00090054 `.c'TyQF evrERTtNo,' " , r` "' CONTRACTOR INFORMATION
nuii.DINcUDIVISION PERMIT. `
RUILDINGADDRESS: , `x, 'I •` f ItERMI'I'No, ,
-40
APPLICATION SUB DArli/
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ONF.:. - - - '�rl • SANITARY NO. CON'I'I101,N(1.
•, tZ O ARCUTECI'IENGINIIR -a. i * ", , BUILDING PI;RA111 INTO
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s0❑ "if f +e� .,�v _ �- , BLDG ELLCr PLUMB MICH
��Z LICENSED CONTRACTORS DECLARATION b i ,w+ ' Job�eSCrlptlon 'J
OZ'—"p Iheib, flrt ll 1 ol Charter 9( b
rr,vo Cm wile Sem ai7000)of 0", ,i3ofrhe Ru IP-fes:oroCod,.rriis in fall force and off,.
.WHeI Li". cr ° Cial INT'.' 'RMDL NFW KTCH REMODEL BATHS RD
0 , ARCHITECTS DECLARATION t -
gy°� l d , e ,d nadbe,sed plf retards T e ADD'.WALL R/I' P
a p
Decried Ir..' idl, -
n e, OWN611 BUIL DER DI'CI ARATION
'�- In nr n m,l ml m e , , I I f thea -
C Z Q billowing g .(Senior7031.5,Busionsland fork, .C Any cal, r,aardy
f 0 'wh 1re,.p nlR , m It p J 11 unf , r r + 1 +tt
pe � P-+ I I 1. 4 ',h 'Ptl ,f ahP _ n fl r J It r -
thathe is hicaredphostrat the provision'"I'llne Cratlocclue,Li,,n,Lavv0CIaTw,9Sq. Ft Floor Area ^Valuation,
(,. neve ngwln Sec 7000) ,D i fth 11 : IP I 'Care) 'yl
A n orll ll Plh -f 1'hbtr r aIlpd p, Any I , i , .1e ,, 1 ,p
0f5 , 703156,any applicantf a ponilit subjects,he uppl ,,,auvlp penalty
fit., In f n Ii 1d,lldollars APN Number Occu T7�.,�
' : ti " + < p343561 c
❑1 n f Or.ra+pony un"canpa y with wuEr,as hour side t,+ren ,
v I11 do the w k and 1,h l o - llw led -uttered for icfl,(S 7614 -
Bu,iac,,and Pr6b,.......cd : nhe Coronet L Law dl al,i to nn , Re�pp�piredln'spec[ ����®'
property Whobuilds r'reproves m n d h J n kl' self - •t ,36903008: 4A{r
0th bh 1I,own cariployce,provided!that n. proolerecall are intended or
orient][ ode.ii hear,,,,,h 'h ii 4 reprotornsul IJ video are year f ,3
nr pl, 11 r h d II have h n d i I proving IIn I h did ` ry ' ` . - �(�
prpasem ale) -, not ., „ ,1iZ�1 FO[U-NDATION NOV'. �� -.
l d p p ,y , I ,c nl 5 'a Treated nt , i0 — GIE_RS-1 7 +) {{����/�
r„ ,il p to(See,IIMq 6 , dP CJ )TI C ( , 10 ->UFER i�U�L��1VtA ^,
F L e L , pply I 1 profanity h IJ p 5 -,1 n i ,
r,d n ra WW�R'
, ,'fL I r ,er,witr ro-I m r m 104 = REBAR'
yd plf ` R&FC1r,m.r 105 = ANCHOR BOLTS).1 4r1 y5 106 ,FhIER -R b�A7;ER fl 560 PENSAPION 155C1ARATION
+ , 202, 'UNDERFLOOR PIUMBSN6
Ih -hy'M n 'IEy of p,3n eocmerau gdhra,bm ; -
I n35rinnd will nn'nw-n d Ce flcure H'Cannon m,elf n to f+ Worker's
I,
RQ3 —. UNDERFLOOR MECHANICAL
'o,p nr provided l by Section 3700 f the ].in;,� Code n n- _ "" ,'204' —� UNDERFLOOR FRAME '
per ncefthe vote or wlfd„his p ,t _issuedy + f " ' -
205 UNDERFLOOR, INSULATION , .
iia t t and
L n Cod lo, h v c r A tronh k 1 hi, dnsurance av required pre l .. 301' — ROUGH, PLUMBING issued MyW ver's CoupcoraternInur e caneredNfl y one a > , -
I 30'22 —` TUB R' QR SHOISIER
Corr cr. ,+ '` PoI ,No: - '
CERTIFICATION Of EXEMPTION FROM WORKERS- 303 • ROUGH: MECHANICAL ' • '
COMPENSATION INSURANCE',U 0. "v. t �` — ^'•
F f I_ ''s
304 ` AOL GH .1 ECTR T .A
'• l l h , ricwl iol ha complo, I'f 11 nn in tar a it hundrul dolHry :1.
I certify thnynn p r,rurni afd-work for xm Cn lnvpe n,is sued ) --306 — HO-D'Q ANS -n - .
_shall ,'Into., y:p y ratio, subject 'ti
A ''„v "••
a 3Cb7 t ,INSULATION: ;
Ca q , Luw,of C I 1 Dole� � ,',� .,
e nppl i, > 308 — •SFIEETROCN
NOTICETOAPPLICANT If ade, nuAit6+his Cerffwa+fF ♦npfon,yn should _
Zh,,orar uh,riu la thew Ar,C r p l: . one Labor code y„ r t - '309 — ;
CITY OF CUPERTINO
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BUILDING DIVISIONT CONTRACTOR INFORMA'CION .
PERP" : ras .r::.^rt
BUILDING ADDRESS: PERM IF No
ON'NEN'S NABIF:1 �'Ifl l'J<7 j ISI_i IfIF_.}' 1 —fi 41HI_i)RI,114 f�l'-IMSTRI.lf f-�i pPPV9P',1Mp'-'Pit y*)1/,?1411'1'i7�lVltiy
IIONF:: I.i 1�.}� 17 II- .1 f41 f.Ii71 Ilpi-1R 1 ME f Y 5.\N'Ill\R\'Nll
3 flii.illiF.''I l.id•II liY3:.1 �";Kt1S1
-. ANCNI'IF.CT/E.NGI\EER: PHOS\'IiM BUILDING PERMIT INFO
ELUG ELECT PLU,AIlf NECII
u INSPECTIONS�r�c r a„r:.-b.1\ DAl F4 INSPCC` TO ARRANGE INSPECTION ,IOP UFSCRIP PION
�a I'>”"1 ..1.. t-} Kux n rYl iCb
CALL 777-3228 MONDAY FRIDAY 23 HOURS
z FOUNDATION/PIERS/II D S ❑ SFBEFORE REQUIRED INSPECTION.JOB ADDRESS RLSD LI'11�'
N9. D KITCHEN REMODEI
;z4;—UFER GROUND AND PERMIT ARE NEEDED WHEN Ph10NING. ❑ AUDITION ❑PLUMBING R14-PIPE.
m Y_ ❑ NIUI.TI-UNIT STRUCTURAL
C` PAD/SET BACK-CERT G
c uRESIDENI'IAI. COMMERCIAL OTHER
i; 1- GARAGE SLABS/PRI:GUNII'E MODIFICATION
POUR'NO CONCRETE UNTII:ABOVE HAAS - HAZARDOUS FI El INTERIOR ❑GIIEMNIiY REPAIR
fiEEN SIONED� 'I RE ARI,A IMPROVEMENT U SWIMMING POOLS
o o UNDERGROUND/STAB ❑ YES 11 yr. B Lnndx,,Wrd dr 3 Cla,A r...f ,.,,n Iy „alu�r�d. ❑ BATH RENIODFI/REPAIR❑ DF;NIOI.I HON
PLUMBING ❑ OTHER
< ELECTRICAL NO Initial I.C.B.O.N
dsc
3 c+.Df)NOr-POUR'FLOO10NT1IPABOVE'HAN BBENISIGNEDr'j3y[3q^ F.XIS'11N-ROOF COVERING CFMIAIFRCIAL,
PLUMBING ❑ NEW BLDG/ADDITION ❑ DEMOLITION
MECHANICAL Namhclof u,I,liFg cmeringn ❑ 'TENANT ❑ FOOD SERVICE
ELECTRICAL. IMPROVEMENT
To he remm'ed To he retained ❑ OTHER
FRAMING VENTS ----
INSULATION
Tiatka k6 sljgFLOORiN TIL'ABOVETI PE OF ROOF .
COVERING
ROOF SI HEATH/DIAPHRANI EXISTING- PROPOSED.
PLUMBING ❑ Built-UpRuof ❑ Buill-Up Rnu l'
'PUBS&SHOWER PAN ❑ Aephall Shingle, ❑ A.phah Shingle,
MECHANICAL Z/.�, ❑ Wood Shakes ❑ Woad Shake,
ELECTRICAUPOOL BOND L-w /- ❑ Wood Shingle, ❑ WoW Shingles
FRAMING/STAIRS/H.EGRESS 1/ ❑ Othe'(Specify) ❑ Other(Specify)
NSUL ATION/VENTILATION Prmide LC.H.O.Report Nn,
OVER NO,WORKIUNTIETA13OVE.HAS BEEN SIGNEDpj'.p,Ei%ggJ Pro%ide MI'gr.Installation Specs,
EXTERIAL SHEARMOLD DOWN
I 'TERIOR SHEAR/ITOLD DOWN
SHEETROCK/SIIErTROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
EXTERIOR LATHtw.scREED
SHOWER LATH
,ANO TAPE OR'PL:ASTERdIYTIC'ABOVE-HAS,REEN.SIGNED;:,`.-h?T',
SCRATCH COAT'
SEWER/WATER
TEMPORARY APPROVALS
1. OCCUPANCY
1 "a:FINALS'"'is„^ti ::...011'k=iT�%:
PLANNING 777-3308
ZQ GAS TEST
F GRADE(P.W.777-3354)
l�r7 FIRE
Z HANDICAP
U Q ELECTRICAL
PLUMBING
y W MECHANICAL
F" VI ENERGY .j
U 'Z. VISUAL FINAL ONLY
BUILDING ...5�1 v -
,OCCUPANCY OF BUII DINGGISOINI ERNII7TED h
a - i •x x 'w
,1UNl'IL BUILDIN(i'FINAL-IS SIGNED BY BUILDINCr "• 1i �r
*a:.. u r � r s:
N:TECTOR 4 ` ,�/mv,, , yk+« A /3 t y�q CERTIFICATE OF OCCUPANCY❑
'RE-INSPECTION: PLYWOOD:
IN-PROGRESS
INSP. Dr\'FF: INSP. DATE INSP. U,\TE
'FEAR OFF INSPECTION: BATTENS: FINAL
INSPDAl'li__ INSP, DATE INSP, DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
PPLICANTS