19535 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
:. 1 - Buildin MI
Project Identification - PrI I'NO.
Building Address: ' , 19535�
wlo�r I
ners ams. Phone:
A A
oul V Okzx - CITY OF CUPERTINO-BUILDING DIVISION
G,�f�a�/7AIN PRTR4aL - Lic'No:
APPLICATION /PERMIT
Arahltact/Engineer. Lic.Na: BUILDINGF].ECTRICA4PLUMBING MTCIIAMCAL CA3 RY CONTROL p
QT41,' ' ))' ELECTRICPERMIT FEE "r JBUILDING`P,ERMITINFO
Addres_e: 5,74, PERMITISSUANCE' �
LICENSF-DCONTRACTOR'S DECLA ATION
Iherebyaffun,that l am licensed under provisions of Chapter9(comment- APPLIANCES JOB DESCRIPTION
u%wlth Section 70(l0)of Division 3ofthegusinessand Professions Code,and my
license Is in full form and effect. PANELS .. I
License CI
Date . Lic.q �/a 21�3G ---..• / U awl \ti,
UP 1)e7ATI N ll
AACHITECI'S DECLARATION OVERI0ANIP5 -
pOZ I understand my plans shall be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
pw�v O '
k IZ�j Licensed Professional SIGNS ELECTRICAL
1<-¢ OWNER-BUILDER DECLARATION SI'ECIALCIRCUIT/M15C
71.., 6 Iherebyaffirm that Ian,exemptfromthe Contractor's License Law for the P
Fgo qqqq following reason. 7031.5,Business and Professions Code:An dl or
county which requbesa permit tocamere Latter,Improve,demolish,ormpair TEMP.MET ROR POLE INST.
M4 anystrudure priorto Its issuance,alsorequires theapplicantforsuch permit to
O file a signed statement that he Is Hnd pursuant to the provisions of the POWER DEVICES
cex
u,res Contnoor's Liceraslaw(Clupter9(mmmencingwlthSai6n7000)o(Divl-
� 5 sion3ofthe Businessand Prolemiom Carie)orthathelsexemptthemfromand SWAIMING POOL ELECTRIC VALUATION
G 5 the basis lot the alleged exemption. Any violation of Section 70315 by any OITILETSSWITCHESHXTURFS
applicant fora permit aubje<s the applicant to a civil penalty of not more than
five hundred dollare(5500. NEW RCSIDENIIAL ELECTR .I'f.
F11,as owner of the property,or my employees with wages as Incur sole 'STORIES TYPE CONSTRUCTION
compensztion,wllldothe work and the structure isnot intended or offered for
0 In(sec,7044,Basin...and Professions Code:The C.etrad.es License law
c•S does not apply to an owner ofproperty who builds or Improves thereon,and
n•$^ who doessuchwork himself mrtheaugh hlsownemployeep,provided thatseach OCC.GROUP RES.UNITS
Improvement ere nal Intended mro(lored(or sale.If howeveg thebuildleg or TOTAL:
Improvement issold within one yearofcompldion,the owner-bullderwlll have
tFILI,urdeno(provingthat he did not build or improve for purpose ofeale.), QTY. ,_i ,.i I PLUMBING PERMIT,}" FEE", FLOODLONE MIN
L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE OD
contractors to cotatmd the project(Sec.7014,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
Wilds or improves thereon,and who contacts, for such plokALTER-DRAIN&VENT-WATER(EA)
cta with a FEE SUMMARY.
tradmr(s)licenxd pursuant to the Contractor]License Law, BACK FLOW PROTECT.DEVICE - "'
I am exempt under Sec. B &P C for thti reason FEES
Owner DRAINS FLOOR ROOF,AREA,COND. SANITARY V N�
Date RECEIPT-
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCI100L TAX Y N
❑i hereby affirm that 1 have acertificatelonof consent to xpytheure,ora - RECEIPT M
cenlllcab C.) rkere Compevatlon lrauranceon cenlfled copy chemo((Sec. GAS F.A.SYSTEM-1 INCA 3800,Lab C.) PARK EGG Y_ N
Pollry a 2rGAS F.A.SYSTEM-OVER 4(EA) RECEIPT M
Com BUILDING DIVISION FET.S cemned ropy is hereby(urnlehed. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
Certified copyis(Iled withthe city Wpedlmn division.
CERTIFICATE OF IXEMPTION FROM WORKERS' GREASE TRAP PAID `
COMPENSATION INSURANCE,
(This acdion need not be completed if the permit is for one hundred dollare - SEWER-BAMTARV-STORM PA.2WIE �, C1 D Date Remi t#
(91(p) tifytJ ' WATER HEATER W/VENT/ELCTR ENERGYFEE Y N
Icertlfy that In the performance of the work for which this permit la Issued,
1 shall not employ any person in any manner se as to become subject to the WATERSYSITM/,TREATING '
Wmken'ComPn...He-lawaof Gllfomia.Data PAID
Applicant Dale Recei t#
Z Q NOTICE TO APPLICANT-.If,after nu king this CertBRate of Exemption,you r NEW RESIDENTIAL P[MB. SQ,Ff.
should Wrome subject to the Workers''Compenaatlon provtlora of the Labor TOTAL:
W Code,you most forthwith comply with such provisions orthis permit shall be
j deemed revoked. BUILDING FEE
d0 - CONSTRUCTION LENDING AGENCY - SEISMIC PEE
I hemby affirm that there is a ennstmction lending agency for the performs- ELECTRIC FEE
� Z ance of the work for which this permit t Wued(Sec.3097,Civ.C.) TOTAL: j .00
O O fonder'.Name PLUMBING FEE
LL � la,nderapddresa• - QTY. t"MECHANICAL PERMIT ''FEE', MECHANICAL PEE
O W, Iron ify thatI have read this application and mate that the above infor ation
is corrcd.I agree to comply with all city and county ordinances and mate laws PERMIT ISSUANCE FEES PAID: ,
} 1 relating to building corotmction,and hereby authorize reprenntatives of this
F U) city to enter upon the aboveramttoned property for inspection purposes. ALTER ORADDTO MECH.
— (We)agree to save,indemnify an d keep harmleas the City of Cu Fortino Date Receipt it
a sinst ltbilitica,pdgrrcnt,coatsandexpen hichmeyinanywayaccrue AIR HANDLING UMI'(TO 10,000 CFM) SUBTOTAL'
ag.imt Id Ity Con nce Oft a of this permit. .
' a MRHANDLINGUMT(OVPA 10,000CEM) CONSTRUCTION TAX
SighaharoofAppli ra for DIffiID(HAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAVA RDOUS MATERIALS DI SCLOSURE
Willtheappil Iorhmam building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei t#
material..defined by the Cupertino Municipal Code,Chapter 9.1 7,and the -
IleaithandSafetyCmdoSection25532(a)7 HEATING UNIT(OVER 100000 BTU) ' TOTAL. 0
F1 Y. r]No
Will the applicant orfuem building occapanl use equipment or devices. VENTILATION FAN(SINGLE REBID) ISSUANCE DATE
which emit havrdous air contand®nt as defined by the flay Area Air p/��
Quality Management District? - BOILER-COMP PfRPOR 10,000 BTU) PAID
Yes. ❑No
haveread the baza ma materials requirements underChapter 6.95 of BOILER-COMP(OVER 100,000 BTU) �ftM1l O !I
the Gllfomia Health Code,Sections 25505,25533 and 25534, 1 ff�'tt�I VV � 0 19J0
understand that if the Building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
ropotalbllity to notify the accvpantof a requirements which at be met .t
p uancn aCcrti0cal o panty City,(it
Cunn brio
G al 77.
Owner o- / ens ate ISSUED BY:-,aj._ "� t VLL
TOTAL:
y'
OFFICE COPY
� t • t -- - PERMIT NO.
POST THIS CARD NEAR FRONT OF BUILDING ". 9535
CITY OF CUPERTINO
INSPECTION DIVISION-'JOB INSPECTION RECORD
p/
��. JOB ADDRESS Z b.2•-� �! I '✓�I (..Y'K p(V&41T'#. LOT# CATEGORY - CONTROL
/� •�- " ' i' iBUILDING.PERMIT INFO
OWNER_t/�._p • CONTRACTOR \ •"'INSPECTION� -E'
.
FOUNDATION/PIERS, -. .r,. ' SIMI
D`ATE:'• INSPECTOR NOTE ALL CRAINSPECTDI 6AANDi DRAINAGE`
UFER GROUND - , SIIALL BE INSTALLED TO COMPLY WITH 30tl DESCIUI'170N
THE APPROVED PLANS AND CITYOP'
PAD/SETBACK-CERT CUPERTINO STANDARDS.
• r GARAGE SLABS PREGUNITE - •�if' 13I be
POUR NO CONCRETE LINTIL.ABOVE HAS BEENSIGNED .
UNDERGROUND/SLAB INSPECTION DATE INSPECTOR
PLUMBING- - -
ELECPRICAL- _ - - '.• '
MECHANICAL- -
.DO'NOT POtIR,FLOOR'UNTIL ABOVE HAS BEEN.SIGNF.D
WOOD FLOOR
'- PLUMBING- `
MECHANICAL.
ELECTRICAL .
FRAMING/VENTS/CLEAR
INSULATION
PLACE NO SIHIFLOOR UNTIL.ABOVE HAS3BEEN SIGNED - I.
ROUGH
PLUMBING - - -
.� TUBS&SHOWER PAN -
I-� MECHANICAL - �•
ELECTRICAL ACUZZI 13OND
FRAMING STAIRS
- INSULATION/VENTILATION
EMERG.EGRESS
SGWHR WATER
'EOVER NO'WO
RK.UNTIL ABOVE HAS'BEEN SIGNED
EXTERIOR SHEAR HOLD DOWN
INTERIOR SHEAR/HOLD DOWN '� 7
- SHEETROCK/SHEETROCKSI-IEAR -
EXTERIORLATI-1/W-SCREEN
SHOWER LATH ,
SCRATCH COAT - -
NO TAPE OR PLASTER UNTIL ABOVE HAS'BEEN SIGNED.' - -
NOTE:NO FINAL INSPECTION. CT N SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS - DATE INSPECTOR
SAN.# - -
ELECT.ENERGY - --
PLUMBING-ENERGY ' "• "
MECH.ENERGY• _
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
GAS TEST - -
MECHANICAL
HEATING - -
ELECTRICAL RELEASE - -Tl RE DEPT.
GRADE
OCCUPANCY'S ' '
TEMPORARY APPROVALS
ELECTRIC
GAS . . _
BUILDINGCE DATE
-- OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL _ ,
BUILDING FINALISSIGNED BY BUILDING INSPECTOR - , , • �. ,
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN rnrl. 1 �U
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND �lt'I a,CIIDtlII�n
PERMIT # ARE NEEDED WHEN.PHONING. f
11 ' ' IMPORTANT!
PLEASE READ RF,VERSE SIDE•BFFORE.CALLING FOR FINAL INSPECTION II65UEDBY:�1(
OFFICE COPY r