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19585 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,— USE BALL POINT PEN ONLY Building Pra en Identlflntlon - PERMITNO. Building Address: 19585 ' nen Na Phone: -P"-9ZVf CITY OF CUPERTINO-BUILDING DIVISION �n n Cp/0tator Na Ltc.N.: APPLICATION / PERMIT -L "1 A rchltet/Engimer.neat/ BUILDING-ELBCTRICALPLUMBING-MEC}UMTR CAL CATEGORY Com—MOL M Lk.No: ' I p - QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Addrcsc Z2.` �./, f2is0N R¢H f-u,(�L pFRh9TISSTIANCE ❑ ❑ ❑ LICF.NSCD CONTRACTOR'S ,.,Sy QD I herebyaffirenthal l amllcensed under provisions of Chapter mmmrna APIsLIANCESRESIDENTUl *MI_ ' s JOB DFSCRI)'IION ingwitleSection 70M)of DiAAon3ofthe BuMn and Pmfe msCode,And my TO( �. LAcc � Iicenee le in foU rex d effect. / f] PANELS -�—/"� ' License Iass 2 Lica Data I Contractor�_ ARCHITECTS DECLARATI 201-1010 AMPS OZ ]undemtand my piaos shag be usednpubec record.. OVER 1000 AMPS SQ.Fr.FLOOR AREA f/SQ.Ff. O p Licensed Professiorul SIGNSELECTRICAL 664 OWNER-BUILDER DECLARATION y> [hereby affirm that l am exempt from the Contractor'.License Law for theSI'ECGLCItCUfT/MISC , oo q❑ following reason.(Section 703 1.5,Business and Professions Code:Any city or Kel i"'u{ countywhich requiresa permit tocoetroct,alter,Improve,demolbh,or repair TEMP.METER OR['OLE INST. / 7 any structuretatemolbbat heeIs lLw requ pursuant t thepor.udperMte JG POWER DEVICES R file a signed statement that he Is licensed pursuant to the proWkm of the "0 t Contractor.License Law(Chap[er9(commencing with Section 7000)o(Divi- , �I SOS alon3ofthe Buelnessand ProfessloosCode)orthat hell exemp[therefromand SWIdMINC IDOL ELECTRIC VALUATION .:y',,� �n the balls forthe alleged exemption. Any violation of Section 7071.5 by any / pe . < applicant fon permit.objets the applicant to a civil penalty of out more than OUTLETSSWITCHESFIXTURFS q five hundred dollars($500). �I,as owner of the properly,or my employees with wages as thele sole NEW RESIDENTIAL ELECTR S2.Fr. STORIES TYPE CONSTRUCTION'[ compensation,wlllelolhe work and the structure V not intended or offend for OSI,% '[ G` • Q, sale(Sec appy Business and Professions Code:The Contractor.Littnx law , I✓/ %Woe docsnotapplytoan ownerofpropertywhonemporimprove.thereon,and OCC.GROUP RIS.UNITS who dcessuchwork hlmeeRarlhwgh hlsown employee,provided that such Improvements am not intended or offered for sale.If,however,the building or TOTAL; /J: 4�yC� Z_ Improvement bsold wlthinoneycaro(compltiogtheowner-buOderwill have a4?a W II)Rkurdcn of proving that he did not build or Improve,for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLOOD TONE APN u I as owner of the property,am exclusively contracting with llceneed PERMIT ISSUANCE contractors to mostroct the projret(Sec.7014,Businem and Professkw Code: e The Contractor's License law don rat apply to an owner of property who ALTER-DRAW A VENT-WATER(EA)builds or Improves thereon,and who contract for such ptojece with a oqRt(+tenial licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY U I am exempt under Sec B k P C for this reasonBACKQ1 TT9 I Ile FEES Owner DRAINS FLOOR ROOF,AREA,CON I. SANITARY Y N • Date WORKMAN COMPENSATION DECLARATION RECEiPr If FIXNRES PER TRAP SCTiOOLTAX Y N EC I hereby affirm that I have•certlBote of consent to self-Insure,ore RECEIPT N rtl kateofWOrken'Compensallen Imunnmorame ifi mpythemof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARKFEE Y N— lvtab C.) aA 'fLa O 38000 a x RECEIPT M AS EA.SYSRT40VER I(EA) Com an C A/ / llif/9C/C/l BUILDING DIVISION FEE S Certifie copy is M1e n ed. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE Certified ropy t(fledd with with the city Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' CRFASETRAP PAID COMPENSATION INSURANCE (chis section need net be completed if the permit I.for one hundred dollen SEWER-SANITARY-STORM EA,2001717. Date RcBmi t# (SI IJO)orless7 WATER HEATER W/VENT/ELF-CTR ENERGY FEE Y N [certify that In the pet..in anye of marnrk Ad se t cern pesubodrmit is to theAd, — I shag not employ any person in any manner m e to become mbkt to the WATER SYSTEM/TREATING Workcn'CompensaHon Iaw.ol Glllomla.Date PAID OZ Appllcent NEW RESIDENTIAL PLMB. SQFr. Date Recei t# Z O NOTICE TO APPLICANT':If,after making this Certificate of Exemption,you Fshould become subject to the Worken'Compensat ion provident of the Labor TOTAL: W Code,you mut forthwith comply with such provisions orthb permit shall beM > deemed revoked. I IW LU C CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirmthat there t a construction lending agency for the perform- ELECTRIC FEE Z ante ofthework m' 1=t is issued 3097,Civ.C.) TOTAL: O Q Lxndere Name PLUMBING FEE LL H Lender'.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW ]cethatrtifyl havereadthbapplloUonand tate lhattheabovelnformation S recomect.l agmeto comply with all eftyand curayordinancmandstate lam PERMIT ISSUANCE FEES PAID: >. W relating to building construction,and hereby authorize mprxacntatives ofthb Z city to enter upon thenbovcmentimzdI property for Impaction purposes. ALTER OR ADDTOMECH. Dale R2Cel [# Me)agree to save,indemnify an d keep harmless the City of Cu part Ino P against liabilities,judgments,mks and expenses which may In any way accrue AIR HANDLING UNIT ITO 10,000 CFM) SUBTOTAL: age lost said City In consequence of the grant Ing of this permit. ' AIR HANDLING UNIT(OVER 10,000 CIM) CONSTRUCTION TAX Signature of Applicant/Contractor Data D(HAUS'I HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZA R DOUS MATER IALS DISCLOSURE WilltheappRra rat orfuture building occupant store or handle hazardous HFATINGIWIT(TO100,0DOB'M miterula.deMedb the Cu rtina Municl al Code,Chapter 9.1 _ Date Recei t# y Pe p p 2,and lM1e Health and Safety Cadr Section 25532(a)7 FIEATING UNIT(OVER 100,00(i PTU) TOTAL: 14111 Y. 1�E�,,No Wllemit lucandu.air curebuilding occupant use the BaequipmeetAre.devices VENTILATION PAN(SINGLE RESID) IS$LIA aTE which emithaement air mrtaminanisae deBnetl by the Bay Area Air Quality Afanagement D�isr}�t 7 BOILER-COMP(31AP OR 100,000 RTU) . Q Ye /line 1�! 2 919gJ haveread izalth et materials tIons 2menH5533 and 255346.95 of BOILER-COMP(OVER 1110,000 BTU) the 011fomW 1 iealth&Safety Code,Stolons 75501,75573 and 25536. I understand that if the bu llding does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. responsibility to net ify the occvpa nl of te ruirements which must be met #1,4,11 r�lp prior to Issuance of a Cert]ficate of Occupancy. ^�s.��lllf f,1 TNAD Owner or authorized agent Date - ISSUED BY:IJV E'T TOTAL: OFFICE COPY ' POST THIS CARD NEAR FRONT OF BUILDING PERMITNO.19585 9 5 V o CITY OF CUPERTINO APPLIrAIlONSUbMnTAE= INSPECTION DIVISION- JOB INSPECTION RECORD '.' JOB ADDRESS 22190 U �9oSS L� .UNIT-# - LOT# CATEGORY CO OWNER R'LCY�L..Q• �S� CONTRACTOR �rCGt1,G� BUILDING PERMIT INFO INSPECTION DATE INSPECTOR INSPECTION OUNDATION/PIERS NOTE'AL GRADING AND DRAINAGE - � 1:10 UrCRGROUND - SHALL BE INSTALLED TO COMPLY WITH - 108 DI5CRII'IION PAD/SETBACK-CERT 'THE APPROVED PLANS AND CITY OF -•� CUPERTINO STANDARDS. GARAGE SLABS I'REGUNITE� - - � - POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB INSPECTION DATE • INSPECTOR .. PLUMBING ELECTRICAL - - MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL uv FRAMING VENTS CLEAR INSULATION dm PLACE NO S(IBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING TUBS&SHOWER PAN AAJ MECHANICAL' ' ELECTRICAL ACUZZ113OND - FRAMING/STAIRS INSULATION/VENTILATION EMERG.EGRESS • SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN - SI-IEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN SHOWER LATH - 'SCRATCH COAT NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID - FINALS DATE 1INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY - MECH.ENERGY BUILDING ENERGY ELECT.FINAL TEST ' PLUMBING - 'GAS TEST - MECHANICAL _ HEATING - ELECTRICAL RELEASE FI RE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSN we 0 BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR � ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN JA At, N J 199Q, 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS BEFORE REQUIRED INSPECTION. JOB ADDRESS AND Oy of ponAwRO PERMIT# ARE NEEDED WHEN PHONING. IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION OFFICE COPY