S 0149 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDINC.-ELECTRICAL FERMI INO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECIIANICAL
BUILDING PROJECT IDENTIFICATION
BUILDING AIIDRESS: SANITARY NO. A ' ATION SUBMIT-TAI.UNIT
40135 T::oReSr ME, _ 00
'ROL
_ OWNE 'SNA 551 QSS$[J qD�JJ11 0 C ICA )R, l .IC NO: �� NIC COMM
ARCIIrOiCT/IiNGINiiI!R: LIC NO 77 6 C AfVAI W V_ . S ❑
NTACY: PHONE BURRING PERMIT INFO
❑ Com uRenl Fed Paid by Applicant(Initial) HLUG ELECT PLUMB ECH
LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 thereby aRrn mar 1 sm I;cen,ed ander roevniom M ChWu 9(�nmercing JOB DESCRIPTION
OcZ wad sectinn]ggu MDivia;un3nnne Ravirc.v and l'mfnaimm Code.and my rr<n,o i. RESIDENTIAL'
WOO PERMIT ISSUANCE
F in full hrce nM tli `�'1O QO �, �I r ❑SIUWL ❑KITCHEN REMODEL
Qc.Uj Licemc Clea Ol Lc.R •+ I- APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING NF:-PIPIT
Vadp�, Ilene C.muctw
F.7h AHCiII'rECTS ITEC RATI PANELS ❑MULTI-UNIT ❑STRUCIlJ RAI,
ZOr,�Z IunJeruud my Mans Dull h,uwd is wMie records, MODIFICATION
UPTO200AMPS
OZ�� C1 INTERIOR [I CHIMNEY REPAIR
r Elm: Loero,d%ofraainrwl 201-HO)AMPS IMPROVEMENT E]SWIMMING POOIS
Y
J OWNER-HUHXHIR DECLARATION OVER I(g1AMP$ C1 BATH RILfODLURFPAIR [I DEMOLITION
yyx K G I bemhy affirm that l oat aa,m from Js,Cwmmrmmr'a License lar for the
W O d V which rec aims a ISatiut 703 1.5.Huainan uM ove,da;oms Code:Any city w marry SIGNS ELECTRICAL ❑OTHER
!Z 3{i then its
.perm;t re mus the.,PlkwL impmve,hper Tit t or repair am arrvclure
I_'�v� pt;mmita;enewdpaHortquithe the for wenpnmil lnfile eug dr himernl SPECIAL,CIRCUIT/MISC.
y)Y
hat heft lianwd random tothcpf Disitio of me aBusma rend ense Prefo m.,bn%cr9
(com.imgwiih Smlinn]Ogq nl Oiviainn 3uldeNmircxurd Pmleuinna Co.k)w 'R:AIP.MEI'ER OR POLIiINST. COMMERCIAL:
nae Ibm he is eacmlm therefrom aM the hose for the alleged!exemption.Any viMmaioss of NEW BLDG/ADDITION ❑DEMOLITION
Seaitm 7031.5 by any npplieom for a permit whjai,if,eppliaam to a civil penalty of POWER DEVICES ❑77;NAN'1' ❑FOOD SIiµVICE
not more.than rive huwhN mines($5D01�
Ih1PROVEh1C\'I'
f�0D lmownvuroadmapmectur isnormm,cciloro.igu>sdeJwle 0aW.Buarwm. SWIMMING WK>L EfF,CUUC
will Jntlewor Codeebe Crurcximr,teMcd ormBtivies et a,,Iy,1Ion ne,of 1_1 OTHER
1 adI %bora CMerllu:C'oumtrrctur'a I andel I'w than'nmapplymlfowner of OUTLITS-SWI'ICHF_S-ITX'R1RIS
pagmery win builds m;mlrmvit th meb r,rwin Junsuch uvmmhimselfwdfough
his own owe,mecs,pmrvdedl r m mch impnmvcmid are nm inmrol' or of4cJ for NI!W RI1s1UL'Nf1A1.F,LF.CIR
sak.IL Mrwever.tFc hilJin6mimpmvenermt is mrd wiminmeycv of cumplmiun.dw Sty IT 41(%)R AREA SISQ.FT.
eraxr-builder will have the buNen of proving that he did nm build or impose Im par- w 1 D
pre of ole), P 1•
0 1,m oween of Oe pro i mo exclav vcly comewler,with liccrod corumvn In 'TOTAL:
conurum the Poved(Sec.7014,Buainna and Pmfe acirt Code)The Con ractors Li. =�
nsc law doer not apply to an owner ofpmpeny who Wills or imposes lbercnn,and QT'Y, PLUMBING PERMIT FF f�1,1
ID
who unread,fw
oreh project,with a crmmelrm,)hceoaW p.I to the Garacmh V L ,/
Liars lax: PERMIT ISSUANCE
❑ I stn exempt abler Sm. ,B&P C for this reason f "UYEHfINO
ALTER-DRAIN&VFNI'-WAl'ER(EA) VALUATION
(lw'rer ITIO
WORKER'S COM PENSATIONDI!CIARowne, HACK FLOW PROTECT.OF.VICI!
1 fandmy anion under pcoahy of e of Corn ent of iM inwm log W(Aaf int:
� Ihave and will mainuine Ceririewe of Cortvmt nadf-inwmfw WdNx Cernpen- DRAINS-Fl,(F)0.R(KIF,AREA.COND. $IGRIFS TYPO CONSfRUCI'ION
a+rob libi for by SeOiso 3'!00 M the LeMx Cede,for the per(mmxrce of rk
woh farwhkh illmosmtitiai elo I1XTlIRIlS-%iH IAAi'
❑ 1 have com!will maiwin WrnVK C of me v Im'urmce, li his,ree by Section
32o0 nrmlc//r[[gg�`La�wmar Code Rrthc lerfunwcc of BrXyn wvt'f�«whcich misprnnit i.iasuM. GAS-EA.SYSfEA1-I INC,4OVD.ETS OCC.CROUP APN
Cy�Wmgr>:n Co E r%CATE OP EXIN NYIRO WOVS'��� OAS-1!A.SYS'I'IN-OVI?HdfC\I
t/ A COMPENSATION INSURANCE GREASFANDU.SFRL WASTE INTERCEPTOR
BUILDING DIVISION FI'XS
Illtisaeclionnml not be cumnpkieJ irtM psnnit is fw orc huMn+l ddlan(S ltLl GRFASETRAP
or ku.) PLANCIIECK IEE
I arify that in the perfomunceofine woh for which Ibis permit is i%%wL l hall SEWER-SANITARY-STORM ITA,21X!IT.
not employ any pawn in any manner a,us,In becnmu sul eco to the Wirkers Compco. ENERGY FEE
Z union""of C.1irmvia.Dare WATER HEATER WNENTIELECRt
O Applicant GRADING FET!
NOTICF TO APPLICANT:IL Aar making div Ccnificmc of 8xcmgion,pm J,n ld WATER SYSTENTREAGNG
F^ become wbjhCom
ecm mm the Wuer's lemiuo amPmv;ainm a be Labor Cadea e,Ymay SOILS ET.F,
Wfoamwith cmo I,.ith arch vasisimm;-,hispermit ahadl he dcemcd rcMcd. WATER SERVICH
Q
5 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLNH. SQ,EY PAID
V O 1said yaRnnmwOnei.acmr 1ionkndineavucof,sec,R perfurmMeme nciptM
the woh for whicb this permit is iso d esu.309],civ.C.)
W F' Lecder',None 1 r TOTAL
UW Ls sAddress TOTA I:
VI anify that 1 have real mix application aarmmate dot the above wromeatiun in HUILIIING Ilih
ZI c..1 agree m rnmpiy wim all tiry anJ a-my onliraarcu amt sus Was rdoting m QTY. MECHANICAL PERMIT FEE
V z Wilding cnnome,imn,and hereby amhwire reperenrarives of this city In,enter upon rhe SEISM IC FEE
abmvecmentioned proper,for inspection pmryx,cx PERMIT ISSUANCIi
(We)agree to save,indemnify aM trap hmndex the City of Co caries against ELECTRIC FE!
Iisb;EJc,judgmerm.cmis endurances wm;h my inany wayaarvcagvnV said Cary ALTERORADDTOMECH.
in coctt
yueenf the gram;n,ofmis permit. %.UMBIN
mm
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO 10.00)CPM) MECHANIC, b
SOURCE.REGULATIONS.
AIR HANDLING UNIT(OVER I0,0WCFSU CONSfRU I<NT.K
Signuure MAppIn cxaemr Dare EXHAUST HOOD(WMUCI) HOUSING MITIGATI N'FEE
HA]ARDOUS MATERIALS DISCLOSURE
Will theappl'ranl or future Lundingwcaprelmweher, Media hvado s,nalc d HEATING UNIT TO I(X).(XN)RTU)
as,deriacd by the Cupertino Municipal CMB.Chapur 9.12,and to Health and Safety HF-,1TING UNIT(OVER Hat."HN)
Cods,Seabn 25532(0)] .���/
E]Yes E"i VENTILATION FAN(SINGLE.RISID) PAID
Dmc neipt x
Will the air comm a rims a definedding by he m sac equipment m dMara which
rim hvnrdoux air comaminanu as dcrired by the IIIb,Area Air Qualify Menugcncnt 11(IILP.H-COMP pHP OR IIX).gXl BTU)
TO AL,:
)u°msf! / BOILER-COMP(OVER IOO.WO BTU)
Oyer [�N6
I have real the T,,,nwa mwervda retire ,andr Chapter 095 Mame Csh- AIR CONDITIONER ISSUANCE UAFE
famia Deal&safety Cede,Sections 25505,?5533 an1255M.I urdormand that if Je NEW RESIDENTIAL MEGA. SQ.FT,
huilJing Jcmn nx curmnJy Mac a tcrwnt,dot it i..ntY ra:ptmaiNlity n nary do iatupant
oftic noaa",hi rte mea P. sofa Ccrifwvc ul
(Trac or
autMrirM agant Uwe TOTAL-; ISSUED BY
OFFICE
POSTTHIS CARD NEAR FRONT OF BUILDING PERMIT NO,
CITY OF CUPERTINO S
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION t7 1149 "
IL
SANITARY NO. ATION SUBMITTAL 111
Iy Ow 'S. ME: CQKFI L+j_L a�j=a�0q )R'�N.. ). I V JO ( VAC CONTROL
® ARCHffER/ENGINEER: : ESS: Lr l' T' El NO
DBUILDING PERMIT INFO
INSPECTIONS DATE INSPEC. ❑ Consultant Fces Paid by Applktant(Initial) BLDG ELECT PLUMB
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL
SHALL BE INSTALLED TO COMPLY WITH [Isimm. ❑KITCHEN REMODEL.
PADISET BACK-CERT THE APPROVED PLANS AND CITY OF ❑ADDMON ❑PLUMBING RE PIP].
GARAGE SLABS/PREGUNTIE CUPERTINO STANDARDS. ❑MULTI-UNIT ❑STRUCMRAL
MODIFlCATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT CJ SWIMMING POOLS
UNDERGROUND/SLAB CALL AFTERNOONS (1:1111 PM - 4:30 PhD C1 BATH REMODEUREPA1R ❑DEMOLRION
PLUMBING 777-3238 MONDAY TO FRIDAY 24 HOURS BE- ❑OTBER
FORE REQUIRED INSPECTION. JOB ADDRESS
ELECTRICAL AND PERMIT#ARE NEEDED WHEN PHONING.
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED COMME�AAL-
ATTENTION CONTRACTORS: ❑NEWBI-DOADDITION ❑DEW)LGIO.N'
PLUMBING NO PERSON(S)SHALL PERFORM WORK ON C1 TENANT ❑FOODSERVI(7!'
MECHANICAL THIS
THIS JOB SITE WITHOUT BEING IN COM- 0OTHER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION ,
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSI
PLACE NO,SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPHRAM
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
• ELECTRICALIPOOL BOND
FRAMING/STAIRS/E.EGRESS
INSULATIONNENTILATION
'.'COVER NO WORK UISTWABOVE HAS BEEN SIGNED
EXTERIAL SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN
SHEERVROCIUSHEEIROCK SHEAR
t EXTERIOR LATH/W-SCREED
SHOWER LATH
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT I D
SEWER/WATER
.TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
FINALS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL
PLUMBING
eMECHANICAL
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!! ---
INSPECTOR. ISSUED BY: -"
APPLICANT'S POSTING COPY