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21825 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Pron, Identification 7 PFRMMITNO. Building Address: ��fr-� 21825 1 O 2 C to120 IrvSv /1VE ens1V6 G o J wenm : one: AA 'i 4& - CITY OFCUPERTINOBUILDING DIVISION �� ` g � Conte useN/�cr��,e�� LIc.ppN. APPLICATION / PERMIT �� L `-' y BULDINGELECTRICAL FLUMBINGMECI IAMCAL CATEGORY CONTROL# W'Architect/Engineer. Lic.No: QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Add. �r�'tI PERNUTISSUANCE F-2- ICY) LmthatIDCONTR under SDECLARATION �7�} JOB [hereby am7(XTatf amg..3dunBex.,a.aonsoffr,.mmr9(commrnc APPLIANCESRESIDENTIAL I �� /[ JOBD RII'I'ION It...I In WU 7000)ofdeffect. fthe BuslneasandPro(esalonaCode,and my license Is ie(u8 force and effect, 1 PANELS S (/y// DateLiceClan Lk.N Il Date —Contractor 1j ARCHITECTS DECLARATION 201-1000 AMPS µo!ce7C I understand my plans shall be used as public record. OVER1000AMP5 SQ.FT.FLOOR EA E b() Umnsed Profmiowl SIGNS ELECTRICAL C52)__2 �QEa OWNER-B ULDER DECLARATION SPECIAL CIRCUIT/MISC �L� L9t� I..,g, [hereby����n that lam exempt fresh the Contractor's License law for the Sod 7 p following reawn.(5ect1on7QHS,Businessand Professions Code:Any city or TEMP METER OR POLE INS['. as:y county which requlma permit tocotutruct,alter,Improve,demolish,orrepair K 3 anystrucure priorm its Issuance,alsorequess theappllcant forsuch permitto POWER DEVICES file a signed statement that he b licensed pursuant to the provisions of the Om� Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- Sy IMMNUNG POOL EL ECT RIC VALUATION 30 yon3ofthe Businmand Profmlons Cede)orthathetsemm therefmmand qq ~ S the basis for the alleged exemption. Any violation of Section 70315 by any OUTLET5SSWITCHESFI%'FURFS $.( Q `QO �5 applicant for a permit subjects theapplkant to a civil penalty of act more than 7 fiftnIA dollars($500). NEW RESIDENTIALELECTA t•J S,C`c SQ.PT. STORIES TYPECONSTRUCTION Til �n a owner ll the property,or my employees with wages r thele sole C ompe tion,wBldolhe work andthutructure le not or offered for 'S O sate(Sec.•Mq Busiriesa and PrMmlosu Code:The Contratlote Llarue Law �S$ does.Mt pplytoanownerofpropertywh.Wildsorimprwnthereonand OCC.GROUP RES.UNITS who doessuch work himself orthratgh his own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or TOTAL: Improvement usuld wlthinoneyearofcompletion,the owner-bullderwlll have x th rdeno(provingthat he did na build orimprove for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE centractorst..aswct the project(Sec.7044,Business and Professions Code: The Contractors License Law does out apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilds or Improves thereon,and who contract for such ptaj is with a FEE SUMMARY ff,,BB.t..4Iacwhe)licensed Pursuant to the Contractor's Licenx Law. I am exempt under Sec. BACK FLOW PROTECT.DEVICE B &P C for this reasonOUTSIDE ITES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_ Owner Date ^� RECEIPT# WORKMAN COMPENSATION DECLARATION FLYTIIItFS PER TRAP ��iW SCHOOL TAX Y_ N_ ❑I hereby affirm that I have a certificate of consent to.11A.sure,ora RECEIPT# 38W,Lab Comperuationlmuranmmaartlfkdcopythereof(Sec. GAS F.A.SYSTEM-1 INCA OUTLETS ,C PARK FFE Y N_ RECEB'T# Policy# GAS G.SYSTEM-OVER 4(EA) BUI LUING DI VISION FEES CO any Mnlned copy is hereby famished. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE ❑Certified copy Is filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID COMPENSATION INSURANCESEWER-SANITARY-STORM EA 200FT Date RCCCI C (Fhlssectlon need net be completed If the permit efor one hundred dollars ($IW)orlem3 WATER HEATER w/vENT/ELECTR ENERGY FEE Y_ N_ I cenlfythat In the performance of the week for which this permit Is Issued, I shall not employ any person in any manner,an as to become subject to the WATER SYSTEM/TREATING W.'Lhs'ComPensatum awaof Cahfomb. Date PAID OZ Applicant NEW RES DENT ALPLMB. SQFT. Date Recei t# Z O NOnCETOMPLICANT:ILanermakmgthb Cenlflcateof Exemption,you should become subject to the Workeri Compensation provialons of the Labor TOTAL: P W Code,you must forthwith complywith such provisions arthis permit shall be BUILDING seemed revoked. W CONSTRUCTION LENDING AGENCY SEISMIC FEE 4 Ihereby afnrmthat then is a corstronion lending agency for the perform TOTAL. ELECTRIC FEE / L 7 Z ance of the work for which this permit b Laseed(Sec.3097,Civ.CJ (,) O Leader's Name PLUMBING FEE L� L F Tenders Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE �CYJ OW Icenlfythulhavereadth applicationandstatethattheabovetnformatlon Ill. Ismrmet.lagreetocomp Ith all cityand county ordinances and state laws t PERMIT ISSUANCE FEES PAID: �. y relating tobulld ctlon,and y autherlu representatives ofthb city to est vo- o property foruopetbn Purpose. LTEROR ADDTO MECH. Z Date Receipt# (W agree t n e,Ind 1 d keep her ch the in x o(Cupe cmu AIR HANDLING UNIT(TO 10,000 CFM[ U st llablll' dgment, fid ex rich may Ina a accrue SUBTOTAL: a airst n onseque of the ❑ of this reel w 7 3I,L MR HANDL NG NT (OV 7 10,ODOC l) CONSTRUCTION TAX 1g reof Applicant/C tr cion to EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZA )OUSMA RIALSDISC SUR Will the applicant or u(ure building occupant store or handle hanrdous HEATING UNIT(70 100,000 BTU) Date Recei t# material ae defined by eCupertino Municipal Code,Chapter 9.12,and the I leallh and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU TOTAL: s ❑Yes M No Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE RF_SID) ISSUANCE DATE which,mit hazardous air contaminants as denned by the Bay Area Air Quality Management District? BOMER-COMP©HP OR 100,0(10 BTU) Yea ��II No p NilB1Ll havc read the h....mous materials requ lrements under Cha pter 6.95 of BOILER-COMP(OVER 100,000 BTU) the California health&Safety Code,Sections 25505,75533 and 75534.1 • n q understand that if the building does not currently have a tenant,that it ex my NEW RESIDENTIAL MECH. SQ.FT ��` .possibility to notify the ompa.tof the requirements6 which must be rmt V prior to Issuance ofa Certificate ofOccupancy. Owner or aulhohl dagent Date TOTAL: ISSUED BY V Tri OFFICE COPY POST THIS CARD NEAR FRONT OF BUIL15ING lKWI Nu. 21825 CITY OF CUPERTINO -- 1 PECTIONyDIIVISIOON J013-INSPECTION RECORD 7' 1 .•JOB ADDRESS �7 L ��' UNIT #may LOT # CAII.oRv — a�oi.. -- OWNER - k� u . CONTRACTOR� wU� BUILDING PERMI'1'INFO 9 E O ti:A `2 '.`1.3�: v Y.io'a'✓? 4DATE* INSPRCWR INSPECTION RECORD Rg FOUNDATION PIERS — N07L ALL INSTALLED AND COMPLY IJDiLDLr Rl UFER GROUND - TI LALL fRARE VFDPAN ACOMPLY WITtI PAD/SET BACK-CERT CUI9iRTINOSTANDARDS. CITY OR GARAGE SLABS PREGUNITE TOURINO NCR=iUNVTlLUMlJoV HAS BEEN St UNDERGROUND SLAB ILC-� • ^INSPECTION DATE IN POR PLUMBING .! r 2 /��I 6' ELECTRICAL MECIIANICAL l - h- ;G, O• OT.- L O S E SIGNED WOOD FLOOR PLUMBING MECIIANICAL ELECTRICAL rRAMING VENTS CLEAR INSULATION PLACES O SU FLOOR UNM ABOVE HAS-BEEN SI .NED ROUGFI I'LUMBING O S y c 3 TUBS&SI[OWER PAN MECHANICAL ELECTRICAL ACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION EMERG.EGRESS l SEWER WATER \ UY R'NOMORK LINTMIABOVE HAS BEEMSIGNAD EXTERIOR SI-IEAR I TOLD DOWN - INIERIORSHEAR/ [OLD DOWN A rWi 2 k O SIIEETROCK/SIIEETROCK 51[EA R y EXTERIOR LATI I/W-SCREEN —414 $i0 R LAT SCRATCH COAT n G iHA9?�SEEIWSIGNEM . )NOTEPNW INSPEMOME¢ C E+ k, BEFORE TtI�I N7ftll FINALS I DATE INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECI 1.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEAIING ELECI'RICAL RELEASE FIRE DEPT. GRADE OCCUPANCY TEMPORARY AI111ROVALS Q Z ELECTRIC GAS BUILDING ISSUANCE DATE 'OE• P NCY' NC" 6NOTa EDt„NTIL ,; 1 �IItI1 r �)i�3A�;if > fifv€6;�1'sl3UIEd}i�-tivSi?ECTOii .� ''f► ARRANGE FOR INSPECTION BY t'HON G 252-9505 BET EEN ` - BEFORE REQUIREDAINSPO CDT nN. TOB DRESS AND OURS 'f v� '•I 1.9y� PERMIT# ARE NEEDED WHEN PHONING Illy of --- APPLICANT'S POSTING COPY