01090092 (3) CITY OF CUPERTINO
BUILDING DIVISION PERNUTA CONTRACTOR INFORMATI
BUILDING ADDRESS: PERMIT NO.
[y 10531 S "FOOTHILL BLVD 01090092
II OWNER'S NAME: APPLICATION SUB DATE
WERNER GERTRUDE A 09/20/2001
% HONE: SANITARY NO. CONTROL NO.
1.
O O ARCHITECT/ENGINEER: I BUILDNG PERMIT INFO
EE BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
•5 le 1 hereby ulflarit that I ser licensed under provisions of Chapter 9(commencing Job Description
'ht with Section 7000)of Division 3 of the Business and Prufeadom Code..and my It... INTERIOR REMODEL
7W it in full force'end effect.- • t "
Lcen.eleaa Lie.g ORIG PERMIT S2183 FILE DESTROYED. VALUATI
0' t; Data Contractor
iLLo� ARCHI7EC7SDECLARATION DETERMINED OFF OF OLD PERMIT APPL.
t g I understand my plans shell h used u public record; Plan�
E p Licensed Professional �-�[.
OWNER-BUILDER DECLARATION
M,y I hcrehy M.the,I em exempt from the Commerce's Licca.Lew for the
follawing.room.(Section 7031.5,Business and Professions Code:Any city or county
I
which me rims a Permit to comoueh her.improve,demolish,or repair any structure
6$ -prior tofu issuance,alm«quires,the applicant(or;ahpemitm(tier sigmdsutement• - - - _
that W iJJicen.d poemans to the proNsmns of de ComrxmYs Limine Law(Chapin 9 ., , �+,t..I7100 ' C ;, *' UanOn
(commrncin8 with Sectiw 70P3)of Division 7 of the Bnipeu ab ProPasimu Code) 1, t, ^• S9 at �Illoo t ` y�12 O l M
or that he is exempt Menfmm and the basis for the alleged exemptio.Any violation - 1t r
of Section 70313 by any applicant for a perm,subjects the appticam to a civil penalty a
of not mom than five hundred dollars($500).
u.V 3 4 Occupancy Type
Cl l;m own.of Ne property.ear my employees with wages m theh sole comprnand on
will do the work.-and Ne structure is not intended or aRend fm inti(s" 1
'Business and Professions Code:The Contractor's Lim.nlad,doss not apply 1 1 ` - FOUNDAT IJOWired Inspections
owner of property Who WILL;or improves thereon.and who dafa each work hi
or through his own employees.provided Nve
et such impromen not endW 1 2 — PIERS
offemA for sale.IL Eowewn the Wilding or improvement a sol - Y 103 — UFER "
'completion,Ne owner-builder wBl haw the Wrden of proving that id amt WO
improve for purpose of uleJ' 104 — REBAR
O 4 at owner of the property,em exclusively contracting wit liceton to 105 — ANCHOR BOLTS '
construct the pr ject(Sec.7044,Business and Prohuioru Code:) Conuam e's
License Law does no,apply m my an owner of propwho Wilms or Imp.va thereon, 106 — SEWER & WATER
. . and who convacu.fm such projects with a contractor(s)licensed pursuant to Me
Contractors Us..Law., 2 0 2 - UNDERFLOOR PLUMBING
❑Lem exempt under Sec. BRPC for this aeawp 203 - UNDERFLOORMECHANICAL
owns:'"',`.- t.„ P''•I ': .ate.,;. °:• .,.- 2 04 - UNDERFLOOR FRAME
� WOAICER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
1 hatch,affirm order penalty of perjury one of the following decimations: 301 — ROUGH PLUMBING
17 I lave and will'maima.a Canifirne of Consent to self-insom for workers 302 — TUB & OR SHOWER
Compensation, as provided for by Section 3700 of the Labor Code, for the
perfomunce of N<work for whim this permit is issued. 303 — ROUGH MECHANICAL
❑Ihave'nd will'mainuin Waika'eCompen.rion lmuaance,ae requirtEMSection 304 - ROUGH ELECTRICAL
3700 of Me'Labor Code,for Ne penfi.as Of the work for which Ids permit is 305 - FRAME
I _ issued.My Workete Compenuuon—lnsmance under W Po4ry number are „
Cama t ;' i + I ':,•'`PoBgNo.:
' 0. 30.6. ;.-.HOLDOWNS .. -
CERTIFTCATIONOFEXEMPTION FROM WORRisq 1 a '' 307' '-!- -INSULATION
.. ..., COMPENSATION INSURANCE" .. _
jnde snudm mad out hmmplmee if the Peru is roar one hundred dollen ..-.•...•._.._ 30$( =' SHEETROCK '. ..:
($100)orkes.) 309 - EXTERIOR LATH
�J'eert)ry Nar In ane peAarmnte aro wn wbik row worm thirpemdt W it.ed,1310 — INTERIOR LATH. _
shill•�a employ ny perwn W ny m.arier w m m became.then to dK worker; 311 - SCRATCH COAT .
Colitpeneadon Levet o(Cdifmvin.Date
Appuaar' 313 - ROOF NAIL
N 1CFrAPPuever,IrsawnamngNlaeenl6m.arE.mpdan,yovamam 501 - FINAL ELECTRICAL ENERGY
Opbecome.bjeet.Ili Workers Campemetian pmvisimu of Ik Lobar Code,you rout
rnrItIt plYwNrmprviantmN.pemdtduBbedsmd.oked. 502 - FINAL PLUMBING ENERGI'•,
err q�'" ""'' CONSTRUCTINeON LENDING AGENCY
I"he.by.from Nat mis�cmmw on lending agency imdia pufmmance 503 — FINAL MECHANICAL ENERGY
Fw serne'e N(wwhich Ni;p mhi iumed(se:3omciv.c.) " 504 - FINAL BUILDING ENERGY
U.
Lan creAdd I at 505 - FINAL ELECTRICAL
V'O run(yButlhew �dNi;apPliaOmaMsa¢NUNeaboein(omutionis 506 - GAS- TEST
lir'- c hraci I agree to comply with all city and county ordinances and state laws.inning 507 - FINAL PLUMBING
O'. to building construction,and hereby authorize opnienudve,of Nis city to enter upon
W the above-mentioned property for inspection purposes.„ , 508 — FINAL MECHANICAL
W; (We)agree to save,indemnify and keep haimleu the City a Cupertino against
y liabilities.jud8menu,ensu and expenses which may in any way xcrue against said 509 — FINAL G
V: City inconsequence of Ne granting Of this pemm.
AMYUce=REGini.AnON3.DS AND WILL COMPLY WfnI ALL NON-POINT Issued 10 N NGSOURDate
Signature,of Applicn✓Contractur - " - - Den, Re roofs
b HAZARDOUS MATERIALS DISCLOSURE "
NBI the applium a(.rote huOdW{oecupnt port or hanale hamdats muuial Type of Roof '
as dented by the Cupertino Municipal,Code,Chapter 9 A and to Health and Safety s ,
Code.Q]'in 255324)t.i1„n.'O No... 1•.x 1..f,.:: I' f .. 1.t i�_,./.,L'., : s . .
Ali.roofs shall be inspected prior to any roofing material being installed. .
,'t will the non building Occupant use equipment or devices which If a roof is installed without fust obtaining an inspection, Yagree to'remove
't hasardous ser canumimnu u defined by the Bay Arm Au Quality ManagementDismiss,? ' all new materials for inspection. Applicant understands and will comply with
❑atm . .❑No Iall non-point source regulations.
I have read the lootrdaut materials requirements ndu Chapter 6.95 of the
Califomie Health At safety Cade.sections 25505.73533 sed 25534.1 understand that
a i(the Wilding does red currently have a renan6 Mut it is mat responsibility as notify to
occupant of Ne requirements which must be met prior to issuance of a Certificate of
Occupant
`Y' ' Signature of Applicant Date
Owner ar•nNonud agent on. All roof coverings to be Class "B”or better
.,. ._,i .�..,•,. _ ,. - OFFICE
CITY DI GUPERTONNO PERMIT CONTRACTOR INFORMATIOS
BUILDINGADDRISSS: PERMIT NO.
r 10531 S FOOTHILL BLVD 01090092
OW NER'S NAME: APPLICATION SUB DATE
;;- WERNER GERTRUDE A 09/20/2001
d ONE: SANITARY NO. CONTROL NO.
257-5076 ,
ARCHITECT/ENGINEER: PHONEa BUILDING PERMIT INFO
INTERIOR REMODEL BLDG ELECT PLUMB MECH
OKZ ,
00
INSPECTIONS DATE LNSPEC. TO ARRANGE INSPECTION JOB DESCRIPTION
<i CALL 777-3228 MONDAY-FRIDAY 24 HOURS RESIDENTIAL:
G 0 v, BEFORE REQUIRED INSPECTION.JOB ADDRESS 0 SFDWL 0 KITCHEN REMODEI
fz'4c UFER GROUN/PIERS/H.D.S. AND PERMIT M ARE NEEDED WHEN PHONING, 0 ADDITION 0PLUMBING RE-PIPE
t 'LIFER GROUND [IMULTI-UNITOSTRUCTURAL
off= PAD/SETBACK-CERT RESIDENTIAL_COMMERCIAL_OTHER_ MODIFICATION
3 u u GARAGE SLABS/PREGUNITE 0 INTERIOR 0 CHIMNEY REPAIR
HAZARDOUS FIRE AREA IMPROVEMENT ❑ SWIMMING POOLS
0< POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
i S p o UNDERGROUND/SLAB 0 YES It ve.-1 undemund shot o Class A roof assembly is myuhcd. 0 BATH EMODEUREPAIR 0 DEMOLITION
0 OTHER
6 R -PLUMBING'.-.. .................._...•,
I,
a ELECTRICAL - ❑ NO Initial I.C.B.O.F - ----
3$ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED EXISTING ROOF COVERING COMMERCIAL:
'PLUMBING ❑'NEW BLDG/ADDITION CJ DEMOLITION
Number of existing coverings 0•TENANT 0 FOODSERVICE
MECHANICAL . . IMPROVEMENT
ELECTRICAL To be removed Tobe retained 0 OTHER
Y.r{y FRAMINGVENTS _
'r.INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE.HAS BEEN SIGNED TYPE OF ROOF COVERING
ROOF SHEATH/DIAPHRAM EXISTING: PROPOSED: -
PLUMBING 0 Built-Up Roof 0 Built-Up Roof
TUBS'&SHOWER PAN 0 Asphalt Shingles 0 Asphalt Shingles
'FMECHANICAL 0 Wood ShikEs• 's �: 0 Wood Shakes i..
E TARN
BOND Cj Wond'Shinylrf '�,' P�, I 0 Wood Shingles
RAMING/STAIRS/E.EGRESS 0 Other(specify) „0 Other(Specify)
- 1NSULATIONfVENTILATION Provide I.C.B.O.Report No.
;'COVER NO'.WORK UNTIL ABOVE HAS BEEN51 NE � Provide Mfgc lnsrellatiz?z�Specs.
EXTERIAL'SHEAR/HbLD DOWN Ot
INTERIOR SHEAR/HOLD DOWN
--. SHEETROCK/SHEETROCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
..E7(Tl'RIOR LATH/W-SCREED.- -� nn /q�
SHOWERCATH. " f..- V �/Q /
NO TAPE OR PLASTERUNTIL A86V6 HAS BEEN SIGNED
SCRATCH COAT
. SEWER/WATER _ - •71-,/
"TEMPORARY APPROVALS
,. .'OCCUPANCY•
FINALS_ .. _
PLANNING 777-3308
zQ GAS TEST_
I„" .GRADE(P.W.777-3354)
pL
W''> ..FIRE__:.'. _
.
0. Z 'HANDICAP' '':
V O ELECTRICAL•'"
O'U PLUMBING'.'
ry MECHANICAL' _
ENERGY'.'
STSUALFINAL ONLY"','- _
BUILDING."': :'
••QCC/UF CYOF.BUILDING IS NOT PERMITTED
• cU7s�7L`BUllDING FINAL;is S[GNED BY HUILDINO_
-•-'•"- '"'1 4'..-. •."s .: CERTIFICATE OF OCCUPANCY 0
.
- 'PRE-INSPEC 7014: - --"" '_ " - -' PLYWOOD: IN-PROGRESS
.DATE . INSP. _ DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
.INSP. DATE INSP. DATE INSP. DATE
NOTE. OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
i•c''c .'r. - APPLICANTS POSTING COPY-
POSTTHIS CARD NEAR FRONT OF BUILDING
CITY OF,CUPERTINO TETNO I,��
. BUILDING DIVISION 0L*3w
�! 21
BUILDING PROJECP N 1FICATIO
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAI
M
WNER'S NAME: 1= PHONF�;, CQN(1 CFOR'S NAME LIC NO:
{ Irl\.{�`� �'.lC'���4 •�'. )'D 0 ,7C, 1.` L . JT,G �. _ :. ) 4' ::'11 i 7 N/C CONTROLM
CHITECfAiNGINEER: LIC NO: AD DRESS:- ❑
BUILDING PERMIT,IN'FO
- •• INSPECTIONS - DATE INSPEC. ❑ Consultant Facs Paid by Applicant(Initial) BLDG ELECT UMB MECH
FOUNDATION/PIERSM.D.S. INSPECTION RECORD JOB DESCRIPTION
UPER GROUND NOTE: ALL GRADING AND DRAINAGE BLUM UAL
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH ❑sFDWL ❑KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF 11 ADDITION O PLUMBING RPPIPE
GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI'UNIT ❑STRUCTURAL
MODIFICATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTIONRIOR O CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PM - 4:30 PM) IMPROVEMENT ❑SWIMMING POOLS
❑BATH REMOIIREPAIR 0 EMOLITTON
PLUMBING " 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑GDR
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS ' 42, 1
AND PERMIT N ARE NEEDED WHEN PHONING. % -� I
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED COMMERCIA a +
PLUMBING ATTENTION CONTRACTORS: ❑NEW BLDG/ADDITION ❑DEMOLITION
MECHANICAL NO PERSONNAS)SHALL PERFORM WORK ON 0TEIMPROVEMENTNT 0FOOD SERVICE
THIS JOB SITE WITHOUT BEING IN COM- DOTTIER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION MNSPECnON SPECIAL INSPECTION REQUIRED ❑ DATE INSP.
'PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATHIDIAPHRAM
PLUMBING
TUBS&SHOWER PAN
ECHANICAL emr
ECTRICAL/POOL BOND C} St
C_. FRAMING/STAIRS/E.EGRESS ( �� s ,�F 9 q
INSULATION/VENTILATION
.COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIALSHEAR/HOLD DOWN ('vzt, R-6
�7 {
INTERIOR SHEARMOLD DOWN
SHEETWROCK/SHEETROCKSHEAR -•ak LL
EXTERIOR LATH/W-SCREED 5 .C.y1 K
pr&6r)ILSHOWER LATH NL1 /9 WI-Ya✓I� Z� �
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS '
OCCUPANCY
ELECTRICAL
GAS
FINALS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL
PLUMANIGBIN
G
ECHCAL
ENERGY
VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY ❑
( BUILDING IMPORTANT: �% ISSUANFE/ATE!
OCCUPANCY OF BUILDING IS NOT PERMITTED PLEASE READ REVERSE SIDE BEFORE
UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!!
INSPECTOR: I ISSUED BY: '
APPLICANT'S POSTING.COPY