20664 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulldin Pm'ea Identification PERMIT NO.
uildidgANdress: '2066 4
to G42
90E�/� A A A
nets AJ I17V 7v'3`4 CITY OF CUPERTINO-BUILDING DIVISION
C tra me Llc.No APPLICATION [PERMIT Q
q� BUILDINC-ME TMCAL-PLUMBINGMECHAMCAL CA RY CONTROL
Architect/Engine Lk.No:
QTY E ECTR PERMIT FEE BUILDING PERMIT INFO
Add. I'FRMI I ANCE. , ❑ h7� ❑ ❑
LIC ENSEOCONTR under S ECns of Ch ON �j.
Ihth Syt.aff4m that lamIkensed.i..3oftbeBr nessa Irloo.9i..r9(mmmenc APPLIA - ]OB DESCRIPTION
]I...hSection forces and died.
the BudneeiandlProfeselonsCode,and my -
Oanssisinful(oraanddfect. PANELS -
Lk<ndc Claes LILN
Date . Contractor e G
ARCHITECT'S DECLARATION 201.1WiSS- AA
��qquu rep ZO I understand my plaru.hall be used as public records. OVER SQ.FT. R AREA S/SQ.FT.
Fe E Licensed Pr f.Wrul SIC LEC L
OWNER-BUILDERDECLARATION UIT/M
I herebyaffirm that Iam exempt from the ContnRora License law for the
ZO Z following reason.(Section 7031.5,Business and Professions Code:My city or M
04 oaantywhlch requiemapernottomrutrucLalterimprove,demolhh,orrepalr
g anystructure prfortoih hsuance,also requirestheapplicae(orsuch permit to DEVICES
PJ file a signed statement the he is licensed pursuant to the provblom of the _ -
3w Contuciorb License Law(Chapter9(rommencing with Section 7000)of Divi- SWIMMING TOOL ELECTRIC VALUATION
SOS. gon3ofthe Buaineuand Pm(embm Code)orthat hehexempttherefromand ,
Sr' the bash for the alleged exemption. Any violation of Section 70315 by any
applicant fora permit subjects the applicant to a civil perulty of not none than OUTLETSSWITCHF_SFIXTURFS
Ove hundred dollars($509). N
EW property, NEW RESIDENTIAL ELECIR SQ.PT. STORIES TYPE CONS7RIK:7'ION
p perry,or my employer with wages nee Their door
k7a
compensation,700 will do Business wok and the s Codurehiot Contractor oroffeirdce.L w ,
O or
see(sec appy to Business and Professions Code:The Contractors Liame Taw
docsnot oesapplysuch wean owner ofpropertywho Wilds mporimpmvmthereomand OCC.CROUP RES UMTS
who dceseuchwork himml(athtough his own employees,provided that such
Improvenormh arenet letended oroffered torsee.I(however,thebuilding or TOTAL: -
Improvementhaoldwithlnoneyearofcompldt mtheowner-buOderwill have
tryR.purden of pmving that he did out build or impmve(or purpose ofsak.). QTY. PLUMBING PERMIT FEE
FLOOD ZDNe APN
Ltr L as owner of the property,am exclusively sl eas ad Ing with licensed PERMIT ISSUANCE
contractors to ro License
the project(sec,appy Burner end of property
Code:
The Coor impeoictor's Ls the Law does not apply to an owner p property who ALTER-DRAM&VENT-WATER MM
Wilds to Impmvea therron,and who contracts for L prokcb with a FEE SUMMARY
ogN(atlaW Oanse under Sot to the Contratlora License Law. BACK FIDWPROTECT.DEVICE
LJ I am exempt under Sec B&P C for that reawnOUTSIDE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N
• Owner Date RECEI7k
WORKMAN COMPENSATION DECLARATIONFDCIURES PER TRAP SCHOOL TAX Y_ N_
[:]I hereby affirm that I have a certificate of consent to del(-Towne,or a RECEIPT N
artlpratea(Worken'Compemallonlmunnaaa certKord copythemof pec.
3900,Lab CJ GAS EA.SYSTEM-1 INC40VTLM PARKFEE Y N
RECEI
Policy M DING DI X
GAS-EA.srsrFM-oven a(en).
Com any BUILDING DIVISION FEES
9Cedified ropy is hembyththhity - GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE -
IQI CertlOed spy b filed with wM city inspection division. - •
K' CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
E
COMPENSATIONINSURANC
Rhleaectlon need not be comp)TI lithe permit CE one hundred dollars SEWER-SANITARYS[ORMEA 100FT Date Rircei t#
%100)aless.) WATER HEATER W/Vp�/ELECTS BNERGYFEE Y N
I certify that In the performance of the work for which this permit letimed,
I shall not employ any person In any manner so as to become subject to the WATER SYSTQd/TREATING
Workers'Compensaeom Lawdof California.Date - PAID
O Z Applicant NEWRIESIDENTSALPLMB. SQFT. Date Remi tN
_Z O NOTICETOAPPLICANT:R,aRermakingthb Cenifi leof Ezemptlan,you
should become subject to the Workers'Compensation pmvhiom o(the Labor - TOTAL:
CC N Coda you mast forthwith comply with such pmvialow or that permit shall be BUILDING W ] denied revoked.
CL G CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z Iherebyafgrmthat there h a arutructlon lendingagency forthe perform- - TOTAL: ELECTRIC FEE
:3anaafthe work forwhichthh permith Issued(Sec.3097,CIv.C.)
Q O Lender's his , PLUMBING FEE
LL H Leadre.Address QTY. MECHANICAL PERMIT - FEE MECHANICAL FEE -
OU I certify that i have read this application and gate that the above Information
lI'm eor lagreeto complywlth all cityand county ordinances and gate laws PERMIT ISSUANCE FEES PAID:
>. N releing to building construction,and hereby authorize representatives ofthis
.(— Z city to enter upon the above-mentioned property for inspection purposes. ALTERORADDTOMECH.
� — (We)agree to save,indemnify an d kap harmless the City of Cu pe firm - Date Repel tilt
go Aimt
IHee este,cogs,and expenses which may In any way acme AIR HANDLING UNIT(1'010,ODO CFM) SUBTOTAL:
C oro ue ofth.gr,.t1oga(MsparmR, AIR HANDLING UNIT roVFlt]0,000CFM) CON$TRlJCT1ON TAX
AppOcant/Contratlor es, EXHAUST HOOD(w/D[JCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
WIIl the applicant orfuturcbuilding occupant store or handtehazardoua HEATING UMT(TO1011,f1006N) . Date RdCCi tN
material as,defined by the Cupertino Municipal Cade,Chapter 9.17,and the
Health and Safely Code Section 75537(a)?• HEATING UMT(OVERiW,009BTU) TOTAL:
❑Yes No
Will the applicant or rWm building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) I DATE-
huhemithazardousaircontamlrantsas defined by the Bay Area Air �aP ,
lity Management District? BOILER-COMP OHP OR I W,11(D BTU)
AW
u�JYes M No
Ihaveread thehavr�oua materials requirements under Chapter6.95 of BOILER-COMP(OVER 100,000 BTU)' U.r JV:;, .I .
the California Health&SafetyCod.,Sections 75505,75533 and 75534.I U t9 I.
bodersland that if the building does not currently have a tenant,that it is my NEW RESIDENTIAI.MECFI. SQ.FT.
responsibility to notify the occupant of the requirements which most be me gg��tt��ss��,aasyy
prior to Issuance of a Certificate of 0ccupanry, SY�'y TfB
Owner or authorized agent 'Date TOTAL: ISSUED BY:
OFFICE COPY
tl'OST THIS CARD NEAR FRONT.OF BUILDING /�nC
CITY OF CUP ERTINO
INSPECTION DIVISION- JOB INSPECTION RECORD
�. L#
'JOB ADDRESS + ' '' .'UNIT# LOT u cA Rv. coN OLM.
OWNER BUILDING PERMIT INFO
CONTRACTOR
INSPECTION DATE INSPECTOR INSPECTION RECORD.. 1 12 1:1 0 ,
FOUNDATION/PIERS NOTE ALLGBADING AND DRAINAGE
UFERGROUND- " SHALL BE INSTALLED TO COMPLY MTH . JOB DESCRIPTION.
PAD SETBACK-CERT THE APPROVED PLANS AND CITY OF
GARAGE SLABS PREGUNITE. CUPEATINO STANDARDS.-
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND SLAB - INSPECTION - ATE SPECTOR
PLUMBING .
h ELECTRICAL.
MECHANICAL
DO'NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - -
WOOD FLOOR -
PLUMBING' - r
MECHANICAL. -
ELECTRICAL - - - .•,�
FRAMING/VENTS/CLEAR _
- INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - -
ROUGH
PLUMBING -
TUBS&SHOWER PAN - -
MECHANICAL
ELECTRICAL ACUZZI BOND _
' FRAMING STAIRS
INSULATION/VENTILATION
EM ERG.EGRESS -
SEWER WATER
COVER NO'WORK UNTIL ABOVE AS BEEN SIGNED -
EXTERIOR SHEAR/HOLD DOWN ,
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR - - -
EXTERIORLATH/W-SCREEN
SHOWER A H - -
SCRATCH COAT
NO TAPE OR PLASTER UNTIL A13OVE HAS BEEN SJCNED
NOTE:NO FINAL,INSPECTION SHALL BE MADE BEFORE
THE CONSTRUCTION TAX IS PAID
FINALS DATE INSPECTOR - - -
SAN.#
ELECT.ENERGY
PLUMBING ENERGY ,
MECH.ENERGY "
13UILDING ENERGY -
ELECT.FINALTEST' - 'q -
PLUMBING'
GAS TEST
MECHANICAL - - - -
HEATING
ELECTRICAL RELEASE '
FIREDEPT.
GRADE '
OCCUPANCY .. .
TEMPORARY APPROVALS
ELECTRIC
GAS
BUILDING 'ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL -
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR '
,
q ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION. JOB ADDRESS AND
PERMIT If ARE NEEDED WHEN PHONING.
IMPORTANT! ) „
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTIONISSUEDeY:� . ' a UtA
I
OFFICE COPY ;