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0957r w¢i H00 QUU rzw H 4 Oi a yl -w Q�a 0oFN w0a W va J >0 ¢DO o u Li ss FZ> It¢ H nim 0 Z 0 LU LU >- ao D z UO_ LL H 0LU 0. } 0. A �J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATIONPERMIT APPLICATION & PERMIT UILDING- ELECTRICAL- PLUMBING - MECHANICAL NUMBER 0957 BUILDING ADDRESS I I I bo z1 Tev OWNER'S NAME / PRONE• yr4J, x*•,c +^'(It2i'r �•9FyyxhC.(� jTj, Ll ,,.rL}»E` TY Y}'�" CTRIC PERMIT,, h.y' FEEo ELEf PLAN CHECK VALIDATION DATE OF APPLICATION [CONTRACTORS NAME//o__ u� /x ./ (y C, NO�J. 1 QT UTLETS-SWITCHES -RECEP 5.00/1,00 Q LIGHTING FIXTURES 5.00/1.00 s CONTRACTORS / ADDRESS //fi�r ((��s �/O-ONE PPLIANCES-RESIDENTIAL 4.00 PANELS 5.00 ANCHITEC oR ENGINEER LIC. NO. SIGNS 6.00 PLAN CHELK FEE P.L. NO. SIGNS TRANS. 3.00 ARCH. SS ENG' ZIP SPECIAL CIRCUIT 5.00 ^PERMIT VALIDATION ( I� (\�jC�((j� �J G ^/f EMP. METER OR POLE INS. 15.00 APPLICANTS IS, MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE (commencing with Section 7000) of Division 3 of the Business and Professions Cod nd my license is in full foree� e Licenlq$Flas I Lic. Number SLOG. ELECT. I PLG. I MECH. Dele_1�J1� Contrdclo! - OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License P Professions Law Code: Any city Code: Any city or county which requirese permit m construct, alter, which. perminess t to improve, demolish, or repair any toff prior to its issuance. also MISC. - REFER TO ORD BUILDING i�`:-y1 s`' INFORMATION's'(`�`�1'; VALUATION SIFT. '/ iS 01 / PERMIT ISSUANCE 6.00 OV ELEC. CONTR. LIC. N0. 9 r'Q requires the applicant for such permit to file a signed acM is Li that permit he is licensed pursuant to in provisions of the Contractor's License Law (Chapter 9(commencingwith Section 7000)of Division 3of the^ Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation ofSeclion 7031.5 by any applicant forapermit subjects the applicanl'to a civil penalty of not more than five hundred dollars (5300).): TELEC.OTAL TOTAL O eJ PERMIT TO �y p T _ ase i'1 -` QTY -" y; PLUMBING PERMIT�Ss�+ zw ,P a3.11 t FEE " , ` {=', t -.:i : �'' ?"S . � 'i� R' n STORIES TYPE CONSTR. ALTER-DRAIN&VENT-WATER (EA.)4.00 ❑ 1, as owner of the property, or my employees with wages as their Ole compensation, will do the work, and the structure is not intended or offered for Sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 2.00 oee. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AREA,COND. 4.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work FIXTURES • PER TRAP 4.00 0 r0. FT. FLOOR AREA TOTAL ACREAGE himself or through his own emPluyees, provided that such improve- ments are not intended or offered for sale. If, however, the building GAS - EA. SVS 1 UTLETS 4.00 or improvement is Old within one year of Completion. the owner- builder will have the burden of proving that he did not build or im- prove for purpose of sale.l. ❑ 1, as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OV E NO 1.00 BUILDING USE RES IND CON PB Our., ❑ ❑ ❑ ❑ ❑ INDUSTRIAL I T R 20.00 LAWN SPRINKLERS- I 5.00 LAWN SPRINKLER VER 5 IEA.) 7.00 ASSESSORS PARCEL NO. licensed contractors to construct the project (Sea 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a contractorts) licensed pursuant to the COnits ctar's License Law. SEWER-SANITAR .EA. 200ft/6.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec. ,B.&P.C. for this reason WATER HEATER W/VENT 4.00 Date Owner WATER SYSTEM 4.00 ACC. DATE ACC. FILE NO. W'ORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof 3 Lab.C.). Policy Nd1j(�pany JAK ZONING ENG. SITE N0. ❑ Certified co y Shercby furnished. Certified co is d h the t inspection division. Applicant- 0IPS . �4yy.�y p FIRE SPRINK Y ❑ N ❑ ENERGY T-24 Y ❑ . N❑ MISC. - REFER TO ORD. CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 6.00 600 FLOOD ZONE AL.U.C. PLG. CONTR, LIC. NO. PLG. 1 { 4 00 TOTAL ✓ / COMPENSATION INSURANCE (This section need not be completed if the permit is for one Y [3 NE] V ❑ N❑ QTY. MECHANICAL PERMITFEE, ' - FEE SUMMARY % hundred dollars(SIOO) or less.) I certify that in the performance of the work for which this per. mil is issued, I shell not employ any person in any manner so as to BUILDING / 60/>(V become subject to the Workers Compensation Laws of California. Date Applicant ALTER OR ADD TO MECH. 4.00 ye NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers' Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10):)000.F.M.) 3.00 FEE AIR HANDLING UNIT (OVER 10p00C.F.M.) 5.00 SEISMIC FEE 3x/j CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 2.00 MICROFILM I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). HEATING UNIT (TO 100,000 B.T.U.) 4.00 Lender's Name. Lender's Address HEATI NG UN IT (OV ER 100,000 B.T.U.17.50 ELECTRIC 3 a I certify that l have read this application and state that theabove information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and VENTILATION FAN (SINGLE) 3.00 s30.5 PLUMBING �, 00 BOILER-COMPI3 H.P. or 100,000 B.T.U.) 4.00 BOILER -COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL Q 00 ;amreby aulhorDe representatives of this city to enter upon the above-mentioned property for inspection purposes. MISC, - r REFER TO ORD. CONST. TAX (We) agree to Save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts and expenses which may in any way accrue ' It said City in consequence of the PERMIT ISSLTANCE 3.00 3 W granting IhiS pe xat4tiiz � III tun of AP an Contractor Ute MECH. CONT. LIC. NO. MECH.,r TOTALIO �`_° .,�':,� 1 '- I, TOTAL-,.`.- A4. 3y4,2./ OFFICE COPY 0 .,. IpiUST H I b CA HD 'L CITY JP�ERTINO :0 S INSPE IDIVISIOIV,I 'r JOB IN! r. �5 WFEE SUINMARY.;--- 4RECORD ON" FINALSf JOB ADDRESS "/���� CAti lin Tc•C OWNER 44FTe�i'�&'0MIWSPECj10N; LECTRICAL W • i,• "�. ) UIIDING FINAL' FOUNDATION "e, I/ Ltli,� OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. - PERMIT PERMIT EXPIRATION GAS PIPING (Groundwork) PLUMBING (Groundwork) ELECTRICAL (Groundwork FILL & REINFORCEMENT GAS PIP PLUMBI ELECTRICAL DIAPHRAGM NAILING ROUGH GAS PIPING ROUGH PLUMBING ROUGH HEATING ROUGH ELECTRICAL FRAMING - WOOD FLOOR ROOF .RONT OF. BUILDING �`� SHEETROCK NAILING e, LIT NUMe A'PI`57. JP�ERTINO J x EXTERIOR LATH' ' '- .� +,{' 1TSA r.'..•NOaTAPE?6 S LT r r �u ~ {'f+c, L,T�' ABOVE HAS BEEN SIGNEDa,","&'° tl ro,� `�� � �`• IDIVISIOIV,I 'r FLOOD ZONE Y❑ N❑ YI: �5 WFEE SUINMARY.;--- 4RECORD ON" FINALSf LUMBING — [Ill.EATING - . ^ NSP. TEMPORARY APPROVALS GAS, ❑ ELECTRIC ElDcc. ❑ BUILDING e. � e", p LECTRICAL W • i,• "�. ) UIIDING FINAL' SEISMIC FEE "e, I/ Ltli,� OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. - PERMIT PERMIT EXPIRATION UNIT# LOT#k '• S. �' ` p�y o�".s.£1a0?r•f�i^. PERMIT EXPIRES IF WORK f_ NTFACTOfl:r' Ops.lez —SEE PERMIT FOR EXPIRATION DATE— •> •MECHANICAL uVibas � rCONST, IMPORTANT! 'y IS NOT STARTED WITHIN .180 DAYS OF PERMIT ISSU- E, PLEASE READ REVERSE SIDE BEFORE f CALLING FOR FINAL INSPECTION._i NSPECTORS'NOTES ANCE OR 180 DAYS FROM LAST CALLED INSPECTION. TE: A REINSP. .E WIL �L. BE ASSESS. UNDER OVISION OF .3051 MI PERMIT VALIDATION w L r H UANCE DATE BLDG. ELECT. PLG. MEC.. ' �BUILDI GPERMIT�;(f—;;TM 91NFORMATION ¢L': . VALUATION $/FT. - i .t PERMIT TO STORIES TYPE C OCC. GROUP S. UNITS Of FT. FL00fl AREA TOTAL ACREAGE 61' , 9UILD INN USE RES IND CON PB Omer ❑ ❑ ❑ ❑ ❑ ENG. SITE SHEETROCK NAILING e, FIRE SPRINK Y❑ N❑ ENERGY T 24 Y❑ N❑ EXTERIOR LATH' ' '- .� +,{' 1TSA r.'..•NOaTAPE?6 S LT r r �u ~ {'f+c, L,T�' ABOVE HAS BEEN SIGNEDa,","&'° tl ro,� `�� � �`• _ FIRE DEPT, ACCEPTANCE 1 DATE FLOOD ZONE Y❑ N❑ A l U,C N Y❑ O �5 WFEE SUINMARY.;--- ,`' FINALSf LUMBING — [Ill.EATING - . ^ NSP. TEMPORARY APPROVALS GAS, ❑ ELECTRIC ElDcc. ❑ BUILDING PLAN CHECK FEE LECTRICAL W • i,• "�. ) UIIDING FINAL' SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTILBUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. - MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, o�' ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLEASE GIVE JOB ADDRESS WHEN PHONING. ELECTRIC PLUMBING f_ —SEE PERMIT FOR EXPIRATION DATE— •> •MECHANICAL uVibas � rCONST, IMPORTANT! 'y TAX E, PLEASE READ REVERSE SIDE BEFORE f CALLING FOR FINAL INSPECTION._i APPLICANT'$P0, GCOPY L IVA V 1 Y 1 V VJ ••• •.,� '[. 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 departments, as required, to assure that the site/building complies with the requirements of these departments. 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. 1' c. New water system in operation. I'. d. New sewer system in operation (Sanitary District). q 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: i 4. PLANNING i' 5. 'HEALTH 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 i a. Required landscaping and irrigation system installed. b. Paved parking, trash enclosures, exterior light fixtures, etc. c. Documents (CC € Rs, easements, etc.) 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 n`ew owners are attempting to occupy the building for the first time and the utility release has been deiayed,,check with the contractor who is responsible for meeting all the above requirements of the various departments. BUILDING INSPECTION DIVISION CITY OF CUPERTINO O. . r.. 1 � i L IVA V 1 Y 1 V VJ ••• •.,� '[. 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 departments, as required, to assure that the site/building complies with the requirements of these departments. 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. 1' c. New water system in operation. I'. d. New sewer system in operation (Sanitary District). q 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: i 4. PLANNING i' 5. 'HEALTH 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 i a. Required landscaping and irrigation system installed. b. Paved parking, trash enclosures, exterior light fixtures, etc. c. Documents (CC € Rs, easements, etc.) 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 n`ew owners are attempting to occupy the building for the first time and the utility release has been deiayed,,check with the contractor who is responsible for meeting all the above requirements of the various departments. BUILDING INSPECTION DIVISION CITY OF CUPERTINO O. . r..