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19561APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Building Address: PERMPTNO. 19561 vners sl,a Phone: S FW �LL .i �yDC 252^i K20 CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDINGFLECTRICAL-PLUMBING-MECliAMCAL / as� O Comrade's Nalne: Llc.No: CuDC72TiNo PLuML3 /n/G 2" Y7 CATEGORY CONTROL# Archil et/Engineer: Lie. Not QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO Address: �� W �f Ij� ❑ 9 ❑ - PERMITISSUANCE LICENSED CONTRACTOR'S DEC RATION Humby aHirmthat l amlicensed under provisions of Chapter 9 (commeno ingwith Se on7000)of DiAslan3ofthe Busik and PreealonsCode,and my license Is In full fort, yd tile. license Clan. C^54 LIc.# 7 -y -,9-2-2r3 Date _ Contrador ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional OWNER -BUILDER DECLARATION I herebyafflrm that I am exempt from the Contrador'sLicenseTaw for the following means. (Section 70315, Business and Professions Code: Any city or county which requires permit to coatNd, alter, Improve, demolish, or repair any structure poor to its Issuance, also require the applicant for such permit to file a signed datement that he la licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Divi. sion 3 of theguAneseand ProfessionsCode) orthat hats exempt therefromand the basis for the alleged exemption. Any violation of Section 70115 by any it subjects the applicant to a civil penalty of not ore than applicant fora permm five hundred dollars ($.500). � 1, as owner of the property, or my employees with wages a their sole compensation, will do the work and the structure Is not intended or offered for .In (Sec. 7046, Buainess and Professions Code: The cmaredots Lt.. Taw does not apply to an owner of property who builds or Improves t hereon,and who does such work himself or through hisown employees, provided that such improvements are not Intended oroffered formic. If, howevegthebuilding or Improvement issold Mthineneyearofcompletiorythemvner-bu0derwill have (IlejIuden of proving that he did net build or Improve for purpose oleile.). U L an owner of the property, em exclusively contracting with Ilaved contractors to construct the project (See. 70K Business and Profmsloa Code: The Contractor's License Law does not apply to an owner of property who Wilde or Improves thereon, and who contracts for d such p lajes with a ryR(Tador(0 Rceaed pursuant to the Contractor's Limme Law. L-� I em exempt under Sec. B k P C for this rcaon APPLIANCES -RESIDENTIAL TOB DESCRIPTION _.� Iya(l SQ. FT. AREA PANELS 2014000 AMPS OVERIODOAMPS SIGNS ELECTRICAL ' SPECIALCIRCUIT/MISC TEMP METER OR POLE INST. POWERDEVICES SWIMMING POOL ELECTRIC OUTLETSSWITCHESFIXTURES VALUATION at �,/� / coo, NEW RFSIDEN7IAL ELECTR SQ.FT. STORIES TYPECONSTRUCTION TOTAL: QTY. PLUMBING PERMIT FEE OCC. GROUP RES. UNITS pp n. L55UANCE ALTER -DRAIN k VFM-WATER (EA) FLOOD ZONE APN FEE SUMMARY BACK FLOW PROTECT. DEVICE FEES DRAINS FLOOR, ROOF, AREA, CONTI. FIXTIIRFS I'ER •CRAP 2O SANITARY Y— N� RECEIPT # Owner Date WORKMAN COMPENSATION DECLARATION W I hereby affirm that I have a cenifiate of consent to self -Insure, m a mAifimteof Workem'CompeaatimlP mncemamrtlfie mpythereof(Sec. 3800, Lab C.) Policy # 5(PHUULTAX Y N RECEIPT M GAS EA.SYSTEM-1 INC60[rILETS PARKFM Y N RECEPT X GAS EA. SYSTEMOVER 4 MA) Com an BUILDING DIVISION ISION FEE S Cy CertiRed copy la hercbyturnle city ertlOed ropy la flied with the city Ins)ettUen division. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need nM be completed If the permit V (Drone hundred dollars ($1I artilyth fe Wucd, (certify that lotany person in an Rha mannworker I shall not employ any person In any manner ars a to become eubjcd to the an as tobeca became Workers Compensation laws of Gll(omla. Date OTICE NOTICE NOTICEco esubjtAM:e akarmakingthis Certificate loons oft become subject to the Workers' Compensation emvblons omits Labor eLabu Code,you =at drevoelorthwith comply with such proWba orthbdement shalt be deemed reeked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the perform once of the work for which this permit b issued (Sec. 3Civ. C.) 097, Lenders Name Lender's Address I certify that have mad thin application and state that the above Information iacormet. I agree to comply with all city and county ordinances and nate laws relating to building construction, and hereby author be representatives of this city to enter upon the above-mentioned property fee inspection purposes. (We) agree to save, indemnify an d keep harmieas the City of Cupertino against liabilities, jrdgmenb, ends a nd expenses which may In any way acme against said Crcv�N/ro� //9�j�/r�ce of the granting of this permit. `��GGAc CREASEANDUSDRL WASTE INTERCEPTOR PLANCHECK FEE PAID Dale Remi [# GREASE TRAP SEWERSANTTARYSTORM EA 2DIFT WATER HEATER W/VENT/ELECTR ENERGYFEE Y N — PAIDApplicat. Dale Recei t# WATER SYSTE.1/TREATING NEW RESIDENTIAL PLMB. .Fr. _SQ.7r. TOTAL: BUIL G FEE TOTAL:3.2 t17 SEISMIC FEE a ELECTRICFEE PLUMBING FEE Z QTY. MECHANICAL PERMIT rFEE MECHANICAL FEE PERMIT ISSUANCE FEES PAID: ALTER OR ADD TO MECH. Dale Recei t# P AIR HANDLING UNIT (T010,000 CFM) SUBTOTAL: AIR HANDLING UNIT (OVER 10.000 CFM) CONSTRUCTIONTAX Signature of Appriant/ ontradm Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.l Z and the I leYes u alth and Safety Code Section No S�ection 25532(a)7 Will the applicant as delioccupant use the BayequipmentArea devices whkhemit hazardous air rotaNnanU a defined by the Bay Area Nr Quality Management District? Yes❑No have read the haaardous raterials requirements under Chapter6.95 of the California Health k Safety Code, Sections 25505, 25531 and 15536. 1 understand that Lithe building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which most be met prior to Issuance offs Certificate ofomparcy. E -ADS'r HOOD(W/DUCT) CONSTRUCTION TAX PAID: HEATING UNIT (TO 100,000 BTU) Date Reeel t# HEATING UNIT (OVER 100,000 BTU) TOTAL: VENTILATION PAN (SINGLE RESID) I$$UA_MOTE - l'.'N 19 N 5 9 ^ WW ISSUED BY. #V BOILER -COMP ©EIPQR 100,00) ETU) ROB.FR-COMP(OVER10D,000BT11) NEW RESIDENTIAL MECH. SQ.Fr. Owner or sotto zed agent Date TOTAL: OFFICE COPY le • POST THIS CARD NEAR FRONT OF BUILDING ,a CITY OF CUPERTINO INSPECTION DIVISION - JOB INSPECTION RECORD JOBADDRESS�/ �J�E:S CRJ�OCI'�[J°P_� UNIT # LOT# OWNER CONTRACTOR PERMIT NO. 19561L J CATEGORY CONTROL BUILDING PERMIT INFO INSPECTION DATE IINSPECTOR INSPECTION RECORD NOTE: ALL GRADING AND DRAINAGE SI TALL BE INSTALLED TO COMPLY WITH. THE APPROVED PLANS AND CITY OF CUPER NO SCANDARDS. - FOUNDATION/ PIERS UFERGROUND JOB DESCRIPTION PAD/SETBACK-CERT GARAGE SLABS PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB INSPECTION _ ATE INSPECTOR PLUMBING ' ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED lly WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL FRAMING/VENTS/CLEAR INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ' ROUGH PLUMBING TUBS&SHOWERPAN MECHANICAL ' ELECTRICAL/JACUZZI BOND FRAMING STAIRS INSULATION/ VENTILATION - EMERG. EGRESS SEWER- WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR 1-IOLD DOWN ° INTERIOR SHEAR/1-IOLD DOWN SHEETROCK/SHEETROCK SHEAR EXTERIOR LATI-I/ W -SCREEN SI IOWER LATH SCRATCH COAT NO TAPE OR PIASTER UNTIL ABOVE HAS BEEN SIGNED NOTE: NO FINAL INSPECTION 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 GASTEST MECHANICAL HEATING ELECTRICAL RELEASE 11 RE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING - OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE BUILDING FINAL IS SIGNED BY BIULDINC. INSPECTOR PAID ARRANGE FOR INSPECTION BY PHONING 252.4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS •. • JAN 9 5 )V4u BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT # ARE NEEDED WHEN PHONING. City of CIIP?Tf100 IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION IMLTEDRY:,c/(1P OFFICE COPY or -'i