S 0582 (2) APPLICA14TTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Buu,DING-ELEf-,rluc\L PE(g�^SIT No.
BUILDING DfVL4loN APPLICATION/PERMIT 1%.IAIBING-h1Fa'HANICAh J 0582
BUILDING PRfli IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SURMI'ITAL DATE
0�
O :N'S NA li- P110 I?' CONTRA (lR'S NAMM LIC NO:
V NIC
CONTROL*
AR HpI Crl6 GI LIC NO: ADDRESS: ❑
CONTACT P110NE: BUILDING PERMIT INFO
❑ Cchl Ment Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH.
LICENSED CONTRACrOH$DIiC1ARA'II(lN QTY ELECTRIC PERMIT FEE
1larebr a1BIm that 1.in Iicen,d raa,I[m,idana of a,aptm 9(,rmnieMina JOB DESCRIPTION
O,zZ with Sa<Iiun 7(mr.f Divhion S of that thio ,tad Ftnfeatian,Chale.and my liana i. RFSIDENTIAI:
00 PERMIT ISSUANCE
favi fir,,oml ❑SFl)WL
PTI
0-
RI:VODEI.
'UE IJccna Cl a- Lic.a AP1t1ANCIS-RESIDLNTIAL []ADDITION ❑PI.UNIBING RF,-PIP:
FF z yl Dale CommiiY
,n6a ❑MULTl-UNI'r ❑STRUCTURAL
CHI7LCT5 DECIAR TION
E- y PANELS MODIFICATION
ZOB�fZ Iunder,lanl my planar Ahall4 u,.dupubliclmxJa
OZ O UP TOAOAMPS - ❑INTERIOR ❑CHIMNI!YRF.PAIR
a__Lq IJcented Pmfeuimul A)1_HxXIAMPS IMPROVEMENT E)SWIMMING POOLS
Y f OWNER-BUILDER DECLARATION OVER IIXXI AMPK ❑HAM REM 'OUFPAIR ❑1)lI T O
C Q I hereby uffimt that 1 an exempt Imm Die Comouc ur's Licence Law for the
k O d U following rwnn.ISch ion]W 1.5.Busin.atd Rnfcuions Ct.k:Any city or-only SIGNS ELECTRICAL ❑OTE117R
:O� which rcNnite,a Parton to construct,Alar.intarri demolien.or miany,acme
(v= 4 phrmdv ieaunnca ulsomquirc,the arPpliom Gr,uuh permit-tile a,igmd oaemuN SPECIAL CIRCUITAIISC.
.2;' Ihu he is lic,aad Pommel mlM pmviaium of We Contractor'Licari lww(CmPla9
W�aC) (-mmrnam,,sidi Sa ion 7000WDivision 3 of Nnev,An
Ne Buaid Prufe•<"tas Crdel ar TEMP.MITER OR POLE INST
t S:a e ohm he i.exempt ihenfmr,ens the Iasis I'nr the allei asen,a,r,Any vmlwien of NEW BI,DGIADDITION [IDEMOLRION
I- Scrim 7031.5 by too,opplicanlfair a prmtiteci Inc ap,loema toe civil Peroltyof POWER DBVICIS El TENANT ❑FOOD SERVICE
FZT cost mos,than f,:hmxlrtJ donate'Sind). IMPROVEMENT
p=Q I,n,owns nflM Pnga•.nX ur mY,mPloyc�w wish srag,+'¢s their ale cunpcn,afvut.
SWIMMING POOL ELECTRIC ❑OTHER
2 will fraf our,
and a:ThaCurt to m i Loc .[u- ki fv—,plY-an,Buof
3 altl Hofwa ,b Curia: no Cnnlnemra Land l ,& ,.eNapplyvNanearn of OUfLCIS-SWITCIIFS-Fl\TURFS
pmpmY wMt hoild,nr imcadl de each i,and wMt al, star sort,a hind,s]or inei riugM1
his.wn employ Ba pmvidcl Bhel each impl,wrnenl,art tut inlcrltir .x iRfertd fa NEW RISIDI:NTIAI,ELECTR SQ IT.
sale.lf.however,the building orimPuvertteNuwd within tart yrur of compinioo.the SQ.Fr FLOORAREA 5/SQ.FT
wrcr-builder will have da burden of proving that he did not hoild or improve for pur-
pose of sde.7.
0 L ne,awn,'of tk property our csnt
clr...cly comeYog with liccat..Nractto TOTAL
arms rr the Douce,[See.7(1x4,Bmims,sed Pm@x,lon,1o.:1 The Cmurcmr',t1-
amcLewdare.mg apply tom Twit,of property arta buildsminRmvn memtn aid QTY. PLUMBING PERMIT FEE p PAID wM conlla,'IA Tor Auch pmjccu wish octavecox(,)liansal purauanl so IIIc C'mt,rtiu's M
Liana Law. PERSHT ISSUANCE
C] 1emeampturc Sec. .B&PCfarIhi,rea<.m
ALTER-DRAIN&VENT-WATER(S\) A UN
h e DNe
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE l INU
I he.eby a1Bmi under priority of P,riury ore of me INnwing dcelNuliins: t
I have and will maintain°Cenificare of Continuaself-in.am far Wir\ch Gmp,n- DRAINS-11.00R.ROOF.ARBA.COND. tCrORIFS TYPECONSTRUC71ON
adan,as pruvidel for by Sectio^3700 oaf Bk Ichor CoJc,for dr,Perfumtarta M the
N Gtr which this pencil ie iewcd. ITV['URIS-PFJt TRAP -
I bn,e AM will maintain Workers Crmpen,etion Imurwce.en required by Section
�Elp ofdie rhos'Code,for the perfmn .fNe ooh fur whichlhis Puncit m iam,d. GAS-EA.SYSTEM-]INC.d OUTE1S OCC,GROUP N'N
My W'mkc Ct tion In Rferill,'
GAS-PA.SYSTLMOVER4(EA)
Carrie, Polity No.: L
CE TIP Al E'O MX[ PfION FROM WORKERS' GNEASP/INDUS'I'Rh WASIT:INTERCF.VfOR
COMPFNSATION INSURANCE BUILDING DIVISION FEES
(Thu.mion roN rot be compktcd ifthe Petah,is f.rme burWd dollar,($100) GREASL'rRAP -
PLANCIIECK Midi
lecnify that in theperfomtanccufffbii farwhi,h 0r,pennil is i.uuW,I dal SEWER-SANITARY-STORM EA.AIB FT.
nth"By any prr,,u in Any on.w its to become subjcm m the Waken'Compcn- ENERGY FTI?
OZ afmn Laws of California lime WATER HC- TER W/VFM/ELECIA GRADING FEE
Z Q Ap,licam
NOTICE TO APPLICANT:If,°flu making Brit Cctihcme M F,aerral you Ahemid WATER SYSTEMIMIATING
F ; beaoc'whjeet Ice the Worla ei Cimpensuion provkims i Ik I� Code,you muu SOILS FEE.a fmhwilb,imply with arch lmsinion,at his mau,tall be okemed reef". WATER SERVICE
0
CONSTRUCTION LENDING AGiiNCY NEW RESIDENTIAL%\10. SQ.FT PAID
U QIherthYaBinn Am Boom isacm,imsfian lending aga.,fisr the perfimmure of DN, Rcn'iptN
Bic work fur,vhich thus p cutis iiii(Sec.21 Civ.C.7
U len ih sit. TOTAL:
U 1<Mcrs A,ldhi TOTAL.:
11 certify that I have mm this Application and slave Ihu thatalwv,infmautim it BUILDING FEE,
to corral.I npac m QTY. MECHANICAL PERMIT FEE
U SEISMIC IL
Z hooding eiauauuion,and hertlry authonr<rt1r„rnlmivea oflris city la rnlrr upim the II
�' above-meNionN pn,moy for ina{ctim pmryr,es. PERMIT ISSUANCE
(Wc)agree to save,indcnmify and kerp lvinnk�„rho City nl Cupertino ugvi¢a IiLECTRIC FEE
Iiabilities.judgnrnta,emu and ex,si which may in Any wry venue against said City ALTER OR ADD 10 MSCI I.
PLUMBING iE
n APPLICANT
Mthe granting UNDERSTANDS ANpermit.
SOURCRELATIONAND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ON]](TO IU.BW CFM)
MECHANIC .F
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER IB,OBO CFM) C(IN5fRUCI'I N'CA
Signatum of ApplieentlCanurta Due EXHAUST HOOD IWMUCTL HOUSING MITIi FEE
HAZARDOUS MATERIALS DISCLOSURE
Will li,applicant or fulu a handing occupant circ ie handle ha.nrokNs ma erirl I[EATING UNIT(11)1001 BTU)
a,Jcliml by Ina Cupertino Municipal CNB,Ckui 9.11,vol Ire flcalN sial Safary
Cole.Section 25531(°)'! HEATING UNIT(OVER 100AX)BTU)
❑Yes El No VENTILATION FAN(SINGLE RESID) PAID
Will then applicant or future building ocupunl ua egoipra m a device,which Data Receipt N
eamouv
B hdair commonam,u,define'by Ne Bey Amu Air Quality Mme, car BOILER-COMP(3HP OR IfM],IXk9 Bl U1 TOTAL:
L��
BOILIER-COMP(OVER II(IJXM BTU)
❑No
red the hvariRen rtmlelials Is under Chaptnfi45 of the Ceh- AIRCONDITIONER ISSUANCE DATE;
in
Safety Odc.Scclirm.25505.25533 old 25534.1 umlauuld then if the NEW RESIDENTIAL MECH. SQ.FP
I armnlly hnvc a Baum.[hat it is my InrmuSiltlyrcnts which tiiCI OTAL.ud' rnt at ISSUEDBY:
OFFICE
\�C,•.,l'\\ • U .��\Y :, 1��':`. 7.`y+�•1 iia l �b`v� '
.,....,r':-• fir, .-v:. ;•ti- n••t _;.:�.L ;, �,� •
'POST THIS CARD NEAR FRONT OF BUILDING
W C '
CITY OF CUPF,RTINO J U`NO 05821 5 8 2
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: I' SANITARY NO. APPLICATION SUBMH7AI.DATE
jD� TJ a //r-" C _;�l . lf / J
QWNER,S NAME!'` ✓ �, 1C YIIONI- COM �A QKSN NAME—
<! LIC NO.
N�(E// NIC CONIROLN
ARCII1TECf/ENGINFSR: I.IC NO: ADD/E / 5(� I C //�L ? / ❑
444 BUILDING PGRMIT INFO
INSPECTIONS DATE INSPEC. E:1ConsultanBLD
t Fm Paid by Applicant(initial) G ri F,g PLUMB MHCH
❑ 0 O ❑
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL
SHALL BE INSTALLED TO COMPLY WITH 0SFUWI, ❑KITCHEN REMODEL.
PAD/SEI' BACK-CERT THE APPROVED PLANS AND CITY OF ❑ADDIT]ON L1 PLUMBING RE-PIPE
GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑Mm.n-UNIT ❑STRUCTURAL
MODIFICATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR El CHIMNEY REPAIR
IMPROUNDERGROUND/SLAB` CALL AFTERNOONS (1:00 PM - 4:30 PM) BATHR MODE 0DEMOLITION
EMOLITION s
❑BATH REMODELREPAIR ❑DF�10Lr ON
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑0THER /ATL«-Y'°�-a..
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS E
AND PERMIT#ARE NEEDED WHEN PHONING.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED COMMFRCIAL
PLUMBING ATTENTION CONTRACTORS: ❑NEW BI.DGIADDIT[ON El DEMOLITION
NO PERSON(S)SHALL PERFORM WORK ON ElTENANT ❑FOODSERVICE
MECHANICAL THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMEJrr
ELECTRICAL13OTHER
PLIANCE WITH WORKERS'COMPENSATION �
FRAMING VENTS - INSURANCE REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE [NSP.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN
MECHANICAL-
ELECTRICAUPOOL BOND
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIAL SHEARMOLD DOWN
INTERIOR SHEARMOLD DOWN
SHEEIWROCK/SHEEIROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LATH
NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER -.
TEMPORARY APPROVALS AUG 19
OCCUPANCY CI I r
ELECTRICAL
GAS
IFINALS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL
PLUMBING -
MECHANICAL
ENERGY CERTIFICATE OF OCCUPANCY ❑
VISUAL FINAL ONLY
BUILDING IMPORTANT: ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED PLEASE READ REVERSE SIDE BEFORE
UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!!
I INSPECTOR._ _ _ __ ISSUED BY: ll....//
APPLICANTS POSTING COPY
NOTICE . . .
When calling for FINAL INSPECTIONS, the following occurs prior to the release of utilities: •
The Building Department coordinates the request for final inspection with the following City depart-
ments, as required, to assure that the site/building complies with the requirements of these depart-
ments.
1. BUILDING: Complies with all building code requirements.
2. ENGINEERING: a. New driveways, sidewalks, curbs, gutters completed.
b. Lot fine grading to drain or bond posted.
c. New water system in operation.
d. New sewer system in operation (Sanitary District).
e. New streets paved, with sewer manhole and-valve boxes raised to
grade. Sewer cleanout at property line to grade.
I. New subdivision lot corners set.
3. FIRE: a. Fire hydrants properly installed and operating.
b. Fire sprinkler system properly installed and tested.
c. Fire alarm systems completed and tested.
d. Fire extinguishers installed, dated and tagged.
e. No parking signs in required fire lanes.
f. Restaurants, hood fire extinguishing systems operating and tested. •
4. PLANNING: a. Required landscaping and irrigation system installed.
b. Paved parking, trash enclosures, exterior light fixtures, etc.
c. Documents (CC & Rs, easements, etc.)
5. HEALTH: All food handling facilities must meet the requirements of the Santa Clara
County Health Department.
Upon receipt of approvals in the Inspection Division from all the above departments, gas and
electric utilities will be released, and you may then occupy your building.
If new owners are attempting to occupy the building for the first time and the utility release has
been delayed, check with the contractor who is responsible for meeting all the above requirements
of the various departments.
' BUILDING INSPECTION DIVISION t "
CITY OF CUPERTINO 1 J
•
Inspection Query for a Specfic Permit 11/7/97
ns ecto Units PasslFail`Coils
D 2F
D I 2P
•
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Inspection Query for a Specfic Permit 11/7/97
'PERMIT# ITUSSSSITUS"STREETGo`t# ,�t`�INSDESCRIPT`: In's,T DATEDESIRE�D_'ateDone
50582 10285 FARALLONE FURN/AC H.O. 9/16/979/16/97
S0582 110285 IFARALLONE I IGASLINE/LOG TEST 9/16/97 9/16/97
•
O
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