19381 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.— USE BALL POINT PEN ONLY
Building Project Identification PERMITNO.
BuiJinJt Add : cz, -Vd19381
' nen Phone: .
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CITY OF CUPERTINO-BUILDING DIVISION
CftIN.— � ua APPLICATION I PERMIT
BUILDINGS.ECTRICAI.PLUMBINGMECHAFRCAL CATEGORY C
A Lk.No:
S SOG Q ELECTRIC PERMIT FEE 'BUILDING PERMIT INFO
Addrt PERMITISSOANCE ❑ ❑ ❑ ❑
LICENSED that ED CONTRACTOR'S DECLARATION
I herebyhSacti affirm Div son Rcen3ofthe under
usinemandPofChapterg
maC(code an enc A[TEANCFSRESIDENTIAL JOB DESCRII'770N
Ing set.In full fmmi Dlvlsion3o(the Bdelneseandlarolcaelons Code,and my 1
E=le In B!Duca and,feet.r PANELS
Lken ICC"I MRA
Dale Contractor IM TO 200 AMPS
ARCHITECTS DE CR TION X11-1000 AMI"'
OVER 1000 AMPS FT.FLOOR AREA
et0 O I understand my plans shalt be used a public records SQ. /SQ.rT•
EE2 Licensed Professional SIGNS ELECTRICAL
rG6 OWNER-BUILDER DECLARATION
n
Thereby affirm that lam eaemptfromthe Contractor'.License Law forth¢ SPECIALCURCUIT/MISC
F7031Z2 1
following recon.(Section
5,Bueinem and Prolesslona Code:Any dty or
F. TEMP.METER OR POLE INST.
muntywhlch rcquirvaperMttocorewd,sites improve,demolth,arrepalr
qqq anymtmmmpr rtotta sancgatomqutrestheappllant(oreochpermltto POWER DEVICES
file a signed statement that he Is licensed pursuant to the provisions of the
3µ Contractor.Ltcense Law(Chapter 9(commencing with Section 7000)of Levi- SWIMt (ING POOL ELECTRIC
O the basis for
Budneseeand
exemption.Any)violaat tion
of exempt therefrom and k_FLC0DZ0NtR
/ 1V`j1I,tUAT10N
6......5777777 the beat for the alleged jeetsthe. Any vtol.dui of Section rat m re any OUTLETSSWITCHESFUTUAIS ]N../�-/l�ll�v
applicant lora pert.(subject the applicant to a dull pemltyet nal coram than
°o five hundred dolourhe($5M.
pro
I,as owner of the roe NEW RESIDENTIAL ELECTR SQ.FT. ES TYPE CONSTRUCTION
�n ❑ property,rty,orhe employees Isawithwages r their
C mm*;cc.7Kwilldess and Profesionstrude:The Contended or offeredLaw
5a O dale(Sec.apply
Business and Professore Code:The C improves herser,Taw
p$R docs netapply la an owner o(property who builds orlmproveathercory and GROUP ftFS UNITS
e, whodoessuchworkhimselforthrough hlsownemployees,provided that such ,
Improvements are net Intended oroffered formic.If,however,thebullding or TOTAL:
Improvement tenldwithlnoneyearofe mpletiorythe owner-bulklerwlll have
t rden of proving that he did not build or Improve for purpose of male.). QTY. PLUMBING'PERMIT FEE` APN
LJ L as owner of the property,am exclusively contracting with licensed pggMRISSOANCE
contractors 10 construct the project(Sec.7044,Business and Professions Cade:
The Contractor's License Law does not apply to an owner of property who
Wilde or imp.thereon,and who contract,for such pga*u with a ALTER-DRAIN&VENT-WATER(EA)
oqp{f+dor(a)Ilcerese i pursuant m the Conlradora License Law. FEE SUMMARY
I_f I am exempt under Sec. 8&P C for this reason BACK FLOW PROTECT.DEVICCum DE E
' Owner Date DRAINS FT.00R ROO$ARCA, SANITARYGOND. SATARY Y N�J
WORKMAN COMPENSATION DECLARATION RECEIPT N
01 hereby affirm that I have a cirttfirate of consent to self-insure or a FUTURES PER TRAP SCHOOL IAX Y N
udiflate o!Workem'Comperealian Ireunnceora mdifkd mpythemf(Sec. RECEIPT N
3800,Lab C.) GAS EA.SYSTEM-1 ING4 OLTLEIS PARK FEE Y_ N
Policy N GAS EA.SYSTEM-OVER 4(EA) RECEUrT N
Com env BUILDING DIVISION FEES
�C (Tied copy t heed with the
GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFIE
�illed copy t tiled with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' - GREASE TRAP PAID / 1 IN
� .n c,
COMPENSATION INSURANCE SEWER-SAMTARY-STORM PA.200FT. Date Rece
(Thlssedlon need not be completed if the permit t for one hundred dollars
(fl00)otifyth WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
(certifythat anyhe person in annce (mannerhe work was toforwhibe. Permit.bje to theed, _ —
I shall not employ any person f any manner eo es m become subject to the WATER SYSTEM/TREATING
Workers'Compensation Law,of California.Date PAID
Applicant
-
Z
Z NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMO._SQFf. DBI¢ Recei Icy
Fshould became subject to the Wmrkers''Campemation provision of the Labor TOTAL:
(/) Code,you Mustfrat hwith comply with such provisions or this permit shall be BUILDTNG
W j deemed revoked. - FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
Q. ° I
hereby affirm that there t a construction lending agency for the perform- ELECTRICFEE
Z anceoftheworkio��wssl�n�1�h this rmit t hened(Sec.3097,Civ.C.) TOTAL:
OO lender'.N.me /V ki - - PLUMBING FEE
u. H .Lender.Add mass - QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW 1cartlfy that l have read this application and gate that the above Information
G incorrect.I agreeto comply with all city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
T relating tobullding construction,and hereby authorize representative ofthis
(_ Z dty to enter upon the above,mentioned property for lrapedlon purposed. ALTER OR ADD TO MECH. Date Revel IN
— (We)agree to save,Indemnify an d keep harmless the City of Cupertino
against liabilities,pdgment,cosisand expenses which may In anywa accrue AIR HANDLING UNIT(TO I0,000CFM) SUBTOTAL:
agaWts EIC inln e/uence of th it g.ftbuipasernit. AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signatureo( ppliant/Contractora EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATER I
Will the applicant ft build) occupant store or handle hazardous BEATING UMTOO 100,000 BTU) Date RCCeI fif
material as defined by the Cu oMunidpalCode,Chapter 9.12,and the ---
HealthandSafetyCade on 25532007 HEATING UNIT(OVER 100,000 BTU) TOTAL:
0 Yes Lin No
Will the applicant orfutum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the gay Area Air
allity Management District? BOILER-COMP DEEP OR 100,000 BTU) REM4 Yes rd No
havam.dthehaza o�matedat requiremontunderChapter6.95of BORER-COMP(OVER 100,000 BTU) pin
the California Health&Saf Code,Sectlon925505,25533 and 25534. 1 'L 7f1 CI'1
understand that lithe building does not currently have a tenant,that Itis my NEW RESIDENTIAL MECH SQ.FT. f9.3UJ
responsibility to notify the occupant of the requlrcmenla which=at be met /��{�
prior to issuance of.Certificate of Occupancy. (,.lova jnro
Owner or authorized agent Data
TOTAL: ISSUED BY:
OFFICE COPY
+ POST THIS CARD NEAR FRONT OF BUILDING PLR.MH NO.r 19381
CITY OF CUPERTINO
r
INSPECTION DIVISION JOB INSPECTION RECORD
JOB ADDR S UNIT# LOT# r CATEGORY co ., if
OWNER CONTRACTOR BUILDING PERMIT INFO
OUNDATIION/PIERS DA4E INSPECTOR NOINSPEC
TE ALLC I LAND DRAINAGE"
UFERGROUND - SHALL BE INSTALLED TO COMPLY WITH JOHOESCH]PEON
PAD SET BACK-CERT - - THE APPROVED PUNS AND CITY OF
CUPERnNOSTANDARDS. ^' 1 l
GARAGE SLABS PREGUNITE q•qi
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED •.'V ��3 I"i'! �• - �,+
UNDERGROUND SLAB INSPECTION DATE INSPECTOR
PLUMBING
ELECTRICAL
MECHANICAL
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED '
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS/CLEAR _
INSULATION
PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH
PLUMBING r-4'� ' \n ^ rte
TUBS&SHOWER PAN IC .
MECHANICAL -s
ELECTRICAL ACUZZI 13OND T ((
IG
FRAMING STAIRS _ t
INSULATION/VENTILATION.
EMERG.EGRESS - .` -_.
I SEWER WATER
COVEWNOaWORK•.UNTIL ABOVE HAS-BEEN SIGNED
EXTERIOR SFIEAR HOLD DOWN _
INTERIOR SHEAR/HOLD DOWN - _ —. F��c R S
SHEETROCK/SHEETROCKSFIEAR
EXTERIOR LATH/W-SCRELN p�;- — 8 l
SHOWER LATH
SCRATCFI COAT
'.NO,TAPE OW"PLASTER UNTIL-ABOVE)IAS"DEEN SIGNED
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE
_ THE CONSTRUCTION TAX IS PAID
FINALS - - DATE INSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECH.ENERGY
BUILDING ENERGY '
ELECT.FINALTEST
PLUMBING
GAS TEST
MECHANICAL
HEATING
ELECTRICAL RELEASE •
T,IRE DEPT.
GRADE - -
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - C
BUILDING FINAL IS SIGNED,BY BUILDING'INSPECTOR
ARRANGE FOR INSPECTION BYTHONING 252-4505•BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,*24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND 0^.c 0 7
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT!
PLEASE READ REVERSE SIDE,BEFORE CALLING FOR FINAL INSPECTION Dev:
s OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING 19381
CITY OF CUPERTINO AL DAM
INSPECTION DIVISION- JOB INSPECTION RECORD
-..: ADDR• S
• �. UNIT p LOT N GATTLORr CONT 'l
BUILDING PERMIT INFO,,' ,
OWNER - CONTRACTOR_ . .
INSPECTION DA'l INSPECTOR INSPE I N RE RD ❑ El El
FOUNDATION PIERS NOTE ALL INGANDDIWNACR JOR DISCMMTON
Si[ALL BE IN57ALLM U FECOMPLY Wl
R GROUND T11C APFROV D PLANS AND CITY OF 6i
PAD SETBACK-CERT CUIUMNO STANDARDS.
GARAGE SLABS PREGUNITE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION DATE INSPECTOR
UNDERGROUND/SLAB
PLUMBING
ELECTRICAL
MECHANICAL
.DO NOT POUR.FLOOR;UNTIL ABOVE AS BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE NO SUBFLOOR�UNTIL` DOVE HAS BEEN SIGNED
ROUCH
PLUMBING
TUBS&SHOWER PAN
wMGCHANICAL J U
ELECTRICAL ACUZZI BOND
FRAMING STAIRS
INSULATION/VENTILATION I
EM ERG.EGRESS
:WBR WATGR
VERINO•WO :UNTIL ABOVE HA S'BEEN•SIGNED>:-:%
—� "TERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAR
EXTERIOR TI-I/W-SCREEN t�A4T2-
Sii W R ATH S y�
SCRATCH COAT g^
NOTAPE OR' R'UNT "A BOVE HAS'BEEN S C ED
NOTE:NO FINAL INSPECTTON SHALL DE MADE BEFORE / '\
THE CONSTRUCTION TAX IS PAID 1 ' "
FINALS DATE INSPECTOR /
SAN.N i
ELECT.ENERGY /
PLUMBING ENERGY
MECH.ENERCY / \
13UILDING ENERGY /
ELECT.FINAL TEST
PLUMBING
GAS TEST
MECHANICAL / /•
HEATING
ELECTRICAL RELEASE f /
FIRE DEPT.
GRADE
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS '
BUILDING ISSUANCE DATE
.00CUPANCY Of BUILDING IS NOT PERMITTED UNTTL
BUILDING F1NAL.IS SIGNED DY BUILDMC. INSPECTOR I
1
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
A 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT n ARE NEEDED WHEN PHONING.
d ,i ,; 4',... -• IMPORTANT! IssullDnr: .
PLEASE READ REVERSE STOP BEFORE. CALLING FOR FINAL INSPECTION
APPLICANT'S POSTING COPY