00080118 CITY OF CUPERTINO, a.
BUILDINGmVISION PERMIT' CONTRACTOR INFORMATION
HUILDINGADDItESS Y t `' A PERMIT NO. ,
OWNER'S NA� PLICATION SUIT DATE'' n
ONE: s PAR I — `] ' '-+' _ / SANITARY NO. .CONTROL NO.'
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O ARCHITECTIENGINEER'. , `a :4 ' erBUILDING PERMIT INFO 4
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BLDG F CCT PLUMB M1IPCH
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L o�y Z ICI NSI DCONTIIACTOR 1 DECLARATION y. - '"Job Description
CZE O I herehY J)nn,h I I" I' I ne p n. TCI a p, 9 f g i
F„ �,� wfllS , 7000) fD 3ortheH, II- re: n C f a,eoyl' • „
°a st
U Del c-Class I I INT REMODEL,'
H ARCHI'I'PCI'S IIFCI ARAI ION '
y� y� , . I 11 :,' J y pl tall be turd,p hl' ores `I - .} '
u°�16pz Loc eel Prefeesonl - "� �•' 1 •Y-
OWNER INILD11R DLCLARA'TION .R
W='w Ihereby H' Intl ndfi theC u I L' 1 for the k' .
e 6 roll B (S 7031.5, e P .'. Code Any city i unlr
F
which I p I I :t' alter, p I I'.l I Y clure 'A
a1'
I I I. y ih appl 11 h pi, rile g J ,,,rano _ „• .:
mai h 1 d p : I I II p roc , 1 (cl poen 9 - r Sq. Ft Floor Area :Valuation
(cn fc,g wtn Sec,o,71NNp of D vii 3 or,he Br,au J Pref aons Cada) `., 1 '
or thin l 11,1 doh basksl ih IIg It Any , n
of tiion mr.d than5fve haneldlleafl rs($5�gD.,.subjects int al nr rieaev;lp penalty, APN Number
( 2 N
,I Icausation,
will do theA 1,h p I 1 IleIf I �1�n�. , - -
Po 11 f : C J �TheC I I .1 I Illpplj� `�J - C uired Inspections
w fp pery WhoIl' p 0 h 1 h kh If . -- l�•
c "I-lh gI h': PI > 1 d'e then h' p r 1
rm Jr .Inn n n 'le.sor. . ,l i.'. m 'o' r Q 3 ZQQv, 101 -- FOUNDATION
onpl( II llerw'll base he hdn rf Pri ih'lh Id I In
t�• % - o- -
of a pag rI ). 10� PIERS +
1 of the p t iy l : ly , , g 01 a tat , 103 — LIFER
,it p ) ,(S 7044 8 o d Not tints c e )The Contra �LDINO
Lac ire L.,w doe. I pply.l r It wen hale 'i pnwc,o,arenn 104 ,/R�EBAR.- Sp _
one h o h'P-1 L''with a , vlortsl I' d p reuanl ,o the 105, .—n;ANCHOR BOL1'J .
.11 1 c arv
❑I pt e'sen /q.,`' H^/�qPcmr(1 10F, '.SEIWER & WAITER • - '-+
Lustre, - 1 �z �- ffAA ry
le, W)RKF,R'S OM1IPENSAT[ON DEcTARATION - 20 UNDERFLOOR 'PLUMB ING
I hotel Far.undor penal,nT 203---` UNDERFI DOR MECHANICAL
R] y of toll 6I d I'
?04 —' UNDERFLOOR FRAME_
'In is u , anri rc a Ir r- w Lrs _
I I 1J r by S , 3700 f n, .Lbor code to, he - 2'09 ”'.UNDERFL_OOR. IhISULAT'IOlVl
pert fih AI - ti l lh,p ,'. e -
, 301 -(t' ROUGH'',PI_LIMPT.NGin
❑Ih d will I Worker Cbnp I 11 IhyS , n -
nao If ho Lb 'ce r n 1•H,n or fin, ar lien h':paint, . 'ry 302= ='`TUB ;&. .OR -SHOWER'
s.cied.M Worker Coni enea,ion Insurance carrier and 1 oliF TIL turban and ti.
P
Caner 'PolicyNo., 303. - ROUGH 'MECHANICAI_
cERru,icADON OFEXEMPION FROMWORKERS' 310.4 — ROLIGH; ELECTRICAL
Y COMPENSATIONINSURANCF' - i - r w s
ern a need nn,ne en,npl,iurr me p�nn .rr n ared'anlf n - r 305 =.,.FRAME"'- g t,„' -
(slounrl�,..) k, 306.--�'HOLDOWNS ,-
I rrylo-i' to p r rm kr n' nn p f :-:veal ''307-• INSULATION , "4 _
hall not c nplay any 1 y 'ss to namn Deet It,ho Workers- -
'[ Cen,pensatinnLaws ofCalifornia.DFN 50A —,,SHEET ROCK
Applicant'
NOTICTTO APPLICANT 1f after ,kngt crrra, fL pi y should 309 = E'XTERI'OR LATH -
,nee hl li ih W Ar C P .'I p rI the Labor Ce y ,n't 5 •.
OZ `mm ',n�pnplywm such r nrmeperni.n,uneJun,wre,e,kw - 31.171 INTERIOR LATH .
ZO I
CONsrRucuONLENDiNGAGENCY Int ' ..17 -, SCRATCHM1COAT
Ihereby'fPhil t rgnpe Yf' th pe},m' ♦"'
C
Lente kr m pe,nlie ...ee(S 3097 et c) t_ • a01,.—Y,.FOINAhh(AI';I -"—'
a o Lee " 5 L _ ELECTRICAL ENERGY'. ” e
Add
502 ; FINAL PLUMBING' ENERGY
Irryln lin Jln. ppr I I:r le mins n T ,p
W an i t I r , I N J „ T h, v
'O U ,nn ld gg , r ps el ny�yn ly: ,r nl ,',yl i m,ra1 50,.r — FINAL MECHAN$CAL"'AL- ENERGY +' ,
p man ep ,pnrr ' p a p 1 504 . —;FINAL `BUILDING' ENERGY
p.h (W)agn Father, td r 'fya Ik Orioles,peaCty fCpn ty s, ,: •n
liabilities l dg I: I P h uy n an,way' r against said
'LIZ Cit; sequeneennl staining print 505 FINAsL EglECTRICAL•
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT IssDed"b �10E " GAS-", , i•..� a• Dale. �/
SOURCE REGULATIONS Y'
Da , ,e,Re-roofs 4�Tp ,.
HAZARDOUS MATERIALS DISCLOSURE ,ry,f] �': F I NAI` MECHAN I CAL
Will the [I building occupant a fl he mons n ter d Type"of.Roof, 1,
;is all Ihythe cpen M —paler chp, oI ado Horn dsfir _ _509 :FINAL GRADE
Cuddle,S T 25532(a), • c
'0y". 71N - All roofs shall be5i%e0Iecfpl�M akI -1 WWN�N0ilerial being installed, '
Wum ppl -r l Ir s p , - yap i I I' n If a roof is inst,681 kithoutfGl9H'Ilbta�iiid��n1 nsrkQR9Sagree toremove
an,h J tcos snsed neJ ly,l Bry AaaA Q Ify Mawgenen,
all new materials for inspection. Applicant'understands and.will:comply with
oYe,_ ID No „ all non-poili[,source regulations. '
A
_ I'h erre la d ' I I y ' neal,cu drCl'N (JS of the }"
-Calf ydnacarlarad,
Sof ry C I S .25505 25533 d 25534 1understand1L 1 n ••t '
Intl h 'I l' 1. ., , IhmT'. y p hl iy, rly lh , )i' ,thew c o,iNhemelr rl issuance cf a Cerrfn le cf
oee la r 1 ., ...
X Z7,_ Signature of AppLcant a Date
Ow ,nmalZee.getit Dae All roof coverings to be Class B or better
�. ...OFFICE•
CITY OF CUPERTINQ
BUILDING DIVISIONRD ° CONTRACTORANFORMATION
Y)
1 ' BUILDING ADDRESS: PI?R.NIII'NO.
OWNER NA.�u II'Kit:-D140i'l 1_'31( c,"'I Ml il':'r I I.If 'NPP'7ic�^ , �,�`144'!101 I SI
ONp' s } y - SANITARY N CON')li0 NO-
i Gil c'; fi 'i"PFi If 1 - (i{ Lit?"I"14EN I ;r.;t l iL;i'1,LNk:F,U L,Ili IF, 4,1,,y I c :°eC4 . (t
^ ARCHITFCT/FNGINEER; PIIONBa BUILDING PIIR\II r INFO
I '1 L-10r .:;:';�.°f1 I by f; BLDG GLECI I'ILAIB Ni E_CII
z
C INSPECTIONS f^Y MI
+ °DATES r INSPECa' TO ARRANGE INSPECTION ,LOB DESCRIPTION
z F iP S CALL 777.3228 MONDAY-FRIDAY 24 HOURS
R z h'g x ' } N;';i a.k: RI:S[DKN"FIAI�•
r
G n r .� - ll ..s BEFORE REQUIRED INSPECTION.]OB ADDRESS ❑ SPDW'1. ❑ KITCHEN REAfODEI
z-a POl1NDAf10N/PIERS/ILDS' AND PERMIT H ARE NEEDED WHEN PHONING.
LIFER GROUND ❑ ADDITION El PLUMBING RE-PIPE
F ❑ MULH-UNIT ❑STRUCTURAL
a z¢ PAD/SET BACK-CERT RESIDENTIAL COMMERCIAL_OTHER MODIFICATION
GARAGE SLABS/PREGUNI I'E
3 - RA7ZIRDOUS FIRE AREA ❑ INTERIOR ❑CHIMNEY REPAIR
a S'PDDR NO CONCRETEUN❑I'ABOVL'1 Ins:6EFNbICNEDIMPROVEMENT ❑ SWIMMING POOLS
v r" ❑ BATH REMODEL/REPAIR❑ DEMOLITION
a� IINDERGROl1ND/SLAB El YES Ir,,,-lundoomnd,k,,,C6.rA undu..emnly LreyulrrJ.
❑ OTHER
i PLUMBING
Cl NO Initial LCR.0.k
o ELECTRICAL — Yh{_�.,� —
u d 2 ADO'NOT POUR''FLOOR'UNTRBABOVEHAS'BEENISIGNED='4-,%4,f EXISTING ROOF COVERING LD-NUN
PLUMBING ❑ NENBLDG/ADDITION ❑ DENIOLIFIIIN
Numbcrofexislingco,mngx 11 TENANT [I FOODSERVICE
MECHANICAL. IMPROVEMENT'
ELECTRICAL 'ro he remo,,f To he remineA Ll OTHER_ —
FRAMING VENTS —'
INSULATION ,
TYPE OF ROOF COVERING
BFLOOR'UNTIL`ABOVE HASrBEEN SIGNED
ROOF SHEATH/DIAPHRAM EXISTING' PROPOSED,
PLUMBING zv)
❑ Rolh-Up Roof ❑ Boill-UpRonfTUBS&SHOWER PAN ❑^Asphalt Shingles ❑ Acphall Shingles
MECHANICAL �A ❑ WoodShAen ❑ Wond Shukn,.ELECTRICAL/POOL BOND `^r'1 ❑ Wnod Shingles ❑ Wont ShingleFRAMING/STAIRS/E.F_GRESS —r40 ❑ Other(Specify) ❑ 011w(Specify)NSULATION/VF,NTILA'f10N Pn vidr LOBO Rcpt rl No.
OYER'NO>WORK}UNnt,ABOVE HAS BEEN-SIGNED 7%q. Provide MIgL In tAlRion.Spec.._
PCTERIAL SH&\R/HOLD DOWN
INTERIOR SHEAR/11OLD DOWN
SHEETROCK/SHF.F.'1'ROCK SHEAR INSPECTION' SPECIAL INSPECTION REQUIRED ❑ DATE INSP
EXTERIOR LATIVWV SCREED
SHOWER LATH
'fNO;TAPE ORPLASTER,UNTB�ABOVE:HAS:BFF.N SIGNED;y ?';'»` '
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
Z PLANNING 777-3308
ZQ GAS TEST ,
.�. GRADE(P.W.777-3354)
FIRE
= Z HANDICAP
(� C ELECTRICAL �l7
O F PLUMBING 90 10
U MECHANICAL. — G]
y _-
An ENERGY O O A
U Z VISUAL FINAL ONLY --'
BUILDING " 4
OCCUPANCY OF BUILDING ISNOT PERMITTED
5ANTIL BUILDING FINAL IS SIGNED BY Hl11CDING i .k"1t"� --
INSPBCTOR '�.', '. „"" ` }. � :'� .I�'`,rA?r,.;$e CERTIFICATF.OF OCCUPANCY El
PRE-INSPECTION: PLYWOOD: - INPROGRESS
INSP. _ DATE _ INSP. DATE. —._ NSP. __- DATE
TEAR OFF INSPECTION: BXFfENS: FINAL:
INSP. DATE _ INSP DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
APPLICANT'S POSTING COPY
r