S 2498APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICA'1'IONIPERNIvir PLUMBING.. MEEIIANICAL S 2498
CPS fyrc�l����-✓ ,ejN c,��r;4VrA. 9. o14
4WCHITE17VENGINEHR:
Lt�rvsa:
m:
o �7ox 23200- /514 ns
❑SFOWL
C'ONTAC'T: PHONE:
❑ADDITION
❑ PLUMBING RI%PIPF
/app ?
-4G-�?
❑ Consultant Fc" Paid by Applicant (Initial)
LICENSED CONTRACTOR'S DECLAHA'O(INQTY
1 herchy ufann Incl 1 am licemal under proriviom of Cnaptcr 9 (commencing
with Noonan 70(XBar Division 3o JProfesainns Ctale, and mylicenw is
in loll form undal'bc �S 7f x n
Linnse :JX lac'N
ELECTRIC PERM IT FEE
U
PERMI"1'ISSUANCIi
APPLIANCES-RESIDIiNI'IAL
El SWIMMING fools
Ulvc Cunlraclnr ��
❑DEMOLIT(ON
m
ARCIII'I'IiCPS IIIiCLARATION
PANELS
yZ
I undentaiday, plumshdlhc used -public records
UPTO 200AMGS
I' -W
E J
W6
Licensed Pf..fissional
OWNER -BUILDER DECLARATION
1 hotel, alliin that um excntpl loam the Contractor s Liccnxe Law' for the
201400NAMPS
OVER ❑XXL AMPS
❑ FOOD SERVICE
G O
Wwhich
C,
�Q
::
Qctgommcncingwith
c" y
re'
�>.not
Sp
F.mJ
following mason, (Meati.... 70315, nnsincss-and Professions Codc'. Any city a county
requiacs a permit to tocconuol, ulnen. Improve, demolish, or repair any amens c
prior to it, ance.:Jso quireslhcnp,llcant for-ohlxrminn tile a signed"moment
isw, m
that he in teemed par ... a,,,am,r..Pjansafthc Cmtlmcmrs l.icovse Law(Cnaptery
Scaiin]11o01 of Division J of,he Rusinesand Profnsiom Calc) or
mar he is exempt Ihcmfrom and the basis Int the alleged cxempf:an. Any violation of
Semon 7031.5 by any vpplicantfory pc man subjects the applicant no a civil penalty of
Icon, than live huvdadl callam($5(X).
D 1, us owner nl'IIm propcmyornry employees, ith wug-ustmir sole emepensat inn.
166 0owork,nnd lmsrfncmrc is nal inmnalrdornlfnmll fore:del Sor.]WO, Bilincue
and Professions CoAr: The Comminor's Licenm law dotes nor apply lit an owmf of
propcnY who build, lir impmves mereon, and who dries such work himself or through
his own employees, provided tbar such intponmaents am not intended Ar oITcrad for
sato. If, however, the building or improvermml is sold within line year of completion, the
nanbuilder will have the burden of proving Phar he did nm build or improve for pur-
SIGNS IiLECI'RICAL
SPECIAL Cl RCU IT/M ISC.
TEMP. MI.. I ER OR P LE INST.
POWER DEV S
SWIMMING I'UOI, RIC
GOES I.ETS- SWI 'I"CUES JRES
IN I:. RGSIDIiN'I' ECI'R SQ FT
TOTAL:
Pwcot alo.).
I, - owner o1 rhe property, ant cxmlav"11 cnntrncung wllh I'ncnWd coif masers no
-Muer the project (Su. 7144, Business and Prom"i"n, Cale:)'I'be Cin..st-.'...i-
anownerofpmmywhobuild.or improves hereon, and
seLaw dmtanot apply rory,
QTY. PLUMBING PERMI FEE
who contacts!or such pmjcros with a conrracrort0 licensed Sussman to the Contractor's
License Inw.
❑ lam exompt under Sec. , B& I' C fnnhis reason
PERMIT ISSUANCE I
ALTER -DRAIN & VENT - WATER OiN
Owner Date
W(nRKER'S COM I'S SAI'I ON DECLARRI'ION
I lathy nllirm under pcndly of lerjury nuc of the Edlowing dcclandions:
1 hvr send will numat,o n a Cenif elle "I Consent m Xd6i-um far Workers Compem
cation, on pmvi Ev for by Section l]W of the LaNtr Cnde. for the performance of the
work for xhich mos flennil is issued.
❑ 1 hove and will maintain Worker's ConrNmettion Insurance, as required by Section
11011 of the Lahor Calc, fur the perl'onnnnce of the work in which this permit is issued.
My Workers Compensation Insurance currier and Policy number are:
Cannot: Iollicy No: -
Cl R I JFjCXFI!
o:CER'1'119CATE OF EX nM Ill ION FROM WOR KI?RS'
CONE 1117NSAI'I ON INSURAWH
(This ostial need nor be completed if the permit is fir one hundred dollars ($ 100)
is, Icss.)
I eerily Ihm in the ary m n manner
of the work became
this the W is issued.) mall
bol employ any len mon as m become suljea m the Wnrken' Compem
Z n,,, n Laws of Cldika"i IIvDmc un
cO Q Applicant
NOFICE'10 APPLICAN'1: If, vncr making this Ct, ilicntc if lixcntplinn, you nhoulA
Mcumc subject ut the Worker's Compensation provisions of the IrMtr Cite, you must
hmhw'ith comply with such pmvmmns lir this permit shall be deemed revoked.
Y7 Z CONSTRUCTWNLCNUINGAGENC1'
V Q Iherehy xtlinn that lhernnw
acanocuon lending ugencY for the performance of
IL the work lin wblan IN, person is Isand (Sec. E097, Civ. C.)
O f -s F' Iwadcr's Name
,r Il Tendo'', Addros
G 1 comity that I [lave mad this application and state that the rM,ve information is
N
connote, I me it, com,lywith all dry aml comm, radmano- and sure laws Morning a,
V Z battling comlruction. and hereby authmbc mpmxnwtives of this city to doer upon the
alloc-mentioned pro,amy for inspection purposes.
(We) agree too s.vv, inJeamily and keep hamJess the City of Cupomino against
Iab,,ticv, jndgtncnls, costs anA cxpcnvcs which buy in any way icons against said City
'1 crR grenme'd he grunling of his pelILIII,
APPLICANT UNDERSTANDS AND WILT. COMPLY WI'I'11 ALI. NON -POINT
SOURCE REGlJ1.Ar IONS w - —
X - / HAZARDOUS NINE ERIALS DISCLOSURE
WIII the applio mt or future bas Wling o ,,apam,l lir locule lar- dons licurdal
s defined by be Cupemino Mmillel CnJe, Chapmr 4,12, lad Tho Ileallh and SIdiD
Cour, Section 21532(li)?
❑ Y"
Will the applicant or far..holding desupml use equipomnt or devices which
it hLardnus air contaminants as defined by the Bay Arca Air Quality Managcnsem
n "'in?
❑Ycx No
1 have read the hexa dour anterial m,mucmems under Cnaptcr 6n5 of the Cali"
f min Health a Safety Code. Scotian, 25505. 25539 and 23514.1 understand that if the
building docs ma currently nave a Eduard. that it is my responsibility to notify [be romp
X
,if, e yaimt nu w mm a me n mto i � $g^Tnf y�
(�agcal U_49
BACK FLOW NROI'9C,T. DEVICE
DRAINS -FLOOR. ROOF, ARBA, CONO.
FIXTURES - PER TRAP
GAS -EIA. SYSTEM-) INC.4 ou ru I:S
GAS -EA. SYSTEM-OVER4(EA)
GREASE/INDUSTRL W'AS'I'I? IN'I HI CE19'OR
GREASH TRAP
SEWER - SANITARY -STORM EA. 2(X1 l?.
WA I'ER IIEA'1'T:R WNEN WELEC IA
WATIdR SYSTEM/['BEATING
WATER SERVICE
NEN' RESIDEWIAL PLMB. SQ, ET.
TO
Q1 Y. MECHANICAL PERMIT
PERMITISSUANCE
ALI ER OR ADD'TO MECII.
AIR HANDLING ONE '['(To 10,000 CFM)
AIR HANDLING UNIT (OVER I0.0 0 CFM)
EXHAUS"1' IIUOD (W/DUCT)
HEATING UNIT (TO 100.0(X) BTU)
HBA'I'INC, I N[I'(OVER 100,0001,'1'U)
V BNTIIATION PAN (SINGLE BESIDE
BOILL'R -COMP (3HP OR 1000 (X) RTU)
BOILHR - COMP (OVER I(X),INX) RED)
AIR CONDI' TONER
NEW REN[DINTIALMECH, SQ. P1l
q 7? 1
0
I nl❑IJC I:L1❑SC1 1'LIIMn /Mb❑t•ll
JOB DESCRWI ION
RFSIDENTIAI
❑SFOWL
❑ KITCHEN REMODEL
❑ADDITION
❑ PLUMBING RI%PIPF
❑MULTI -UNIT
❑STRUCTURAL
MODIFICATION
❑INI FRIOR
❑CHIMNF:YRF:I'AIR
IMPROVEMENT
El SWIMMING fools
❑ BATH REMODEUREPAIR
❑DEMOLIT(ON
❑ GTIIHR
COMMERCIAL
❑NEW BLDG/ADDITION
❑DEMOLI"ION
❑TENANT
❑ FOOD SERVICE
IMPROVEMENT
❑ afB1:R
FLOOR AREA
S'IORIE In'ewrolnu�u�n
OCC GROUP' APN
BUILDING DIVISION FRGS
PLANCIIECK IEE
GR C
SOBS FEE
PAID
Dale Ro,oiplN -
BUILDING ldl?
FEE SEISMIC FIB;
FLEMRICI' E
PLUMBING E:
NIECES 'IC
CONSTRU ION TAN
IIOUSIN ' MITIGATION IiH.
PAID
Dale Reeei"to
T r
ISSUANCE DATE
3-
ISSI11iD BY:
It^
r
POSTTNNOV 09 '99 12:25PM LIFESCAN/SALES ADMINISTRPTION
CITY OF CUPERTINO
BUDDING DIVISION Dv0 I IGTION
TUI LDR•1GAODNG:Yt (� �.�. `�� /` ���� �� �: *r�r •!,i.0 ♦r.C. ` V. ��
L t�
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MPLI • L' rR
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❑
CONwOLt
MeT �worw:RR: LIG NO,
AIMRRSS: ... . • r J f i% "(� A' `/ • !; J
INSPECTIONS
:UFER
DATE
INSPEC.
❑ Cmwltmt Pm Fluid by Applkent(InitLl)
BUILDING PERMIT INFO
BLDG ED0 PL MECN
o ❑ ❑
DATION/PIERS/H.D.S.
INSPECTION RECORD
NOTE: ALL GRADING AND DRAINAGE
SHALL BE INSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
JOB DESCRIPTION
1{Pcmp.NTIAI:
OW'DwL O KITCEEN RD.IODEL
❑ADDmON ❑ PLUMBING REdIPE
OMuLR•uN[r ❑sTRurnIRAL
MODIFICATION
OINRNIDR ❑ LMW NET RPPAOt
IMPR0064BNT swimmWGPOOLS
ORATNRDMDDILMMAEt ❑DEMOLITION
❑OTHER
GROUND
PAD/SET BACK -CERT
GARAGE SLABS/PREGUNITE
POUR NO CONCRETE UNTII. ABOVE HAS BEEN SIGNED
TOCMRE�D GE INSPECTION
CALL AFT DONS (1:00 PM - 0:30 PM)
777.3228M 4 '0 FRIDAY 26 HOURS BE-
FORE RBQU INSPECTION. JOB ADDRESS
AND PERMIT q ARE NEEDED WHEN PHONING.
ATTENTION CONTRACTORS:
NO PERSON(S) SHALL PERFORM WORK ON
THIS JOB SITE WITHOUT BEING IN COM-
PLIANCEWITH WORKERS'COMPENSATTON
INSURANCE REQUIREMENTS.
UNDERGROUND/SLAB
PLUMBING �. i
ELECTRICAL
DO NOT POUR FLOOR UNTIL. ABOVE HAS BEEN SIGNED
QP)1MN1N-I&1 r
0 NEw RIDGlADDmoN ❑DEMOLITION
0TENANT Oe00D SERVICE
R PROVB"
ENTME
�DrHeR
PLUMBING
CHANICAL
ELECTRICAL
FR.IMING VENTS
INSULATION
INSPEC710N SPECIAL INSPECTION REQUIRED ❑ DATE
INSP.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS & SHOWER PAN
MECHANICAL
v ICAL/POOL BOND
G/STAIRSIB. EGRESS
INSULItTION/V BNTILATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIAL 5HEAR41OL.D DOWN
INTERIOR $HEAR/HOLD DOWN
SHEErWROCK/SHEETROCK SHEAR
EXTERIOR LATWw-SCREED
SHOWER LATH
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATBR
TEMPORARY APPROVALS
OCCUPANCY
—A lq2gI
.
ELECTRICAL
lu
GAS
By
FINALS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL
PLUMBING i
` HANICAL
ERGY
FINAL ONLYG
CERTIFICATE OF OCCUPANCY ❑
3BOICITUrLOPANCY
IMPORTANT}
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION!!
J -yCE paTE
✓ C�
Issup.0 .
OF BUILDING IS NOT PERMITTED
UNTIL BUILDING FINAL IS SIGNED BY BUILDING
INSPECTOR. ` -.