2943 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
. . CITE'OF CUPERTINO BUILDING-ELECTRICALPERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL2943
I as BUI G PROJECT IDENTIFICATION
BUILDINGADDRESS: 7 ) SANITARY NO. APPLICATION SUBMITTAL
CF-xis PJIAo C S S'rEVeNs GR�k ® Vc GJ ZTlNo
OWNER'S NAME: Tr_0 PHONE: R'S ME: NO:
1 4194z96D we CCOONNTSRO`L.
• ARCHITECT/EIJGINEERi ',U Cy LIC VO: ESS ,s p ❑
CONTACT.
,,g , 1 PHONE: 1 BUILDING PERMIT INFO
D 1 2qt.1^, W L/ zj 34iq Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSEDCONTRACTOR'S DECLARATIONQTY ELECTRIC PERMIT a FEE
I hereby alarm Boat I am licensed under provisions of chapter a(enmmendng !OB DESCRIPTION
aWooce, with Section 7000)of Division l onhe Business and Promoiso Cute,and my license i, - RESIDENTIAL
�W- in full force and ellen, PERMIT ISSUANCE
F.U� License Class Li,.a-r7 rr_QI .(Il I ❑SFDWL CJ KITCHEN REMOD
N<6 Dam_ Contract., APPLIANCES-RESIDENTIAL ❑ADDITION OPLUMBING REPII
F-Dm ARCHITECTS DECLARATION PANELS ❑MULTLUNIT ❑STRUCTURAL
Z O w 1 understand my plan'%hall be used us pubis mores MODIFICATION
OZnO UP TO 200 AMPSe`l
F�F'LLI Licensed Professional 2u.LI(IBO AMPS ezzo
C1 INTERIOR OCHIMNEY REPAIR
II OWNER-BUILDER DECLARATION IMPROVEMENT
be Ce 6 1 hereby affirm that I am exempt from the Contractor's License Law for the OVER IBBOAMPS ❑BATH REMODEL/REPAIR ❑DEMOLITION
X
O W UUF following reason.(Section 703 L5.Business and Professions Cola:Any City or county r5 SIGNS ELECTRICAL ❑OTHER
W
L N which requires a permit to v.naruct,alter,improve.demolish,or repair any structurev
F"—yg pdomo its Issuance.also".bn me applicam forsuch pe.imo,ileosigned Haeme^t SPECIAL CIRCUITMISC.
'IyyT (hat he is liecnmt yun.aa to the p,avbiam apse Carriacou....Looms Law fChapm,9
Wrap Cl faommcirr
eagwith Secdon 1000)ef Division 3 ofthe Businessiand Professions CaP.
le)tar TEMMETER OR POLE INST. I COMMERCIAL
A..yx Cay Nn he is exempt fisherman and the dual for the alleged exemption.Any violation of ❑N W BLDG/ADDITION ❑DEFIOLRION
Wim Section 7031.3 by any applicant for a permit subjects Ne applicant to a civil penalty of POWER DEVICES ANT ❑FOODSERVICE
'more don five hundred dollars(SSW). 7r Ij111PPPpp
LOO ❑l.aowner of the progeny.or myemployecx with wags as theinale compemauon. SWIMMING POOL ELECTRIC IMPROVEMENT
will do one,work,and the structure is not intended or offered for sale(Sec.70".Business []OTHER
W �_ and No(..iom Code:The Cmurectma License law does not apply 1.an owner OfITLE-fS-SWITCHES-FIXTURE
y�' property who builds or improves themon,and who does such work himself or through
his awn employees,provided that such imprevemcms are not intended or offered for NEW RESIDENTIAL ELECfR SQ FT.
sale.IL howeverthe building or improvement asold within one yearofcompleomp.the SQ.FT.FLOOR AREA SISQ,Fr..
owner-builder will have the burden of proving that he did not build or improve for put
pose o(uleJ. ^/
C]I,as owner of the prolxrty,am exclusively contracting with licensed contractor to O L \�
Constructthe pollee'(S.C.]Ola.Business and Promed.nx Code:)The Conwanh Li -
Cense Law does not apply to an owner of progeny who builds or improves thereon,and QTY, PLUMBING PERMIT•i, +t EE `
who contracts for such projects with a contractors)licensed pursuant o the Contractors
License Low. PERMIT ISSUANCE
1 am exempt under Sec. .B&P C for this reasonaiggb
A R-DRAM&VE.NT-WATERLEA) s VALUATION
Owner Done
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTECT.DEVICE CE
1 hereby affirm antler Clo of perjuryall o(lefollowing Wormeiom
�. .oBS
._,. C]Ihave aMwill mountain a C<rtificam of C.nummsel6inwrtfor WorkcfaCompcn- DR S OOR.R REA.GOND. STORIES TYPE CONSTRUCT
.'ion,u provided for by Section 37M of the labor Cade,for me performance of Jte
work(or which this pemJ,is boost. FIXTU TRA
C]I have and will maintain Workers Compensation Insurance,as required by Section
37M of rte Lobor Cade,for be perfomuncenf the week for which this a mm is aimed GAS-EA. -I INC.a OOTLETS OCC GROUP APN
Fly Worker's omnenasu nInsurance Cartier and Policy nu ' rex ,
Cartier. Policy No.: jG�.SC EA.SYSTEM )
ER71FICATE OF EXEMPTION FROM lVbRKI
COMPENSATION INSURANCE ISWA EPTOR _
(Thissectian need armee eampiesedifthepemdtis foronehundneddollars(SI 1 �Jf,}r^;C;<,:i}:BIRTD NFEES;%%a P, :•.;'
or less.) GREASE TRA PLANCHECK FEE C
leenifyla table performance o(the work forwhich this pemdt is hawed.is a1I SEWER-SA TARY ;TOWEA 200 FT.
net employ any person in any manner so as to become u
subjeeo the Workcri Com n ENERGY FEE
OZ .anon Laws of Califomia.Date ai
WATER HE NT/ELECfR
Z Applicant GRADING FEE
In NOTICE TO APPLICANT:If,ager making this Certificate of Exemption,you shoal WATER SYSTEM/1'R
aj become subject to me Worker's Compensation provisions of the labor Cede,you mum SOBS FEE
IoMwith comply with such provisions or this pemtiuhall be deemed revoked. WATER SERVICE
is,
CONSTRUCTION LENDING AGENCY I TIAL PCMB. SQ.FL PAID
U 0 Ihereby afR ran Boort iso contraction leading agency(onhe perfomanm of Date Receipt
0 (-' the work far which this permit is issued(SeeINT,Civ.C.) Ny
U Lewers Name AL.
y lance/s Address
L S I certify Nu 1 hve read this application and oma'houM above inl.rtnai.n is BUILDINGfLIEP G VS cores.I agree to comply win all city and county ominu¢es and rule tow,reaming a. QTy, MECHANICAL PERMIT ,° E
U Z buildingcomraction.and handy colonel representatives of this city,oenurti the SEISM(
abovcmcmioned platen,for inspection puryoses. PERMIT ISSUANCE-
el Igrt 'o save,lode and keep ha a le City of Calamine against ELECTRIC FEE
. Babilit es,judgm is. sun expenses hichma i anywayaccrue ins,said Cityr. TER ORpDDTO MECH. PLUh BL FEE
'nl LI9\N ce \N his t t C WITH,\LL ON INT
App AIR HANDLING UNIT(TO IBM CFM)
S 'RCE REG ' \TIONS. S,7,
v � - 1�� MEC Cd E
/ / AIR HANDLING UNIT(OVER 10,"CFM) CONSTRU ON TAX
ignm pplsa Conrac,.r Dau EXHAUST HOOD(W/DUCTI HOUSING ITIGATION FEE
ZARDOUS MATERIALS DISCLOSURE
Will the applicant mature addling.ccupam store or handle hamNuua material HEATING UNIT(TO 100.000 BTU)
a dainty byte Coulomb Municipal Code.Chapter 9.12,and be Health aW Safety
CWe,Section 2353Ae)'! r�(/ HEATING UNIT(OVER 100.IX0 IITLII
❑Ycs W VENTILATION MIN(SINGLE REBID) PAID
Doc ceipt x
Willie ler Contaminantm or s as
definedding by the nt use Bay
Air nt tor nanny Manages ement
eatich BOILER-COMP OHP OR I oo.uh)BTU(
•. emu luruNnw air conmminanrt as de,inN lythe Day Area Air Quality Management T
Disnnl BOILER-COMP IOVER Ilk 10)BTU)
�Vcs � I
I have mod the bamolms mammals lexparemems under Chapter wsi of the Coli. AIR CONDITIONER I TE
Ibmia mhh&Safny Cute.Bastions 353(13.'3533 awl 2553x.I unJcnun,nee if me NEW RESIDF.NTL\L MECH.
huddit•Jmanm urtendyhaveamtunt.halt in resamsihili,ymnaify lMrccupam
4� ai�merex nm.p�tn iuua ro• aCanili•7 Uwe y TOTAL: ISSIIED
nc r_Ir❑
-.WL\O AUUHY.11:
2A 2,
OWN�R'SME: PHONE: CONTRACTOR'SNA.ME: LICNO:
L
CONTRO +
RC,BITECIENGISEER: LIC. : ADDRESS: ❑ '� -'� ' y
BUILDING PERMIT INFO
INSPECTIONS DATE INSPEC. ❑ Cnnsulmm Fees Paid b.':\ppiicum Ilnilia0PIM ELE9T PLUMB MFCH
L / u
7PAD/SET
NDATfON/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
R GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL
BACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑sFDwL ❑K ITCHENTHE APPROVED PLANS AND CITY OF ❑ADDITION ❑PLUMBING RE-PIPE
AGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑14ULIbUN'IT ❑STRUCTURAL
MODIFICATION
R NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED NGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR747 DERGROUND/SLAB ALL AFTERN NS II2:30 PJf - J:UII P\I) IMPROVEMENT
❑BATH REMODEL/REPAIR ❑DEMOLITION
PLUMBING 777-3228MONDA TO FRIDAY 24 HOURS BE- ❑ol-HER
ELECTRICAL FORE R INSPECTION. JOB ADDRESS
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNEDAND
ERMIT#ARE NEEDED WHEN PHONING.
T10MMF4ClA1
hAN
ENTION CONTRACTORS:
PLUMBING / '�/ ❑ WBLDG/ADDITION ❑DEMOL1T70N
MECHANICAL N(S)SHALL PERFORM WORK ON ANT ❑FOOD SERVICE
SITE WITHOUT BEING IN COM IMPROVEMENT
ELECTRICAL (�' -� [THWORKERS'COMPENSATION ❑oTHEaFRAMING VENTS E REQUIREMENTS. .�'
INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
INSPECTION SPECIAL INSPECTION RLQUIRED ❑ DATE INSP.
��,�1
ROOF SHEATH/DIAPHRAM &Wz ,0A4-2— 9/ e VlPP L - AIM 7—
PLUMBING
PLUMBING /,(JS ile-D 4'f
TUBS&SHOWER PAN
MECHANICAL T m /t l rjo.�/C. Z/ G S/3 9G /✓YO
ELECTRICAL/POOL BOND
FRAMING/STAIRS/E.EGRESS
INSULATIONNENTILATION
7E)CVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
TERIAL SHEAR/HOLD DOWN
TERIOR SHEARMOLD DOWN
EETWROCK/SHEETROCK SHEAR
TERIOR LATH/W-SCREED
OWER LATH
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED- i
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY —'
ELECTRICAL
GAS
FINALS
GAS TEST MAR
f� - ;
GRADE MAR 4
FIRE
5/21)9/ 1 W O 2k23
HANDICAP
ELECTRICAL
PLUMBING 0
MECHANICAL
i
ENERGY CER IFICAT OF OCCUPANCY ❑
VISUAL FINAL ONLY
0..IILDING IMPORTANT: �ISSunI�-1C—E DATE
CUPANCY OF BUILDING IS NOT PERMITTED PLEASE READ REVERSE SIDE BEFORE
UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!!
INSPECTOR.
ISSUED B
APPLICANT'S POSTING COPY
UNITED
SAVINGS
ee46BANKF.S.B.
20510 STEVENS CREEK BOULEVARD
CUPERTMO,CA 95014
408/973-1881 FAX: 408/973-1912
March 20, 1997
Christy Akatiff
Administrative Clerk
City of Cupertino
10300 Torre Ave.
Cupertino, Ca. 95014
Dear Ms. Akatiff,
• to response to your inquiry regarding our permit#29432, attached please find a copy of our sign
off. The building was finaled on 5/13/96 conditional to the fire department approval of door
hardware at exterior utility door. Then on 5/21/96, the fire department inspected the door and
signed off on that day.
I hope this will be helpful to complete our permit. Please feel free to call me at 408-973-1881 if
you have any questions.
cerely,
1
een Low
Vice President, Branch Manager
•