31080 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELFCI'RICAI. PERMITNO. 310 8 0
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
zi 6 � wa7
OWNER$N4MF.: ( PH( 1,� / CO LIC.m, Nr1.ICN0,
�oar�Ne 4 oamEogv%o PIN fR�/ NIC CONTROL
4RCHI I InUlYENGINEER; LIC NO: AUDURf.51� S Oe,�,vz.¢ gcyo• ❑
CONTACT. PHONE: J[r BUILDING PERMIT INFO
�Fy-vs •�,1"Z z/Oooa ❑ Consultant Fees Paid by Applicant(Initial) B ELE PLUMB MECH
LICENSED CONTRACTOR'S DECLARRAA>TION TQTY ELECTRIC PERMIT FEE
1 hereby a1Em,me 1 am Boned ower provisions of Chapter 9(Comment, JOB DESCR
WIPTION
nn with SenioDi
n 7000)of vi en 3ofine Business ons Profeavions Code,and my l icenseix
W O O PERMIT ISSUANCE RESIDENTIAL:
C-F• in full Talc raw effect. OSFDWI. /KITCHEN REMODEL
QUV License Class Lic.p AI'PLIANCPS-RESIDENTIAL OADDITION ❑PLUMBING RE-PIPE
F 7z-u] Data—Contractor
to 4 ANCNI'l1iC'1'S DECLARATION 0MUI.TLUNIT 0STRUMURAL
F.Dm m PANELS
Z O'n Z I undeamnd my plans shall he used as Public acotd MODIFICATION
OZ—M UPTO200AMP5 [_1 INTERIOR [ICHIMNEY REPAIR
FQ�E-ul Licensed Professional I014000AMPS IMPROVEMENT
C ; OWNER-BUILDER DECLARATION OVER I000AMPS O BATH REMODEUREPAIR 0DEMOLITION
6' Q ( I hereby affirm thm 1 am exempt from the Conuacmr's License Low for the
x�x'OiV following reason.(Section 7031.5,Business and Professions Code:Any city Or County SIGNS ELECTRICAL 0OTHER
which requiem u Permit to Conamcl,aheq improve,demolish,or repair any swewre
EF ct�0 prior to itsionanee.also requires the applicant for such pcmtiuo file a signed.aaament 'ECTAL Cl RC UITIMTSC.
E} G
that he is licensed pursuant to the provisions of the mmcter's UCCm LCw(Cbaper9
W 5DO (commcncmg wnh Sectinn]UW)nf DivizionJaf the Business end Pmfcssians Code)Or TEMP.METER OR POLL INST. COMMERCIAL:
2 e tE mar s 0,exempt therefrom and the basis for the alleged exemption.Any violation of O NEW BLDG/ADDITION O DEMOLITION
lis Seci, 131 5 h any applicant for a permit subjects the applicant m a Civil It f POWER DEVICES
.M.y y Penalty OTENANT 11 FOOD SERVICE
not more than live hundred Jolles($510).
F.Z Y IMPROVEMENT
=Q ❑Las owner ofthe the samy.mmyot amended withwagn as mic(Seeea Businesax SWIMMING POOL ELECTRIC
C F•�
will Pr the work,COLandIC he ttimContra not amended Law
do for of apply to an.oolur of ❑OTHER
Land Professions Cwe:The oyes Contractors License Luo des not apply is It owner of OUTLETS-SWITCIifS-FIXTURES
his o nY who holes,or improves thereon,and vwhoem Jon such work
te Mesal or through LC
his own employees,provided that such improvements arc not intended or offered for NE RLSIDENTIAh EL1!CTR SQ I'H
In
sale.IL however the building or improvement is sold within one year of completion,the SQ .FLUOR AREA ASQ.IT.
owner-builder will have the burden of proving that he did not build or improve for put. ``1N1�PI/NN
Ixtao sole.). OI'�gyw
has,owner of the poetical am exclusively contracting with licensed cnmranors m TA II[(I I/7l
construct the project(Sec.]Dir,Business and Profession,Code:)The Contracmev U.
rase Law dtns not apply to an owner or property who builds or improve.uhcreoa.and QTY. PL BING PERMIT FEE � �uYE'yr�N
wh vaaabmcm fur.ueh projects with a umvmm
nanm(s)licensed pursuant the Cnctmr'sxxn� Q
License Law. PERMIT . Q
O 1 am exempt under Sec. ,B&P C for this reason
ALTER-DRAT .NT-NATER(FA) VALUAT N
Owner Dam
WORK17R'S COMPENSATION DECLARATION BACK FLOW PROTECL DEVICE. ` fy�'tC - l�
I hereby anion under penalty ofperjury one of the following declarations:
11-1(M1ave and will maineina CenificaeufConunuO.self-irmeafor Worker's Compen- DRAINS-FLUOR.BOOP AREA.GOND. STORIES TYPECONSTRUCDON
,radon,as provided for by Section 3700 of the Labor Code,for the performance of the
walk for which this permit is issued. JAIgFURES—PER'TRAP
1 have and will maintain Worker's Compsma ion Insurance,a required by Section
3]00 of the as CrAcem,thepe ma<eof the indlwork for which this Permit is rs}yed. GAS-EA.SYS -1 INC.4 OUTLETS OCC GRO APN
Corzerrk C a�In macro p"ICYN y ytrtlscmtQ{}/:Y GAS-EA. EM-OVER4 EA)
CERTIFICATE OF EXEMPTION MOM WORKERS' [I
COMPENSATION INSURANCEGREASFJ&UWASTE INTERCEPTOR
(This section seal not be completed iOM1m
e pctit is for one hundred dollars l31(X0 GREASG'fRAP . I GDIVIS 'FEES
nr less.) PLANCHI!G F.E.
I astly main the performance Of the work for which this permit i,imxuoarsen. SEWER-SANT Y-' EA.
C200IT.
oat employ any person in any manner m as m become.ubjan0 the WOrkeri OmpcLNERG PEL
Zz -do.Laws of California.Date WATER HEATER W E
Applicant GRAD
try NOTICE.TO APPLICANT':If,are,making this Cenifici a Of Exemption,you should WATER SYSTEMn'REATING
become subject to the Workers Compensation provisions of the laborCWayou must SOILS I"`
W forthwith amply with such pro,ismns on his Penni,shall he deemed avokcT WATER SERVICE
Q
CONSTRUCTION isac(INLENDIending NCY NEW RESIDENTIAL('LMH. SQ,pT. PAID
U O Thereby affirm the mere isacanswniun lending agency fm the perfmmancc of I ate Receipt
He walk for which this Permit is issued(Sec.31197,Civ.C.)
�' Ir I.Cader,None TOTAL:
V I.cndcr's Jdress AI
1< nirY mat I have read thin apPlicatian and•eaenms the above information ix HUILDI FEE
(A Co.,l Treem comply with all ciy ono county Otdin .and zmm laws mladngm Q'ry, MECHANICAL PERMIT FEE
U Z rgi-,b 90 nociam and herehyamhmim representatives ofthis city n.emer upon the SEISM( TEE
above-torn +ncd pmPc for ia.puctinn purpo,cs. 1'HRMIT ISSUANCE!
( e gee m C.indemnify and kccp hamtless the City of Cupertino against ELECT IC PLL
liabilities'u m ,cntvnd expenses which may in anyway name again,sail City PETER OR ADD TO SUCH.
inconseq -a a the grantingofmimpermit PLO UNG FEE
APPLICA '1 'N IRRS'TANDS AND WILL COMPLY WITH AI,L ON- INT AIR HANDLING UNI'[('In I(UXX)CFM)
MEC( NICAL PEI?
SOURCE ONS. // q
3 L1 97 AIR HANDLING UNIT(OVER 10.(XNCFM) CONSTRUCTIONT
SignamrcofAmoucOmranar )ate EXHAUST HOOD(W/DUCT) HOUSING MITIGATIONP
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant more or handle hawdous material HEATING UNIT(TO 100.000 BTU)
as derined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cole.Section 25532(aV HEATING UNIT(OVER 100,00)BTU)
❑Yes ON. ILPAID
VENTILATION PAN(SINGLE RESID) Date Receipt as
'll the applicant or future building waniam use equipmem or devices which BOILER-COMP(JHP OR IUT,IXNI BTU)
a hoz: Jon....C'onot men,ns,a feed by the Be,Arca Ail Quality Managcmem TOTAL:
ton] BOILER-COMP(OVER 100010 BTU)
O . ONa
gnircmcn p AIR CONDITIONER
1 're
me IC r"'
m:ncdal,re t,ander Chapter h,95 ansa can-
ISSUANCE
fomiii run
Code,Sections 25505,2553)rend 255]4.1 undcrvan the if enc NEW RESIDENTIAL MECH. SQ.IT.
building dt + urrcntly haveamnent the it is my responsibilitye co mcupum
Ofthe aqui ieh most Name,primmiumnce ofa Ca�tfi of �_T(:jg
(lwnefor i ath i fit agent Date 'R)'1'AL; ISSUED it
OFFICE
FEB-04-199e 16:43 NEWTON INC. 406 974 8949 P.002
,pjST THIS CARD NhARFRUN I VrOUILW11-Ul PMML(Nt).
OF CUPERTINO 3108C
BUMPING DlVlq�10N; VUILMGrX JECTIDENMICATION
"'n'EUEPWG =tt $ANITARYIW APP
CON�Cr?,Kj NAM� LIC NO:
MNTAOL a
7 NC
CNnECTNNGIN[ERt
ILDING PERMIT INFO
INSPECTIONS DATE. INSPEC. sultanj Paw Paid by Applk..'(initial) 0 R1.2cr PLUMB M MA
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB D&�R?N
UFER GROUND NOTE! ALL GRADING AND DRAINAGE RFSMrNTIAI:
SHALL BE INSTALLED TO COMPLY WITH O.SFDWLHEN RP,MODE
PA CITY CIADDITION MBINCRE.Plil
D/SEI'BACK- THE APPROVED PLANS AND OF
CUPERTINO STANDARDS, MODIFICATION
SLABSfPREGUNITE C MULTI-Umm C3S7'RUC.TtMAl.
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION � INTERIOR
OCIUMNEYREP
AIR
vENT
ONDEROKOUND/SLAS CALL AFTERNOONS 02:30 1'M - 4AM PM) � ATHEOMFPAIK Cj npwourlON
PLUMBING
777-3228 MONDAY TO FRIDAY24 HOURS BE-4,
ELECTRICAL FORE REQUIRED INSPECTION.JOB ADDRESS
AND PERMIT ARE NEEDED WHEN PHONING.
DO N07 POUR OR UNTIL ABOVE HAS BEEN SIGNED COMMERCIAL'
ATTENTION (:ONTRACTORS: C3 NEW BLDG/ADon-toN 01317MOLMON
PLUMBING NO PERSON(S)SHALL PERFORM WORK ON OTENANT 0 Foon srima
MECHANICAL THIS JOB SITE WITHOUT BEING IN COM- imp90vFMEU4T
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION OOTI.IER
isFRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION INSPEMON SPECIAL INSPECTION REQUIRED ❑ DATE INS
PLACE NO SUBFLOOR UNTIL ABOVEHAS BEEN SIGNED
ROOF SHEATHfDIAPHRAM 11
PLUMBING_ 7
TUBS&SHOW FR PAN er
, �71
MECHANICAL L
FCAUPOOI,110N)
6tsTAiRsjL:.rcr Fss
ITRAMM i
INSULAT)ONAfENTILATION
COVER NO WORK UNTIL ABOVE HAS BEEN SI P D
CXTERIALSHF.ARjHOLDDOWN I
INTERIOR SHEAR/HOLD DOWN
'Rjo�
H
E
ITROCK S
HEAR
EXTERIOR lAH7W-SCRFFD ILI--It
SHOWER LATH
QTAPE OR PLASTER UNTIL.&.BOVF HAS EEN SIGNED
SCRATCH COAT Tr-
SEWERAVATER 171 �
TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
FINALS
GAS TEST Y_
GRADE
FIRE
HANDICAP
ELECTRICAL 'o-q
PLUMBING 'Ci
hMECHANICAL.
ENERGY CERTIFICATE OF OCCUPANCY L:1
ENERGY
ISSUANCEI�An
VISUAL FINAL 3
BUILDING d_'/—ci'2"F_ IMI'CRTAN'P
OCCVF Cy 0 PLEASE READ REVERSE SIDE BEFORE
OCC;{F OF BUILDING IS NOT PERM
1�N IL,aT D
314t�)Rjlt:DING FINAL IS SIGNED By BUILDING CALLING FOR FINAL INSPECTIONH