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00030042caner Ul'1'Y of, I:UPCKI INU BUILDING DIVISION PERMIT CONTRACTORINIFO t-MATIO. 9UILD^IN^G AUDkF_SS: t✓l✓ / � �('y�o�g `^ A�/� Jf 1 sof V'sC /�" ^ ���sss II�1e111 ` / J�sS—Z_V ILCII L/�s J SANITARY NO. AP (CAT�IO(N SUtlM'IT\rAL GATE � OWNS 'S NAME: I\DZ✓//V ( �� /]�� �.`/ ZS Iv Nom^ ' V / &A—AER Sa- NS-` —q NIC El CON ROLA 20 ARCHIIEEs'CTIENGI1NE BULDING PERMU INFO '. u CO OZ = LICENSED CONTFt CFOR'S DECLARATION 1 hereby affirm 1 licensed under previsions of Chapter 9 (conunenclmg m Nam Job Description with Sectiom70130)of Division3ofNe Businer end Profeuioe Code.and my limmuris in full force and effect 1s�` S d z Lice. Cleo Lim. M ��j ly Sa N Daa Course., NIVi,1 ARCHITECTS DECLARATION C z O i y I undentund my Plus still be sexes as public remand. za a a G ticrosd Professional OWNER-RUB.DER DECLARATION F ¢ 1 hereby affirm Unit 1 am exempt from Use Contncmr's License Law for the f m O following reason. (Section 7031.5, Business and Profession. Cade: Airy city a many S Ft. Floor Area q J.Sb o J Valuati n aF = 3 � which reydmx. petits m ceewet alter. improve, denwhdt a repair enr straanne issseance. cascara 0r applicant fwsuchpmnd w file. signall him .. 'nanous also Ne of the Contractors Lmeee Law (C Paf9 �OO u Natheklicemadjunuanua prevision mammeneing with Secure 7(y)(1) of Division 3 of cit Busine.a and Professions Codc)or APN Number .ti ecuP" dn aY Type that he is exempt therefrom and the basis for the alleged exemption, Any "almost or Salon 7031.5 by any applicam for a permit •ubjecr the it"behat to a civil penalty of 1 pt more Nan five hundred dell. (SW). I,asownerofthemepeny,mmyamployceswimw.gesutneir.aleemmPuuadon, Required Inspections willdethework, and Ne no rots Bodneu Livens Lawdoforsale(Sec.10a4, Code: The vcs do mr'. Liarlu law soca rwt apply to lf owrcr of nti Contractor's and arty who thereon, and who dao such Lech himself of throughfar cams build. or vides S ds his own <mployas, provided dal such improvements are not inmnded a offered to his a We If, however. Nc budding m len a emont is hold within one Year improvefor the rbuildea will have the burden of preying the he did not Iwid a impreve for port- pore of trier). ❑ 1, u.war of the property, nn si consenting with "fhe contnor's Awa/ J mid Code:) Tim...donor's i- Business and :) the Wotan (Sa.70 sine car. and cense law does nut apply to en owner of property who builds or improve carton, end U n d, who build, LicenseLaw. find SYCn Pmj%th W IN a LanOlcmf(s) II[en.[d PYRYMt w ILK CanhNlOr• License Law. ❑ I am exemptreser Secs . B & P C for Nis ninon Dam WORKER'S COMPENSATION DECLARATION ()N hereby affirm under pendty of perjury one of the following deAvationa: 1 have and will alums a aCenificamofColnoue. self -insure fa Workers Compere union, as Provided for by Salon 3700 of Ne Labor Cade, for she performance of the work for which this permit is issued. 1 have and will maintain Worriers Compensation Insurance. as required by Section 3700of dim labor Code, fa the performance of she work for which this permit is issued. My Workers Compensation Inmrana carrier and Policy number rte: Cartier: Policy No.: CERTIFICATE OF EKEMPrION FROM WORKERS' COMPENSATION INSURANCE (This section need not bccwnpined lice permit ie fororohundred dollen (5100) or les.) 1 certify Nal ince performance ofthe work for which this permit is issued, I shall nos employ any persum soy manner an es m became subject m the Worker' Compere smion Laws of California. Dam Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exempriw. you should become subject an the Workers Compensation provisions of the Labor Cade, you mall ' forthwith comply with such Provisions or this permit amid be deemed nvokad. CONSTRUCTION LENDING AGENCY O O I hereby aRrm that them is a construction larding agency fa Ne perfumunce of Z the wok for which this perrtd is issued (Sec. 3097. Co. C.) FLenders Name ya }_ lenders Address fzl I certify that 1 have road this application and ansa that the above itdnrnetion is 0. Acromel.I alliance nd e to comply with all city acounty ordumnces arta Stam laws mlming 10 7 Z building construction, urs hemby anduoiu representative of this city to enter upon flue C..) abovamemioned property for inspacfion purposes. it. E" (We) agree an Yrs, Indemnify and kap hared. the City of Cupertino agmut O [) liabilities. judgments. courts and expenses which may in any way accrue against said City } Wo in cmice ornee of due granting of Nis .it [� h APPLICAMI' UNDERSPANDSANOWII.I.COMI'LYWITHALLNON-POINT V Z SOURCE REGULATIONS. Signature of APphicanVConarmor Date HA2:ARDOUS MATERIALS DISCLOSURE Will theapplicant or future laniaing acapenr use m handle hamdoux..'on l in defixd by the Cupertino Municipal Cache, Chapter 9.12, and the Health and Safety Code, Section 25532(.)7 ❑Yea ly eb Will the applicant or future building occupant use equipmem or devices which nit haaardou an conterminous as defined by the Bay Arn Ab QW iry Management iM1Viel7 [3 Y. I have read the hamaddis commul. tequimmenls under Chapter 695 of Ile Cali- Imnie Health & Safety Cade, Sections 25505.25333 and 25534. 1 understand tun if the buunin, docs tea cormady have am ... L dol n is any responsibility to notify Ik occupant of the nes mamenu which men be man priorm issuance of a Certificate of Omup.rwy. MAR 0 8 2000 W�=M Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without First obtaining an inspection I agree to remove all new friaterials for inspection. Applicant understands and ill pl r wit all non point source regulations. 2d& Oro Siv tura of rpplicant Date OFFICE All roof coverings to be Class "B" or better I M 111 CITY OF CUPERTINO rr,'IIUILDING DIVISION BUILDING PROJECT' IDENTIFICATION - Gr�j�.y.T� l3^ BULLDINGADDRESS W, ��./,,�. • .�=�'-rte;,✓<�i % �1 v.. •-i �� SANITARY NO. APPLICATION SUBMITTAL DAI ._^ �/j OW7RNiIE: 'SNAME: �r. PHONE: C " 70RS NLIC NO: NIC CONTROL / .f/ :IIII E4T/ENGINEER:r -Ll 'O: AU 5S: - INSPECTIONS DATE INSPEC. ! Consultant Fees Paid by Applicant(initial) BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ❑ ❑ ❑ Cl FOUNDATION/PIERS/H.D.S. 3� INSPECTION RECORD NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS, 106 DESCRIPTION RESIDENTIAL DSFDWL D KITCHEN REMODEL []ADDITION ❑PLUMBING RE -PIPE NIiULTI-UNIT DMODIFI URAL MODIFICATION D INTERIOR D CHIMNEY REPAIR IMPROVEMENT F] SWIMMING POOLS D BATH REMODEUREPAIR L1 DEMOLITION ❑,aliER -o-�%?�7/,+•'�T� UFER GROUND _ Q PAD/SETBACK-CERT'—:V. GARAGE SLABS/PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION CALL AFTERNOONS (1:00 PM - 4:30 PM) FORE REQUIRED INSPECTION. JOB ADDRESS777-3228 MONDAY TO FRIDAY 24 HOURS BE- AND PERMIT #ARE NEEDED WHEN PHONING. UNDERGROUND/SLAB 3,c ob T © PLUMBINGlf�oo ELECTRICAL „y _•'-"'"-'T DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED COMMERCIAL: D NEW BLDG/ADDITION [I DEMOLITION TANT DFOOD SERVICE DEN IMPROVEMENT 0OTHER ATTENTION CONTRACTORS: NO PERSON(S) SHALL PERFORM WORK ON THIS JOB SITE WITHOUT BEING IN COM- PLIANCE WITH WORKERS' COMPENSATION INSURANCE REQUIREMENTS. PLUMBING MECHANICAL ELECTRICAL FRAMING VENTS INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP. PLACE NO SUBFI_OOR UNTIL ABOVE HAS BEEN SI . ED ROOF SHEATH/DIAPHRAM _!IO PLUMBING TUBS & SHOWER PAN - -Q MECHANICAL .ECTRICAL/POOL BOND FRAMING/STAIRS/E. EGRESS INSULATIONNENTILATION -Y 2. / 1p COVER NO WORK UNTIL ABOVE HAS BEEN SIG / Q EXTERIAL SHEAR/HOLD DOWN INTERIOR SHEAR/HOLD DOWN 1,, Joe, Q x/ SHEETWROCK/SHEEIROCK SHEAR ` 1'✓ 1 / "� ��Q` I r��/� EXTERIOR LATH/W-SCREED SFiOWER LATH NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED , SCRATCH COAT SEWER/WATER F 10 TEMPORARY APPROVALS OCCUPANCY Q61 ELECTRICAL GAS FINALS GAS TEST GRADE �. FIRE (j J.-/ GL HANDICAP ELECTRICAL Q PLUMBING IECHANICAL -NERGY CERTIFICATE OF OCCUPANCY ❑ VISUAL FINAL ONLY BUILDING % Q IMPORTANT: PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION!! ISSUANCE DATE -- - ISSUED BY:~� Y OCCUPANCYOFBUILDINGISNO'f PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. APPLICANTS P05TING UUPY 1/ rmm APPLICANTS POSTING COPY t_ l Y ON CUPERI7N0 - pE - T - v r BUILDING DIVISION ' BUILDING PROJEC9IDENTIFICATION . G ADDRESS: Is;, g D r0/ll SANITARY NO. ION SUBSIITTnI, DA1 , /• -- , (�' 'T'}OWN 'NAME: I PHONE:/- %i •v -iii„ /J% CONTRACTOR'S NAME: LIC NO: NIC CONTROL# W 7l� ��%�I%I /—��-✓,.."L,� CJIITECT/EHGINE R: ADDRESS: BUILDING PERMIT INFO INSPECTIONS DATE Fees Paid by Applicant (Initial)RLDG ELECT PLUM1IB MECH FOUNDATION/PIERS/H.D.S. �7(�INSPECTION RECORD JOB DESCRIPTION RESIDENTIALPAD/SET eINSPEConsultant UFER GROUND ALL GRADING AND DRAINAGE BACK -CERT + OL BE INSTALLED TO COMPLY WITH ❑SEOWL D KITCHEN REMODEL APPROVED PLANS AND CITY OF ❑ADDfDON DPLUMBING RE -PIPE GARAGE SLABS/PREGUNITE RTINO STANDARDS. ❑MULTI -UNIT; ❑STRUCTURAL POUR NO CONCRETE UNTILABOVE HAS BEEN SIGNED MODIFICATION TO ARRANGE INSPECTION ❑INTERIOR DCHIMNEY REPAIR UNDERGROUND/SLAB -pp i) IMPROVEMENT CSWIMMING POOLS ❑ BATH REMODEL/REPAIR 0DEMOLITION PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- DOTHER ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AND PERMIT # ARE NEEDED WHEN PHONING. PLUMBING , ATTENTION CONTRACTORS: EWBLDGIADDmoN CDEMOLmoN MECHANICAL NO PERSON(S) SHALL PERFORM WORK ON 0TENANT DFOOD SERVICE .Ddb THIS JOB SITE WITHOUT BEING IN COM- LMROVEMENT P / COTHER / ELECTRICAL PLIANCE WITH WORKERS' COMPENSATION FRAMING VENTS INSURANCE REQUIREMENTS. INSULATION INSPECTION SPECIAL INSPECTION REQUIRED DATE INSP.- PLACIE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGN17D ff''• ROOnSHEATH/DIAPHRAM HRAM _ J' FEB 1 0 PLU 2909 /TW 43 UBN,MECEBOND/,_0A e EGRESS p INSULATION/VENTILATION ., COVER NO WORK UNTIL ABOVE HAS f3FFr4 SIGNEIJ r EXTERIAL SHEAR/HOLD DOWN INTERIOR SHEARMOLD DOWN SHEETWROCK/SHEETROCK SHEAR 7 EXTERIOR LATH/W-SCREED SHOWER LATH Cl NO TAPE OR PLASTER UNTIL ABOVE HAS 13EEN SIGNED SCRATCH COAT SEWER/WATER TEMPORARY APPROVALS OCCUPANCY ELECTRICAL �. ,•g -�C./ W �`- ` '�• a ` GAS lI- FINALS ". - _. .... . -t GAS TEST _ z f GRADE C, M FIRE HANDICAPj`t ELECTRICAL - rI. G / PLUMBING eA )v Q 't t ECHANICAL 0z': wN•! ERGY ERTIFICAT OF OCCUPANCY ❑ VISUAL FINAL ONLY BUILDING IMPORTANT: ISSUANCE DATE ... �:' _ _ OCCUPANCY OF.BUILDING IS O' IIER'NH'T- EIJ PIL ASE READ REVERSE SIDE BEFORE ' UNTIL BUILDING FINAL IS SI 1NED BYBU .DING CALLING FOR FINAL INSPECTION!! INSPECTOR. - IssueD BY. APPLICANTS POSTING COPY