B 0493 (2) APPUCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO 0 4 9 3
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL SOOOI
s BUILDING PROJECEIUE'TIFICA'11ON I
BIIILDINC.ADDRESS,. - SANITARY No A PPLICAI'ON SUHMI"I'fAI,DAI'f
CSN a�.l �A� c v G 3 �� (0 4�i�
1, O E: CONTRACTOR'S NAME: LIC NO: NIC I CONTROLa
t sc C ' lbfldlR: LIC NO: ADDRESS: ❑ 2
"NTACT PHONE: ,I BUILDING PEI(MIT INTO,
O^ ❑ Consultant Fees Paid by Applicant(Initial) BIJ s BLB I' PLUS MEC
i
ICENSLD("TRACTOR N DI CLARAfION QTy ELECTRIC"PL'RMiT '� .PEE(
7fa, eny affirm bar I 1 .ed 1 previsions f[hapter 9(malme ing _ _ JOB DESCRIPTION
DMZ
witho 7(I'):fDVls ofthc primas and mylcc. i RESIDENTIAL;
+1100 PERMIT ISSUANCE ❑A DWL ❑PKIII LUMBiNRCE-PIPE
1- r Bul
�UVs. APPLIANCES-RF.SIDI3NTIAL ❑ADD1770N ❑PLUMBING HE-I'll'EaC'.ntmctoRCHFfECTS UEC ❑MUl;fl-0NI'I' ❑STItUCFURAI.
ZOvrJiZdmtand my plans pM1all be used us Puhhe r,<or" PANELS MODIFICATION
UP TO 200 AMPSO4F.a ❑I9'EOVE ❑SWIMMING POOLFsed.,F- ofessional 201-IBIXIAMI'g IMI'I(OVEMIiNT (]SWIMMING POOLS
s •.I OWNER-BUILDER DECLARAd ION
O Y .] OVER 1000AMPS 11 BATH RIiMODEIARF.PAIH ❑DEMOLITION
IY Q 1 hereby a07rm that I am exempt from the Contractors License Law for the
xL O,1 U following m;aon.(Section 7031.5,Business and POreAi ere Code:Any city or count, SIGNS EI.ECI'RICAL ❑OTHER
W a W r' which rearires a permit ort construct,alter,improve,demolish,or repair any structure
�LLOQ snort.its issuance,also requires the applicant for such permit o File exigned statement SP[CIAI.CIIiCUII
''/MISC.
that he is licensed p...and telae antitoxins of the Contractors License Law Cooper
W�JOO (eommendngwlth Sectio 17001 Division 3ef the Business and Protocol...CudG., TEMP.METER On POLE IN57l COMMF,RCIAI:
a 6 e that he is exempt Ihmefr.m and the hails for We allege)exenrytinn.Any violation of NEW BLDG/ADDITION ❑DEMOLITION
I^ Section]011.5 byanyupplicanl for a permit subjects the applicantto a civil pewltyof POWER DEVICF_ti ❑TENANT ❑FOOD SERVICE
F. not more than five hundred d.11.(5500).d Q IMPROVEMIIN'f[71I,m.wner of the prepeny,orIllyentpl.ycc.with wages us their solo ovaula ration, SWIMMING POOL ELECTRIC
willd.the work,..dthe sauctore lived imondedoropeml f...Io Sec.VOW,Basiness []OTHER
yFm
and sensory
poldrion...Gs or improves
Climate es thereo Liver-w Law revs n.t apply s if owner of OUTLETS-SWITCHES-FIXTURES
hi—wo who builds or impmveo thereon and who Jres soca work himself or through
his own employees,provided ohm such Imams slid w am nil intended m pletim1 for NEW RESIDENTIAL BLEC'f1t SQ Ff.
sale.If,Lnweveq the building Orimpnnxmcnt i.told within...year of cumPlninn,the SQ,FT.IL(N)R AREA S/SQ.I7.
Cce-builder will have the burden of proving that he did not build an improv,for par-
sed.de.).
Cl 1,as owner 3 a9q
f the Prop,ty um exclusively contracting th licensed cnm
scJ rect to 'I(rl'AL
construct they J t(Ses,7(Wt Business d 1 f: Cal,)The Contraction L- q - -
t L a Iapply it,an owner.fp anywhob le,mmpntveo memo n QTy, .I PLUMBING PERMIT FEE a--,-a
who hearth prol,cts with a contraaor(s)licensed pursuant m the Contractor's Ca� ' ✓I
License Law. PERMI IISSUANCE
❑ I nm exempt under Sec. .B&P C fm this reason
AI:I ER-DRAIN&VEIN T-WATER(EA) VALUATION
Dare
KE3 e,7 o
WORR'S COMPENSATION DECLARATION BACK PLOW PROTECT DEVICE
ner I herehy alRrm under penalty of perjury one of the following declarations:
I have and will maintain a Cenificme ofCosentto self-insure far Worker'..Comfier- DRAINS-FLOOR,ROOF,AREA.COND. STORIES 'TYPE CONS'I'RUC'I'ION
ration,as providaJ for by Scenne. W of the Labor Code,liar the a rlbmmnee of the
rk for which this permit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers Compensmion Insurance,as acquired by Scdian
3900ofthe LaborCodes Blithe crorriOncerd the work for which this prntit isissued, GAS-ITA.SYSHIM I INC.4 GTE I.ETS OCC.GROUP APES
My Wo am all..In a d Policy num9,+aC
m y rr
Caner: �I1 tra� P�:M OBSESS' GAS-I?A.$YSTL'M OVER 4(BA)
T KATE FF. M INNURAN KIiRS'
COMPENSATION INSURANCE. GI(IiASIAINDUSTRI.WASTti INTERCEPTOR
ftU1LUING VISION FOES'
IYhissectio e brooch ndredJdlure131IXry GI(EANII'FRAP
or loss.) � Y.vk- y''']�I( PLAN ITCK F.:2
ImnilY"'f in the onmfiMdt rnr Jnich y)Yrmit is isweJ,lshell SBWF.H-SANITARY-S'IORM GA.21101'1'.
n.t employ any persa.to am,courser..as I.became wdject to the Worker'Comp,.- EN 1 Y TEE
O,Z cation laws of Califomis.Date WATER HEATER W/VEN'VELEC'Ik G V,DING FELL
y Applicant '
q r�i NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTEMORFAl INC SOILS FEE
a , bacame subject the Workers Contpamut ran provisions of t he Lnbu Code.you nmst - - _
Pl forthwith ca:mply with such Emr,nonsmthispermitshill bedarned revoked, WATER SERVICE
a
CONSTkUCTION LENDING AGENCY NEW RISIDEN'f1Al.PLMB. SQ.PI( PAID
-L)0 (hereby affirm that isaelimination lending agency for are permar m..,ofU. at Rttcipta
the weak for which this permit i.issued(See.3097,Civ.CJ rb
C Lenders Name 'FOIAL:
U Leos is Address TOTAL.
f-� Icetliethat (ply readthisty an ciunyopramohm he abuse admiration elating ix
s-%
Z1 correct.I to)comply and withal] county ordinances mixture lawsrelatingQTY. MECHANICAL.PEI2MI'1" EEIi
V z building nm.wninn,and hereby vuthnrize mpmsmnmiva ul this oily roomer na0n the � SEISMIC I: '
whose-memi.ned pntpety for impection pmrames. PE RMIT ISSUANCE.
(We)agree m save.Indemnify and keep Includes,the City of Cup.nim.cannot ELECTRIC)EU s
liebilhies,judgutcros.colots and expenses which may in any way areae against said City gI.TER OR ADD TO MECH.
in consequence of the granting of this permit. PLUMBING FF:F.
ADPL IC,IVT UNUE RS'I'AN US AND WILL COMPLY WITII ALL NO-POI T At R H A NDLING UNIT(TO 10,000 CPM)
- 6 � MECHANICAL i
SOGOLATO AIR HANDLING UNIT(OVER tf,f0CPM) CONSTRU(TIONfA
X
Signature dfApphrarWCurtr ate EXHAIIS'1'HOOD(WIDIICTI HOUSING MI'I'IGATON FEE
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicantar from buildingoccupuntmm�or handle h.mN.usmmerial HEATING ON]fit'0100.000 BTO)
as dm,Sr,hY the 32(TJ? -Muni`'ipal c.ae,chapter 9.1x,rad the Henlnt and inlay
as de,rod!by the Cc v)7 (_rys`n"' HIiA)ING UNIT(OVER 100.000 1fI'U)
Dyes VENTILATION FAN(SINGLE RISID) PAID -
Dum R,e,ipte
Will the aatilamon for fumm building oremarm use equipment m devices which
emit haearJous tar communications defined by the Bay Area Air Quality Management 1301LEk-COMP(JHP OR W,I1W BTU) TOTAh:
Dismicrl BOILER-COM P(OVER 100.000BTU)
Cl Yes
I brae read the hazarda
sou enols carcinomas undo Chapter 6.95 afthe Cali- AIR CONDITIONER ISSUxi DATE
famia Health& fcty Cade,Sections 25505,25513 and 25534.1 mtdcrxtand that it the NEW RESIDENTIAL.MI!CH. SQ.IT. 1
hvilAingJxp t foody laic menan6 that" ropnmsibility to not t ort
of the metal which st be cif a Cenificm orf( �n
Disorientation o sage Dam TOTAL: ISSUED BY: Q
OFFICE
Mm Kangas lWk
Mphears •. Sunrevers ..Mannan .
Sgmkbar 26.M
96006s-so
Chunk SchmbwM
O'8teo omup
2001 Wiadwwd way,Salle 200
Sen Mateo,Ch 94404 �
Subjeen pall VWW-96andadft VAritlki' den
i Mar Chuck,
On September 26,IOW we perfotmod alod survey of the Walden of the fcuadeden[ammo fat the
WUWp being oontaucoed on Laa`4 B^,3•i 1,3.12.3.20 and 3'21 at the 0ak valley proJaet ln Cuperdw.
v
Tho results tf dw navvy eleuly,show the the loo mon of the foundation tom are cossimat and in
ooefomw=with the design Wcedou of the bW&V,as sold Weadons Aro abown on the plant prepared by
our lata
TWs laaw is Wmeeed to provide you with the verification of those units per our rcm. 11[hero ae NY .
other rpresdona a000aWq these loauions,plow do not hWtW to call.
Stamely.
BRUN KANOAS PODIA
�� enAabr�ease
_ BmdlAy A,Bilbo PI.S,6141 IM
n P1404Mhmaga G u} ma.04
S �epaetmant ��f OF 0A lir
h
3EP-25-0't0 ^Iia;Vu Frw'o:kARZA EUINEERINII COMPANY - OAKLAND 51053d2177 i-IIB P.02/02 Ju6-310
' IlAT! JOB N0.
Engineering Company
425 Roland Way , 2801 Berrington Court 14 tipreckles Lane, SU114 208 PROJECT
Oakland,CA 9462Hayward,CA 84545 Sal(nas,CA 83BOB
PH:(610)568.4001 PH: (831) 456.8180 wcnmN
FX:IS 10)63&2177 FX:(831)465.8181 Ain
;ATS e n - curuiR
Hone Project ManagerCOr'6T_-� ___
WSA NES TeN1. 0-al AM
Task Coda •S.01o 6C °al PM
PRiiiNT d ilT
Hours Charged to Project Signed On-Site dy
PEROT#
THE FOLLOWING WAS NOTED: rev
_nex Ft n' nau i,�k. ap Pao(• 0 INi P948 := mn M. -r, /nl'd* J.0S6
-'2 " 1 ( 6C�j . el a-19 ( Nq� Vrnn&4- 2.7'44. t3 c��61e e� aS1w. <
ram H .-ts 01Ar'e- 4-r._a9r� �Ig.,A e±...A T/dR
;bl5d nas a elLI FJ=r� 5 all P0h14'e s t-0 F:r..n
f'M*PI&AE"t M0L4crt&l Ao.,n . AJa_= Qnjr aEevj [Alda..-.
&1Ad A-te eF 100 gM r11 al'ei-i a I yr dl,6r, T a/.o nnrT
Fn r- el(I Sba&d.blm SkrJ_r h1Q1Q1&LA7n3 el,A -AAM :UWAdA
Rlun.e� hc+d -rArrv� c� t�lpar der
y-4,'v% clt� rt rLe.e _
• 1rA -os
LAD;t I Clnt G1C 'T(n Is lot- ia^ -o 0 it .Q k=Lr iz a4 f'xWA.,J' rhm
iFV1^ ° Mf+s00 3-04 r 3-12 _ ".A 3.111 � M.GG
"A 20iardal Mh
p .4r h _ „'e aMd 4•]t/t S '_I_<n i n r ej. r h -
l.7�Hn ouy% e.+n Le410 V1;I,J�I N,6 in h'uv%s..._ 5eiAJ d,' ed -re
rr L...rr��no-r.J Kiln FYiP CaT n vT.It I.] �r..vt_e.....� ✓'r1-S�(jLP�'rA'1 .
COPIES TO NAME: Er C) i11 F 1!,1JI81117
SIGNATURE: PRINT NAMI a k� t,
• OFUGINAL r64 if 02b7,}31- d8
ENGINEERING WEST IN'C:
• OBSERVATION CHART
OAK VALLEY DEVELOPMENT CUPERTINO,CA.
8-29-2000 PAOE 4 OF 4
UNII
of en at oor oo n na. r. as o m .
2 1 38 13CAMWI 4.25.2000 1 6.13.2000
J 1 A I 3CAR 4-25-2000 1 6-0-2000 8-29-'2 00 16-29-2000
4 1 4A I 3CAR 1 4.25.2000 '6.31-2000 1 8.15-:1000 1 8.16.2000 4.25.2000
_6 — 4.12.2000 5.20.20 00 8• •2000' 00— = — •— — —6• 0
— — 0 4 SCAR 4,12.2000_ 5.26 X00 41'000 1. 0071=
0 — — — — • 000_ .�.
_."5 " " 4 1 •2000 6.10.2000
e BMR 5.21.2000 NA ':
9 BMR 5.21.2000 NA
10 1 D 4.1 00 0
11 5D 1 SCXPJION 4.12.2004 1 6. . 7.28.2000 7.26.2000 8.14.2000
1 45 3CAR 4.12.2000 5.1010.22000 0.2 00 •20. 07-20-2000
13 7C 1 1 8.27.2000 8.6.2000
4 1 2D 1 6-27-200018-5-2000 1
16 3C 8.27.2000 8.6.2000 _^
18 1 BC BONUS 1 8.15-2000
17 1 3E 6• • 00 6-15-2OQO
18 1 BMR NA
19 BMR NA
20 18 3.30.2000 5.10.2000 620-:!000 0.20.2000 Na =0.2000
2/ 3A 0 000 RUN=0. 000 00 7. 0. 0 - 000
22 1A •20.2000 8.20.2000
23 4C 3CAR 7.20.2000 8.20.2000
24 38 7.20.2000 8.29.2000
25 88 SCARISON 7.20.2000
27 1 BMR •20.2000 NA
• 3 28 1 B 17-2062000 NA
29 1 B
30 1 5A BONUS
7t _ B 3CAR
i 3
3
K
35
38
7
3e _
4 ._
41
42
chose
•
v0-a O[6t 96Z GOV Ls3M JNEW73NIDI43 dZZ!CO 00-62-8MM
. ROT' P
.urke
• ' Jim Rlploy(SMTP:Mploydg0pecball,nolj
Monday, March 00, 1990 2120 AN
PAT OVRKE
OAK VA -LEY
y '
CA
Llnou POWAy p14nlln9,
I wllhin Ihi 11141/ Palk u4 ooMlil4nl wllh Iho londseopo
A doevmenle Ptopued by Ih11 oMda bpd Povlowed by Iho ally
Sea bnd,eonbim w1111 1114 prollminery epprovol doUMOnla,
.!play
2n G1ovp, Inc,
'FINAL PLANNING SIGN ®FF
DaE ° 1710 0
SIONATURE
1111711101LJAN MATOn, nwpokNIAUlmo,171' TIMPIInNkI0101171,0100 $AC11AI1L0161p11f9.14il
o.�lu,l M4�rh 1 1996 ' '
,
C �� •. �. .1. �,� CCC_ _
cr
F• a. '
n:
UPI A;
s
�:'.'. • fie.+ ' • .. . / ,
.INSTALLATION CERTIFICATE (page 1 of 4) = CF-6R
crmet Number
cess
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (Tho
information provided on this form is required;however,use of this form to provide the information is optional) After
completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at
occupancy,per Section 10-103(b).
HVAC SYSTEMS: ./ .
Heating Equipment ltiealias
Equip. Iof Effickm Duct Ducar Nesting
Type(P4CEC Certified MfrName Idenikal (AFUE.eto.)t Location Piping load %Gpaciry .
hht and Model Number S •IRvalue ata etc. R•ralue tuAv tu&r
r
Cooling EgrlptrttntDug Cooling Cooling
Equip. CEC Certified Cangasor /of ' 001ctancy
Type(pkg. Unit Mit Name and Identical (SEER cte.)i Location Duct Load, Capes
heal m Model Number S ms -IR value and etc. R•ralue twhr
AMA A
iE
IT. >_reads greater than or equal to
1,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2),equlvaleat to or more r
efficient then that specified in the certificate of compl(anco (Form CF-1R)submitted for compliance with the Energy
Epeiency Standards for residential buildings,and 3)equipment that meets or exceeds the appropriate requirements for,
manufactured devices(from the Appllance Efficiency Regulations or Part.6),where applicable.
IYAAAL
W'0-dfL CE
_
Signature,Date Installing Su contractor Co. Name
OR General Contractor(Co.Name)OR Owner
R HFA N . gYSTF.MS@
Distribution If Recir- I of Rance Tank Et0 External
'l
}fearer. 'CFC Certified Mfr Type(Std, ailatiott, Identical Input(kW Volume crates' Standbys -awn
Type Narua d:Model Number Poim•of-Use) Control Type Syswru or Btu/ltr) (gallant) W.RE) (X)
Z For small gas storage(rated Input of less thea or equal to 75,000 BuM.electric resistance;and beat pump water beaters,list Energy Factor.
For large an storage water beaters(rated input of grocer than 75.000 BrulM),I4t Reeovay Efficiency.Standby loss and Rated Input
For instantaneous gas water heaters,list aewvety amelency and Rated InpuL
Faucets&Shower Heads:
All faucets and showcrheads installed ere certified to the Commission,pursuant to Title 24,Part 6,Subchapter 2,Section
the undersigned,verify that equipment listed above my signature: l)is the actual equipment installed;2)Is equivalent
to or more efficient than that specified in the certificate of compliance(Form CF-1R)submitted for compliance with the
Energy,FjicieneyStandards for residential buildings;and 3)the equipment meets or exceeds the appropriate requirements
for manufactured devices(from the Appliance Bffrelemy Regulations or Part 6),where applicable.
•signature,Date installing Subcontractor(Co.Name)OR
General Contractor(Co.Name)OR Owner
COPY TO: Building Department
Building Owner at Occupancy