25959 POST THIS CARD NEAR FRONT OF BUI'—'-
CITY OF CUPERTINO
77:-.44NG DIVISION 2 9
RUILIANOADDR11,1: SANITARYNO. AFq'I.ICA"ONSUTIMII'IAI.T)AIE
'11 z 4o,
WNI ItS NANIfi.-
CONIRAC10RISNAM17 UC NO:
I
NIC CON I ROL#
RCI 111 11cl fl;NGINFER: LIC NO: ADDRESS El
E E BUILDING PERMIT INITO'-�
INS�'CTIONS DAI'Tyl INSPrC: INSPECTION RECORD
BLV" I'Lumn m,
FOUNDATION/PIERS/1 1.D..S. NOTE: ALL GRADING AND DRAINAGE
UFER GROUND SHALL BE INSTALLED TO COMPLY WITH TOO DESCRIPTION
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF
CUPERTINO STANDARDS.
GARAGE SLABS/PREGUNITE
POUR NO CONCRETE UNFILABOVE HAS BEEN SIGNED INSPECTION SPECIAL INSPECTION DATE
UNDFRGROUISNINSLAB REQUIRED [I I-
PLUMBING 4092 rlqS 01q
1--�IJECTRICAL 1141.
'LOOI U
DONUI'POUR 17LOOl�UN [LgAI30VEIIASBL-,*'NEb.,
PLUMBING
MECHANICAL
HLECTR]CAL
FRAMING VEN'T'S
INSULATION
PLACE NO SUBF-iOOR UNTIL ABOVE'HAS BEEN SIGNED -;"t'
ROOF SII I FATI 1/1)[A I'll RA M v
PLUMBING
FU 13S&S I IOWER PAN
FC%I IANICAL -j
LECI-RICAL/1'001-BOND
FRAMING/S"IAIRS/E. EGRESS .11
INSULATION/VEN'T'ILATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIOR SIIEAR/1101,1)DOWN
INTERIOR SHEAR/HOLD DOWN
-ROCK/,'
`IIFE
- "1 31 IFETROCK SHEAR 3-11. 9'11
['X'—IERIOIZI.A'1'11/W-SCIZi--FN 1-25"�*t
SI IOWER LATI I
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN 7fTEIS
SCRATC1 I COAT
SEWRR/WATI-R
TEMPORARY APPROVALS
BUILDING
ELECTRICAL
GAS
FINALS
y w
GAS TEST
GRADE
FIRE AP ED FOR OCCUPANCY El
HANDICAP ECTION ISSUANCEDA'IE
ICA L/rN FI-RGY CA LL TO
01 �1'1V1RNV0GNrS(IIN2�3p(0 I'M -4:00 PM) 777-
252-4505 MODAY TO 17RIDAY 24 HOURS ESSN PERMIT ARE NEEDED WHEN
RP A I D
,UNIBINGIENFRGY BEFORE RE RED INSPECTION. JOB AD-
R U
4
FC1 1ANICAL/ENERGY 1, IN JAN 25 1994
BUILDING/ENERGY A I'l FINTION CONTRACI�016-
H-ECTRICAL FINALTEST NO PERSON(S)SHALL PERFORM WORK ON t,vrcjj I IjqU
THIS JOB SITE WITIiOUT WORKER'S
OCCUPANCY OF BUILDING IS NOT PrRM[I -'D COMPENSATION INSURANCE.
UNTIL BUILDING FINAL IS SIGNED BY BUILDING IMPORTANT!
INSPEC'l OR. PLEASE READ RE-VERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION!!
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BIm7sINr.-RLRCTRICA, PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT rL C.PROI CI IDENNICA6 25959
IIUII.DING PRO.IRCI'If1U:N'1'IF'IC,A'1'IfIN
WILD ODRIS�� ^ ,^i UNIT# 1.017110230 SANITARY NO. AI'fLICATION gUBMITTALDAIY.
IiRS E
PHONE: CONT CTOR'S NAM LIC NO:
NC CONTROL p
RCHITECDENGINHER: LIC NO: ADDRESS: ❑ '
¢ONTACf: PHONE: QTY. HI,ECT IC 1154ITFEE BUILDING PERMIT INFO
BLD E PLUMB MSCI{ -
s 2fo 4-0 2 PERMITISSUANCE
LIC17NSED CONTRACTOR. DECLARATION ApPLIA E : DENTIAL
nmz Thereb,arG.thallamlicen,e underprovisionsofChapter9(cotmncncingwith BOB DESCPITON
1;100Section7")of Division 3 ofthe Business and Professions Cale,and my license is in p
F b Efull force and effect. Vz
<- License Class Lic.p DAMPS
vFi�y Date Crimean 10110 M S Al -
VQNZ ARCHITECTS DECLARATION OVER S SQ.IT.FLOOR hA $/SQ.FI'.
CZ-0 IunJeratmJ my plans shallbemedaapuhlicrecords. _ /nIa/\ 1l r
1=42Fq..' feseimmSIGNS CAL LL��VV �C
<�2,"'Ij Licensed l'rol �O
aC OWNER-BUILDER DECLARATION SPECT IRCU BSC.
yy OyWU F I heresy affirm shot 1 um exemptthe Commfrom the ctnr's License Lew for the
txFi.l'3 W m following reason.(Salus.7031.5,Business and Professions Code:Any city or county TEMP, fE OR POLE INST.
q LLJ�.<.1 which requires a permit to conswet,alter,improve,demolish.or mpalr any snucmre POWER VICES
yt�,>•� prionnits iasumcc,elm¢quires Ne opplicantformcM1 pertn11 fileesigned statement
W 6J'G p that he is licensed pursuant to the provisions of the Contractors License[,so(Chapter
as 9(commencin with Section 71100 of 3oflbe Business and Professions Code SWIMMING POOL ELECTRIC
XM (commencing )e j VALUATION
Wol or that he is exempt herefrom and the basis for the alleged exemption.Any violation of
tzQ Nation 7031.5 by any applicam forapermit subjects the applicantto a civil Penally of UTIETS-SWITCI IRS-FIXTURES ^1
C o
an five hundred dollars($500). L�
nerof the property.ormYemPloymswithwugee aetheirsolenrmpensution, NEWRESIDENTIALELECTR —SQ.Ff. S'I'ORIIS TYPE2WNSJCTION
a3°° J bew.rk.nndtheatmnure is Intl inlenderl mrof(ercd fasale(SecAfFl4,BusinevVa l Pro does Cade:The Contractor's License Law does not apply 10 an owner of
propenyw OCOGROUPS
nwnemployces,provide)that suchimprovemenvv urenot intended oroffercdfor Ula If,
however,the building nr improvement is sold withinoneyearofcompledon,the owner- L:
builder will have the burden ofproving that he did not build or improve for p irpme of
sale.).
❑ Las owner ofthe property,am exclusively contracting with licensedwnuactore toQTY. PLUMBING PERMIT ITE FLOOD LONE. APN
consumer the pmjmt(Sec.70,14,Business and Professions Code:)The Commctor's
hicemu Law dcesnmd apply to un ownerof property who builds orimpmvnthereon,andPERMIT ISSUANCE
who contacts for such projects with acontmeter(s)licensed pursuant mdse Contractor's
License Law. ALTER-0RAINffi VENT-WATER EA FEE SUMMARY
( )
❑ 1 ems exempt under Ser. ,B&P C for this reason TS E FIDS
BACK FLOW PROTECT.DEVICE SANITARY Y N
Owner - Date— DRAINS-FLOORROOF, GONDRECEIVE'#
, , , .
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
❑ Iberehy affirm thatlhavicettnificum of consent road!-insure,or uoeniB<ote of Fl%TURES-PER TRAP RECEIPT#
Workers lnaumnce aracenifiedcnpy Nertof(Sa.JgO,lab CJ which ti PARK FEF. N
awerx all employee's undenhis permit. CAS rtT,A.. ,T -SIN ECEIIT#
Policy EUI SION FEES
ContponY GASLA. _ST-S ) 1 PLANCHECK Ff
❑ Ceniftcdeopyisherebyfumished. .
t
❑ Cenilied copy is fled with Ne city inspection division. iCREASUINDUS'fRL WASTtI IiRC OR GRADING I>
CERTIFICATE OF FAEMPTION FROM WORKERS' CREASE SOILS F'
COMPENSATION INSURANCE
(ThN,ection need nm be completed ifthepermit is forone hundred doll.SUXB SEWER-SANITARY-STORM EA.20F1'. f•.NER IFF. ��
or less.)
I cerci fy that in the performance of the work for which this Permit is issues,l shall WATER HEATER W/VENT/ELECTR
not employ any person in any mwmer an as m become subject to the Workers' 4 PAID
Z Compensation Laws of California. Date WATER SYSTEMnREATING Date cetp
Applicant
Q 0 NOTICEI0 APPLICANT:If,after making this Certificate of Exemption,you should NEWRESIDESU' 1. SQ.IT. TOTAL:
t-� crj became subject o the Worker's Compensation provisions of the Labor Cale.you most
R�, ^ forthwith comply with such provisions or this pemdt shall be deemed revoked. BUILDING FEE
0. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
7 z I hereby affirm that there is a construction lending agency for the performance of L: ELECTRIC IrEE
U O the work for which this pemrit is issued(Ser.309],Cie C.)
IL rt Lender's Name
O U Lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 certify tout I have read this application and state that the above information Is
.�" W cement.Ingres to comply with all city and county ordinances mdatam laws relining to PERMIT ISSUANCE MECHANICAL FIiE
1" building construction,and hereby authorize representativesofthis city memter upon the CONSTRUCTION TAX
U z abov>memloned propcny for inspoetion purposes. LTER OR ADD TO MECH.
(We)agree to save,indemnify and keep hatmless the City of Caperton against
liabilities,judgments,costsmid panes which may inany way ecentan.ainst said City HANDLING UNIT(TO 10.01)CPM)
in consequence of the grunting of this Permit.
AIR IIANDLING BIND(OVER 10,(100 CFM)
.41 Signature of ApplicaniComrunor Date EXHAUST 11001)(W/DUCT) PAID
HAZARDOUS MAI 7RAi,S DISCLOSUR17 HEATING UNIT(TO 100.IX)0 BTU) Date Receipt It
Will the applicant or future building acupmt store or handle hseardous material
is dolined by the Coped inn Municipal Code,Cbapmr 9.12,and the l leahh and Safety HFAT'ING UNIT(OVER 100,00 BTU) 'f
Cade,Smtion 25532(x)?
11 Yes 13 No VENTILATION FAN(SINGLE RfSID) LIA
ISSUANCE DATE
Will iheapplicamor fumrchuilding mccupoccupantuseequipmem ordevices whichemit
NOILER-COMP DHP OR 10,00 BTU)
nnolims is contaminants as defined by the Bay Ante Air Quality Management BOILER-COMP(OVER 10,00 BTU)
solea
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.PT.
I have mead the hazardous materials requirements under Chapter 6.95 of the JAIL 5'1994
,1(�(�ss
California I leash&Safety Code,Sections 25505,25533 and 25534. 1 understand that Oa7t�
ifthe building does not currently have a tenant,that it is my responsibility to notify the CITY Uh
ocupant of the requirements which must be met prior to issuance of a Certificate of V
ccupancy. t Urch Iry
Owner or uuth.rimd til Dam 'IT-It ISSUED BY:_
OFFICE
L
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