S 1480 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO (WILDING-ELCM RICAL PE@`{mIT NO.
BUILDING DIVISION APPLICATIONITERMIT PLUMBING-MECHANICAL kJ 1480
BUILDING PROlhouI'IDRNTIF'ICSFION
BUILUINGADDRI?S5: SANITARY NO. APPLICATION SUBMITTAL LIMIT
/6
OWN
ERS NAME; &047-ST-5661 PHONE C091RACTOR:S NAMIi:I/ / LIC NO;
� V/r /fie FPS�c / NIC
CON'I'ItOLp
RCIHTECDEWGINIiER: LIC No ADDRESS:
DDRESSff O��+��I� ^A Q �b ❑ �S3
AW
CON'I'ACr: JjPHONE: T I •-+T BUILDING PERMIT INFO
G /�/�`' +('sw)s61—vuf� ❑ Consaltanl Fees Paid 6y Applicant(Initial) BLDG LC PLUM({ MECH
V° C�
LICENSED CONTRACTOR'S DECLARATION QTY ELIiCPRIC PERMIT IIiE
I hereby affirm thm 1 nm IicereW antler provisions of Chnpmr 9(commencing JOB DESCRIPTION
n%Z wish Seclinn71XN11nf Doislon3afthel{urine.annJl'ndaosars;CaJgond my lical is z RESIDENTIAL
w00 PERMITISSUANCF. s
CSF in full liommu eRe Z 6 ❑SFDWL CHIiN REMODEL
Q,U(J Liana Cl Lic.N APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
FFi Z L Dam COm wmr
�m ARCHpECTSDF,CLARATION PANELS ❑MULTI-UNIT []STRUCTURAL
ZOyZ InnJersmntl my plans shall he axed as puMle recnds MODIF'ICAT'ION
oy_0 UI'T0200AMPS EI INTERIOR ❑CHIMNEY REPAIR
1-•y Fly Licensed Professional 201-IIIDBAMPS IMPROVEMENT [I SWIMMING POOLS
`y a; OWNER-BUILDER DECLARATION OVER 10(I(IAMCS ❑BATH RF.MODEL/REPAIR ❑DEMOLITION
yL C W 6 I hereby action that I am exempt from the Contractors License Law for the
hJ 30.F following reason.(Section 7031 5,Basin...and Prom.sions CnJm Any city nr county SIGNS ELECTRICAL OTHER
uWl y.y which acquires a permit to construct,akar,improve.demolish,or repair any swnme
F•�' a
pro .)its issuance,also requires the applicant for such permit n0 file a signed dormant SPECIAL CIRCUI'1'/MISC.
W } that he is licensed pursuant mthe pmvisinm of the Cummcmrs License Los,(Chapter 9
=qO (centmencing with Section 7")of Division 3 of the Business and Professions Code)or TEMP.MM ER OR POLE INS F. COMMERCIAL:
t1 y e W that he ix exempt therefrom and the basis for the Nlcged exemption.Any violation or ❑NEW BLDG/ADDITION ❑DEMOLITION
YMt W Section 70315 by any opplaren for n permit mbjem,the applicant too civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
F_ not more than five hundred dollars(5500). IMPROVElAwr
E � hal mvner of the pmpcny,nr my employm wish wages as their wde cnmpcnmtion, SWIMMING FULL ELECTRIC
will Jo the work,and the structure is notYimende i m oll'ered fluidic(Sec.704,Business ❑OTHER
Wanti Professions Cade:The Conm¢nnr's License Law does not apply to an Owner of aTrLEI'S-'WITCHES-MIXTURES
property who builds or improves hereon,and who Joe,such work himself o,through
his own employee.,provided that such Impmvmnems am not intended or offered Tia NEVI&KARN'I'I AL ELEC3'R SQ IT
sale.IL however,the building or improvement is sold within one yearofcompletion,the SQ.FT.FLOOR AREA $ISQ.FT.
owner-builder will have the burden of proving that he did not build in improve for pur-
se 4eUcawC.).
C-] 1,as owner of the propty,son
erexclusively conhacong with licensed eammcmm m TOTAL: Z0
m,huct the Police,(Sec.V(W4,Ilueiness and Profcssinns Gama)Tim cancer 'a(.r-
eam Law Cars not apply to an owner of Property who builds or improves the thereon,and QTY G MIT FEE
who coarse¢for such projects with a cnmmcmrts)licensed puasuum m Me Comrumor'x
License Law. PERMIT ISSUANCE
❑ into exempt under See. .B&P C for thinreuxnn J p
ALTER-DRAIN& NT
VE '-WA'I'T?R(FA) O• VALUATION
caner -Date
WORKER'S COMPENSATION DECLARATIONaffirmBACK FLOW 1'HOTECI'.DEVICE �9J ,,\w
I hereby arm under penalty of perjury one of the following Jalaretinmic VV V
❑ I have and will maintain a Certificate ofComanrto self inure for Workers Contra- UItA1NS-FLOOR,R9ARI?A.COND. STORIES 'TYPE CONS RUCTION
said.,us provided for by Section 370 of the Lobar Code,for the pcdo mance of the
wark far which this permit is issued. PIX'I'ORES-PER TR
J�pI have mall will maintain Workers Compensminn Inwmnce a.requirtd by Section ✓
�i0 of the Lobs Code.Toa the perfammueof the work for which thin permit is inwed, GAS-EA.SYti1'EM-I INC. LAS OCCGROUP APN
My Wurkyc'sfpmp t anti l'nlicyl�u�Me are:y- GAS-EA.SYS'11iM-OVERq( A
Camm.! /'/T/P.:/" lpty}e curiePolicy Nn,:�/ 1�
CERTIFICATE OP I?XEMPGON FROM WORKERS' GRI?ASE/INDIISTIiI.WASTIi "E PI'QR JJ
COMPIRSESHON INSURANCE BUILDING DIVISION FRES
phis semion wed not be completed iftho pemtit is forme,hundmddollars 1$10)) GREASETRAI' S
m lens.) PLANCHECK IFF. QCT.
Icvnlf"llat in lhoperfnrnumcndth,vank linsuch thispennit i,isxued,lx hull SEWER-SANITARY-STQItM IIA.200 FI'.
am inutility anytweam in any manneranus to become,tInecnathe Wmkerc'Crm11a. ENERGY FEE •' I p
sauna Inw,of Ciiforairs Date WATER HEAL ER WNENTIELEC'Ut GRADING FEE
z Q Applicant
1..t rn NOI'IC17 TO APPLICANT:If,after making this Cur iliome of Exemption,you should WATIiR SYSTCh1/fHEATING
!'t becntne subject m the Woke,',Compensation pmvisinn.of the Lubar Code,Int,to nst SOILS FEE
fnnhwall comply with such provisions or this permit.hop be deemed revoked. WATER SERVICE
=�z CONSTRUCRON LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
I hereby air,,.thus there is a connotation lend ingagetmy for the adommnce of Dam Recciptp
(,-')� the work for whichthis pcnml is issued(Sec.3097.Civ.C.)
"V-1• U Lender's NameT'O'TAL:
W Lender's Address 'DOTAL:4�3• �S
1.. y 1 certify that 1 have read this application and sate that the abrve information is
BUILDING PER
{.o h correct.l agree to comply with all city and county artinanres undmam laws adming to QT1'. MEC(IANICALI'ERMIT FEE
IJ Z huilJing consauctfonand hereby authorize reprexenmtives of this city to enter upon the SEISMIC FEE -2x0
abnva-mvmiomed pmprny for impeaJon Campuses I'1?IIMIT ISSUANCE
(We)agrem save,ve,indemnify and keep hanndess the City of Cupertino against Inl'ItCTRIC IJ:1? S/- Z o
liabilities,judgments,costs and expenses which may many way accnm against mid City At:]ER OR ADD TO MECH.
in amxqucace nfthe go 'this pemtiF MECHANICAL N3,
APPLICANT UNDERSTAt Da ANI)WILL COMPLY WITH ALL NON-POINT AIH HANDLING UNIT('r010.1NX1 CFM)
MGCfIANICAI.PEG Ll I I 6
SG I?RPFULA'TIUNS. /
AIR HANDLING UNIT IOVI?H I(I,IXIBCPMI ) ON TAX
al.re of Applie't/CnntrvmorI JDmt8EXHAUST 14001)(WMUC1') HWIN 1 FF.E
IA"l.ARDOUS MA RIALS DISCLOSURE
Will tficnppdicem or refund ball Jing ocntpant Imre or handle huimmuts mmcrial I MATING ON IT(TO 10,0(X111 U) lift "law
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Ilcallh and Sddy a
Cde.Smion 25532(.)4 HEATING UNI'I'(OVER 00.0m)BTU) ��: GUrtn�IfvU
❑Yes I FI. VI;NTILATION EAN(SINGLE RESID) 11D
Use¢ Receipt M
Will the applicant or future building occupant use equipment or devieCA Which C
call boaardous air eormatmnoms us Jafmcal by the Bey Area Air Quality Mtmagemmn HOILER-COMP(3HP OR 100,000 BTU) f(TI'AL: 6J`
District? MOILER-COMP(OVER 10,00 BTU)
❑Yes �Na
I have read the hmadmis materials requiremenm under Chapter 6.95 of the Calf- AIR CONDITIONER ISSUANCED
miiMa(leant&Salary Coda,'a loon 25505,25533 and 25534.I understand that if d'a NEW RESIDENTIAL MECH. SQ.PC
huildi esnoteurs-tayhac mnanl,lhei it is myrespmaihiliry mnotify�o upant
of rtgt m n.whichm 1+€nnl tc'ort ixsmncenfa Cenificm v kQ
Ow rauthorneA ug t (, U;ne TO'EAL: 1-!I k ISSUI7D B"���� • "��Oek.(�1^(-� I
OFFICE
Sent By: The MathWorks Inc.; 4089738495; Nov-1 -99 10:35AM; Page 1
POOTTNIB CARD NEAR PROW OF BUILDING
OF CLRqur IN0
3111MOC DIYQIDN
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Bul NNURINrik7S: .Ah 1 A 'A SUBMITTALDA
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SNAM �r-AW4TVC4-a e,ATI; / RK•
(TInECTIBNQtI,wm: UL'Mr. Y;
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— �i O,tikrNM/. / LkKCi1 +rv7c6 �S:S
BUILDING PERMIT INFG
INSPECTIONS DATE 1NSPRC. ❑ (*n Iww FIYR PRM AJ Applk.nt(Initwl BLLM) YL107. N.UMR MP;'H
GK 13
POUNDAMON/PIERSIH.D.S. INSPECTION RECORD
JON DESCRIPTION
UF[IIOROUND NOTE: ALL GRADING AND DRAINAGE pPsDENn.l. �_ /Ftf/
PADISET BACK-CERT WALL RE INSTALLED TO COMPLY WITH 0gFnwI. IL/ kummml.
THE APPROVED PLANS AND CITY OF OAmmom ❑PLUMRINGRE•PIPE
GARAGE SLABSIPREGUNITE CUPERTINO STANDARDS. OMum-ummr ITMUCTURAL
POUR NO CONCRETE.IINTII.ABOVE HAS BIERIGR MODRFICATM
EEN SIGNED TO ARRANGE INSPECTION UINUCHIMNCYRF'IAIR
UNDEROROUND/SLABIMPWWFWFNT ❑SwIMMINCmm
CALL APTCRN(I(1N5 (L•BO PN • 4:10 PMI ❑
BATH RFMGUILAMPAIR tjMMCXnnN
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ptmlrx
HI.F47MICAL FURL REQUIRED INSPECTION.JOB ADDRESS
DO NOT POUR FLOOR UNTIL ABOVE HAS BEBPI SIGNED AND PERMIT R ARE NEEDED WHEN PHONING.
PLUMBINO ATTENTION CONTRACTORS: ❑Nllw NUIWADpmUN ODsmouT +
MECHANICAL NO PERSON(S)SHALL PERFORMWORK ON UTENANT I7 R10DSERV R:R
THIS JOB SITE WITHOUT BEING IN COM- DAPROVrilARNT
ELECTRICAL PLIANCE WITH WOR KERS'COM PENS ATION 0MCR
PRAMINO VENTS INSURANCE REQUIREMENTS.
INSULATION INSPECTION SITUTAL INSPECTION RGQUIRF;D n DATE ANSP.
PLACE NO SUBI7AOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATWDIAPHRAM
PL BINC _`_._...,......, ..
SHOWER PAN
MOCHANICAL ..__......
6.LF.(.TRK'AIJR)OI..BOND �.
FRAMING/STAIRS/E.EGRESS
INSULA710NIVENTILATION — �-
COVER NO WORK UNTIL ABOVE NAS PEN STONED
EKTERIAL SHEARMOLD DOWN
INTERIOR SHEAR/HOLD DOWN ,
SHEETWROCK/SHEETRO CK SHEAR ^--
EXTBRIOR LATWw-SCREED
SHOWRR(.ATH
NO TAR.'OR PLASTER UNTIL ABOVE HAS REBN SIGNED
lZRATCH COAT
SEWERAVATER
TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
PINALS t �`
GAS TEST
GRADE
FIRE
H DICAP F
/✓L .tf F...�' .�I7fiC ../�1... . .
ICAL
MF1'HANI('AI.
ENERGY ,.�f' .
VISUAL.FINAI.LININ cp.wriFICATP; O[• OC'CL`PANC N' U
BUILDING f(.._.... ..,. I\IM IH'TlN'I': ISM AMT IIA
D..-I ,3
OCCUPANCY OFBUILDIN61 NOTPERMITTED PLEASE READ REVERSE SIDE HEF'OkE
UNTIL BUILDING FINAL 15 SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!' '�• -