S 2837 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BPLUMBING E MECHANICAL
UILDING DIVISION APPLICAI'IONIPERMIT 4111AING PROJEfT IDENI'IfICATION J 2837 037
RUILI)ING&®RISS: q!} '�feod 1 / xu^ 6A ei5r_ '�/ SANITARY NO. AI'Ph✓(,AIIUN 51111041'1"IAL UAI'I
21HOS AM�(P]�(��� I ZINE:K C(/)✓��RA l NA 11/iW .�✓�N(�ll/1
8111'" 64r"
14, NIC CONI'ROI.N
/ CI "ECCEN(HNEHR: LIC
�NO: wDUNftiS 2
CONTADC'I': s ZONE' 4I �N my"
C44"A kill.' ❑ BUILDING PERM IT6 3
(,req �WAArS AIA -W- ,W) � Consultant Fees Paid by Applicant(Iniliap CLD(( [a PLUMB MliCll
LICENSED CONTRACTORS DF,CIARAI'IONQPY. ELECTRIC PERMIT FE
m un
1 herehy:ntu n mI ran lime—I der,soMmanx ofChapter 9(commencing JOB DESCRIPTION
"Z with SccGon lOW)of Dlvlelan3ol'thc ltusiness and Prolcxdom Cudcundnry l mere l x PERMIT ISSUANCE RFSIDFNTIAI,
WOO�w. in full force and eflect. ❑SFDWI, [:1KETCH17N REMODEL.
QUU Licence Clusx Lica APPLIANCES-RESIDENTIAL E;AdDITION ❑PLUMBING RIS PIPIT
F-Zu: Dale Comm for
wary ❑MI&HI.ON]], ❑SI'RUCI'URAL
ARCHITECTS DECLARATION
I„p N PANELS MODIFICATION
ZOtNL IunJecu:uW my plan.v vh:tll be nxcd uv public mcurJs UP FO NNI AMPS
OZ�O El INTERIOR [I CHIMNEY REPAIR
Fz, Licon.ci Prnfcseimad 201-1000AMPS IMPROVEMENT SWIMMING POOLS
-� OWNER-BUILDER DECLARA'I'1ON OVER LIN Pg ❑RATH REMODHIJREPAIR ❑DEMOLITION
C w Q I hereby off n that I am exempt from the Contractor's License Low for the
G 6 U following mason.(Section 7101.5,Cminds and Professions Code:Airy city e,county EIJiCTHICAI.
W 31i.h which requires a permit Io construct.alter,improve.demnGnh,nr it any smmeture
pr rtI t '1: 1 th PPI Id hpa 'u II 8 J I t nn 'EL CULT/MISE. ••1 `
f,�}�
Ill.(he I IP II hetP tt C I I L'I 1(hpm'9
1yap0 (comm 6 with5 man 700(h fU i J ffl B.,inc,, dPrfc - :Code)nr N1'I*7'-d0R POLE IN.SL MFR 1:
Q.L I ed l Is 11 fry d the 1m,1,1' dl 11 6 1 Ipd A y v olid en of I ONE.Iff-P/mD0'IO(�99 In0.:
FION
Section 7031.5 by any appl cant fill a l ndt subject'Ute apple I I 'l penalty t l ICI! TE 1 dd �'.J7.7 I°IiRVICIi
not marc than five hundred dollar.($510). IMPROVEMENT
�=6 Lav uwnerof the m In with wines ax lhcirmde cmn enutian, P ,ICI,2 pn,� y,r lnyeniP ndes wi ! I ❑U'rI IICIt
a,, we will 11 the wad.end the stmetumisnoumm�JWor awdtwssotapttACW, caner ox
13 and Pny whob Code,imp Ce,there n Llad wa Law dam not apply hun't an owner nh Ol1TLETS-SWI S-Fla RES
his o ny who builds or provided
thereon,and who nonsuch work intended
of or Ihmugh
his own entplayms,pnrvideJ dM1m.ouch impmvemems me not imm�deJ or offered for NEW BESIDES'I'IAL LiLECTR SQ IT.
adc.lf.Iarwcvcr.dm huildln8 nr nrprovnncul icsold within...cysvl'of complctien,de SQ.Fr.FLOOR AREA 95QFF.
.
ractuar.buildervill Lave the LmNen of proving that he did nal build or improve for pur-
,I, of sale.). TO'CAL:
I,as owner of the pit rat,mu csel....Oly Ointment,wilh Ilcen,wd nmtiucwrs m
instruct the project ec.1044,Rusiness and Profevsions Gond The ContractoC%Li-
I,Law doesnot ltpply es ort "moof proper who Isldsor impnwes mcrcon,imd QTY, PLUMBING PERMIT FEE
who cammets tar such pried,with a,i m acturtO licensed pursuant(I)IM1c Contractor's
License Lnw. PERMI I ISSUANCE
I am exempt under Sec. .It h 1'C tin this mason
ALI ER-DRAIN k VENT'-WA FR(EA) VALUA PION
m Use
WORKER'S COM PENSA'I'ION DECIA RAT ION 14ACK FLOW PRUIEC'1'.DEVICE ` O O O
I hoctly affirm under lwnally of perjuryone of the follows,declarations: !
I�IhnvcandwillnntinluinuCuniEwmnl'Cu.i'maoelf-imam for Wader's Compel- DRAINS-FLUOR,HOOF AREA,COND. STORIES TYPO CONS IRUM IOP
nation,as pmvided for by Section 3100 of 0c Labor Cale,for the Performance of IM1c
work to,which(hix permit Is issued. FIXTURES-PER(RAI'
E]I have and will maintain Workcr'x Cmnpensadion Inwrellm.as required by Section
J of lie Lbor Code.forthe performance of the work for which lhispemtid is ismeJ, GAS-1'.A.SYS'1'IiM-I INC.4OU'ILICTS UCC GROUT'
CwNCon pcnsuunn Lrvunumcconic l'nlipI unbra /
�r (IAS-FA.SYSTEM-OVHR 4(EA) tk I 11�f
'I: IPICAII:OF EXEMPTION FROM WORKERS' (IRF,ASMNOUSTRLWASTE INTERCEMOR !EI V`J
COMPFNSSHON INSURANCEBUILDINGDIVISION FEES
( etionyecdnd M(amplet JifthepennilisforaPIAN [ne hundmJdnllars($IINp GREASETRAP O
ur Ic xd / ItiE
Immlylha'n icperfnrm co(thc wnrk forwhichth'rs p:rmit......aLl Qrull ITN ICi
Sl'
EWER-SANITARY-STORM IIA,Ed I . O
.;Ile Lvany pent I
asm Mconu mbjcn mthc W'urkeR Compel- I
0 n Iv of C '1,, ID11
,r no WAIPRIIEAIVRW/VENT/RLECCR
G UI GFEIi
.z applicant
( ICE,10 APPLICA :IL after making this Ceni iemc or Exemption.You should WATER SYSTEMO RIATLNG SOLI. FEE
F 7 I come nobject m the Wm kern Cmnpcluuliun pmvisiunx of the[.all Cole,you must
t.. forthwith comply with such provision,or this Permit shall be deemed mvoked WATER SERVICE
'
IAt
CONSTRUCIIUN LEG, NEW NI31DIlJ'I'IAI.1'10411. SQ.17L D: c Rccciptn
U O 1 herchy affirm That there is a cnmfech0a lending apal,herdic"fieureance of
U. - the ml,for which this....it ix.sued I Sec.3091,Civ.C.1 A.
. -
O U LcnNxmc
Lcndvadcr',Address OCTAL
yI certify dim I have revJ this application and time Ih0 the above information is BUILDING PITC Q d
unmm.Iagree ti.comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE SEISMIC IL; 2 r O
U Z buildin8cnnumclin i.I I faulty uulborix representmivex al'(hix city to eras'upon be //�'
shave.Incntioted pmPeny for inspection pmrynn. PERMIT'ISSUANCE ELECTRIC FEE 2� f(p
(We)n8rce m suvc,mdaumify and keep harmlms the Cidy of Cupertino again
Ii I evimi,enc ,,coxuand expenxcswbidnnay In any way aacruc against laid City ALITRORADD'IOMECIL PLUMBING FEE
cal he granting of this Permit.
I'PLICAaT UN ERS'FA ')S AND WILL COMPLY WITH ALL NON-POINT A I R HANDLI NG UNI'I'(TO 1.000 CFM) MECHANICAL FEL:
0 (RCE R ULA ONS,
--11 AIR HANDLING UNIT(OVER LQ(NO CFM) CON,FRUCCION TAX
namecof nnfaanUCommctur Dade EXHAU$THOOD(W/DUCT) 1 IOUSINGMD'IGA'IIONIEF
. IIA'LARUOI]S MATIiRIALS DISCLOSURIi
Will the applicant or future handing occupant store or handle Imounims mu¢rial HEIMINGUNIT('r()110,1X1)BTU)
ics diined by the Cnpenino Municipal Calc,Chapter 9.12,and Me Health and Salery IICATING UNIT(OVER IIXLUfX)BTU)
Cala'whoa 255J21u)"
�Ym' [-J No PAID
VENTILATION FAN(SINGLE RIiSID) Doc Reamirt N
Will the applicant or home huilding occupant use equipment or devices which BOSS iK-COMP 131111 OR 1141,0X1]it U)
mil hazardous air contaminants as defined by the Bay Area Air Quality Management 'IOI'Au
Ltmllmp It011.Hli-COMP(OVER 11N1.INN)It
Ycs ❑Na Q
have :(the bamnlnus m:ecrials reyuimnends under Cb:gncr 495oflhc Cal' AIH CONDITIONER ISSUANCE DATE '
'a NeaIN R. felly Ct 5ecdinnS 2551)5.255JJ and 255Y1.1 unJenwnd lhm if the NEW RESIDENTIALMECIL SQ,I.-r
hnilJing Jucn nolo rcnlly hua mount,that hix my mslwnxihiliry mortify thececupnm
alb quirtmmiu hicb ilei prior In issuance nlaCmt k -yPWwy
OwI t Ja6cm `` Unlc T A C ISSUHO BY:
OFFICE
POSTTHIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PEkVIT y NO. ����
BUILDING DIVISION
BUILDING,PROJECT IDENTIFICATION '
BUllp"IADUISS. v, r / /' SANITARY NO. APPLICATION SUBMITTAL DAT
'i0}
•'� rR'S NAME:1 1 P�LF ONE:.::I C Z S ra..I Nva NIC CONrT/ROL#
EC(ENGINEER: LIC NO: Ir ADDRESS r ❑
"l"1�4ti E'+'✓<:, ,`,<jl,t:c. � i.f a'_'1 i''L. '7'1 I K.Jvl r.c✓t i (i!:v,l I✓' •I/ ...
✓'- ->„_ -- / ' - - BUILDING PERMIT INFO
1 I. INSPECTIONST'� '�,a t •DATEINSPEC.', ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLUMB MECH
OF _ r INSPECTION RECORD 106 DESCRIPTION
UFER GROUND _�` E �L NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL:
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑SFDWL ❑KITCHEN REMODEL
'� THE .APPROVED PLANS AND CITY OF CAV51TION ❑PLUMBING RE-PIPE
GARAGE SLABS/PREGUMTE CUPERTINO STANDARDS. ❑MULT'I-UNIT El STRUCTURAL
MODIFICATION
POUR NO CONCRETE UNTIL.ABOVE HAS BEEN SIGNED`Il. I TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PNI - 4:30 PM) ❑IMPROVEMENT �DEMOLINGPOOL$
BATH REMODEIIREPAIR ❑DEMOLRION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- El OTHER
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
DO NOT:POUR'FL90R UNTILABOVE HAS,BEEN SIGNED AND PERMIT#ARE NEEDED WHEN PHONING.
COMMERCIAL:
PLUMBING ATTENTION CONTRACTORS: ❑NEW BLDG/ADDITION [I DEMOLITION
MECHANICAL O PERSON(S)SHALL PERFORM WORK ON ❑TENANT
IMPROVEMENT 0FOOD SERVICE
THIS JOB SITE WITHOUT BEING IN COM- POTHER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION
FRAMING VENTS SURANCE REQUIREMENTS.
INSULATION wspecrloN SPECIAL INSPECTION REQUIRED ❑ DATE [NSP.
'PLACE'NO'SUBFLOOR UNTILABOVE HASBEEN SIGNED
ROOF SHEATH/DIAPHRAM
_ PLUMBING y 7/
TUBS&SHOWER PAN _��_o� 12 _
SLECTRICALIPOOL BOND O-pV /,qf7�'�' �i`�/ I!i'J
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION ->.-QO �ij ✓' �•
;COVER:N(WORK'UNTIL`ABOVE�HAS BEENi SIGNED;,;
EXTL'RIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETWROCK/SHEETROCKSHEAR,
EXTERIOR LATH/W-SCREED
SHOWER LATH
',NO-TAPE OR PLASTER UNTIL'ABOVE,HAS,BEEN,SIGNE,StVAT(N COAT G7
EWEVIATER A0 27-
.TEN96RARY`APPROVALS'
o Z
OCCUPANCY
�
ELECTRICAL r'£' � �� 74-/L 11'ZZ '�C., -
GAS CQ.j
1- of
FNALS f.- cu �iH .a+f ”? ite 'f' iif�+,/f _ � 4'bti - '�
GAS TEST _
GRADE ^(9 00 + 5e
FIRE - 2 tii� �;Y •" Qfi nJ
HANDICAP
ELECTRICAL
AII
LUMBING -0o
IECHANICAL 3'7oo
ENERGY CERTIFICATE OF OCCUPANCh'�
VISUAL FINAL ONLY
BUILDING IMPORTANT: ISSUANCE DATE
�.00CUPANCYsOF.BUfLDI G ISNOT+PERMITTED_":KH PLEASE READ REVERSE SIDE BEFORE
',UNTILtBUIL'DING FINAL:IS SIGNEDtBY BUILDING;`; CALLING FOR FINAL INSPECTION!!
"--INSPECTOR ly�) , -a ' Irk,.'.?,.,� II ', R:< `; IssueD BY:
APPLICANT'S POSTING COPY