17961 (2) POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER
CITY OF. CUPERTINO 17961
' INSPECTION DIVISION
JOB INSPECTION RECORD
PERMIT EXPIRATION '
JOB ADDRESS UNIT#- LOT# '
PERMIT EXPIRES IF WORK
OWNER CONTRACTOR IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSIDE CTION RECORD L�)BbDAYSOFPERMIT ISSU-
FOUNDATIONNC OR 180 DAYS FROM
NOTE: r 2 } CALLED INSPECTION.
LIFER ALL GRADING AND DRAINAGE SHALL BELLE .Z
PREGUNITE TO COMPLY WITH THE, PLANS AN ciTY bF .PERNI T VM IOATVON
CUPERTINO STANDARDS. ''4.'�t
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB .s of _:u_. •` . ,,�', 'L%
PLUMBING '
ELECTRICAL ISSUANCE DATE
MECHANICAL FLOG ELECTPLR. mECR.
❑ ❑' C� ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WOOD FLOOR INFORMATION
PLUMBING $LFT.
MECHANICAL
_ ELECTRICAL - tt11 PERMIT TO
FRAMING IIIIrI( �!f'IC
INSULATION - STORIES rvPE CO STR.
OCC GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED yL zo—i
ROOF NOTE:NO FINAL INSP.SHALL BE MADE.BEFORE- So I r FLOOR ARFA TOTAL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID -
BUILDING USE
ROOF SHEATHING RES IND CON PF O,I,.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. [I
ASSESSORS PARCEL NO
ROUGH SAN.N - T
PLUMBING - ELECT.ENERGY
TUBS 8SHOWER PAN PLUMBING ENERGY T RACT NO PARCEL NO.
MECHANICAL MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ACC DATE ACC.FILE NO
FRAMING' ELECT.FINAL TEST
ZONING ENG.SITE NO.
INSULATION PLUMBING
GAS TEST GAS' '
MECHANICAL FIRE SPRINK ENERGY T�74
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING - y ❑ No , "[]
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE ALUC.
INTERIOR SHEAR .FIRE DEPT. v [:I " ❑ "E'
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING
INTERIOR LATH TEMPORARY APPROVALS. BUILDING
SCRATCH COAT ELECTRIC - PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE-HAS SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY. PHONING 252-4505, ELECTRIC
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
O PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE —
IMPORTANT! CONST.TAX
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
BUILDINGAPPLICATION & PERMIT V
_ AODREss �
- BUILDING -ELECTRICAL-PLUMBING-MECHANICAL 17961
OWNER' PLAN CHECK VALIDATION
"AU�EA S/11//,f// CITY. ELECTRIC PERMIT FEE
�� TACTO ( PHONE
/ CONTRgC10R'
"ME
OUTLETS-SWITCHES-RECEP 10.00/1.00
LIGHTING FIXTURES10.00/1.00
RA oRv PPLIANCES-RESIDENTIAL 4.00
goon ss tz,:N
SE g PANELS 10.D0 DATE OF APPLICATION
ARCRITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P,C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH ass ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
IIP FrEMP.METER OR POLE INS. 20. 1 Al IT/�w1Ll/1/'
APPLICANTS MOTORS SEE FEE 5 J L11V Ri1Y fUr�
ADGREss
SERVICE CHANGE - 2000 �I I
Foo LICENSED CONTRACTORS DECLARATION
G u v I hereby atiirm that I am licensed under previsions of ChaPt,,9 ISSUANCE DATE
i7 < w (commencing with Section 7000)of Division 3 of the Business and • 'BLDG. ELECT. PLG. MECH.
H o z Professions Cod t an license is in full f ❑ ❑ ❑
I y y
z o'I'^ - [)are CIaM-C:_ (�_Lic.Numl>a•
o m r Date Contractor
a x BUILDING PERMIT
2 n i Q
OWNER-BUILDER D
R-BUILDER f;CLA RA' ON INFORMATION
K:
I- 1 hereby affirm that I am exempt fru.the C.ntmcmr's License MISC.- REFER TO ORD
uO¢ Law for the following.awn.ISec.7031.5,Busimssand Professions VALUATION S/FT.
H - PERMIT ISSUANCE 10.00
Codc:Any city or County which mquiresu permit toconsirucL alter
T ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
S reQUlres the applicant for such permit to Illi'a Ugrud statement that TOTAL PERMIT TO
n se $ he is liccnwd pursuant to the provisions of the Contractor's License
F z¢ Law(Chapter 9(Commencing with Section 70130)of Division 3 of he f,,(
f 4 O Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 1'1
CT
¢ H 0 the basis for the alleged cxctnptlon.Airy violation ofSrati.n 7031.5 STORIES TYPE CO STR.
i ; - by any applicant for a permitsubjects the applicant toa civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not more than five hundred dollms($5001):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the stsu tore is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'rhe Contractors License Law dog not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES,PE R
IXTURES-PER TRAP 5.00 so.ET FLOOR AREA TOTAL ACREAGE
( himself or through his own rove, I,c,,provided who
such such
work
e-
ments are not intended or offered for sale.If,however,the bulling GAS-EA.SYSTEM-11NC.40UTLETS 6.00
r improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER3000 RES IND CON PS Omer
m cl
❑ 1,as owner.t the property,uexu . .
sively contracting with ❑ ❑ El ❑ 13
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Codc:l'he Contractor's License Law docs not apply
to an owner of property who builds or improv s thereon,and who LAWN SPRINKLERS-OV ER 5(EA.) 1.00
contracts for such projects with a contocmr(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
0 lam exempt under Sec. ,B.AP.C.fur ods WATER HEATER.W/VENT
reason
Owner Dam WATER SYSTEM 5.00 ACG DATE ACG FILE NO.
W'ORKERS'COMPENSA'I'ION DECLARATION WATER TREATING EQUIP. 5.00
1 lurch,atfrm that I h see curt if irate.1 convent to self-m a c,
or a c•rti6caIS of W,. , ompensatioppp Inmmncc,qua ccrtit icd ZONING ENG.SITE NO.
copy La C.1.
Wi Ctu
O Curr 11 Ey iv lercby u n lied. RE SPRINK ENERGY T-14
Z Z art- py f N r' h r c it division. MISC.- REFER TO ORD. ❑
O licant Y N❑ V � N
y CERTIb ATI:OF EXEVII'I']ON FROM WORKERS' PERMIT ISSUANCE 10.00 N.IV
FLOOD ZONE A.L.U.C.
W5 COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.0 (This section need not be completed if the permit is for one TOTAL Y❑ N 0 Y F N
Z hundred dollars IS 100)or Icss.l
U O I eerily that in the peffunnanee of the work for which this per- CITY MECHANICAL PERMITFEE FEE SUMMARY
LL 1- mit is issued,I shall not employ any perm.m any manner so as t.
Ow become subject to the W.rk,G,Compensation Laws of CAlorou,
0. rime Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} W NOTICE 10 APPLICANT: If,after making this Certiticatc of FS-
� ? emption,you should become subject to the W.rken'Compcnsation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions ur this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.FAA. 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 6.00 SEISMIC FEE
I hereby HID. that there is a constriction lending agency fur EXHAUST HOOD(WITH DUCT) 5.00
the Performance of the work for which this pennit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
- Lender's Address HEATING UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I cenify that I have read this application and slaw that the above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating In building c.nvruct ion, anJ BOILER-COfuIP(3 H.P.or 100,000 B.T.U) 6.00 ev�
hereby authmoc cpreventatives of Hirt city N.
eDWr upon the
alwve-me I.rmed property for inspection purpox . BOILER-COMP IOver 100,000 BTU)SEE FEE SCH. MECHANICAL
(We) agr to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino aga sr IiuM1llir ies,judgments, cu As and expenses which CONST.TAX
ay in any w accrue against said City in consequence of the PERMIT ISSUANCE 10.00
arming of ibis •retie MECH.CONT. LIC.NO. MECH.
TOTAL TOTAL / qq
of Applicant/Contort., Date 1V0
OFFICE COPY
•APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPF.RTINO B ILDING-XLEUIXICAL PERMIT No. 28218
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROTECT IDENTIFICATION
BUILDING/A S:�• � /� ,.sr IO UNIT# LOTN SANITARY NO. APPLICATION SUBMfRAL DATE
OWNF AM {O /(/��(�I/, CONIRACIOH'S NAME LIC NO: 7NC �CONIROLYARCI 1ECT NGWLER: LIC NO: ADDRESS
fflM
CONTACT: PII NE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECTPLUME
PERMIT ISSUANCE jP 1:1 .
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IDH DESCRIPTION
OCZ IM1erehyerDivikutl em iflic edunJerpov rofilvnri mf Ch ori,an anyh,eh.will
u100F fill fus 9(100)of Uivisinn Jof the Ousircu oho Pm[evitme Code,mJ my licensie in PANELS
FFy7F full Tutt and cffm.
II<--j uUl U«vc Clma Lic.N UP T0200 AMPS
tn6a Dere Com.. 201-1000 AMPS
F-y L - ARCIIIIECI'S DECLARATION SQ.ET EJ_"AREA g/SQ.IT.
OVER 1000 AMPS
OZ—M IutNlcrswal my plane 4dl he lad as vublit renNJx.
�yC j SIGNS ELECTRICAL
Liccmed Professional
ycl OWNFA-BUILDER DECLARATION SMCIALCIRCUIT/b11SC.
���(('C)WU I homily affirm flet I un exempt from the Contralls liceme Lew f«the
Iv13 u-y followi.,I.,(Section 7011.5.Buaincsa arta Professions Code:Any city or comny TEMP.METER OR POLE INST.
C yO Q which regwrza a pumnii to eotstri alter,Impnvc,d holoh,or repair any shacmm
J r pour to iDwawa,dw"alrts the applicant f«such permit to file a sigtM suminent POWER DEVICES
z o o mat W i\Iitateea pntwant m me 1=mNi,inn,erne contr.efer.Ixe,oe I�w(clteper
aaoP,: 9(canmeMng with Smion7"firifDivision 3.f the Ravius od Pmfmiau Code) SWIMMING POOL ELECTRIC VALUATION
F.—y or than be is exemry merfrom and the boss for IS,alleged exemption.Any violation of OfPI FfS-SWRCIIIS-Fl%TURIS
❑G4 Section 01315 by anyapplicant forapemtilsubjmt,meappluant lna trill paWtyor
d,,SS nml i. him Gvc hu drel dollws($500).
❑ LasowrsrmrOtc pmprry,«myempbyeewim wegnumeirwkcampcousin. NEW RPSIDPNTIALHLE —SQ.FT. STORIES NSIRUCUON
a3— will do Jcsions Chile:
The
LrtdMe Liow ddfmnle(Sec.to lin Bowan of
and wh ons Coo:The cmthanon,License Taw alta not apply to on vwrter of
-wh eaywhobuildsnr impuvnch alloaffilwWlona wchwhohimselfonhrougM1 It.
rnnPluy¢s,pnndN mel such impmnrcmsve MN lmerdN or Mfertdf«sole.It. OCC.GROUP RES.UNITS
howevm,the W iMEng M impovcmrnf In mid wlmin ane yarof completion,tk owrcr-
Wilder will hive the burden of proving halt the aid ret buik mer improve for W rpme of TOTAL
vlcl.
❑ I,utswneraf dte progeny.ant cxclusivelycmfnningwimlicxnsed axumnmfo QTY' PLUMBING PERMIT FEE FLOOD ZONE APN
onetmef the Pmjev(Sas.0044.Businese colo Profasisoa Code:)The Comrecmr'n
License law does not apply town owttcrofpnpleny who imitatorimrences tlw-tcon,eM PERIOU ISSUANCH
wW contmcu f«sucb proj.with a convacmr(O Ilcerovl perwa in to tW Comhacmh
Entree law. -DRAINS VENT-WATTR(FA) FEESUMMARY
❑ 1 em'exemp ualer gee. ,B A I'C f«mss m\an
BACK R PROMCL DEVICE OUTSIDE FEN
Pwrcr Dvc SANITARY RECEIPTN N
WORKMAN COMPIWSATION DECLARATION DRAINg-FL R,ROOP,ARFA.COND.
❑ Ihcscby off 0utlhavea«nifrnfc of cvunntmvJf-inwre, crtifiote of SCHOOLTAX �N N
Wmrkesa'Cartpueafunlremanx«ecmifiM ropy thereof(.Sec. ,Tab C.)whch Fl%TIIRFS- TRAP PARK EtiE Y N
lower,all employm's under this perain. GAS PA.SY -I INCA plHLFTS RE EIPI'N
PdicyN BU[I.D1NGDtLaLgWkT,.q
Cool GAS-EA.SYSTEM VER 4IEA) PLANCHEC(FEE
❑ Coifho copy is M1ertby futn'uhcd
❑ CrnihM enPY is hkd wire fI dry ins divisum. GREASH�NDUSIRL -INERCEPTOR GRADING FEE
CFRTIIICATE OP L%LM ON FROM WORKERS' • GR P SOILSITH
COMPENSATION NSURANCE
(Thisamionnm'I tta WcompletW it the itiaforweehmdr I ) S' IiR -STORM EA.XgFT. ENERGY EEE
or Imo,)
lanifymarinmepMamvnccofinework whit m' iI ISM1 WATFA IIF W/VENDELECIR
ret map), eny Person in wy manner u f t fn grS' PAID
Comprnvuioniaw of CNliromw. Da, WATT YSTEM/TRIATING )are RacipN
Q z Applicant
z O NOTICE TO APPLICANT:ILWu making misC re enryfirn.you salad RESIDENTIAL PI.MB. SQ.hT. TOTAL
fn bccwrr eubj«t to me W«ler'a Compen�m pmv of the LaborCode,you twat
formwim tomlNy wire such pwviaum mi,pemdt Ile dernN covoketl. BUIIDIN INJ Cl
0. [� CONSTRUCTION LUNDING A 1'NCY SEISMICITE
Z Ihere by off met mere iaecmarucfion lemling erryfmmle Peff«nuruc -
U the w«k r«which mi,permit H iawea(Sem 11;T,CIN. Ff BCIRIC EEE
Iencer'a None
OF Lutderl Address QTY, MECHANICAL PERMIT FEE PLUMPING FEE
LULL 1 ccolfy Ihv I lwve fuel this uppliratlom nolo note that the abovo informoinn is MECHANICAL
oorecl lt,l m coni with all city aml county mdinunces state law relating to PERMIT'ISSUANCIi
rr
F' IZI
Wilding cauuucuon,and hereby wdwriu rtpesewrivwo(mucitymenfn upon me CONSTRUCTIO TAX
U z aWtrve- ten6orcd prll fm ituyectlon pnpees. ALTER OR ADD TO MECH.
(We)agrs a rdrmnify mJ keep M1mmkaa the Cin ofC. agaiml
N."ifia,jud osueMcxpnws dchmaym. w cc �^6^'mmraid City AIR I IANDLWG UNIT(TO IO,"CEM)
in mn.se,act nli
AIR HANDLWG UNIT(OVER IO,OD)CEM)
Sigrwutet Appliont/Cou Doc F HAUST HOOD W/DUCT)
PAID
IIA%ARDOU., A'IERIAISDISCLOSURE HEATING UNfT LTO IIp,O(p BT V) One ReccipY
Will fie applicom M future buil,ling escupmf more or handle M1awJoue mveriel
its aeBml by m,Cul,mainw Mwlclpal Code,Chaper 9.1200 live Health W Safety HEATING UNIT(OVIR 100,000 BTU) )T
Code,Section 25332(a)T
E)yes 11 No VENTILATION FAN(SINGLE RESID)
Will dx:epplicanite fufwe Wildingtacupmtureeyuiprwtt«device wM1iclemil BOILER-COME(3111'OR 100,(pfI BTU) ISSUAN ELATE
hoaharou all mvaminanu m dchred by One Bay Area Air Quality Marugemrnf BOILER-COME(OVER POP,"BTU)
District? A '
❑Ya' ❑No NP.W RPSIDENTIAL MGCH. SQ.FT.
I have orad for,hazardous ttwrerids rogulretrome choler Chsper 6.95 of nal
Califinie I Icahn A Safety Code,S«lions 23503,25533 and 235M. Iundcssursd man JUN
6
if me W Iding dom lave
s ncurrently it trnvu.thinupbility m
ur if u my rauiminify theo«vplan of the rcquuvrcw whish mux W met prior m hamRe of•Ccruf re of
0,milvally
Owneraemhonudegem Dome ISSUEDBY: tt 'fYV
OFFICE
g„ WA ---�� -- - - -- - —
- - - -- ---- --- ----- ---- .. �1Ew _��•s_FiR�Pt,Rc� INsra-�'(��. Gar DV3� 2N -----=
- --- — — =- - - = - - _. _ M�� I urai �T�
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- - -- - ----- ----�--- ---- �-- ----•--� --- �-� -----_ 2x6 --'
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---- - ----.. _ .. )-J I^ _
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- --- - - — - IWT PLAN& -- -- -- - - --- ==
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—
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�0%64 5: �fl{�LL PjL✓D — — --- - —•- - -- -- Sckc E. �4 r FT_ — ---
C> A)r.4� V/E&J
M v
(roN& F: fwc. FRfl/q %4-E STo%
INSTA -FLAME
INSTALLATION AND OPERATING
CFM INSTRUCTIONS
nEe
ywt
4�
e�Y trY�
DIRECT VENT WALL FURNACE
MODEL DV32
• PLEASE NOTE: In order to comply with applicable codes and product warranties, only CFM INC. supplied
venting components may be used.
DO NOT USE FIELD FABRICATED VENTING COMPONENTS.
WARNINGI IF THE INFORMATION IN THIS MANUAL IS NOT FOLLOWED EXACTLY,A FIRE OR
EXPLOSION MAY RESULT CAUSING PROPERTY DAMAGE,PERSONAL INJURY OR LOSS OF LIFE.
FOR YOUR SAFETY FOR YOUR SAFETY
WHAT TO DO IF YOU SMELL GAS: DO NOT STORE
` Do not try to light any appliance.. OR USE GASOLINE OR OTHER
` Do not touch spy electric switch; do not use FLAMMABLE VAPOURS AND LIQUIDS
M phone in your building. IN THE VICINITY OF THIS OR ANY
* Immediately call your gas supplier from OTHER APPLIANCE.
your neighbours phone.Follow the gas
suppliers instructions. ' Installation and service mustbe performed by
If you cannot reach your gas supplier call thepeed installer, service agency or your
fire departmenFEE gas pplier.
* Open windows/Extinguish all
CFM-USA INC. CFM INC.
9300-D AIRPORT OR NE `a' ® 475 ADMIRAL BOULEVARD
FORT WAYNE, INDIANA Max 0® MISSISSAUGA, ONTARIO
46809-3047 L57 2N1
PLEASE KEEP THIS MANUAL FOR FUTURE REFERENCE 52759
4/94