S 1203APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING. - ELF.CE'RICAL PIdgi r NO. 12 03
BUILDINGDIVISION APPLICATION/11ERMIT PLUNIRM:- hmcunslCAL k`.7 1
'L'C /I+ IC I�N30) ► A)L tI:SS +�. �R.."Ss
LPHON_E.nn
V 7� 7
CONTACT: 1 ,p
f l ` ❑ Constitaut Fecs Paid by Applicant (Initial)
BUILDING PERMIT INFO
nl.l% lil� PLUMH hl[CII
11zZ
100
•I_
M
•Zm
las
p w
)hZ
?L:W
a
d U
LICENSED SDECI.ARATION QTY IiLECTRIC PERMIT hEF.
1 nerenr artir+n win 1 unit licensed am « pmvtsimie nl Cnapmr v (ainttnadNg
with Section 7K0) ofDivrvion l ofhhe Business and Pmrex,ions Core, and my Meenu is
w' Q PERMIT ISSUANCE
n full force and effect. -'-7 44,s
License Ck ss Lic.p TA�^j Jnr APPLIANCEti- RESIDENTIAL
Dine Cnnva
TAPANELS
IunJenlanJ n+y plon,c mull nc tined )¢Public mcurds UP'1021XIAMI'S
JOB DESCRIPTION
RE IOEN'I'IAI.:
'FDWI. '0 KITCHEN REMOUEI.
ADDITION ❑PLUMBINGRIid'll'1!
❑MUI1rl-UNIT ❑STRucTURA1.
MODIFICATION
❑IN'I'IiRIOk ❑CHIMN17Y REPAIR
IMI'NOVI!MENT 0SWIh1h11NG I'(>ULS
BATIIREMOUEIJREPAIR ❑DEMOLITION
❑ Orlllik
Licensed Pere.aiaml 201-101NIAMPS
OWNER -BUILDER DECLARAUON U
VER 1000ANIPS
1 hereby .flim, that 1 un+ ese.un Iron the, Cmornmor's Jecow Law lin the
fallowing reason. (Section 7031.5. Business and prepositions Cede: Any city on county SIGNS ELECT
' iF
'Oa
3},
�QQ
C
(^ a'
J -.y
CxO
yF m
L 3 ^
which injuries a permit to construct. alter, improve, demolish. or ,pair any "morn
prior to its iuuance,aHorequires 'he applicant Eunuch venmil m file asignedstacment PIiCIALC C .C.
that he is licensedpursuant it) the pnivionars(if life Cmnmcmr'sljocinseLaw ICh:pmr9
(commencing with Seeti,n 7000 of DiOsion 3ofthe Business and Professions Comd., ZM1'11 I POL :
tbut he is exempt therefrom and the basis Ibr the alleged excmpJon. Any violation of
Section VIII 5 by any. applicant for I subjects the applicant m a civil Penh f wF:R DEV ti
pp Penni Yu
not more than five hundred dollars Won),
QLa, owncrnfthc Pmpeny. nr my employees with wages as tneirsolecompcmmtion. 1WIM. Of. li TRI
as
will Jo the work, aor thmtrucmm kind im ended ar oflered for stile (Se,, 91-4. L-11.11,❑
and 1'ro nessinn Code: lite Contractors License Law does not apply to an owner of OUTLETS-. H S -PIX UHILS
property who builds or improves thereon, and who dtu'such wink hitnadfor c oo
his Own employees.provided that .such improvements am not intended or offered! for NEW RESIDEN'DAL ELECI'a SQ I'I'.
'
,ale. If, n IhJngir'mprnvc m t IJ ted year of Il t he
oldIlhthecnofongttnJ'dIbIJ Pf pur,qji*
COMMFRCIAI'
[1 NEW BLDG/ADDITION ❑DEMOLITION
❑TF:NAN'1' ❑FOUR SERVICE
IMPROVEMENT
OTI IBR
SQ. FT I1.WRAR•PA.
L
LSV. 9'
I:c1 )
01 f the psrtY exclusively c 6 lit I' J contractor, topocc
+ nit project Se o04d ve d professions ( J JIT C h 's
conic I J tapply t fp pcnY buildsOffensesthereon,mnd QTY PLUMBING PERMIT FE8
Ci nruw r s
whottmtmcb frwcM1prgnwuh aanruumin) TfinailPr or: e.tits
Liccmc 1<w. PERMIT ISSUANCE
0 1 pari exempt ruder Sec. . It & P C lin dos reason
ALTER - DRAIN & VENT- WATER (EA)
Date
VALUNFION
�wncr
9e, l6 -
WORKERS COMPENSATION DITCLARAI IONolloin, BACK PLOW PROTECT. DI!VICI:
Imo herd alliin under penulry ,I' perjuryone ur the lollnwi Jecl.raions
,S'IOHIIS
'1'YI'Ii CONS 'I'ItUC1'ION
or
have and will maintain aCcttificum nfCnnscnunsdr-insom for Worker's Cnmpcn- URAINti-ILIN)R, ROOP. AREA, COND.
w
,main ..s provided for by Section 3]1X1 of the Lahor Calc, for ohc pnloron c of Ibc
wo r which this permit fitssued. FIXTURES - PER TRAP
have and "will maintain he pours CompensationrInsurance, whichper be Scctinn
3'I(p of the "her Code. for the pernmhmnec of the work for nick this permit is issued. GAS -IiA. SYSTEM -I INC.40U'1'LE'I" s
My Wnrlyri Cnmpensytion lnyu i)q carrier l'olkY� 1'^1 R.O-- _'�i%�
Currier: CC In bw d�Sa/.Tier and
No.: 7/C/( GAS -I!A.SYS TEM-UVBk4(EA)
OCC. GROUP
ANN
ClikTll+ICAI'li Oh E%IiMPI'ION19tOM WORKERS' GREASE/INDUS'I'RL WAS I IN .1
COMPENSAHON INSURANCE. _
1i1i .DING DIVISION
FEES _
(rfa,wo ur mud nm be to pler,ifthepermit is boon Incurred dollars ($ I q)) GREASETRAP
ds.)
Loy any+nalinthe any performance01the f becorr%object to the W rkersConolpell SI!Wlilt- SAN ITARY-S'I ORM I!A. 21x1 t1'.
nm unplug tiny Penun in any manner sous mhecomc wnject to the Wnrkeri Cnmpen-
lit ' I:I�+
Evi 19!li
6RAL1 G FIE!
Z
ZO
=
>hcnnm
smi nn law.coI Culifomla. Date WATLR III!AFER W/VI!Nl7El.1!CrH
1¢r making this Cc,ipcum of Iixcmption. Yon nhoidd WATBH SY$'D!M?HI!A'CING
N(YTICE'IOAPPLICANT:,11, a'
subkcr to the Workers Compensation provision m Of the LabCode, you mus
forthwith cnmplyw'ph iucM1 Pmmsinns or this permit shall nc decnsJ ro'nkcd WATF IR SERVICE
SOILS F E
U O
Q. F -t
U
,r DLI
0.
F'(n
U Z
CON S'1'RUC '1'ION LENDING AGENCY NEW NESI DENI'IAL VLM B. SV. FI'.
Iherch'fliOn tit where ixannnwnion lending agency for the peRommnce of
the work liir which this permit is issued (See, 3097, Civ. C.)
Lender's Nume -
PAID
Dasa Hsc
rrn'n1.:
-' . T
Lender's Adder,
I II.UING Fp f �+
1 ccody that 1 have rail this application and state that the above information is
a tea. I.grcemc itNywith .11 city and nutty ommamCs and. tato law, relmialto qFY. MECHANICAL PF.RMI'r IIiE
holding consmniom,and herehy:Nthorine representatives rrthisciry ma¢rupnn the
SE 'MIC FEE
above-mentioned pmpcny for inspection purposes. FERMI l' ISSUANCE
(We) agree r+sase, indemnify and keep harmless the City of Cupertino against
Iiabilitics,judgmamg. costs and expenses which may in any way formic against said City ALl'1!R OR ALU TO MECIL
ECIRIC PEI!
I'll IMBING FEE
.solum. nbe gmnnng,nnis per)nI
Nem T / PhY WfrH ALL NON -POINT Alk ANULINIi UNI'I'rIO In,IXX)CPM)
APPLIRCEACNT iDERNTANDS A I.I. CUMII
IA
1ECINICAI.IT;1?
SOUIiG1UP.ATlo'
in ,� AIR IIANDLING ONE I'(OVER InfirmCPMI
�+ /g/Let
CONSTRl1Cl'ION TAX
I LOUSING MITIGATION 193E
Signmurco pelt Contactor' EXHAUST' 1 I00D(WIDUC)
ILC S SUNNI S DISCLOSURE
I the applicant or future but sonic or It die hmrolusntateri.l I IIIA'I'ING uba r(TO I(NIIMNI R Of
n defined by tltc Culp inn Municip.l Crede. Chapmr 9.12, and the Health and Safety
Cork, Section 25512Ia)'! / BEATING I1Nl'1'(OVI:R 100.010() BTU)
Ej Yes n vimiLxr1ON FAN 151 NGLE RI!S IM
i
I
- et
1' IU -
Dam Raeipipt p -
91R[Yorrin!
which BOILER- COMP p11P OR 100,0010 BTU)
Will rdusapponta mantra (refined by the Bay Area
mit havrJoua air contaminants as Jc1inCJ by the Buy Arca Air Vuolity N1anagcmm�o
AL:
/ BOILER-COMP(OVER IW,(XIB RTU)
❑Yes
ISSUAN
I have rcadrhe h,anlnusrwterials reymmmcn u under Clexncn(J)5 of the Call- AIR CON GO IONF.R
&m+iu IlcJtn & Safety Cisle, Smion.2551 _. Sll and 25517. I midersmnd that afire NEW RESIDENTIAL MliCll. SQ. PL
building Juices our rung ntlY ox,;W yw,pomibilitym maplytherx:cupnnt
OFFICE
lr
POST THIS CARD NEAR FRONT OF BUILDING
fC
H. Y NNI-, OS l l b G CCPY
CITY OF CUPERTINO
BUILDING DIVISION
_ BUILDIN(: PROJF,Cr.IDENTItYCAT10N ��
I PEI(t•Irr Na
'6 1203
BUILDING ADDJI S: �- ` (j _
SANITARY NO.
APPLICATION SUBMITTALW
OWNER "NA E: T )
PHON
C%i-4'�,!�
Gowlt, RSUNZ t y1 .
❑
CONTROL ft
�"
i� %+ �'
1'"t. l::.e �:)G-i1ri'..
C.�� O i (p O
Au�III
IP'1 i�r(.Jj �:.`>v7 f.. /W rc. l 'S. zc0[,.-
,
INSPECTIONS S'- '` 'DATE i INSPEC,'
> ❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT IN41
FO •, ..
8,.�:I c ELac.C/r PL,+un��B Meat
L' I- LJ VJ C�
FOUNDATION/PIERS/H.D.S.
INSPECTION RECORD
NOTE: ALL GRADING AND DRAINAGE
SHALL. BE INSTALLED TO COMPLY WITH
THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
JOB DESCRIPTION
FDWL El KITCHEN REMODEL
❑ADDITION El PLUMBING RE -PIPE
❑Muurl-UNIT [ISTRUCTURAL
MODIF`POUR'
❑INTERIOR ❑CHIMNEY REPAIR
CHIMNEY
IMPROVEMENT E] SWIMMING POOLS
❑ BATH RF.MODWREPAIR ❑ DEMOLITION
❑QI'BER
UFER GROUND
PAD/SETBACK-CERT -
GARAGE SLABS/PREGUNITE 1lf y
NOCONCRETE UNTIL ABOVEHAS BEEN. SI NED''
TO ARRANGE INSPECTION
CALL AFTERNOONS (1:00 PM - 4:30 PM)
BE -
777 FRIDAY24 HOURS BE-
FORE REQUIRED INSPECTION. JOB ADDRESS
AND PERMIT# ARE NEEDED WHEN PHONING.
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
'DO NOT POUR FLOOR_UNTIL; ABOVEEIAS BEEN SIGNED,
COMMERCIAL;
❑ NEW BLDG/ADumON ❑DEMOLITION
0 TENANT EItOODSERViCE
�IMPRO MENT
OTHER
ATTENTION CONTRACTORS:
NO PERSON(S) SHALL PERFORM WORK ON
THIS JOB SITE WITHOUT BEING IN COM-
PLIANCE WITH WORKERS' COMPENSATION
INSURANCE REQUIREMENTS.
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS
INSULATION
INSPECTION SPECIAL INSPECTION REQUIRE]' DATE [NSP.
:PLACE NO SUBFLOOR UNTIC.ABOVE HAS BEEN SIGNED:
/'r(i( Q� t?JLJ CO •f07T0
ROOF SHEATH/DIAPHRAM ��
PLUMBING /
.4-4Z��-POP .S
TUBS & SHOWER PAN
MECHANICAL
C `f l — /A / y l
ELECTRICAL/POOL BOND l7 �•�
FRAMING/STAIRS/E. EGRESS pr�L
�61i
n?J �• ` �2 (�'
INSULATIONNENTILATION �'
COVER NO WORK UNTILABOVE HAS BEE SIGNED_• ,-,
C{ -I1 - L h4C tYC
EXTERIALSHEAR/HOLDDOWN - -
INTERIOR SHEAR/HOLD DOWN 4N'
4�5
46
SHEMVROCK/SHEETROCK SHEAR
�� '>"•r��
EXTERIOR LATH/W-SCREED
/'- �^/
SHOWER LATH
NO TAPE OR PLASTER UNTIL- BOVEHAS;BEEN GNED,
Gam. d
'SeraT-CH COAT
SEWER/WAT R te'Ll.'"�'�I J� " I "�
C"L.
TE ARY AP OVALS, -142'0,107"i__:++' '.I -I
t' , R.•-�
OCCUPANCY
"�;,
I' 1� SC
ELECTRICAL ' '• -UJ �/
77
:r G(i -G
GAS (�
GAS TEST
- ...,,. %' ./ . � I /, J ', .7•T C_ /l `
I •j
GRADE
r r
FIRE Z_fCL3
HANDICAP
PRIOR TO FINAL OCC 74CY
ELECTRICAL
PLUMBING
q
(£,Q/1,� 'h g•7'F'i �Gllaiv (.� !� ( CSI!
MECHANICAL
ENERGYCERTIFICATE
OF OCCUPANC
VISUAL FINAL ONLY
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED`:;
UNTIL BUILDING FINAL IS SIGNED BY BUILDING'
INSPECTOR:.
IMPORTANT:
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION!!
ISSUANC. A'TE
t
ISSUED BY:.
fC
H. Y NNI-, OS l l b G CCPY
•
NOTICE . . .
When calling for FINAL INSPECTIONS, the following occurs prior to the release of utilities:
The Building Department coordinates the request for final inspection with the following City depart-
ments, as required, to assure that the site/building complies with the requirements of these depart-
ments.
1. BUILDING: Complies with all building code requirements.
2. ENGINEERING: a. New driveways, sidewalks, curbs, gutters completed.
b. Lot fine grading to drain or bond posted.
c. New water system in operation.
d. New sewer system in operation (Sanitary District).
e. New streets paved, with sewer manhole and valve boxes raised to
grade. Sewer cleanout at property line to grade.
f. New subdivision lot corners set.
3. FIRE: a.
Fire hydrants properly installed and operating.
b.
Fire sprinkler system properly installed and tested.
c.
Fire alarm systems completed and tested.
d.
Fire extinguishers installed, dated and tagged.
e.
No parking signs in required fire lanes.
f.
Restaurants, hood fire extinguishing systems operating and tested.
4. PLANNING: a.
Required landscaping and irrigation system installed.
b.
Paved parking, trash enclosures, exterior light fixtures, etc.
c.
Documents (CC & Rs, easements, etc.)
5. HEALTH: All
food handling facilities must meet the requirements of the Santa Clara
County
Health Department.
Upon receipt of approvals in the Inspection Division from all the above departments, gas and
electric utilities will be released, and you may then occupy your building.
If new owners are attempting to occupy the building for the first time and the utility release has
been delayed, check with the contractor who is responsible for meeting all the above requirements
of the various departments.
7/0) (1 //_ 1c,
BUILDING INSPECTION DIVISION