19636 (2) APPLICANT TO FILL IN INFORMATION WITHIN REO LINES — USE BALL POINT PEN ONLY
Building Pro'ect Identification PERMIT NO.
-
_1B0dLi ne a 5Z-/
3— �-, - 19636
1 L4L c e r v
v{ _ arse. }�e �t Phone:
y\\ � CITY OF wme7N0 BUILDING DIVISION �,_^7^ G/ D
C°^treetora : uc.Na: APPLICATION /I PERMIT ' ( l
BUILDING-ELECTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL N
Architect/Engineer. Lic.Na
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRunder provisions
I herebyaffirmMW)rl iv Licensed ofthe erpessand sof Chapter9(commmc APPLIANGLSRESIDEN7IAL JOB DESCRIPTION
inense is in full MW)rd the Business and ProfesaloneCode,and my
bmnsebinfuu force arta ic,# PANELSLiosR—,-- \2) C�1�'a�y�{>I/
Date Ckse mdr I -�I
Date Contactor 701-]000 AMPS
ARCHITECTS DECLARATION
p CO I understand my Ales ehaB he used as public records. OVER 1000 AMPS SQ.Ff.FLOOR AREA S/SQ.FT.
Ij Licensed Professional SIGNSELECTRICAL
6Y1 OWNER-BUILDER DECLARATION
Ina 3
Iherebyaffim thatIexemptfromthenornstrode law forthe
SPFCIALCIRCUIT/MISC
foVowing reasnn,(Setlon 70]1.5,Buelnaand Professions Code:Any or
Geq
-
countywhichrequlresapermltmcomtmd,alteglmprove,demolLh,orrepalr 'CEMP.METPR ORIOLE]NST.
anystmmmpdortoltsWuance,aborequtmatheapplla trorsuchper tic
E 1
Ilk a signed statement that he is Ilconsed pursuant to the provisions of the POWER DEVICES
3w C.M.d.e.Llceme Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMINGIDOL CCR]
Mon 3 of the Business and Professions Code)or that he b exempttherefromand VALUATION
0 the basis for the alleged exemption. Any violation of Section 7BILS by any OUTLETSSW ITCHES- S 006 - 11,
applicant for a permit subjetmre
sthe applicant to a civil penalty d not othan
$ flvv h,'drcddollare(SSIB. NEWRESIDFNIAL SQ STORIES TYPE CONSTAIKTION
�n
Was owner of the property,or my employees with wages as their sok '�'
compensation,wllldothe work and the structure Is not intended or offered for
0 Is(Sec.7094,Buelness and Profesakma Code:The Cmdrator'sUcenae law
P'ds$ does not apply to an owner of property who Wilda or improves thereon,and y I
OCC,GROUP RES.UNITS
who does such work himself or through hisown employees,provided that such
Improvements are not intended oroffered forsals.If,however,thebulli ing or TOTAL:
Impmvement bsold within one yearof completlory the mvnenbullderwlll have
t rdeoofpmvingtha,hedid notbulld or bnprove for purpossofukJ. QTY. PLUMBING PE FEE FLOOD ZONE APN
L as owner of the property,am exclusively contracting with Ilcensed PERMIT ISSUANCE
contractors to construct the pmjet(Sec.7044,Business and Profamlons Code:
The Contractue.Lkenue Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wild.or improves thereon, and who contracts fee such paojects with a
,Il¢act°r(e)licensed pursuant to the Contratot'e License Law. FEE SUMMARY
to
a s exempt under Sec. .B k P C for this reason BACK FLOW PROTECT.DEVICE
�k OUTSIDE FEES
Owner Date — — J11 4� — DRAINS H.DDR ROOF,AAG,GOND. SANITARY Y N—
RFCEIPIN
WORTef COMPLNSATIO DECLARATION FIXTURES PER TRAP SCITOOL TAX Y N
❑I h by affirm that 1 have a certificate of consent to wlf-houre,ora RECEIPT
mrtiflmteo(Wor r Compev timiw ranmoramnife mpyther°or(Sec.
3800,lab C.) GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
Policy N GAS EA.SYSTEM-0VER 4(FA) RECEIPT N
Cany BUILDING DIVISION FEES
omMCenlBed copy 1.hereby fumle
❑CertlRed copy b filed with the city ity inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCI'IECK FEE
CERTIFICATE OF E%ETIPEION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.200FC. Date RCCeI tN
(Chis section need not be completed tithe permit Is forone hundred dollars
(510(fiaWATER HEATER W/VENT/ELECTR ENERGYFEE Y N
Imnifyify that In the performance of the work lorwhkh Wepermit bbsued, —
I shall not employ any person In any manner an u to become subject to the WATER SYSTEM/TREATING
Workers'Compensation Laws of California.Date PAID
C• Z Applicant NEW RESIDENTIAL]'LMB. SQ.FT. Date Recei t#
Z O NOTICE TO APPLICANT.If,after making t his Certificate of Exemption,you
F- should become subject to the Workers''Compmustlon powbko,of the Labor TOTAL:
(/9 Code,you must fon hwith comply with such provblom or this permit shall be
LU > deemed revoked. - BUILDING FEE Z.07
CL CONSTRUCTION LENDING AGENCY SEISMIC FEE a
I hereby affirm that there b a construction lending agency for the perform- ELECTRIC FEE
7 Z ance oftheworkforwhlchthbpermitis Weed(Sec.3097,Civ.C.) TOTAL
U Q Iandere Name PLUMBING FEE
LL L.oder.Address QTY. "" MECHANICAL PERMIT FEE MECHANICAL FEE
OW Icertify that have read this application and stale that the above informality
(L Is corms.I agree to comply with all city and county ordinances and state laws PFRMITISSUANCE FEE—PAID:
>_ 0. to building construction,and hereby authoelve representatives of this
H U) city to enter upon the above-mentioned property for Inspection purposes. ALTER OR ADDTO MFCH. DBte RCCeI tq
— (We)agree to save,Indemmfy an d keep harmless the City of Cupertino P
against habilBka,judgments,cone and expenses which may In any way amme AIR HANDLING UNIT(1'010,000 CFM) SUBTOTAL:
ga t said City in mosquence the granfl oft .permit
"1
z y q AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION TAX
Sig ureof Applcant/Contractor Date ea IXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAb RDOUS MATERIALS DISCLOSURE
illtheappile"oorfumre building occupant vM
xupant store or handle hardous HEATING UNTT(TO 100,000 BDate Reed t#
material as dented by the Cupertino Municipal Code,Chapter 9.11,and the
I1.1th and Safety Code Section 75537(a)7 HEATING UNIT(OVER 100,000 BTI) TOTAL: a'Zr
❑Yea M No
W111lheapplicant or future building occupant use equipment ordevices VENTILATION FAN(SINGLE RESID) 'ISSUANCE.DATE
which emit hamMous air contaminants as defined by the Bay Area Air PAW
•
Quality Management District? BOILER-COMP(311P OR 100,000 BTU)
4 Yes No
haveread the has, ouamatenab requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BN)the U71990
the California Health k Safely Code,Sections 25505,75533 and 25534. I
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT.
responsibility to notify the occupant of the requirements which must he met
prior to Issuance of a Certificate of Occupancy. p Ciro ra rltrrrtino
Owner or authorlud agent Date TOTAL: ISSUEDBY: UL
OFFICE COPY
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO /g
INSPECTION DIVISION
J NSPECTION ECORD
• PERMIT EXPIRATION
JOB ADDRE UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNERAc R IS NOT STARTED WITHIN
/ ECTION DATE INSPEC R INSPECTION RECORD iBO DAYS OF PERMIT ISSU-
FO N ATI ON ANC. OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION.
U ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS.
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING
ELECTRICAL ISSUANCE DATE
MECHANICAL aLOG ELECT I PLO. I MECH
El El 13r]
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
WINFORMATION
WOOD FLOOR
VALUATION SIFT,
PLUMBING
MECHANICAL
ELECTRICAL PERNIT TO
FRAMING
STORIES TYPE CONSTR
INSULATION
OCC GROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
SO.TT,FIOORAREA TOTAL ACREAGE
. ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING Res INDCON Pa 011.1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ 7 ❑ ❑ ❑
ASSESSORS PARCEL NO
ROUGH SANA
PLUMBING ELECT.ENERGY
IRACTNOPARCEL NO
TUBS&SHOWER PAN PLUMBING ENERGY
MECHANICAL MECH.ENERGY
ELECTRICAL BUILDING ENERGY ACC.DATE ACC.FILE NO.
FRAMING ELECT,FINAL TEST
ZONING ENG,SITE NO.
INSULATION PLUMBING
GAS TEST GAS
FIRE SPRINK ENERGY T2E
MECHANICAL v AE v ❑ N�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD ZONE AL.D C,
INTERIOR SHEAR FIRE DEPT. v N� Y ❑ NE]
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH BUILDING BUILDING
INTERIOR LATH TEMPORARY APPROVALS
SCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC
O
H� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! CONST. TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
APPLICANTS POSTING COPY
{
T
N M07CE
0 0 0
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
departments, as required, to assure that the site/building complies with the requirements of
these departments.
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.
f. 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
CITY OF CUPERTINO