20736 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification P /k a. � a PERMITNO.
Building Address: CA-e oLJ �a 20736
Bolsa Iva &)Vhpr 2c1 � �E t
c
nero Phone: AppucATORTUMT77=A
t { JlN4QS
74 1_ CITY OF CUPERTINO-BUILDING DIVISION
ic4p3n�ntractors Name: _ LIc.No: APPLICATION / PERMIT
aTgD R.SL CO I G BUIILDINGELECTRICALML BING-MECHAMCAL CATEGORY COOL
A;�rchlteR/En neer. Lie.Na b1
L QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Ada 44" "is ':*Wet- 5u4v- yl�
nLt-LLQ PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRA OR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(menmenc. APPLIANCES-RESIDENTIAL JOB DRSCRQ'TION
Agwlth Sect1on7000)of Divbion3 ofthe Buslnessand PmfesslonsCode,and my
license is in ful4ffceand cited. PANELS
License Clas Lie.p�.�_�_.�..,_y/�
Date' IL yj�_Cantranor R4a/WaUPT02 AMPS
ARCHITECTS DECLARATION 201-1000 AMPS
Ob C7C. (understand my plans shall be used u public records OVERI000AMPS SQ.FT.FLOOR AREA ('�S/�SrsQ.�F�.T..s
U Licensed Professional -�T r.L {c-A CD
SICNSE L �+'^-' J IJ
OWNER-BUILDER DECLARATION SPEC CIRCUI LSC l T
ZF, 7, Iherebyaffirmthatlameaemptfromthe Contractor'.Llcense Lawforthe
OL following reason.(Section,7071.5,Business and Profevbns Code:Any city or
C�i" 'aTEMP'MI V_POA�county which requires a permit to construct,alter,Improve,demolbh,or repair '�'
q �.a any stmnure prlorto Its nuuance,also requlresthe applicant for such permit to ppkybg ES
6 file a signed statement that he Is Earned pursuant to the proWlons of the
Ou.
Contractor's License Law(Chapter 9(commencing wiIS
th Sectlon7000)co Divl- VALUATION
SOSslon3oftheBusineasandPMeviomCde)urthathetsevmptnerermmand G E W
<5 the basis for the alleged exemption. Any violation of S Ion 17 1 by any TCFIFSE
O� appllontfor a permit subjects the applicant to a civil para llyofnamorethan
$ five hundred doll..($500). RESfD A
..�n ❑I,as owner of the property,or my employee with wages as their sole SQFL SCOWLS TYPECONSTRUCTION
compensation,wlll clothe work and thestructure is not mended or offend for
OO sale(Sec.700A Business and Professions Code:The Contractors License Law
(/-,1 does not apply to an owner of property who Wilds or improves thereon,and OCC.GROUP RES.UNITS
CC whodoessuchworkhimselforlhrough hisownemployees,provided that such
improvements arc not Intended oroffered forsale.If,however,thebuilding or TOTAL:
Improvement issold within ane yearofcomplatlon,the owner-builder will have
YLenotproving that he did not bund orimprovn for purpose ofsaln). QTY. PLUMBING PERMIT FEE
L as owner of the Property,am emlualvely mntraning with Ilreneed FLOOD ZDNE APN
t non to mrewnthe (Sm.7 Business and Prafessmna Code: PERMIT ISSUANCE
Prulc'ct 044
Coof impr's Clime.law dcea who
apply tct an owner of property who ALTER-DRAIN k VENT-WATER(EA)
WBda or lmprovee thereon,and who manes for such p.ojecte with a FEE SUMMARY
L_jI or exempt
under antSec to the Contractor'.License Law. BACK FLOW PROTECT.DEVICE
c I_I I am exempt antler Sec. B h P C for this rca+on
OUTS I DE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
Owner DaRECEIPT p
WORKMAN COMPENSATION DECLARATION �.�S PER TRAP SCHOOLTAK Y_ N_
01 hereby a(((rm that I have a cerHBate of consent to self-Insure,ora RECEIPT p
mnl0carken'Compensattanlnsuranre ora rertifled ropythereo(LSec. GAEA.SYSTEM-I INCA OUTLETS PARK FEE Y N
3800.Labbc.)C3 S UTL
RECEIPT p
1'oliry p GAS EA.SYSTEM.OVLR d(FA)
Com any BUILDING DIVISION FEES
ertl0ed copy Is hereby furnished. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
ertified copy Is filed with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID � ��Q,Q
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.2(K)FT. Date Recoi t#`'1'Lj/�
�
Ghlssection need na be completed If the permit isfm ane hundred dollen
(5100)orleet.) WATER HEATER W/VFN.IyE cr.I.R ENERGY FEE Y_ N
I cenifythat Nmm
the perfounoftheworkforwhlchthis tis issued, �-a� —
I shall not employ any person in any manner so asto become subject to the WATER SYSTEM/TREATING PAID I �1� 9673 1
Workcri Compensatlm Um.fGllfomia.Date _1=1= x
O Z Appellant NEW RESIDENTIAL PLMB. SQFT. Date Recei t# 7va�
Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you
should become subject to the Worken'Comperoatlon provisions of the Labor TOTAL:
N Code,you must forthwith comply with such provisions or this permit shall be BUILDING "E O U.(3D
W j deemed rcvoked. ,
d O CONSTRUCTION LENDING AGENCY SEISMIC FEE L
I hereby affirm that there Is a construction lending agency for the ed(Sperform TOTAL, ELECTRIC FEE
Z anco ofthe work for which this permit is issuec.3097,CIV.G.)
02 I.ender'.Name PLUMBING FEE
LL H I.ender's Addreas QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W I canifythat I have mad thbappliatlon and statethatthe above information
Is correct.I agree to comply with all city and county ordinance and state laws PERMITI,SSUANCE FEES PAID:
Nrelating to building construction,and hereby authomm representatives of this
F city to enter upon the above-ea tioned property for ins retlon purposes. ALTERORADDTOMECH.
? Mr)agree to save,Indemnify an d keep harmless the City of Cupertino Date Receipt#
V ag.Wtlia Ili .,?AdgAS, sand a sea whichmaylnanywayaaue AIR HANDLING UNIT TO 10,000CFM) SUBTOTAL:
agalnatsd tyle da Cc. fYtVantingofthlepemdt.
j / O f AIR HANDWNG UM'f(OVER 10,000 C7FM) CONSTRUCTION TAX
iA actor D e IXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
t�41t�Z Dtscw Re
Bent or future bullding oaupant scene or landle havrdous HEATING UMTGO 100,000 BTU) Date Recel t#
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
I ealth and Safety C pion 25532(a)? HEATING UNIT(OVER 100,000 BTU!) TOTAL:
YesnQ No
Will the applies At (t core buildingoccupant use equipment or devices VENTILATION FAN(SINGLE RFSIU) ANGF,,_DATE
which emit haaardom air contaminants as defined by the Bay Area Air
,• Quality Management 1 7 BOILER-CAMP pEI'DR 100,000 BTU) „T J U ay
4Y No V
haI read(he th&Safw made,Sections
2555,2553 and255er6.95 of BO ER-CAMP(OVE 100,000 BTU
the Californb tl Ithh Safety Code,Sections 75505,25533 and 25534.1
undervta t IftM1 all oes rrently haveatenanttlut itismy NEW RESIDENTIAL MECH. SOFT. mq{yl �,{iva"'•"
rapanslb' o cal t onvp o( he requlremente which mu t be sSPi�
prior to n Iflate f psnq. /s
e- 7
n rauthcrl Dat ISSUED BY:
TOTAL:
kG' I p1S INt - OFFICE COPY
1'fi1iM1T NU.
POST THIS CAR AR FRONT OF13L` LGINC Q O
CITY OF CUPERTINO (��J
INSPECTION DIVISION- JOB INSPECTION RECORD
.j J013 ADDRESS L� • �Ul.s �^� UNIT# LOT # CATTI'ARY
-^ Y'^�-` X �+ �T� •"y'tJ�'� UILDINGiP,ERMIT INFO'r"r'i`r
OWNER C4 `wok 5 h cQV„'60NTRACTOR 1� �- �\ UJ'd'it. wa,inarztwurtew,mavrx.x„:hn•n.n��rv�1�+14wiRd
INSPECTION:' !":"+'ar'�r.'.'f;' ''+,"11.'''x-'!?`•t':T':DATEli INSPECTOR INSPECTION RECORD ice" El 11
FOUNDATION/PIERS NOTRALLCRADINCANDDRAINAGE L�
UFERGROUND SI TALL BE INSTALLED TO COMPLY WITH JOB DCSCWI'TION
TIIF.APPROVED STAPLANS RDS. CITY OF
PAD/SET BACK-CERT CUI'ERTINO STANDARDS.
GARAGE SLABS PREGUNITE
POUR NO CONCRETE!UNTILIABOVE'HAS,BEEN SIGNED: INSPECTION DATE INSPECTOR
UNDERGROUND/SLAB
PLUMBING I ��
GLECTRICAL
MECI[ANICAL
UO NOT POUR FLOOR'UNTIL ABOVE'HAS.BEEN SIGNED
WOOD FLOOR
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION
PLACE.NO'SUBFLOOR UNTILIABOVE!HAS"BEEWSIGNED]
ROUGI 1
PLUMBING
TU ISS&SHOWER PAN
MECI-IANICAL
ELECTRICAL ACUZZI BOND
FRAMING STAIRS Z J ✓-�
INSULATION/V GNTILATION
EM ERG.EGRESS
SEWER WATER
COVFWNOnWORW UNFIBYABOVE'HAS'BEEN.SIGNED4`lY0'
EXTERIOR SHEAR HOLD DOWN
INTERIOR SI1EAR/1-IOLD DOWN
SIIEETROCK/SHEETROCKSHEAR .G
EXTERIOR LATH/W-SCREEN
SHOWER LATH
SCRATCH COAT
NO'TAPE%ORPPLA Rr,UNTIH.ABOVE'HAS:BEEN.!SIGNED
NOTE:NO FINAL.INSPECTION SHALL BE,MADE llEFORE
THE CONSTRUCTTON4AR,IS'PAID=c:I✓".9' ''+,�%i'I• -U
FINALS DATE INSPECTOR
SAN.#
ELECT.ENERGY
PLUMBING ENERGY
MECI-1.ENERGY
BUILDING ENERGY
ELECT.FINAL TEST
PLUMBING
CAS TEST
MECHANICAL -/S-
HEATING
ELECTRICAL RELEASE
FI RE DEPT.
GRADE:
OCCUPANCY
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING ISSUANCE DATE
OCCUPANCY,OF BUILDING IS NOT.PERMITTED UNTIL ' •
BUILDING FINAL.IS SICNED,BY BUILDING'INSPECTOR 'i
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS 'I 'y rr 19
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND 90
PERMIT# ARE NEEDED WHEN PHONING C4 of
PL,&4 " ,tv`. IMPORTANT! 3 bt£',! S °u ?�S'i t 4li.pJaC:dt `� Is5u1;nBY:
S`, READ REVERSE SIDE BEFORE CALLING FOR FINAL'INSPECTION
APPLICANT'S POSTING COPY
t
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' � , .!G �1Z�•' t+\ R �1 \\\Cal t•` _ / v t\`'� _ 1` ` 3 /("�0 "Jj\`p, �!J\`.
tl �r
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Tity of Tuppruuo W�
13rliartm it of Nitaitig 3jiltyrrtioit sr
This certificate issued pursuant to the requirements of Section 307 of the
/tee
Uniform Building Code certifying that at the time of issuance this structure mis
F in compliance with the various ordinances of the city regulating building
construction or use. For the following:
Use Classification Carol ' s Ice Cream Bldg. permit No. 20736
1
Group B-2 lype Construction V—N �\ t
Use Zone Planned Development
w4-
OwnerorBuilding Nickels & Dimes/Tilt
-- Address -U123 N Wolfe Road Kt -•,�/ t
Building Address 10123 N. Wolfe Road Cupertino, California
/
By: 'Top Antonucci QZ
M-I Ir
BuildingOfficial Date: Janna
POST IN A CONSPICUOUS PUKE
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