23520 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project Identification - PERMIT NO.
Bujld Address: 1� , 23520
Iwnera one:
aJlw1N � 4 CITY OF CUPERTINO-IrL IL ISDIVISION L O Z
Contractor's Name: r Llc.F. AppLICATlO I ERMIT
BUILDING .FCTRICA7. GM
F7ECHAMC CA Y CONTROL
• S . `t BUILDING PERMIT INFO
. �wPERMIT E .
Address W PERMIT] AN • ❑
LICENSED CONTRAC OR'S DECLARATION
Thereby affinnthat lam lkensed under provisions ol Chap[er9(commove. APPLIMI DENTAL OBDESCRTFTION
IngwllhSrcbm7000)0fDibkW3 oftheBusinessanciProfesslonsCode,and my "� 1_'^Fr_p- b .mow. e )� ( •�
license is in full force and effect. PAIM1 ls—` (�,�.,^N •L
Licence Cie. LICXT son It
aQ� V\ PW
Date Contractor
ARCHITECPS DECLARATION 20A090 AMPS
�z Iunderstand myplarushabeusad aspublic recent.. - OV 1000AMP5 SQ.FT.FLOORAREA $/SQ.
OFT.
q COC -1�
Fi U Licensed Professional .. GNS ELEC L l UTC ' Qe Vv.d•In I Z,t, O V
7n 6 OWNER-BUILDER DECLARATION /MLSC 1 / /
-
ZH G lherebyaffirce that am exempt fromthe Conteador's License Law for the ( GO
po followingremon.(Section7MI.5,Businessand Professlons Code:Anydtyor
O Z - .M OR PO ]NST.
C c.untywhichrequimsapermitwwmtmd rov
,alter,lmpemo
,delish,orrepair
anystrvdure pdortoib lssuaKe,atm requlrcsthe applicant(onuch permit to CR
c. file a signed statement that he is licensed pursuant to the provisions of the
µ Contractor's License law(Chapter 9(commencing with Sealer 7000).!Divi- VALUATION Z)
HBO don3o(the Busineeaand Professloro Code)orthat hels exempttherefromand NG POOL ELECTRIC¢ the basis for the alleged exemption:Any violation of Section 7031.5 by any O E WITCHFS.FIXTURES
p0 appllunt fora permit aubjecbtheapplicant tea dull penalty.fret more than ' 1 0
�fie p fv ndred dollars('910. NE ESIDENTALELECTR STO PS TYPE CONSTRUCTION
E as owner of the property,or my employees with wages as their sole �'FT'
Cz5] ensatlon,wBldothe work,and thestructure latent letendedoroffemd(or
F Q sale(Sec.7644,Busness and Profesed..Code:The C.Mrad.e.License Law
53 does net apply to an owner of property who builds or improves thereory and OCC.GROUP RES.UMTS
who does such work himself orthreugh his own employees,provided thatsuch _
Improvements are not intended oroffered for sale.If,however,thebuilding or 7
Improvement Issoldwithin oneyearolcomplmion,theowner-bullderwill have
the urden o(pmving that he did not build or improve for purpose of sals). QTY;`.t„ PI:UMBIN�.PEI�MIr 't}'.FEE FLOOD TONE APN
0 L as owner of the property,am exclusively contracting with Horn PFRMl'I'ISSUANCE
centrad.rs to construct the pre)act(Sec.7644,Business and Professions e:
The Contractor's License Law does not apply to an owner of props who
WildsALTER-DRAIN&VENT-WATER(EA)
or Improves thereon, and who metra&. for such p, Ith a
c,3 Ltt[[ador(s)licensed pursuant to the Commuter's License Law. ..FEE$UMMARY`
LJ I am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE nurqIpE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
Owner - Date RECEIPT It
WORKMAN COMPENSATION DECLARATION FMNRF_S PER].RAP SCHOOL TAX Y N
QI hereby affirm that I have a certificate of concent to self-insure,ora RECEIPT X
certlflcateci Workers'Compensation Insurance ora certified ropy thereof(Sec.
3800,Lab Ca GAS FA SYSTEM PARK FEE Y N
Policy X RECEIPT If
Com any GAS EA'Sl'Sf[7tf BUILDING DIVISION FEES
ffCenr fiedcopyts hereby furnished. IG
EASE/INDUSTR PLANCEiECK FEB
❑Certified copy b filed with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' EASE TRAP PAID 10413
COMPENSATION INSURANCE WER-SANCCARY-STORMRA 200 Date Recei Ik
(Thiske Ionneed not becompl&ed Ifthepemdt Isis one hundred dollars($100)orlessaATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N p
Icerti(ythat he the performance of thework(arwhkhthie permit tsIssued, .
I.gall not employ any person in any manner m an to became subject to the WATER SYSTEM/TREATING
Workere'Compensation LawsefC lifornia.Date
0 Applicant
Z 0 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB, SQ.FC. Date Recei Id
should become subject to the Workers'Compensation provisions of the Labor TOTAL:
CCN Code,you must forthwith comply with such provisions orthb permit shall be BUILDING Z.N
deemed revoked.
CL G CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there Is a construction lending agency for the perform- ELECTRIC FEE
D Z ance of the workfer which this permit ts issued(Sec,3097,Civ.Ca TOTAL. a
00 Lender.Name PLUMBING FEE
U. F Lender.Addreas QTY. 'MBCHANIGAL.""PERMIT MECHANICAL FEE /
OW _ 1certify that l have mad this application and state that the above information •/
IL 6correct.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE l FEES PAID:
>- relating to building constmetion,and hereby authorize reprecentativesofthls
N
(— city to enter upon the above-mentioned property for inspection purpeass.1 1 ALTERORADDTOMECH.
Z Date Ri tli
_ (We)agree to save,Indemnify an d keep harmless the City of Cupertino - eceP
against liabilities,judgments,mks and expenses which moym anywayaccrue AIR HANDLING UNIT(TO FLOW CFM) SUBTOTAL:
against sal Ity in consequence of thl 04 Ing athis rmiI.
C 6 MR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Igratemof Applicant/Contractor te ! EXHAUSTHOOD(W/DUCT CONSTRUCTION TAX PA ID:
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU)
material as detinedby the Cupertino Municipal Code,Chapter 9.17,and the Date Recei tN
Health and Safety Code Section 25532(a)? HEATING UNIT(OVER 100,013 BTU) TO
Yes s( No
Wlil the applicant ,INo
building«mpant use equipment or devices VWI1LATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District? BOILER-COMP(3FIPOR 100,000 BTU) - P I D
❑Yes ❑No W
/ I have read the th&S fuy C.erials r i..25 en,25533 Chapter 6.95 of BORER-COMP(OVER 100,000 BTU)
the California Health&Safety Code,not Ions 25505,2x a tenant,and 25534. I
usporsandthat notify the heocgdoee oft erecetly equire stuswichthat It be my NEW RESIDENTIAL MECH. �'LT JUL- 9 1992
responsibility touance of a notify occupant ccupa requlrementa which must be met _
prior to issuance ofaCertitlate of Occupancy. -.
v"1IY lit- CUT(�
Owneior authorized agent Date tri))lSs/
ISSUED BY
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING PERMIT NO
23520
CITY OF CUPERTINO 11 IAL VAM
INSPECTION DIVISION- JOB INSPECTION RECORD {
ADDRSC4344c; 13Wtl� UN1TA LOT CATEGORY coNrRoyfgI
WNER CONTRACCOR CK — UILDINGEERMITINFO::;«n�ri
w
.E >r INSPECTION RECORD
FOUNDATION PIERS A - : ' NOTE ALL GRADIND AND DRAINA°E
UFEKGKOUND SHALL BE INSTALLED 7O COMPLY WITH o '
PAD ETBACK-CERT 'INE APPROVED PLANS AND CITY OF i ......
GARAGE SLABS PREGUNITE CUPEwnNO STANDARDS.
SLA .y d
UNDERGROUND SLAB
PLUMBING INSPECTION DATE INSPECTOR
'
ELECTRICAL
MECHANICAL
07 t Wi6WWfjYI
WOOD FLOOR
°LUMBING
MECHANICAL �
ELECTRICAL
• FRAMwc vENTs cL
INSULATION -
1MCIE4140-ISUBt t i i
ROUGH
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL ACUZZI BOND
FRAMING STAIRS •�",
INSULATION/V ENTI LATI ON
E ERG. CRESS
SEWER WATER
4 0 iWAVI
�"' :TERIOR SHEAR HOLD DOWN
TERIOR SHEAR HOLD DOWN
SHEETROC /SHEETROCKSHEAR
MR
S A
SCRATCH COAT
lybinL
NOTE:NO FINAL INSPECTION SNALL DE MADE BEFORE l
THE CONSTRUCTION TAX IS PAID tui
SAN.#S DATE INSPECTOR SPE.
KB
MBING ENERGYP' SUP RTS
LCT.FINAL TEST
PLUMBING
GAS TEST • i
MECHANICAL
`HEATING
ELECTRICAL RELEASE
FIRE DEPT? KD
GRADE
OCCUPANCY
TEMPO OV
ELECTRIC
GAS
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR
- ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN '
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
• -BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT#ARE NEEDED WHENPHONING.
IMPORTANTI
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ISSUEDBY:_
APPLIQANT'l,