19370 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
6 Buildin No'ed Went flcall PERMIT NO.
ding Addreas: ' 19370
S 4 = D
neo a Phone:
APPLICA
CITY OF CUPERTINO-BUILDING DIVISION
crno-ado aName: Lie.No: APPLICATION It PERMIT
BUILDING-ELECTRICALPLUMBING-MECHAMCAL CAT[CARY CONTROL YT7S
Architect/Engineer. Lie.No: JJ ((
Qn ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: B PERMITISSUANCE O ❑ ❑
LICF.NSEDCONTRACTOR'S 141CFAIArTI111
I hereby affirm that l am licensed under provisions of Chapter 9(caurrancru, APPLIANCES-RESIDENTIAL Jpfj gf�C�ON
Ingwith5 dion9(100)of DiviMm3ofthe Buslnessand Profs IonsCo ol.odery aY Vel-f l
license le In h d effect. PANELS - �Y-
License�lic.p .} -7� r
Date Contractor ,S/ 201-1000AMPS Ga,I-•,(. 1`
ARCHITEoused IAIIA N OVERIOOOAMPS SQ.FT.FLOOR SQ.FT.
�'l. I understand my phm shall be used m public remNs.
qqp? Opp
E d O Licensed Professional SIGNSELECTRICAL
<a OWNER-BUILDER DECLARATION
1n IiS SIaEC1Al CIRCUIT/MLSC
Iherebyaf@mthatlamexemptfmmthe Contmdoes Llmnw IAwforthe
po 'followingma n.(Sedion7N15,Businessand Professions Code:Aeydtyrr
FZI-'�'gqyy
muntywhich requires a permit tomrod
tru ,alter,improve,demolish,orrepair IFMP.MEI77t OR TOLE INST.
Es❑ nystmMmpdortoltstswance,alsorequlrestheappUmntforwchper tto
K file a signed statement that he Is licensed pursuant to the provision of the POWER DEVICES
Ou, Contractor's License Law(Chapter 9(commencing with Section 70W)ofDivi-
H�OS se 3ofthe Business and Professions Code)arth.t he Ls exempt therefroand SWBdh9NG IDOL ELECTRIC
irm VALLU,AtTIOf50
the basis for the alleged exemption. Any violation of Section 90315 by any OUTLETS-SWITCHES-FIXTURES �D e y(/-
apphrniforapermitsubiM theapplicanttoadvllpemltyofnu=m ban
Og fyehundred delta.(ASW).
I,as owner of the property,or my employees with wages as their sole NEW RESIDENTIAL ELECTR SQ.FT.
STORIES TYPE CONSTRUCTION
t co nation,wllldothe work andthe stmctum is not intended or offered for
5 O xale(Sec.7014,Business and Professions Code:The Contractor's License Law
[ S$ docs not a pply to an owner of property who Wilds or improves t hereon,and OCC.GROUT' RES.UNITS
CC.. whodoeasuchworkhterselforthrough Fisown employees,provided that such
improvements are not intended oroffered forage.If,however,the W(Wing or TOTAL-
improvement
OTAL:i provement bseld within owyearofcompidlogtheowner-WlWerwlll have
tkXnen of proving that he did not build or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
lAf Las owner of the property,am exclusively contracting with licensed PERMITISSUANCE
c n dors to construct the project(Sec.7014,Business and Professions Code:
The Contractor's License Law don not apply to an owner of property who ALTER-DRAIN&VFM-WATER(EA)
Wilds or improves thereon,and who contracts for such p(ojmts with a FEE SUMMARY
,S�actrr(s)licensed pursuant to the Crntvdora License Law. BACK FLOW PROTECT.DEVICE
U 1 am exempt under Sec B&P C for this reasonOUTSIDE FEES
Owner Date DRAINS FLOOR ROOF,AREA,GOND. SANITARY Y_ N_
• WORKMAN COMPENSATION DECLARATION
❑ RGCEOTN
I hereby affirm that 1 have a certificate of consent to self-insure,or a FIXTURES PER TAMP SCI IDOL TAX Y_ N_
reni(Imteof Workers'ComNe tlomlm mnmmaceAlfkWmpythereof(Sec. RECEIPT
3300,Lab C.) GAS EA.SYSTEN-1INCA OUTLETS PARK RE Y_ N_
Policy If RECEIF T N
GAS PA.SYSTEM-OVER 4(FA)
Com any BUILDING DIVISION Fit ES
Crmfied copy is hereby furnished. GREASEANDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy Is filed with the city inspection division. G� pGsaJ
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETAAP PAID 1z-7—�r
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FT. Dale RCCeI t#
(This section need net be completed Bthe permit bfor one hundred dollars
(4100)wlessJ WATER HEATER W/VENT/EL[CTR ENERGY FEE Y_ N_
I certify that In the performance of the work for which this permit Is Issued,
I shall not employ any person in any manner m as to become wbjed to the WATER SYSTEM/TREATING
Workers'Compensationlawsof Cahfomla.Data
PAID
0 Z Applicant NEW RESIDENTIAL PLMB. SQFT. Date Recei IN
Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you
should become subject to the Workers'Compensation provisWm of the Labor TOTAL:
N Code,you must forthwith comply with such provision orthls permit shall beBU NG Y
W > dremd revoked. '
d c CONSTRUCTION LENDING AGENCY SEISMIC FEE
Ihereby affirm that them is a construction lending agency for the perform TOTAL: ELECTRIC FEE
Zante of the work for which this permit is Icwed(Sec.3099,Cie.C.)
Iendgrea Name PLUMBING FEE
LL LL O landre.Address QTY. MECHANICAL PERMIT FEE
O W I¢dlfythatl havereadthbapplicationand slatethattheabove Information MECHANICAL FEE.
V correct.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
} N relating to building construction,and hereby authodae representatives ofthis
F city to enter upon the above- noned property for inspection purposes. ALTERORADDTOMECH.
? abmeti(We)agree to save,indemnify an d keep harMess the City of Cupertino Date Receiptq
V 'gained Bab Ms,judgments,cnstsaM expenses which may teary waya.c AIR HANDLING UNIT(TO 10,IX10 CFM) SUBTOTAL:
again fey in gxlue ftM granting of this permit.
_ AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX
urcof Appltra rnaador e EXHAUSTHOOD(VJ/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUSMATERIALS ISCLOS RE
WIIl the applicant or(afore Wilding oav eel store or handle haeallous HFATIRC UMT(701m,0000M Date Recef tin
materialasdeftned by the Cupertino Munid al Code,Chapter 9.12,and the
I Iealth and Safety Cede Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑ Yes n No
Will theapplicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DA'L'E '
which emit harardouaalt contaminants as defined by the Bay Area Air J, /qac av1 vGL.
Quality Management District? BORER-COMP(3HP OR 100,000 BTU) �D
Yes n No
Ihave readthe b.9usmaterials requirements under Chapter 6.95of BORER-COMP(OVQI100,000 BTU)
the California Health&Safety Code,Sections 25505,25533 and 25531.1
understand that lithe building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. �1L 4 47.289
19
rnpomibllity to notify the occupant of the requirements which must be .Av.a
print arses egra Cee sof Om pa ncy.
er or au rind agent e
TOTAL: ISSUED BY �• _ _
OFFICE COPY
O.
PERMIT N
v POST THIS CARD NEAR FRONT OF BUILDING 19370.
. CITY OF CUPERTINO A A A
INSPECTION DIVISION- JOB INSPECTION RECORD
JOB ADDRESS ' �r ( Y 1"t, UNIT# LOT# CATEGORY CONTROLN
OWNER 1 rl� j,n CONTRACTOR „ BUILDING PERMIT INFO
INSPECTION DATE JINSPECTOR INSPEC1 N RECORD
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE n'
UFERGROUND SHALL BE INSTALLED TO COMPLY WITH ^,- JOB DESCRIPDO
PAD/SETBACK-CERT N
THE APPROVED PLANS AND CITY OF ,� +� -. ✓✓rA h. L GARAGE SLA0.S PREGUNITE CUPERTINO STANDARDS.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED �-
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING _-
ELECTRICAL 7
MECHANICAL FpQ U S 6H(3GWCLTS ^L—�15--E
S
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 U L�
ROUGH _
PLUMBING �`-30 o aG/ co c
TU16&SHOWER PAN CALL rl p O
ELECTRICAL/JACUZZI BOND
zz
FRAMING/STAIRSja-
INSULATION/VENTILATION
BMERG.EGRESS
. SEWER WATER
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SIJEAR HOLD DOWN
INTERIOR SHEAR/1-TOLD DOWN
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE IINSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH,ENERGY
13UILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS _
BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL �p
1311ILDING FINAL IS SIGNED BY BUILDING INSPECTOR '� /�" � '✓� G
. 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 Cit, of CBR?rt1[�
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ssu DBY:
OFFICE COPY '