S 1527 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO BUILDING.ELECTRICAL PB ITNO
BUILDING DIVISION APPLICATION/PERMITI LONIIIING-MECHANICAL 1527
BUILDING PROJECT IDENETIFICATION
�,.KILDING ADDRESS: SANITARY NO. APPLE AT 0, SUBMITIAL OAFE
14 0 2 1/Icl<sb✓� lir Tsam(a.� co�3 6 26s1 l t1N(�C`
.rfRpF'ER:S KAMC ('HONE: CONI MAC]OR'S NAh11i: LIC NO'.
RICk- w0.r''i o5 ?S3-567 C g Q we coNrxol.«
ARCHITECT/IdsGINLE LIC No: ADDRESS: ❑
8.a • ew C2215 c�a\'x -95\20
CONTACT'. PHONE: BUILDING PERMIT INFO
❑ Cnnsullanl Fees Paid by Applicant(Initial) li Ehli(_I' PLUMB MUCH
Rlok M. (laaw\o !a ¢08
4I7400S
LICENSED CONTRACTOR'S DPCLARAI IONQTY ELECTRIC TERM IT FEE' JOB DHSCRIIaI'ION
I hereby affirm that I in h,go,J mode,provtaion..I'Chunmf 9 Man aleming
�wZ -thSeei.m'1i00H.fDomm.3 ofthe Busincxs and Pm&usma Cole.amn,Reerse i. RESIDENTIAL:
u1 2 with PERMIT ISSUANCE
wu,_ in full lnrcc and deet. _�,,❑��rrSf--D��''W�� I. ❑KITCHIiN REh10D1!L
QVU License Class -\ Lac....... APPLIANCES RESIDENT •V✓ VJCZwyIT10N PLUMBING RI PIPE
NZuI Datc TSCoaDEnr
wQa - R ]MQIThHND' ❑STRUCTIJRAh
ARCHITECTS DECLARATION l.O
Z O4 Z 1 unsicretund my planx shall be ural us puM1lic rcmNs UP 105 9 ` CEI DIPMN CATI(1N
OL`�� UP 10 2114 AMT'S � � 3♦
FyF� hiccnseJ l'mRsssionul 20I-IIX00AhIP$ IMPROVEMENT SWIMMING I'OOIS
f,
OWNER BUILDER DECIARAI'[ONOvl!R 10x1AMl'S ❑[JA'I'U ELMODI!I JRF'AIR ❑DI:MOI.I'TION
a z w� I hereby anion tat l atm eX,u,t eon tire n a
e C. las,Lxe r
ieenLaw for e OIAliR
O a a
U following reams.(Section]831.5.Business and Professions Cale:Any city or cnunly SIGNS ELI!CTRICAL ' /J ❑
li]3 LLIn wM1ieh requires 1,whit m Cnnvtnal,odor,improve,datiolkh,m opamenr
l any sie `,
F'LLC, Prion.irisstrime.alsorequirestbeapplicanl Gnsuch l+s'rmit to Hleasignedslacneat SPECIAL CIRCUIDMISC. y
ythin he it llcenscd pursuant to the provisions of the Contractor'%License law(Chapter 9
H. (commencing with Section'/01XB of Division 3 of Jte Busing„and Prolessiens Codr)or '1'1!MR M I i'ER GR('ULE INtiI'. �, '�.^ COMMERCIAL:
L G.a that he is exempt therefrom and the basis for the alleged escmptmn.Any violation if, ❑NI'-W BLDG/ADDI'T'ION ❑DEMOLH ION
Section ID31.5 by any applicant for apcmtil subjects the applicant u+u civil penalty al POWER DIIVICI!S ❑'IENANrr ❑FOOD SERVICE
N of..... tl+mt five hunda'J JOIIttrs 15.51XB.
F=GLas owner of the m n loges with wages their sole core tion, SWIMMING i'UUI .i"I'RIC IMPROVEMENT
❑ P M Y.or my enp y gen uv pens° ❑01HE.R
(. will do the work,and the amcture is nm intended ormenad for rete(See](W,Businexs
a 3 w and Professions CoJa The Comment"'License law docs not xPP1y In an nwnct of DU',LETS-SW"CITE TURES
property who build,or Improves thereon,and who does such work himself.,through
his own employees,provided that with intpmvemctras ate not intended or oltemd lot NEW RESIDENTIA.1'n
orr.Il:h+wuvur,ute buildingo,imnrivement is sold within oneyeur of completion,the SQ. °I'.IlOUlt AREA E/cQ.Pf.
owner builder will have the burden of proving that he did not build or improve or pur-
pa,eofsale.l.
O h avwner of the property,am exclusively contracting with licensed vacrIctory to
m,trucl the project(Sec.9141.Business and Professions Cale:)The Compactor's Li-
eerasc law does not apply to an awmer of property who huildsor in+pmvca thcrasm,and QTY. 1'I,U PERMIT FEF: �QD ��
who wrweta forsuch pmjmu with a contractors)Iicense.l premium it)the Commili is
License law. �O PERMITISSUAN "\/ 1000 «r~jed
1] atneaen,utmlcr Sea Bk PCfirthis moon
AEIER-DRAIN&VENT-W . (HA) VALUATION
owner Date
WORKER'S COMI'BNSATIUN IJT;CLARATIUN BACK RpWI'ItOI'ECI'.DEVICE
1 M1ind limaunderpenaltyofperjuryencof thefollowing W..k atiool
�on,as prookeforbinection3me of Coonan.Code,for the Waderace of the
DRAINS-FLOOR,ROOT'.ARLA,GQND' STORIES "TYPE CONS'IHUCI'ION
amok,as pmviAhi for by Section J]W of the lair,Cade,for lM performance of the
work for which this maintain
is Worker
PIXTUHIiS-I'[R TRAP
1 have and will maintain he to nCompensation Insurance, 1,required by Section
3]IXl of the Labor)ole.tin the parlurn+ance nil'rhe work lbr which this lxnnit is lssacd GAS-PA.SYSTEM1I-I INC,JOUThii TS (KC.GROUP AI'N
My Worker's Compensation Insurance carrier and Policy murder am:
l-i n1
Carrier; Policy No, e. :R iRJU'CIiRTITICATE 01'EXEMPTION FROM WORKERS' it : CEI'(COM PEN SAI ION I NSURANCIi IhAS(Eis section need not becompletediflheltemot is formic hmueJd.11ats($100)in la".) PLANCHECK 19I certify that in the arrhomtince of the workfor which this permit is issue .I shall - .1 ,AL2 IIT.not employ any perwan in any.ounneruo`,�I``+ott h, ocheWorker,'Crena- LNI!RGYEEI!Z natin Lawn of California.Date aac.Y\'1.\av /VFNpadECfHZ O Applicant GRADINGI'I:NOTICE TO APPLICANT:IL after making this Cendiehic of Esquirh m,you should TREATING SOIIS FIiE
bcamte s compywit Worh po mittncnewiis ermisinnwtthe hied voko. nmxtHabwitM1artply with wcM1 prnr':inn,onhi>permit shall be Jeen¢J revoked.
a
O CONS'(RUCTION LENDING AGENCY NEW RISIDEN I'IAL PLMB. SQ.Fn PAID
'7 zs ihemb lirmlbat thereisaconstmetionlendingagencytonM1e perfonnunccof Uwe sII
U O +'
the work for which this perms iso cJ(See.JIM)].Ci¢C.)
IL F' I die',Name
V Lender`s Adds,,,- - '1'UI'A h:
I certify that I have oad this application und Hare tum the abase information is HUIhDING /a
.F.oN arrenJ ng.t,,.,mply wi,h.11gily anarnumyordimances oul,ti laws alarm,in QTY. NIFCIIANICAL PERMI'P PEI: �J /11
U Zi hurldingcnnxtmefmn.anti Iaehy authorize repre,aianiv-of this city m ewer upon the SEISM( SDI V
ahavo-memirnN pmpeny for inspection puHxsses. =Ml:CH.
ANCE! ELF 'P /3• Q
(We)agree o,visa,Indcnmify:ural kccp ha less the City of Cuncnioo agaimt !
Iiabihdcu,judgetents,costs and capemes which may in any way accrueagainxt said City DO' MlMI!CH.In eon"'irro ,of the grunting of mi,pen it,.APPLICANT UNDERSTANDS AND WILLCOMPLYWI'T'H ALL NON-POINT ING UNIT('IO 111,1XXICFM) I ANCA. ' /ItSOURCE REGULATIONS. ING UNI'I'(OVER 10,000 CPM) CUNS'ISignuuaenfApplicamUCtnmetor Dale OOD(W/UUCI'JHAZARDOUS MAIERINS DISCLOSURE
Will theapplicatn or future bullcm,«euparalsmutnrhandle hazallous anterial IT('1O (X1.001 BTI)
as sldinal by Jut Cupertino Mun'icip'al Code,Chanter 9,12,and the Hcahh and Safely
Code,Section 25532(a)! _Cts!/ I ITA'1'INC,UNIT(OG
100.g)()B l'U)
h
0Y" VI?N'IILA PION AN IS I NGLE RESIDI PAID Data Rccciptp
s Will thcappllcnr or future building uceapmnt me equipment ordeviccc which BOILER-COMP OR I hIT00 BTU)
mil ha/allous air contaminants as delined by the Hay Arca Air Quality Management It
Dol...I? MOILER-COME,(OVER 10X1,100 BTU(
C3 yes V<'
I have Mad the hmallous umtefials put..ams order Chapter 6.950 the Call, AIR GONDfTIQNIiR ISSUANC):.,IJATIi
let i IRa11Ii k Safsay Calc,Sceti.m 25511.5,25543 and 25539.1 mndcaumd that if the N17 RESIDENTIAL MBCII. SQ.FT. / /� /J� q
hmIdingohcsnol cunentlyhtseatenara,ova itkaryer,pon,militymnrnifythcaeulmnl l k/ —
011' requircmcnts w hi uht tbu nret prior to ho arse.nil it Ccnincamo tJscu '
Date\ �
Ownsror umbar nJ agcm u tc TOTAL: ISSUEDBY
OFFICE
POST THIS CARD NEAR FRONT OF BUILDING '
CITY OF CUPERTINO - PEIIMITNO. 1527-
BUILDING DIVISION
86l:.I11NG'PAUJECT IUF.NTIFIC,\TION-
BUILDING ADDRESS: SANTARY NO. APPLICATION SUBMITTAL DAD
it 1 (
iNER'S NAME: , PHONE: CONTRACTOR'S NAME: LIC NO:
•\ I ;,�, I i"_ .: '''Il _ NIC CONTROL
ARCHITECT/ENGINEER: (LIC NO:: i ADDRESS: ❑
BUILDING PERMIT INFO
INSPECTIONS iDATE INSPEC. ❑ Consultant Fees Paid by Applicant(Initial) c e[a' P,)„DMB . MECH
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL,
PAD/SET BACK-CERT SHALL BE INSTALLED TO COMPLY WITH SFDWL ❑KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF ADDITION ❑PLUMBING RE PIPE
GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI-UNIT El STRUCTURAL
MODIFICATION
-POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR (:I CHIMNEY REPAIR
IMPROVEMEM' ❑SWIMMING POOLS
UNDERGROUND/SLAB CALL AFTERNOONS (1.00 PM - 4:30 PM) [I BATH REMODEUREPAIR ❑DEMOLITION
PLUMBING 777-3228 MONDAY TO FRI DAY 24 HOURS B E- ❑OTHER
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
DO NOT POUR FLOOR UNTIL ABOVE HAS'BEEN.SIGNED AND PERMIT k ARE NEEDED WHEN PHONING.
COMMERCIAL
PLUMBING ATTENTION CONTRACTORS: ❑NEW BLDGIADDITION El DEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOOD SERVICE
THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION OOTHEft
FRAMING VENTS INSURANCE REQUIREMENTS:
INSULATION - INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP.
PLACE NO SUBFLOOR;UNTIL ABOVE HAS BEEN D.'
ROOF SHEATH/DIAPHRAM F-�L�` ` 1'��'1`.ci/oQ, o
PLUMBING /E s / H/ PC 0-
TUBS&SHOWER PAN
ECHANICAL
�EFCTRICAL/POOL BOND -f
FRAMING/STAIRS/E.EGRESS
1NSULATIONNENTILATION + .a
COVER NO WORK UNTIL-ABOVE HAS BEEN SIG ED
EXTERIAL SHEAR/HOLD DOWN �z-
INTERIOR SHEAR/HOLD DOWN
SHEEI'WROCK/SHEEROCK SHEAR
1y. EXTERIOR LATH/W-SCREED ee
SHOWER LATH
NO TAPE OR PLASTER'UNTI -ABOVE HAS BEEN SIGNED,
SCRATCH COAT uu,,
SEWER/WATER '7
'-TEMPORARY'APPROVALS - i -' -
OCCUPANCY
ELECTRICAL
GAS
p
C TEST !�/ `l- _ I",
j'b� _ '��. L (: _ -•• 'i lT
GRADE QQ
�'
FIRE
HANDICAP C �' —;?R-
ELECTRICAL ELECTRICAL
_
LUMBING
(ECHANICAL ` i
ENERGY CERTIFICATE OF OCCUPANCY
VISUAL FINAL ONLY
BUILDING ` IMPORTANT: ISSUANCE-DATE
'IOCCUPANCY;OF BUILDING( ,NOT•P,ERMITr �.'�^, PLEASE READ REVERSE SIDE BEFORE
"'u IN,P[NAC IS&CGNED'BY BU DING CALLING FOR FINAL INSPECTION!!
;INSPECTOR:.;; :,
:1" If;,,"
'-- ISSUED BY:
APPLICANT'S POSTING COPY