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22213 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Bedd� 1{/Addecss: �/ ^ kas Q V s �d,�-�-� 22213 ners .omn -:ayVIs"P9 p p CITY OF CUPERTINO-BUILDING DIVISION [ ,►.� I concraao�s/Na o�:� _ uc.No: APPLICATION If PERMIT �' 1 �7`�a'y'• BUILDING-ELECTRICAL PLUMBINGMECI IAMCAL CATEGORY CONTROL If ArchBect/pct � LIe.Na: QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO Address: !�3 �� UJ/(JB DQ• PFRMITISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am Lemsed under providoes of Chapter 9(commenc- AI'['LIANCESRESIDENTIAL JOB DESCRI'ITON Inense 1.1.fell 70(0)and efden3 ofthe 8udnemand Pro(evlonsCade,and my Icemc lain full force and effect PANELS License Class CZ,�Llc.S o 5r--_--�5' -4/ Contractor 4 - w'0`4 —UP TO 200 AMPS ARCHITECT'S DEC ARATION NfCCHa 2014000AMPS pWpW w9w2. I understand my plain shall be used as public mounts. OVER1000AMPS SQ.IT.FLOOR AREA $/SQ.IT. Fi U�j Licensed ProfesnoNl ISIGNSELECTRICAL 6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MLSC i-., 9 I hereby affirm that[am exempt from the Contractors License Law for the 7p '� following reason.(Section 7031 S,Business and Professions Code:Any city or y F., c 77IDtp.MET73R OR POLE INST. ountm=mpHortolap ante a em uimtheapmv ntfors ch,orrepalr Q B�EE .Q� any stsucture statement that he Is licensed pursuant to the rovisl ss;of t e 1'OWFR DEVICES Ep;K U 01e a signed datement that he U licensed pursuant to the proWsions of the Q3"GContractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIs1MINC POOL ELECTRICVALUATION S O sion3 ofthe Business and ProfessionsCode)orthat he is exempt therelromand ~SIF- the W sb(or the alleged exemption. Any violation of Section 70315 by any OUILETSSWITCHFSFIXTURF5 WE � applicant for a perMtaubjeasthe applicant taacivil penalty of not morethan $� five hundred dollars(SSM. NEWRFSIDENTIALELECTR S[CRIES CONSTRUCTION .• ❑1,as owner of the property,or my employees with wages as their sole t Zz compensation,will dothe work,and thestructure is not Intended or offend for ❑ sale(Sec.7044,Business and professions Code:The Contractors License Law does nota pply to an owner of property who builds or lmprovo thereon,and OCC.GR who does such work himself or through Msown employees,provided that such Improvements are not intended or offered for sale.If,however,the building or TOTAL: Improvement is sold within oneyearofusnpletion,the Owner-builderwill have trden of proving that he did out bund or improve for purpose of sale.). QTY. PLUMBING PERMIT UL as as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCEcontractors to construct the project(Sec.7044,Business,and Professions Code: The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EN Wilds or Improves thereon,and who contracts for such Inojeces with a Em co doK9)hcensed pursuant to the Contractors License Law. BACKFL)WPROTECT.DEVICE Ily U I am exempt under Sec. B&P C for this mason rt DRAINS FLOOR ROOF,AREA,COND. ' Owner Date RFGEI7a WORK MAN COMPENSATION DECIARATION �.��.�a SCHOOLTAX Y_ N_ ❑1 hereby affirm that I have a certificate of consent to self-Insure,ora RECEIPT X cenBioteofW.Iloce Comperuation Insurance or.untitled copy thenuf(See. GAS F.A.SYSTEM-1 INCA OUTLETS PARK FEE Y N_ vi y ab Q)LJ a 1078 334!3 J RECEB'T N Com any r'A/Q• CAS EA.SY5TEM-0VER4(EA) BUILDING DIVISI ON FE ES , Certified copy ta hereby to retained. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certified ropy 6 filed with the city Inspection divides. CERTIFICATE OF EXEMPTION FROM WOR KERS' GREASE TRAP PAID COMPENSATION INSURANCE SEN'F.R-SANRARY-S]ORM EA 200FT Date Recei t# (fhbuctlon need next W completed BtM permit is for one hundred dollars (5100)wless3 WATER HEATER W/VENT/E-ECTR ENERGY FEE Y_ N_ I cortify that In the performance of thework forwhlch this permit Is Issued, I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING Workers Compemdi m Law.oI GlBb Om .Date PAI D Z Z Applicant NEW RESIDENTIAL pIMB. SQFT. Date Recel t# Z O NOTICETO APPLICANT.If,after making this Ceettilote of Exemption,you should become subject to the Workers'Compensation provisions ofthe Labor TOTAL: ~ W Code,you most forthwith comply with such provislons orthh permit shall beBUILDING -E CC j deemed revoked. d C CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm that there is a construction lending agency for the perform- TOTAL; ELECTRICFEE Z an.of the work for which this permit is issued(Sec.3097,Cie.q PLUMBING FEE U O lenders Name H Lenders Address QTY. MECHANICAL PERMIT PEE MECHANICAL FEE LL U I unify that have read thisappbcatlonad Katethat theabove Information i PEES PAID: O ID correct.I agree to comply with all cityand countyordleances and date laws PERMIT ISSUANCE } 1 relating to building construction,and hereby authomm mprescntativn m inns Ofd F- Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH. �a Date Receipt# (We)agree to save,Indemnify an d keep harmless the City of Cupertino AIR HANDLING I1NR(CO 10,000 CFM) U against liabilities,udgment,co and exp n which may In anywaya zee SUBTOTAL: ago raid City In con oft aurin of this permit. c en AIR HANDLING UNIT(OVER]O,000CFM) f CONSTRUCTION TAX Signature ofAppllcDate AUS"f HOOD(W/DUCT) 0.j CONSTRUCTION TAX PAID: HAZARDOUS IXFIMATERIALS DISCLOSURE Will ia the efind!b or fumpertinbuilding ompantode, hapten le hazardous HEATING UNIT(TO 100,000 BTU) Date ReCei [# material as defined by the Cupertino Municipal Code Chapter 9.1 1,and the - I Irollh and Safety Cedn Section 25532(a)7 HEATING UNIT(OVER 100,00D BTU) TOTALC 71. ❑Y. N No Will the applicant or future building occopant use equipment or devices VENTILATION FAN(SINGLE REED) / ISSUANCE DATE which emit hazardous air contaminants as defined by the Bay Area Air Quality Management DkW 97 BOILER-COMP OHPOR 100,000 BTU) Yes No Thave read the Ja materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BN) - the California Health&Safety Code,Sections 75505,15533 and 75534. I I understand that if the building does not currently have a tenant,that It is my NEWRES1DFNT'IALMECH. SQ.IT UN responsibility to notify the occupant of the requirements which most be met 190 prlortoissuanccefa Ceni Ocatcofounpancy. I aT• 'tB4 Owner or authorized agent Date TOTAL: ISSUGUB . OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING 2 ZZ, -1- CITY OF CUPERTINO SSG z INSPECTION DIVISION JOB INSPECTION RECORD pa c`(� B VLL&`tZ PER IT EXPIRATION JOB ADDRESS O �O D ' `c+- �a�LI_ UC_UNIT# _LOT# PERMIT EXPIRES IF WORK OWNER S CONTRACTOR CC, IS NOT STARTED WITHIN INSP CTION DATE INSPECTOR INSP ON TIRECORD 180 DAYS OF PERMIT ISSU- FOUNDATIONANCE OR 180 DAYS FROM NOTE: LASTCALLED INSPECTION. LIFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF Pt OMITVALIUATION CUPERTINO STANDARDS. �I GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB '� n PLUMBING ��✓ —� ELECTRICAL ISSUANCE DA IE IILU(i L1 EC1 I'Lli. MLCH MECHANICAL ❑ ❑ ❑ VJ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR VALVAIIUN S/F i, PLUMBING MECHANICAL 1'LNM1IT IU ELECTRICAL FRAMING �' C StO IE,S FvIE CONS", INSULATION UCC GUOUP 111.5 UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED sU n .0 Knl ma.. lornl Man mE • ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE DIAPHRAGM THE CONSTRUCTION TAX IS PAID oU WING USE ROOF SHEATHING Ias INu CON Pe ue.., APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. 0 L L L L ASSESSORS PARCLI.NO. ROUGH SANA PLUMBING ELECT.ENERGY TRACT NO PARCEL NO TUBS 8 SHOWER PAN PLUMBING ENERGY MECHANICAL MECK ENERGY ' nCc,DnIF ACC FILE.NO ELECTRICAL BUILDING ENERGY FRAMING ELECT.FINAL TEST TONING ENG SIZE NO. INSULATION PLUMBING GAS TEST GAS EIRE SPUNK ENFRGv T}n MECHANICAL , L NL L NO COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING rLoou vaNl. nl.uC EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. v ❑ NL L NL SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING BUILDING INTERIOR LATH TEMPORARY APPROVALSrA SCRATCH COAT ELECTRIC PLAN CHECK FEE GAS NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR.UJ MICROFILM /� ' Ch ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC V1 • ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING 0 PLEASE GIVE JOB ADDRESS WHEN PHONING. - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE j TOTAL p CALLING FOR FINAL INSPECTION. APPLICANTS POSTING COPY