30319 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELEC PLICAL PERMIT NO. O l
BUD DING DIVISION APPIACATION/PERMIT PLUMBING.MECHANICAL "1'
IIIIII,DING PROJIiC'I'[[)ENTIFICATION
BUILDING ADDRESS: n - SANITARY NO. APPLTICAION SUBMITTAL DATE
�kl✓/ . VlV1 S,,tLc
OWNER'S NAME: PHONE: CO ACTO 'S N LIC NOi
V
NIC CONTROL
( 'HITE /. INE R: '6 LIC NO:O a ADDRESS: ❑
C Ac : ,�,A� PHONE: BUILDING PERMITINFO
.PAV- � I�y[� � ❑ Cansultant Fees Paid by Applicant(Initial) BLgR E PL� MECH
LICENSED CONTRACT'OR'S DECLARATION / QTY ELECTRIC PERMIT FP.P lr;'[`
1 Hereby err mat 1 am Hamad sneer pmvbmna ar cnapmr 9(commencing ,JOB DESCRIPTION
-DaZ with Section?M))af MsNionJofthe Bmincomid Professions Conn.ondmylicense is RESIDENTIAL:
O O PERMI"1'ISSUANCE
WC in full face mJ effect. - CSFDWI, CKITCHHNREMODEL
�UU Wccnsc Class Lic.p APPLIANCES-RESIDENTIAL []ADDITION CPLUMBING RE-PIPH
stfa Dam Convenor
F.Dm ARCHITECTS DECLARATION PANELS []MULTI-UNIT []STRUCTURAL
rA 1 undemtand my plans shall be used e,public records MODIFICATION
OZ^,u�J, UPT02(N)AMPS ..
'r 0.s= Licensed Prnf,,xi...I CIN'PROVR CCHIMNI%Y REPAIR
0.Y' 301-IOIM AMPS IMPROVEMENT
Oat I am exempt LDER
m the Contractors
1 hereby affirm that 1 am exempt from the Convectors License Law for the OVER 1000 AMPS DEATH REMODIi1lREPAIk ❑DEM01.1'fION
aO&V following rnsai.(Seenimt 7031 5,Business and Professions Calle:Any city or mm.ty SIGNS HI.HC'rRICAI. ❑OTHER
LL F' which requires a Permit in construct,alter,improve,demolish,or repair any structure
prior 1.to its issuance,arequires theopplimma Ramch pennum file.signedumement SPECIAL CIRCUIT/MISC.
y lso that he lifiiceased Summand, puremonsofthe Contractors License Law(Ci ft
CSO (emnmencing L of Division J ofthe Business and Precision,Cafe)or TEMP.METER OR POLE INST'.
thin he n a lheref alis for the alleged exemption.Any violation of - ❑NEW B G/ADDITION 'C DEMOLITION
^y Sec' IS by sm p ant for mit mbjtt9s the applicant a civil penalty of POWER DEVICES CTENA �C,l•FOOD SERVICE
media fiveh do t St IMPRO' Ii?L T 47 j!
Zq n 1,' a yens with wages as their sole compensation, SWIMMING POOL ELECT RIC V
70
n .undlhe acretM.r offered for sole(Set.7044,Business COvi"r
m end Pmfe on.Crate TT License Use does not apply to an owner of UUTLCI S-SWITCHES-FIXTURES i III y OF
pmpeny who b cream, d win dos such work himself or through
his own hoided Nat such improvements me not intended or offered for NEW RESIDENTIAL.HLECTR SQ
sole.IL nwever,the building or improvement issnld within one year edcompleion,the SQ.FT.FLOOR AREA S/SQ.FT.
ownerbuildef will have the burden of proving that he did not build or improve lav par-
Set
,as crof the pmpeny,ate exclusively contracting with licensed comrvetors to TIT r�
unn
'.'be
'am""
(Sce.](W4,Businexrand signs CodeO'ne Contractor's Li-
c se Law does res., mon ownerof pm fly wh I,,Le orinlprove,doncou,and QTY. PLUMBING PFRMIr FEE ^O� y�-•I
who Om=lsfawe mj tswimaoom mr(s)Ii�cnscd Pummel to the Contractor's C "'�• f/.I�I
LiccnscL w. PERMIT ISSUANCE
❑ 1 �em ld _,B&PCfon bre on
n c Dam
ALTER-DRAIN&VENT-WAITR(EA) VALUATION
WO KERS CC,1 SATIONDECLARATI[N BACK FLOW PROTECT.DEVICE Q^ �—
` I hereby affirm under penalty of perjury one of the following deductions: v L
Ihavm anJ will mainmin uCmiOcate of Consemmself-insure for Workers Cnmpen- DRAINS-FLOOR,ROOEARF,A, STORIES TYPECONSTRUCTION
alien,uv provided for by Section 371x)of the Labor Code,for the performance of the
work for which this permit is issued. FlXTUR' AP q
❑I have and will maintain Worker's Compensation Insurance,a required by Section .t f
37(Mofine LaMVCadgfortbcpeKormunceofthe work forwhich thisperair is issued. GAS-EA. QST tl ISO t 5 / OCC.GROUP AI'N
My Workers Connpmaction Insurance carrier and Policy numberare: )s )s
Cartier. Policy No,: GAS CA. STgvI OVER {F!A
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRFASDINDUSTRL WASTE INTERCEPTOR BUILDING (VISION FE S
[This adinn need ern M1c completrA it rho pennh is lnfano hundred dollars(SlflO) GRP.ASIi TRAP
nr less.) - PLANCHECKFEE
d fymatinthe o�ce ofthe work for whichthis permit is issued.l shall
P n v�fi SEWER-SANITARY-STORM EA.200 P1'.
no em oya person / a0 to ba a ct tya�e Wm f neem F.NF.RGY IEE
z vtion f sof :al' j(�. 'm - — — WATI?R HEATER WNENTIELECTR
r��0 APpI'ant p GRADING
y NO IC f g tons nificate of Exempti nu old WATER SYSTEM/TREATING
a')�' become suM1j7me War els Compensation provisions of She laMu GNe,you must SOILS PER
w fnnhwith complywdh such provisions or this permit shall be demand revoked. WATER SERVICE
� z CONSTRUCTION LENDING AGENCY ' NEW RESIDENTIAL PLMB. SQ.FT. PAID
VO Ihertby affirm theuhere is a construction lending agency la the performance of Date «eipt4
the work for which this permit is issued(Set.3097,Civ.C.)
U Lender's Name 'fOt'AL:
Lenders Address er- VI oil l�
y I certify that I have read this application and elate than rhe above inf s noir is BUILDING FEE
IA correct.I agree to comply with all city and county ordinances and state laws existing to QT•Y. MECHANICAL PERMIT FEE
U building construction,and hereby amthorite representatives of this city to enter upon the SEISMIC FEE
,Moe-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree to sive,indemnify and keep Stainless the City of Cupertino against HLH IAIC FEE �'•
liabilities,judgments,costs and expenses which may in any way secure against said City gLTEIt OR ADD TO MECH.
in consequence of the granting of this permit. PLUMPING FEE �•
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.(MOCFM) MECHANICAL FEE
SOURCE REGULATIONS. I�
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCTION TAX
Sigmmreof ApplirmaJComrmtnf Dam EXHAUST HOOD I WMUCD HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will thcapplicam mature building occupant smrewltmalle i,milimsmearid HEATING UNIT(In]MASS PT'U)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cade,Section M532(a)T I HEATING UNIT(OVER I0Bf00 BTU)
❑Yes CNo
VENT ILAI'ION FAN(SINGLE RESID) PAID
Will thesinnafurore building caccu,sed useeiwhich
Date Receipt#
hazallom air conmminanma defined by the Bay Area Air Quality Management
BOILER-COMP I7HPOR 100.000 RTU)
rid'! TOTAL:
C]Yes CNo * '• BOIL(?R-COMP(OVER IIIII,oIq PTU) -
I have read the hanrdous materials rcgoimactns under Chapter 6.95 of the Cali AIR CONDITIONER
ISSUANCE DATE
forms Health reSafety d,haea tema25505,2553)and 25534.1 indemtandthatifine NEW RfSIDENTIAI,MECH. SQ.FT.
hadmwnhe requirements
doeenotts which baso.tenant, o,h isoyoe f a Certiymnotify veenmipam
of me rxluinemrnts which muse be met poor m issuance of a Cenilicam of Occupvncy.
Owner or authorized agent Dam 'OT ISSUED BY:
OFFICE
POSTTHIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERMIT N(
BUILDING DIVISION :
I I, 1111 A; ,,BUILDING PROJECT IDENTIFICATION
BUILDING ADDR07: SANITARY NO. IZAPPLICA
i,-QWN4RSNAME: I PHONE.
0WRACTOR'SNAMEEi LIC NO:
I ; 11 1-- )4r- NIC C,
BITEUMNGINEE )IC NO: ADDRESS:
f, t:,7
4
�
NSPECTiO
.BUILDING PERM,
D-ATE Consultant Fecs Paid by Applicant(Initial) PU
0
S4
FOUNDATIONIPIERS/H D S INSPECTION RECORD
UFER GROUND NOTE: ALL GRADING AND DRAINAGE JO-B DFSCRIP.
I RESIDFNTIAL
PAD/SET BACK-CERT I SMALL BE INSTALLED TO COMPLY WITH 0 SFDWL
GAR AGE THE APPROVED PLANS AND CITY OF OADDITION
A, CUPERTINO STANDARDS. 0MULD-UNT17
OVE;HA_S,BBEN:SIGNflMx_ ION ' 0INTERIOR D
UNDERGROUND/SLAB TO AR" '� OC IMPROVEMENT
CALL AFTER? 0. E02.S.PNE IT,!1 - 4:00 PM) RATH REMODEUREPAIR 01
PLUMBING 1 777-3228 MONDAY FRIDAY 24 HOURS BE- COTHER
ELECTRICAL I RE REQUIRE SPECTION.JOB ADDRESS 6_xw*gr�
DO NOT POUR'FLOORIUNTIVABOVS HAS'BE ND PER RE NEEDED WHEN PHONING.
.. I..-1-1 1 A
PLUMBING 11—el ATTENTIONCOMMERCIAL
—9,/ CONTRACTORS: 0 NEW NT
01
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON []TENANT 01
THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
ELECTRICAL OOTHER
PLIANCE WITH WORKERS'COMPENSATION
FRAMING VENTS 70 INSURANCE REQUIREMENTS.
INSULATION 74— INSPECTION SPECIAL INkIJECTION REQUIRED El 1)
PLACE NOS.UB,FLOOR,UNTILAB E HA BE SIGNED,
S�ROOF SHEATHIDIAPHRAM ,_�OArJ C_i Ip�
PLUMBING i lot,
TUBS&SHOWER PAN
MECHANICAL . I
• ELECTRICAL/POOLBO!ND__/
4 kal /a.
FRAMING/STAIRS/E.EGRESS/Z.. 4-99 011"Ir or (-- 144--1
INSULATIONNENTILATION .......
COVER NO WORK UNtl0ABONT- AS BEENSIGNED,17 z
EXTERIALSHEARMOLD DOWN
INTERIOR SHEARMOILD DOWN
SHEETWROCKtSHEETROCK SHEAR
NYU
EXTERIOR LATHIW-SCREED Cr—rd, oe 91
SHOWER LATH I
NO TAPE OR OVEJ14'PEEN S1
_,qNEDg
SCRATCH COAT
SEWER/WATER I
TFMPORARYAPPROVALSA�,L�ii.1,14.,�4,;y,P`,�,�Iw, %I&
-OCCUPANCY I i
1C
FINALS'...,;'
GAS TE
DE
FIRE
HANDICAP
ELECTRICAL 7,
PLUMBING•
MECHANICAL
ENERGY
VISUAL FINAL ONLY j CERTIFICATE OF OCCUPANCY Po'�/, -f 2
BUILDING I IMPORTANT: ISSUANCE
OCCUPANCY",ORBUI PLEASE READ REVERSE SIDE BEFORE
, LDING;I$,N PE
J,NTIJ��UItDfNiT`ftNXi;!&1jbI . I CALLING FOR FINAL INSPECTION!!
E& t�,V
OR
.1, , ,i APPLICANT'S POSTING COPY UED BY.
1