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20624 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Proed Identification PISWT NO. .. .Buildings4ddreas: ' 20624 wme aces: / one: d {tS/d4G�� 4,U LiN CITY OF CUPERTIN0.BUILDINGDIVISION 7 qa • AGant ad°' NN LI=.Na: APPLICATION / PERMIT d BUfLDING-ELECTRICAL r LIIMBENG-MECHANICAL CATEGORY CONTROL If Archlted/Engineer. a, Lt.Na,. QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: PEFMTISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licnaed under provision,of Chapter9(darromenc, APPLIANCES-RESIDENTIAL JOB DESCRIPTIONIngwlth Sect1on7000)of Divlslon3 afthe Ballarat ProfeulomCode,and m limn.la In MIT nddfect. PANELS Llanse Gla Co M_ar Date Cantndor 14,1,040- ARCHITECTS DECLARATION 201-10M AMPS IXO O I understand my plans shall be used as public records. OVER 1000 AMPS SQ.Fr.FLOOR AREA $/SQ.FT. Licensed Professional SIGNS ELECTRICAL �6 OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC 1., 1berebyafflrrn that I am exempt from the Contractor's License law for the O 6 followingreason.(Section 70315,Butlneas and Professions Code:An d r O Z,F, o city TEMP.METERORPOLEINST. � a countywhich requlmeapermlt tocovtmct,alter,lmprove,demoWh,orrepair q$$ any structure priorto Its issuance,aborequirestheapplicant forsuch permit to POWER DEVICES Ltl rNG file a signed statement that he Is Licensed pursuant to the provisions of the 83u, Contractor's License Law(Chapter 9(mmmsecing with Section 7000)of Divi- don 3ofthe Business and professions Code)or that he is exempt therefrom and SWIMMING POOL ELECTRIC VALUATION Sn S the basis for the alleged exemption. Any violation of Section 70315 by any OQ OUTLETSSWITCIIFSE)(T[RES r y appllcant(ora peroutsubJecta the applicant too civil penalty of more than /J �J five hundred dollars(;500). NEWRESIDENTIALE.ECTR SQ.Fr. �n Fj I,as owner of the property,or my employers with wages as their sole SItyRZS TYPECONSTRUCTION c urporawl.n,will do the work and the structure la not Intended or offered for O sale(See.7044,Businessand Professloro Code:The CuntradoesUcerue law t;4 �,7 $ does not apply to an owner of property who Wilds or Improves thereat,and OCCIGROUP RFS.UNITS WW whodoessuch workhimaelforthrough hisown employees,provided that such Improvements are not Intended oroffered forsale,If,however,the buildingor TOTAL: improvement Issold wlthinoneyearofcompldlonthe owner-bullderwill have tll,L�urden of proving that he didnot Wild orbnprove for purpose ofsale.). QTY. PLUMBING PERMIT FEE FIDODZONE APN u L as owner of the property,am exclusively contracting with Ilmnxd PERMIT ISSUANCE conmcmm to construct the project(Sec.7044,Business;and Professions Code: The Contractor's License Law don not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA) Wilda or Improvea thereon,and who contracts for Audi p(okcts with a �'�R(Tacuria)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LJ I am exempt under Sec. B&P C for this reason GRAINS.FLOOR ROOF,AREA,CONTI. SANITARY Y N • Owner Date RRCERrrIf WOfirm tAN COMP ENSATION DECLARATION FDnURES[RR TRAP SCHOOLTAK Y_ N— �I hereby orke that I have o lmurate of count to pythemof ora RECEIPT Y cenlllcate o(Workers Comperuaelan hsuranre oaartllled ropythereof(Sec. GAS PA.SYSTEM-I INCAOUILETS PARKFFR Y N 3800,Mab CJ 1'ollrya GAS�EA.SYSTEM-OOVER DINGRRCEDIM Com any.Ca/g/p (S)�6 BUILDING OI VISION FEES CenlfifrTcopybhereby(umished. GREASEANDUSTRL WASTE INTERCEP3UR PLANCHECK FEE Certified copy b filed with the ctly Impectlon dlvitlon. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATIONINSURANCE SEWER-SANITARY-STORM FA,20017. Date ReceI tN (Thlsaectbn need rad be complded](the pemdr b(or one hundred dollars (5100)wfy that WATER HEATER W/VENT/ELEC'TR ENERGY FEE Y N I certify that N the performance of rm wok so a to b this permit closed, — I shall not employ any peau In any manner.v to become subject to the WATER SYSTEM/TREATING Workers Compensation Lam o/California. Date PAID - Z Z App°tint Date Recei tq Z O NOTICE TO APPLICANT.]Ldter making this CAdUlaxta of Exemption,you NEW RFMDENTIAL PLMB._SQFr. Fshould became subpct to the Workers Compensat ion provisions of the Labor TOTAL: CC W Code,you=at forthwith comply with such provisions or this permit shall be j deemed revoked. B Q7 W G CONSTRUCTION LENDING AGENCY SEISMIC FEE L 1 hereby affirm that there is.construction lending agency for the perform. ELECTRIC FEE Z ants, la W of the work for which this permit Issued(Sec,3097,Civ.Q TOTAL: OO Landale Name PLUMBING FEE 1L t- Lcadels Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Imbu rtifythatl have read this applicationand natethat theave Information 1 iscorred.I agree to comply with all city and countyordinanas and state laws PERMIT ISSUANCE FEES PAID: } relating to building construction,and hereby authorize reprexrdtives.(this Zcity teener upon the above-mentioned property far inspection purposes. ALTERORADDTOMECH. Dale ROCCI t# (We)agree to save,indemvlfy an d keep harmle.the City of Cupertino P V against llabilltba,judgments,costund exp nxe which may In anywayamue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: agald City lenm p(the nt(VA Ing o(thla permit. /fafa�s�- (� ms's. d AIR I-IANOWNG UNIT(OVER 10,000CFM) CONSTRUCTION TAX ^ Signature of Applicant/Contractor Date EKFIAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recel tk material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cod ion 25532(a)7 HEATING UNIT(OVER 100,000 BTM TOTAL a F1 Yet, No Will du.pplinat Alture building occupant use equipment ordevicn VENTILATION FAN(SINGLE REED) ISSUANCE DATE which sour hazardous air contandvnts as defined by the Bay Area Air . Quality Management chtld7 BOILER-NMP OHP OR PAINS BTU) ?Yca CJ No i have read the hazaAouamaterlals requirements under Chapter 6.95 of BOILER-COMP(OVER 100,1xpBID) iCFyy$dj the Callfom(a Health&Safety Code,Sections 75505,25533 and 25534. E - understandthati(the building don not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.E7. (� reeponlblllty to not the occupant of the mq.1mmenta which mu at be and JU V 7 IaGI� priori.Anuanceofa Cert in oto ccupancy. v` A s--4,v pp �ll��LLqq��,� ,,��rI��,,� Owneror au dzed'agent Date ISSUFDu��li1A1JN✓62"'" TOTAL: OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING �}� PERWT NO. CITY OF CUPERTINO 20624 INSPECTION DIVISION- JOB INSPECTION RECORD JOB ADDRESS SDI yS �>TcRZs' /��TC A UNIT u LOT$1 CATEGORY CONTROL x OWNER /U/1 / $d ZIA) CONTRACTOR d17 BUILDING PERMIT INFO INSPECTION I DATE JINSPECTOR INSPECTION RECORD FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED TO COMPLY WITH JOB DESCRII'DON PAD/SETBACK-CERT THE ArrRovPn rLANSANDCITYOF CUI'F.R'DNO STANDARDS. GARAGE SLABS PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB INSPECTION ,DATE INSPECTOR PLUMBING ELECTRICAL MECHANICAL 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 ' ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL/JACUZZI BOND FRAMING STAIRS - INSULATION/VENTILATION EMERG.EGRESS SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN ' SI-IEETROCK/SHEETROCK 51 TEAR 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 1S PAID FINALS DATE INSPECTOR - SANX ELECT.ENERGY PLUMBING ENERGY MECH.ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE - - - FIRE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC ` GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE r QLULDING FINAL IS SIGNED UY BUILDING INSPECTOR . 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 5 IgE,J PERMIT# ARE NEEDED WHEN PHONING. IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION JSUE,DBY' /-' m OFFICE COPY