28265 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B ILDING-EIbK'CT'RICA], PEJMITNO.
APPLICATION/PERMIT PLUMBING-MECRANICAL N� C
BUILDING DIVISION BUILDING PROIRCTIORN-1'MCA'fRDN L J
BUILDING D 15. SANITARY NO. APPLICATION SUBMET,TA/L DATE
UNIT# LOT# —
OWNERSNAME: \� PHONE: C NTRACfOR:S NAME: LIC NO:
NIC CONTROLM
RCHI CI' 'INFER: I LIC NO: DURESS: ❑ �!'�
CONTACT: PHONE: BUILDING PERMIT INFO
p 4A1 uLs�L QTY. IiLECI'RIC PERMITE BLDG Le ECr PLUMY, MF.CH
§645 .w �/� a-1J U PERMIT ISSUANCE:
V`, "'NLICCENSEEDD CMA R'S DECLARATION APPLIANCES-RESIDENTIAL
QWz Iherebynffinmhmlionimakidan erprovisionsof Cheper!J(commencingwith JOB DESCRIPTION
POOq Section 70tDivision 3oftheBusiness and professionsCodaand my]a..isI. PANELSpull 'S 1
Liceace nse
Cla, effect UP TO 200 AMPS
.rQ,ZW Liana Cl¢ Cmdo
N y Dule Comlacmr201(-y OVER
AMPS Z_ � ARCHITECTS DECLARATION SQ.PT.FLOOR ARCA E/SQ.lel'.
��� lundeatand my plana shall Fa used ax public rccorJv OVER 10 10 00 AMPS
Foes SIGNS BLEC71IDEAL
Y ,-4 Licensed Pmfessimal �Y
�< OW NEN-BUILDER DECLARATION ON SPECIAL CIRCUIT/MISE.
a LF I hereby affirm that I am exempt from the Convenors Liaises Taw for the
following reason,ISeninn 7031.5,Business send Professions Cale:Any city or county TEMP.METER OR POLE(NST.
u'op which requires a Permit to convect,alcor,improve,demolish,or repair my vmctum
>+� pnor mits isxunor..No rcyuitcslhe.,licant far such Permit to fleasigned smemem POWER DEVICES
pal_D O that he is licensed pursusm to the provisions of the Contractors License Law(Chapter
L 9 with Section TOop SWIMMING POOL ELECTRIC
(rnmmencingwi )of Divisinn3oRhe Business end Profesaiona Code? �VAL so's—
or that he is exempt hcrefrom and the b is for the alleged exemption.Any violation of OUTLITS-SWITCIiFS-I:IXTURFS
4 Section 7031.5 by my applicant for a permit subjects the applicant m a civil penalty of
not mnre than five hundmd dollars($51.). NEW kFSIDCNTIAL ELHCTR 5 Q.
o' ❑ I,asawncraOhepropny,armyemployeawithwageamtheirsolecompensation, Q STORIES TYPL'CONSTRUCfION
y rt.. will dothe work,and thegracture isnot intended oroffcred foreale(Sec.7044.IJuslncss
UP—
and Prafessitsas Code:The Cmdracmra License Law does not apply to an owner of
property whnhuilds or improves thereomand whodoes such work himaelfonhrough his
OCC GROUP NES.UNITS
ownemployces,provided mm
that such improveesmenot iatendeduroffertA forsale.If,
however,the building or improvement is sold within one yemofcomertion,theowner- ).A
builder will have nue burden of proving that he did not build or improve lot purpose of It IL
❑ Lusnwncr or the property,am exclusively convecting with licensed wntracmrsm QTY. PLUMBING PER MIT HE I1.00D LONE APSE
onawrs the pool.(Sec.7014,Business and Profesnowns Codep The Connectors PERMIT ISSUANCE
License Law does ant apply m an ownerof phopmy who builds or improves thercer,and
who contracts par such projects with a contractnms)licensed pursuant to the Connector's ALTER (EA)License Law. FEE SUMMARY
❑ 1 em exempt under Sm. B&P C for thin rcuum OUT
SIDE FEES
Owner Dme
DRAINS-FlAORBACK FLOW PRO,'IR 'A.COND.
PROTECT.IJ. E SANITARY Y N
RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y
❑ I hereby affirm that l have a certificate ofcousennn self-insure,or a certificate(ifIsIXTDRE$-1'ER'I'NAP BE CEI
Workers'Compensation Insurance oracertified copy thereof(See.3800,Lab C.)which PARK FEEYN
Covers all employed.under this poprot. GAS-EA.SYSTEM-1 INC.4 O EIPT#
Policy# _ BUILD( DI VISION :iES
Company GAS EA.SYSTEM-OVER .A PLANCHECK FEE
❑ Certified copy is hereby famished, v 6
❑ Certified copy is fled with the city inspection division. GREASEIINDUSTRL WAS .T PfOR GRADING FEE t(�
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE t
COMPENSATION INSURANCE
phis section need nm odcomplemdifthe pemhit is Tanana nandreJ eollars rllW) SEWER-SANITARY-STORM EA.2WFT ENERGY FEE
or lcasJ
I certify that in the pemormance of the work for which this permit is issued,l shall WATER HEATER W/VENLCLECTR
not employ any proven in any manner so as to become subject to the Workers PAID
Compeasatimlawsof Celifoeie. Dam WATER SYSTEMrTREATING —Dale kcceipt#
Q Z Applicant
Z0 NOTICE To APPLICANT:1f,ufter making his CeHlficme of Reniona,you should NEW RESIDENTIAL PLMB. SQ.Fr. TOTAL:
t-+ Vl become mbjec ni he Workers Compensation pmvi.m.,a!fie labor Code,you must
forthwith comply Man such provisions ad di,permit shall he dcemeJrevoknl, BUILDING HIS _a
yQ CONSTRUCTION LENDING AGENCY SEISMIC TLE
z I hereby affet that there is a construction lending agency for the performance of
Uework for which this permit is issued(Sec.J09'l,Civ.CJ T ELECIRICFEE
0 Lender's Name
Q U LLender's AtJresa QTY. MECHANICAL PERMIT FEE PLUMBING FEE
I cmify That 1 have read this application and state that the above information is
bind construction,
tocn,and hereby sadamo munryotatives esaod stat slawsr upon the PERMITISSUANCI3 - MIiCHANICAL FF.E
U � almocng rationed property
herebyuuctionu representatives ofthie city to enter upon the CONSTRUCTIONTAX
V 7 ebnvememigree pmpve,ind inspersion purposes. ALTER OR ADD TO Mf:CH.
G (We)agree to save,indemnify and keep harneess hM1c City r Capstone id Cit t
liahilihics,judgmena,costsvhdcapenus hich cony' any wayeceme against said City AIR HANDLING UNIT(TO 10,000 CFM)
in sequenc sltbeg mtin fth' It.
2qrzAIR HANDLING UNIT(OVEN 10,00)CFM)
Signmureo pUG nor Dee BXHAIIST I IOOD(W/DUCT)
PAID
HAZARDOLkMATERIALS DISCLOSURE HEATING UNIT('10100,000 BTU) Date Rmcipt#
Will the applicant or future building oecupam store or handle haaudaus material HEATING UNIT(OVER IW,(XpBN) TOTAL:
as defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Surety
Cede,Section 25532(a)7
11VENTILATION PAN(SINGLE BESIDE
❑255 C1 No
Will the applicantor(ulurchuildingoccupant usmyuipmenturdeviees whichemih
BOILER-COMP QHP OR 101,r11)BTU) ISSUANCE DATE
bazvdous air contaminants as defined by the Boy Area Air Quality Management BOILER (OVEN IW.000 BTU) -
District? q
❑Yu 0 N NEW RESIDENTIAL MECH.—SQ.Fr.
I have read the huaardus materials reyuiremems under Chapter 6.95 of the Kt'
Califomia llealth&Safety Cade,Sections 25505,25533 and 23534.1 undersmadtam V(� 491,9 119 d the h.rding docs not currently haven,(nam,that it is my reslmsi
ahility to notify the J
occupant of the requirements which must It con prior to issuance of a Certificate of
Occupancy.
t
Owner or nmhaized agent Date ISSUED BY:
OFFICE
FROM : KELLY GORDON DEV 408 241 1353 PHONE NO. Oct. 14 1996 03:35PM P2
RV
CITY(fiLDI CUPE
'UU[LUING UIVfSJONSIUN +xMl Nu. �N
BUIL•DINO ADDRKNSs B 1 INO PA(J CT D InCA N `8 2 6
aXNJURY NO. AP .xa NSUBMITfnL O.
OWNERS NAMkI CONTRACTORS NAME: IJGN
PNON _
•."it\•': A -Y ..•1 NK NrA Ll `.
AR TP,tT N nCN : ADOR
INSPECTIONS Dw7E. ArSPEC.
INSPECTION RECORD
BUB•DwoPERhOTCM
BLI)< eJ-hCT PLUMB `ABLTI
FOUNDATION/PIERS/H,DS. /• t NOTE: ALL GRADING AND DRAINAGE
UFEAGROUND syr 'r-'e SHALL BE INSTALLED TO COMPLY WITH IORDPscruPnDN
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF _
`'• t,,; ���
GARAGE SLABSlPREG[INITE IA-7-7 - CUPERTINOSTANDARDS. .�
PGURNocoNii(sI> iJNT>L,�oVEHA_SSEBZ4sci� ' INSPECTION SPECIAL INSPECTION
UNDERGR0 /SLAB RE UIRED ClDATE INSP.
PLUMBING ,� i�
ELECTRICAL � � 7i .,, c'v.•-�,� ��q�- �p�
Dp'NOTPOURFLDORUNS7I:ABOY&Ef/Yjf,E@LgT
PLUMBING -
MECHAMCAL /-9-
ELECTRIC•4l,
fR4EG VENTS 9-y�
NSUTATION
Rf�10ENOSDBFI.00R'.UN'l7IABOV6'.HA§�BBp%f5i(3l�Di
ROOF SHEATH/DIAPHRAM
PLIJMBQIG !� ?
'f UBS&SHOWER PAN
bIS
CHANICAL _
ELECTRICAL/POOL BOND /FRAMING/STAIRS/E.EGRESS 7s 9
NSULATIONNENTILATION
COVERN6 WORIR .
UNRC'i:ABOVF.�TFAS;BE@t;SiGNEIT+:.
EXTERIOR SHEAR/fIOLD DOWN 1 -�jr
INTERIOR SHEAR/HOLD DOWN _
SHEETROCK/SHEETROCK SHEAR•--.'-r ��•�-Y
I F,XTERIOR LATH/W-SCREEN "J
SHOWER LATH
NOTAPBORMASRF,RUNTIGABOVE;HASBEQi'SI@IFD'. -
SCRATCH COAT
SEWER/WATER
T MPORARYAPPROV
BUILDING
ELECTRICAL
GAS
F1NAlS'
LASTEST `.,,.
GRADE
FIRE APPROVED FOR OCCUPANCY
ire
low
HANDICAP TO ARRANGE INSPECTION ISSUANCE DATE
ELECTRICAL/ENERGY CALL AFTERNOONS(12:301 M•a:OB PM)
4C t� 252-450.5 MONDAY TO FRID•aY 24 HOURS
UMBING/ENERGY 9G t.0 BEFORE REQUIRED INSPECT ON, 10B AD- 7
ECH.aNICAI./ENERGY DRESS AND PERMIT n ARE NEEDED WHEN
�!- Sc "-e PHONING. SEP 29 1995
BUILDING/ENERGY cj►9L `� ATTENTION CONTRACTORS:
ELECTRICAL FINAL TEST -9 NO PERSONS)SHALL PERFORM WORK ON
THIS JOB SITE WITHOUT WORKER'S CITY ur L.� _nIInV
O
dE.
�
1�7N,•,CIF:9 * ` �02DINC` IMPORTANT!
q d PLEASE READ REVERSE SIDE BEFORE
e .. �rv` CALLING FOR WN,1 TArcocr-rrnVI,