27596 (2) APPLICAN.s TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BUILDING-ELECI'RIAL PERM)I'NO.
BUILDING DIVISION APPLICATION/PERMIT
PLUMBINGROJECTNIDRNJ-[CAI, n 7 C 9
BUILDING PNUJF.CI'IDRNI'l ItICA•I'IfIN L J
Ii UILI)I�UDItle55:7 STG✓SIDS 62F9.1, 94'1 LOT# SANITARY NO. APPLICATION SUBMITTAL DA'Z'E
OW2F2S FSS Irl NE: CfOk'S NAME: yny LIC NO: i s
RCI II'rGCf/IiNGINEER: LI O: ADDRESS: -
adialow El
oM'A T: PHONE: BUILDING PERMIT INFO
/ /�Z,2af QTY. I.LECIRIC PP,NMIT ITB
J Q ' L�' 1 BLDG ELGCT <- MEGA
PERMIT ISSUANCE I��y C�YVI(�
LICE.NSEDCONTRACfOwisoun LARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Ortiz Ihercbyaf Division
amliceBaunderprovisions .Chapter and(commencing se with
tv00 Sedi..coand of Divis.n3nf the Nosiness end l'mfessions Cutle,and my license is in PANELS
rtuci-5ryut License and effcet. h
Fzw license Class Lic.# UPT02W AMPS
mQy Dae Contactor 201-I(Ip0AMPS
Z O,Z ARCI IIT['CTS DECLARATION OVER I"AMPS - SQ,IT.FLOOR AREA E/SQ.IT.
O Z— 1 understood my plans shall he used as Public records. _
Pm J SIGNS ELECTRICAL -
9yy , licensed l'ndessionel
K0 Q hie I..-s.sai fRDECLARAr10N SPECIAL CIRCUIT/MISC.
O aF I hemby affimr that 1 am exempt liom the C.nwcmrs License law for the
J•3Wrn folmwingmason.(Section703 1.5,Businewnad Pmfesxioda Code:Any city.,county TEMP.MITrERORPOLETNST.
C 2 which mquiresapnmit mronss the applicant
for
such nnutt,orrepairudstate ant
}0 printesscensedurromagaires thevisios offla,Co pemniuoLicerile a se La statement POWER DEVICES
_gipm 9(comt he isncingdtursuum too( of'Di ision the Contractors License Lew Chapter
o-4%eLL Y(commencingwithomfoorruid of Division 3ofine ed earaa to Profexdats Code) SWIMMING['001,F.LIiCIRiC VALUATION
W_m or thathels 1.5 byanaefromend the carni orbetsthedexemption.Any violation of OUTLETS-SWITCHES-FIXTURES 1 rL �Iq ,
�Z4 Seninn'lO3 LS by any applicamforepehmit subjects the aptlicum too civil penalty of 1/` s^
C � not than five hundreJtlnllars
I,as.wnero (5500). NEWRESIDENTIALELECER _SQ.I>r.
fthetropcn".,my employees with wagesa+Neirsole compensation, STORIES TYPECONSTRUCI'ION
y3-, will Johhe work,and theatmmuro is notlmentletl nrnlfereit fnrmle(Set.5044,Business
and Professions Code:The Contactols License Law does not apply to an owner of
property who build,munprovosthareoq and whodoeam,h work himself.,thri his
own employees,provided that such improvememserenot imendedurofferd forale.IL OCC.GROUT' RES.UNITS
however,@o building or improvement is sold within one yearofcompletiou,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale).
❑ I,asownerufinepropeny..mexc[usivelycontactingwiihlicenscdcontmotomto QTY. BING PERMIT PI?E O APN
construct the project(Ss 7044,Business and Professions Code:)The Convector's
License Lawdoeanm aM[ymonownerofpropenywhobullds.rimprovestherasa.and I'I%KNIT ESS N
whncnmricts for such projects with aconotwom(a)licensed pursuantto the Comoretar's
License Law. ALTER DR ENT- 'HR(EA) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C for ffik meson ❑qCK FLO W PRO CF, SANITARY Y LES N
Owoe. n,,. RECEIPT#
DRAINS-FLOOR,RODE, OND.
WOR AN COMPENSATION DECLARATION SCHK FE-F, X Y N_
ooIx
❑ I Coda,mrodma]ahave.certifiam of cm,theod(Sesam,ur Lab C.)whiceorh
/'1 RECEIIT#
nekers'Compensmiun]er thiscar acenified copythereol(Sec.3800,Lab CJwhich ` 17XTURFS-PFR'IRAP PARK ftIi
en all,Pmpleyee's under this permit GAS-FA.SYSTEM-1 INC 4OUTLITI R CEIPr
Policy# R 1 VI NI;GES
Company GAS-EA.SYSTEM-OVFR4(EA) PLANCHECK b'.
❑ Certified copy is hereby furnished.
❑ CmifiW copy is fled with the city inspution Division. GRFASNINDUSTRL WASTE INTERCEPTOR GRA /+
CERTIFICATE Or EXEMPTION FROM WORKERSGREASETRAP SOIL
COMPENSATION INSURANCE
(Tis sectionneed not be completed ifthe hermon
it is fore hundred dollars FU00) SE OAHR-SANITARY-STORM EA.2001'1'.
or le".) IiNI?RGY
I certify that in thcperhnmance of the work Porwhich thispemhitin issued,[shell WATER HEATER W/VFNT/BLEC'IR
not employ any tenon in any manner so as to become subject to the Workers' PAID
Compensation Luwsof Caldmrniu. Date WATER SYSTEM/I'RIiATING Dateke i
O Z Applicant
Z P NOTICE'I'OAI'PLICAM':Il;.ftermelingthin Cenilicateuf Excmption,y.ushould NEWRESIDENT'IALPLMIL SQ.FT. TOTAL:
FIp become subject subjeco the Worke/s Compensation provisions ofthe Labor Code,you must
C4 > fn thwithcnmply with such provisions or this permit shall he deemed revoked. BUILDING I moa,
P. Q. CONSTRUCTION LENDING AGENCY SEISMIC `
z I hereby affirm that them is a construction lending agency for the performance of T F.LF.
U O the work for which this temhir is issued(Sce.3041,Civ.C.) r
Undies Name Q PLUMB FFC Lendcr'a Andress QTY. MECHANICAL PERMIT FEE
V E certify that I have mad this application add state that the aboveinformation is Jr
coaect. [agree no comply with all city and county ordinances and state laws reltiongm PERMIT ISSUANCE MECHANICALJE
F" building construction,and hereby UnJUS O representatives of Nisciry memer upon the CONSTRUCTION I'
V Z above-mentioned property for inspection purposes. ALTERORADDTOMECIL
(We)ugm<prove.md...By odd keep hmmleas the Cityol'Cupenino against
liobilittesjodgmen¢,c.stsand expenses which may in any wey acemi,itainetsaid City AIR I[ANGLING UNIT(TO 10,00)CFM)
consequence of the gra gof this t.
m AIR HANDLING UNIT(OVL•R lO,gp CIM)
n
Signature.f Appli Contra ors, EXHAUST HOOD(WNUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,t),MI RTU) / Dam R\p
Will the applicant or future building occupant store or handle hazadous material HEA FIND UNIT(OVEk 100,11(10 BTU) TOT ,
as defined by the Cupcninu Municipal Code.Chapter 9.12,and the Health and Safety
1 Code,Section 25532005 �/ VENT ILA'I'ION PAN(SINGLE RESID)
ElYes F'�
111$SIJANCE DATE
Wilhhe licantorfmumbuildin•uccu .maw tordeviceswhich emit BOELER-COM,(3HPOR 100,00(1 RTU) Y , n
aPP b p Area Air e ^ _g n
huaartlous air cnntuminenu as defineA by the Bay Area Air Quality Management BOILER 1W,OW RTU) � `�0n��
aamY / y
❑Yp9 (R'E+ NEW kFS1UEN'f1AL MECU.' SQ.FT. � �J
1 have mad the havanl.us materials regniremena miner Chapter 6.95 of the C/n'UI-
ifthe mil lie dh&Safety enttle,Se tions 2n,that
it is and 25514. I undo stand that
if the building tides Out currently have a mnanrJhm it is my responsibility to notify the `r i
occupant.tile rcquintne v which must ten prior m issu�e of u Ce iflcute of
Occupancy. S-
Owner or amhodee4 agent or Dae ISSUED BY:
OFFICE
MAY-Q6 97 99:09 FROM: TC:40E7773333 PAGE:02
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PaRmn'No.
27596
BUILDING DIVISIONS suDou+ o1imDQNNIC�T1uN
BUILDING ADDRESS: .
ANI APT NO. AA`UrA ONiukkMALbAIE
2-2757 w✓cti/5 Q''C/C
VIS F 1I A5 ++N�) '✓LL � O 'S AM LIC NO. N —c i OPWO74 .
nYClll ECfIEN01NEERIC NO: A 0.E95:
SUirl !A U.vArI '
INSPECTIONS DATE �INSPEC. INSPECTION RECORD BUILDING P0IMC[TNPo
. YLDG ^� MD Magi
FOUNDATION/PIERS/H.D.S. NOTE: ALL GRADING AND DRAINAGE 0 /W
UFER GROUND SHALL BE INSTALLED TO COMPLY WITH lob oar mmoN
THE APPROVED PLANS AND CITY OF
PAD/SET BACK-CERT CUPERTINO STANDARDS. ".
GAAAOE SLABS/PRECUNIfE
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED INSPECTION SPECIAL. INSPECTION DATE INxr.
UNDERGROUND/SLAB REQUIRED ❑
PLUMBING
ELECTRICAL
DO NOT FOUR FLAOR UNTIL ABOVE HAS BEEN SIGNED
PLUMBING
MECHANICAL
ELECTRICAL
FRAMING VENTS
INSULATION.
INCE NO SUBFI.00R UNTIL.ABOVE HAS BEEN SIGNED ''//
ROOFSHEATH/DIAPHRAM fG d Y, �
PLUMBING
TUBS&SHOWER PAN
I
ECHANICALECTRICAL/POOL BONDAMING/STAIRS/E.EGRESS
SULATION/VENTILATION
OVER NO WORK UNTIL ABOVE HAS BEEN S{GNED
TERIOR SHEAR/HOLD DOWTERIOR SHEARMOLD DOWN
SHEETROCK/SHEETROCK SHEAR /
EXTERIOR LATH/W-SCREEN
SHOWER LATH
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNIP
SCRATCH COAT '
SEWER/WATER
TEMPORARY APPROVALS I&L41=C& + /
BUILDING Q CJOe w 2it✓2Iti.
ELECTRICAL > Q 7,7
GAS
FINALS
GAS TEST
GRADEA 111PRO
FIRE
HANDICAP TO ARRANGE INSPECTION ISSUANCE DATE
CALL AFTERNOONS(12:30 PM•0:00 PM)
ELECTRICAL/ENERGY / / 2524505 MONDAY TO FRIDAY 24 HOURS
UMBINGIBNERGY —/ BEFORE REQUIRED INSPECTION. JOB AD- "
DRESS AND PERMIT M ARE NEEDED WHEN ., 1
CHANICAL/ENERGY "" "' PHONING.
BUILDING/ENERGY ATTENTION CONTRACTORS:
NO PERSON(S)SHAH.PERFORM WORK ON UL S 199
ELECTRICALFWAL7EST THIS JOB SITE WITHOUT WORKER'S CII!',,
ANCY OF 9UiLbINO IS NOT PERMITTED COMPENSATION
UNIMBUILDING71INALIS.SIGNEDBYBUI.DWGIMPORTANTI .
IIQ.I'vgntr'ne_.,,,_:•,, <�,:,,r._y,,,,.--,.. PLEASE READ REVERSE SIDE BEFORE . / ..