26101APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO R�II'D>Rf'-FI..' A.
APPLICATION/PERMIT PLUMBING-MCCHANICAL
BUILDING DIVISION BUILDING PROJF.CI' u)lKN fIFICATION
PERMIT NO.
�i i� ei O �I
G o t 1
BUILDINGADDRESS:
SANITARY NO.
APPLICATION SUBMITTAL DATE
% /—fit/00
lGl`--� /I `^' vov UNIT# LOT#
3
OWNERS NAME: PHONE:
CON AC"1 8 A
N/C
ityl
CON'IEOL#
ARCHI'FECf/ENGINHp LIC NO:
ADDRESS:
CONTACT: PHONE:
(���j� %^fI/-^�/.�/s
' 2 i*<<�
QTY. " ELECTRIC PERMIT FEE
LXTAU
5& �I
',H.UILDING PERMIT INFO
BLDG ELECT LU B MECH
ISSUANCE
_II
frCS •c,, �'/V (✓Vl (/I
❑ ❑ ❑
LICENSED CONTRACTORIS DECLARATION
(commencing xe with
IM1ereby Division 3 offlensedunss nd PrifesioCCode, and
Section 9000) of Division � on 3 of the Business end Professions Code, and my license is in
Clasfull force it effecs/5 Jam- 73
License
License Class C Lie. #
APPLIANCES - RESIDENTIAL
PANELS
UPTO200AMPS
108 DESCRIPTION
e, 1c ,�
IG�rA/'1ix�xsJ/.
� '�
Duce Convector
201 - RMII AMPS
ARCHITECTS DECIARATION
1 understand my plans shall be used as public records,
OVER TWO AMPS
SQ. Irl'. FLOOR AREA S/SQ. FT.
II f\, II
is trE ® I
SIGNS ELECTRICAL
Licensed Professional
OWNER -BUILDER DECLARATION
SPECIAL CIRCUIT/MISC.
\^ ,r.
1 hereby affirm shat 1 am exempt from the Contractors License ittw for the
following recon 9031.5. Business and Professions Code: or county
p B T
It IL\ 71 IU.�/ IIVy
ER
TEMP. METER OR POLE INST.
to
Permit
which requires a permit re construct, elmc improve, demolish or repair any structure,
epairm
its ant file signed
POWER DEVICES
that he sof theochpemdno a(Cheam
thatheis licensedth Sectiosotheprovisionsof the the usin is License Law (Chapter
licensedgalsorra to the pr visio Lice
9(commencing Division 3e Professions Cade)
SWIMMING POOL ELECTRIC
xemit thendnrnandthe tlexlicant n.Any ivil Pemioy of
fumed exemption.
or SecM1m M1eis L5byayapplanund the basFemil s theallegedhe
Senior703 5 any,Imd doll for u permit suhjeas the applicant to a civil Penalty of
OUTLETS -SWITCHES -FIXTURES
e flu v
nm more Nen rofthedmerty, ormymars l
wages mNeinole c0mpBusinessS'I'ORIIS
❑.yusvork,a Nepsuract,ormyempinded
NEW RCSIDENTIALELECTR—SQ.Ff.
'1'YPFi CONSTRUCTION
conflicted 9o94,Business
intendedWe
will dothewons ander
he Corekno
and Professions Code: The Law does
tenors License Law does nos apply to en owner of
apply
propertywhob, ves
improvesthereon,andwho daosuch workhimulrorshmugh his
provi such
own employees,lding
ne iearrofdoroffieredpletio, finthe
oCC. GROUP
RES. UNITS
nts
or improvement
howevegthe buildingofimprovementissoldwithinoneyear of c prove for thrower-
is sold withinowner-
builder will have the burden of provin6 that he did not buil) or improve for purpose of
'TOTAL:
i --"."v.
'. -, pPLUMHINC, PERMIT 1 3 s FRE
❑ I, as owner oflhe property, am exelusivelyconvacsing with licensed contract t
NLO ZONE
APN
construct the p ximl (See. 9040 Business and Professions Cade:) The Contractors
License Law does not apply to an ownerofpropeny, who builds or improves thereon,and
PERMIT ISSUANCE 2 I (f/J
Lvers. Lew. race forsuch projects wiNacontmmorts)licensed pursummoshe Convectors
Licenu
ALTER -BRAIN&VENT - WATIiR IRA)
FEE SUMMARY
❑ 1 em exempt under Sec. B & P C for this reaton
BACK FLOW PROTECT. DEVICE
OUTSIDE
Owner Date
DRAINS - FLOORROOF,AREA,COND
..
SANITARY Y N
RECEIPT#
WORKMAN COMPENSAO'ION DECLARATION
❑ Therebyoffrat NmlM1avicecenificem ofnmsenno self-innura.m. cenilicmeof
Workers' Comperimhon losurunce cr.cmified eopylhereof(Sar. 3900. LmCJ which
SCHOOLTAX YN
RECEIPT#
FIXTURES -PER TRAP
PARK PER Y_N
GAS - RA. SYSTEM -1 INC. 4 OUTLETS
ecoco, all employee's under this perift
Policy #
Policy
RECEIPT-
ECEIPT' #
BUILDING DIVISION FEES
Company
GAS - Eq. SYSTEM -OVER 4 (RA)
PLANCIIECK FEE
❑ Certified copy is hereby furnished.
GREASPJINDUSTRL WASTE INTERCEPTOR
GRADING FEE
❑ Certified copy is Bled with the city inspmron division.
CERTIFICATE. OF EXEMPTION MOM WORKERS
COMPENSATION INSURANCE.
GREAS17TRAP'
SOILS ITH
SEWER - SANITARY - STORM FA. 200FT.
ENERGY FET?
('This section need not be completed Erie permit is forone hundred dollar O VNE
orlcss.)
WATER HEATER W/VENT/ELECTR (1U
aof work for which Nispermitis issuW,lshell
Icenifytbasin N�4E
not employ any pe n m t become subject so the Workcn'
PAID
COmpensmimi - �s
Applicant
WATER SYSTEM/BEATING
Dae Raeipt#
NOTICE TO APPLICAN 1: It, after, making this Certificate of Exemption, ynushould
beccm subject so the Worker's Compensation pravainnscifth, Labor Code, you muss
NEW RESIDENTIAL PLMIL SQ, FT.
1'0i
Ibnhwith comply with such provisions or this permit shall be deemed revoked.
BUILDING FEE
CONSTRUCTION LENDING AGENCY
SEISMIC PER
1 hereby affirm than them is a construction lending agency for Ne performance of
the work for which this permit is issued (Sec. 31197. Civ. C.)
Lenders Name
TOTAL: ♦
-
ELECTRIC FEE
Lender's Address
QTLY: it '.MECHANICAL PERMIT FEE
PLUMBING FEE 11 00
1 cemfy that 1 have read this application end .see that the above information
correct. l agree a comply with all city and county ordinances and state laws relating in
PERMI'T ISSUANCE
MECHANICAL IEEE
huilJingcons ion,und hereby authorize represenesiveso(this city to enter upon she
above men( red mpeny fn inspection purinses.
inspection
ALTER OR ADD TO MECI I.-
CONSTRUCIONTAX
Wc a o save,' am"and kap hnnmless the City of Cupertino against
Nabi ies jud ems,co Idlhm.yinanywayrommicageinstsaid C'
AIR HANDLING UNIT (TO 10,(011 CFM)
inc he. ofthe ng of thisreit.
AIR HANDLING UNIT (OVER 10,1100 CFM)
n
gnat eat Applican0 nntracmr Data
EXHAUST HOOD(W/DUCD
PAID
HEATING UNIT (TO 100,000 HTII)
I IA'ZARUOUS MATERIALS DISCLOSURE
Dae Receipt #
Will the applirnm or fumre building acupantmomor handle hamNoosmaerial
es defined by she Cupertino Municipal Code, Chapter 9.12, and the Health and Selcty
fIPATING UNIT (OVER 100,0(NI DTD)
'T01'AL:14 c0�
VENTILATION FAN (SINGLIi RI?,SIU)
Code. Senior 25532(00!
CI Yes CI No
Will the applicumw
nrfure buildingoccupanmuWum ipmeordevices whichcmis
BOILER - COMP (3HP OR 100,(100 BTU)
ISSUANCE DATE
locoed is air comeminunts as defined by the Bay Are. Air Qualiry Management
District?
BOILER- COMP (OVER 100,010 BTU)
A' D
❑ Yes ❑ No
NEW RESIDENTIAL MECH.—SQ. FT.
I have read the M1uuvdous materials requirements order Chapter 6.95 of the
MPR - 7 1994
California Health & Safety Cade, Sections 25505, 25533 and 25534. 1 understand thin
ifthebuildingdoesnot currentlyhaveast ois my responsibilityanotify the
c of the requirements which must be ma prior to issuance of a Certificate of
b, met
1114U
O
Occupancy.
upas
Cl IT yr k,Urtn
ISSUED BY: x �L
Owner or mahorixd agent - Date
TOTAL:
OFFICE
0
E
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO
INSPECTION DIVISION
JOB INSPECTION RECORD
JI
P, C*us4 Vu (�j�.
JOB ADDRESS oou G�II UNIT# _LOT#
OWNER L_n/iyNuX-LeCVcoNTRncroR !
PERMIT,..,'+.
1:,' }
PERMIT EXPI
PERMIT EXPIR ES
IS NOT STARTED 'A
180 DAYS OF PERMI
ANCE OR 180 DAYS 1
LASTCALLED INSPEC
prMIT VALIDATION✓
I
,
-_
NCE DATE r1
EG0C
:F ISSUANCE
❑
INSPECTION ' T ' ' ti - DATE',: INSPECTOR
INSPECTION RECORD
FOUNDATION
NOTE:
ALL GRADING AND DRAINAGE SHALL BE INSTALLED
TO COMPLY WITH THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
LIFER
PR EGUNITE
GARAGE SLABS,
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND/SLAB
PLUMBING
pmu
ELECTRICAL
MECHANICAL
AUG
00 NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED
BDILDINc PERM IT•
L
WOOD OOD FLOOR>;
PLUMBING
VALUATION
;SIFT.
7
MECHANICAL
ELECTRICAL
�{ve w
CO
PERMIT To
FRAMING
INSULATION
O
l L wee
STORIES
TYPE CONSTR.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN S GNED
occ. GROUP
Res uwrs
ROOFSO.
NOTE: NO FINAL INSP. SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
`T, 1100R AREA
TOTAL ACREAGE
DIAPHRAGM
ROOF SHEATHING
BUILDING USE
Res IND cory Pe 1 opo.,
0
APPLY NO ROOFING UNTIL ABOVE HAS BEEN JIGNEDIEF
NALS::•' DATE' INSP.
ROUGH
ASSESSORS PARCEL NO.
PLUMBING
NERGY
TUBS 85HOWER PAN
G ENERGY
iRACI NO.
PARCEL NO.
MECHANICAL
NERGY
ELECTRICAL
ENERGY
ACC DATE
ACC. FILE No,
FRAMING
NAL TEST
INSULATION
PLUMBING
ZONING
ENG. SITE NO.
GAS TEST
GAS
MECHANICAL
FIRE SPRINK
V ❑ N
ENERGY T 7
Y [j' NE]
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
HEATING
EXTERIOR SHEAR
E ECTRICAL RELEASE
FLOOD;
Y ❑ "❑
ALuc
v "�
INTERIOR SHEAR
FI DEPT.
SHEETROCK
GRAD
FEE SUMMARY,:
EXTERIOR LATH
BUILDING
BUILDING
'
INTERIOR LATH
TEMPORARY APPROVALS
SCRATCH COAT
ELECTRIC
PLAN CHECK
FEE
GAS
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
occuPANcv
SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR.
MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505,
o� ONE WORKING DAY BEFORE REQUIRED INSPECTION.
z PLEASE GIVE JOB ADDRESS WHEN PHONING.
—SEE PERMIT FOR EXPIRATION DATE —
ELECTRIC
PLUMBING
MECHANICAL
CONST. TAX
IMPORTANT!
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION.
TOTAL
-IL "-'
OFFICE COPY