERMIT NO,22205 Building Address: . !d�T 7y7n_eir­S am one. A AE1 A S CITY OF CUPERTINO�BUILDING DIVISION Con" '. sine: Lic.No, APPLICATION /PERMIT BUILDING-ELECTRiCALPLUMBING-MECHANICAL CATEGORY CONTROL N Andric / jj� Lk. o: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO A PEthDTISSUANCE ❑ ❑ LICENSED CONTRACTOR'S DEC RATION I hereby am ffirthat l am Ecensed under provision,of Chapter 9(mmmese APPLIANCFSRINDENTIAL JOII DESCWI"ITON Ingwith5 ion7000)of DlWslan3ofthe Budnmand Profes onsCade,andmy license Is In nd dfed. O O PAND-re �(/I - •s }� Lim ss Lk.N t,fie 1 ���J�I•I�j� e — Coraractor \1\I`f: 2011000AMP5 ARCHITECTS tJk)VB OVERIWOAMPSEA E/SQ.FT. wp 7 I understand my plain eha8 W urd es pubOc rem O E Z� Licensed Professional SIGNSELECTRICAL - J TER ,rl <w OWNER-BUILDER DECLARATION 1 �j Ihereby affirm that l am exempt from the Contractors License Law for the SI'ECIALCR4CUIT/MISC 4 o 9 9� following reason.(Section 7m1.S,Business and Professions Code:Any dry or TEMP METERDR OLE NST. �/ cmntywhich requlma pernitwmmtmM altep Improve,demolish,orepair Gaa[[ anystm=mpnortulm LswanceaWrequimtheappbc tforwchper tto POWER DEVICES a a file a signed statement that he is licensed pursuant to the provisions of the JI / 4 p �0 O� Contrador3 License Law(Chapter 9(commanding with Section 7000)of Divi- SVVM NG POOL ELECTRIC AL A'TION 30 sion3ofthe Businmand Profmlom Code)orthathebeumpttheefromand the balls for the alleged exemption. Any violation of Section 7031.5 by any Q EE OUTLETSSWITCHESFIXTURES applicant n ntfor a permit subjects the applicant to a civil penalty of.&nre than live hundred dollars MSM. NEW RESIDENTIAL ELECTR SQ.FT. - NS'IRUCTION .- ❑I,as owner of the property,or my employees with wages a,their sob 'Z compensation;willdothn work and the,trudurc boot intended or offered(or �p rude 6ce.7fK4,Business and Profmlona Code:The Contradoee Licenae Law U T S$ does not apply to an owner of property who Wilds or improves thereon,and OCCiGR lJ{6_ RFS.UNITS who does such work himself orthrough his own employees,provided that such E �O /�� aa) impmvementaarenot Intendedorofferedfes e.ILhoweverthe WIldingor TOTAL: G improvement bsoid within oneyearofcompledan,theowner-bullderwlll have tlr rd en of proving that he did not Wild or improve for purpose of sale.). QTy. PLUMBING PERMIT FEE FLOG ZONE APN u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contradmn to construct the project(Sec.70K Business and Profmions Code: 2�Q The Contmdors License Law does not apply to an owner of property who Wilds or Improves thereon, and who contracts for such PPjects with a TE-DRAIN&VENT-WATER(EA) ` dor(s)licensed pursuant to the Contradorb License Law. FEE SUMMARY 151 am exempt under See. B &P C for this reason BACK FLOW PROTECT.DEVICE FITS DRAINS FLOOR,ROOF,AREA, D , SANITARY Y N� Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION TURES PER TRM SCHOOL TAX Y N ❑l hereby affirm that I have a certificate of consent to self-insure,or a a RECEITT N certificate o(Worken'Comperuatlonlmuranm ora certified ropythereof(See. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N 3800,Lab CJ RECEIPT p PWiry N GAS EA.SYSTEM-OVER 6(EA) BUILDING DIVISION FEES � Com a ertl0ed copyathereby fumbhed. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE Certified copy at Ned with the dty Wpedlon division. ' CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATIONINSURANCE SEWER-SAMTM ARY-STOREA.2(10FT. Date Recei t# (Hossection need netW completedi(the permit b forona bund ed dollars ($100)orl..) WATER HFATERW/VENT/ELECTR ENERGYFEE Y_ N_ I certify that in the performance of the work(orwhich this permit h baued, I shell not employ any person in any manner,o as to become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws of CaOfomla.Date PAID OZ Applicant - NEW RESIDENTIAL PLMB. SQ.IT. Date Recel t# Z O NOTICE TO APPLICANT:If,after making that Certificate of Exemption,you should Wcarre subject to the Workers'Compenaation provisions of the Labor TOTAL: CCN Code,you=at forthwith comply with such provisions or this permit shall BUILDING FEE W > deemed revoked. SEISMIC FEE CONSTRUCTION LENDING AGENCY d 13 Thereby affirm that them bammtrodlon lendingagency for the perforrry TOTAL: s ELECTRIC FEE Z ante,of the work for which this permit Is Issued(Sec.3097,Civ.C.) PLUMBING FEE ' V O Lender's Name IL I— Lenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEES L) �cenlfy that l have readthisapplicationand katethat theabove Information O Wd red.Iagree to comply with all cityand routyordinancesand statelaws I PERMIT ISSUANCE �(9-;' FEES PAID: } a elating to building canstmdton,and hereby authorize representatives ofthat F Z city to enter upon the above mentioned property for Inspection purposes. ALTERORADDTOMECH. Date, RL'Ce1Pt# (We)agree to save,Indemnify an d keep harmless N the City of Cu peno L.I AIR 11MTTf010,000 CFM)against liabro i0tics,judg..t, ,b and expenxawhlch ruylnanywayaceme SUBTOTAL: agar itAA abn _.2y In +N .(the sting his parnB. CONSTRUCTIONTAX AIR HANDLING UNIT(OVER 10,000 CFM) Ignatvre of ApplicaunfMcintractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTI) Date Recet t# material as defined by the Cupertino Municipal Code,Chapter 91Z and the Ilealth and Safety Code Sedion 2S532(a)2 HEATING UNIT(OVER Iffy"BTU) TOTAL: ❑ Yes M No Willtheapplicant or future building occupant use equipment ordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE which emit harnrdous air rontamlnads as defined by the Bay Area Air Quality Management District? BOILER-COMP DHP OR 1 WpOD BTU) Yes No havereadthehaza Ws materials requlrcments under Chapter 6.95 of BOILER-COMP(OVER 100,000 STU) �ks3Bir the California Health&Safety Code,Sections 7550.5,25533 and 25534.7IT F=• u ndcmta nd that if the bu Ilding doe,not cut rently have a tenant,that it b1N RESIDENTIAL MECH.my SQ.' q Q} responsibility to notify the occupant of the requirements which most be met s� [,`� v 8 PIZ! prior to Issuance of a Certificate of Occupancy. I ♦ S aCC Uo-1 (o.00' Owner or authorized agent Date ISSUED 4 t`.�at'rs%"'"`�^ � TOTAL: OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDIN CITY OF CUPERTINO P INSPECTION DIVISION PdrT f3 AM JOB INSPECTION RECORD tial ( / PERMIT EXPIRATION JOB ADDR ESS_ U�I Q QrL� UNIT fk _LOT# PERMIT EXPIRES IF WORK OWNER S CONTH CTOR IS NOT STARTED WITHIN INSP CTION DATE INSPECTOR INSPECTION RE RD '180 DAYS OF PERMIT ISSU ANCE OR 180 DAYS FROM FOUNDATION NOTE: LASTCALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED' PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF PERMIT VA1.90AnoN GARAGE SLABS CUPERTINO STANDARDS. � T JC(� �•�w\D I, POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED I UNDERGROUND /SLAB PLUMBING O ELECTRICAL ISSUANCE DATE MECHANICAL BIOe. ELECT ILI, meeTl ❑ ❑ ® ❑ 00 NOT POUR FLOOR,UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALUATION PLUMBING MECHANICAL ETU L TD ELECTRICAL FRAMING U I INSULATION STOR¢s TYlj CONS IH. OCC.GRODV RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO TT fLOOTTMTCA TOTAL.ACRE ARL ` . ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID BUILDING USE ROOF SHEATHING I I ITT:.`• IND CON PB on." APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ ❑ ❑ A SSE SSUns PARCE L NO ROUGH SANA PLUMBING ELECT.ENERGY ITIACI NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECH.ENERGY ACC.DATE ACC.FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST ZONING. ENC, SI1E NO. INSULATION PLUMBING GAS TEST GAS "ILESPRINI wER6YI7) MECHANICAL v rv� v 0 rv0 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING EXTERIOR SHEAR ELECTRICAL RELEASE "°T'u n>NI. n.Luc. Y❑ N❑ -1 IN INTERIOR SHEAR FIRE DEPT, SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING INTERIOR LATH TEMPORARY APPROVALS BUILDING SCRATCH COAT ELECTRIC PLAN CHECK GAS FEE NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED13Y BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTF11c NLA • 1- 0 ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O PLEASE GIVE JOB ADDRESS WHEN PHONING. Z CONST,TAX Q - SEE PERMIT FOR EXPIRATION DATE - f" IMPORTANT! PLEASE READ REVERSE SIDE BEFORETOTAL CALLING FOR FINAL INSPECTION. GO APPLICANTS POSTING COPY.