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02100150�L CITY OF CUPERTE , C1111 F CUPEI�TINO PERMIT APPLICATION FORM o 2 � t--0 G 5"' APN # ?- �j Date: b �' 62— Fee Description Fee Group B iildisig Address: L(6 ^ - Owner's Name: � � Phone #: Q Z � l �Q � Contractor: � 0 � Licenso #: 47i Contact:�O � � \ Phone 4_ Applicant/Contrairtor: Fax #: Building Permit Info: ld (I ec lamb ech • escription: Residential: Commercial: �� Sq.Ft Floor Area: $ /Sq.Ft.: Architect/Engineer: Valuation: Type of Cons Mc',r - Occupancy Group: .- Quantity Fee ID Fee Description Fee Group BAPPLO I HER Otlier 62pliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Of{' /Comm/ asi BUILDING BCONSTAXI3Q Con. Tax for BQ Zone B•UMI)ING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUII.DING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1.001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <-- 200A ELECTRICAL BENERGY Energy BUILDING BFNERGYADD Energy Add Multi BUILDING BrjNVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit, Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMN13V41MULTI New Multi - Family Res MECHANWAL BNEWIMLTLT1 New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Cowin Mechanical MECHANICAL BNUCONDO New Coriuu Plumb PLUMBING 2C/ 1 of ! o 7�, F4 r` CITY OF CUPERTINO �n OF PERMIT APPLICATION FORM CUPEkTINO nanti Fee ID Fee Description Fee Group BNUMULTI New Multi-family Res PLUMBII\TG BOVERTIMS Ins ,ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPER ITEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLA.NCHK Plan Check Fee BUELDING WLANCKADD Plan Check Add Multi BUILDING BPLANCKREP I Plan Check Repeat Fee BUMDING BPREPIPE Repipe Of Fixtures PLLWING 13PSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM StomVltain Water PLUMBING BPTRAP Kitchen Tra p PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 din MECHANICAL BREMAIRHAN A/C Units <= 10,000 ciin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL 13RENU URN Relocation of Furnace MECHANICAL 13REMFURNOV Re lo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Msc:A pparatus ELECTRICAL BRENfNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL REMRECEPT Rc tl Switch & Outlets ELECTRICAL REMRELOCA Relocation of Hood MECHAINICAL BREMREPALT Repair/Alter Heatin' MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Mar uee ELECTRICAL. BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 maz a}p.- lxWr �ztw tn4� ?_ 2 O:c�- --tt!�-a4 L- L' a�o? za a: Ci N WG vt �Z LJ C rt J W, CITY OF CUPERTINO ' C0NTRACT0R',1 W- . BUILDING DIVISION pE ..'ION:-. AulrP&2WD_J_W_s:HILL LA CLEAR OAK DESIGNS PEIMITV02100150 ovvRV N e JOHN R AND LESLYE C 1723 B ROGERS AVE I APPLICNITt7$JrS1TG11112002 / K" 10N*F; (408-1436-5443 SkKJTARY NO. CONTROL NO. ARciIrrt.gm _NK.Iv;EER: j BUILDING PEELAFTINFO BLDG ELECT PLUWB MECH cl o I.ii CON'TILACI.ORS DP- CLARATION D"scription I btcchv apitm [htl I em lia.nsnJ ondtr Mviuiuns of Chapter 9 (euanmencing KITCHEN R SMODE11oh withScedun WAJ)of Disitaitla 3 n( on: Business rail Prufextions Co t. and my Itecrhse it in fo11 force and • en it 'A L� LJCCItsc Cln Lw. tl Gj1...lTV ITaI� —�., •9r Q.. al IEC�; LAI ,uhlic re I trnderFlnnd tmy P,I6to��a[_l_heeused �t♦f�t�- u�hli�t amNt Lircued ru cssional OWKFR- BUILDER DECLARATION 1 hereby affino that I awn eserirpt burn ft Crmna:wrs LiocrSC fair fat the 0 0 a follCrts•Ing reason, (Section 7031.5. B uincs4 and W."sions Cndr.; Any city Uf c=ly which mqulics a MLA to cmimru: i. Llict. in itiov^_. QCrtu(ish. fir tptfr any St uetc-e prior to its ismuonce. also requires Ih; aprliem for btlth pecmll W fibs a tigrcd SWtcmcnt that W it Ircemied pursuant to the preivlscnti of ih-- GmimfuriLacrm f„ aw (ChsM 9 ff*R711UQ-1FD Aft§ Valuation '. (. vmn• cxing with Se6o. 17CK" ofkli= ivco3tf the flasineab end Profasinc ;Cpde)07 thou he is citempt thmtrrom and the basis -fnr the allrfcd ctercIttlea Any vioWon, of Section 76313 by any spptkmm for a permit subjects the nmliv= to a civil N1,01 of I�Tj IJ ' Occupancy TYPc nd7 rucue than Gwe hundred dollars (MO). 102 — PIERS ❑ [, av owner of tht ptvpeary, or my e- fiplayeca with •F�hgm R their sniteompen� don, will do L:rr work, and the structure U rxu inleaAed oroUered ILr file (Ste. 7044. Busir••+ Required Inspections and Itufessfons Cod-, The Cocimuads Litensa La. does con oppy to au uwnw or 104 - REBAR propenywhobuilda at impprows thereon,tnd'%tm docstrxh woik6mmuat through Ltis uwacr lo)tes. 7roide4 Lhatsuch irnpro%msenisart nminiettdador ofertd arsal. If, 105 - ANCHOR BOLTS hoarver. the huiWiaacU im(aovetarl IS sold w111hino.4 ear of comovilog theoanr lU� - SEWER & WATER builder .111 lta i the burden or prnvlt`g Liar he d5d not L•udd or L•nprnn for purport of Able.), 202 - UNDERFLOOR PLUMBING 0 L as owner of ite propmly. am esChcvvelycunlraciing wdh liximso0 cnninmrs to 203 - UNDERFLOOR MECY AN I CAL Con #rUO Ot prIOCCL (SM 7944, firmness and ProfCWiixS Codes)Ilw Glaarreirlb L} cen,% Law dnes.not apply' to an owner rA prtpeny whir Nilds ar tnipnrrns drrnn, turd, 204 - UNDERFLOOR FRAME µ410 Cunlm.-Mforanch projects wih a Conuaclotfi) liomsed(mMuant to the Crx=actdb 205 - UNDERFLOOR INSULATION n 1 nn etcmrt uoiler Sx A S P C fcr this rerNOn 301 - ROUGH PLUMBING (facer Dale 302 - TUB & OR SHOWER WORKER'S Z;OM .NSAT?0N Drc AR noN 303 - ROUGH MECHANICAL 1 hereby affiinn tinder pefiahy of pctj=y ont of the rollourEng dedtealiom: 304 - R070GH ELECTRICAL 0 1 have and µt71 maiwmin a Ctrtifi:atc ufCtrtsral toad(- insole furROfkcirsCorcpco. 305 - FRAME sation, 47 prunirltd fir by Serlim 3701 of tie l aber Co&, fm the perfarmenve of the p,orlit for which his pmenit is i3auvd. 306 - HOLDOWNS 0 1 hive and will maitlain Wofixes Campo whim Itnurz=r. as %qu4..tcd by $St+ttiun - INSULATION 3700 of the ti:ar Cam, for Vic pwformance of the work far which dais permit is awed. My Workeel Conhrernali z lcdunusce Carrier LNF,'n� hcy r -507 308 - SHEETROCK Ponc e '309 - EXTERIOR LATH cz ' COMPLNSNTI(hN�su� CE °RxF�ts 310 - INTERIOR LATH (ribs mcUon tied not he cetnpieted if the pettrit is fos tme hunted dnllars(S I CO) 311 - SCRATCH COAT ov4sQ 313 - ROOF NAIL 1 readN that In the ptArmance (if tfx wnri for which this pemtit is Issued. 1 atoll not 5 01 - FINAL ELECTRICAL ENERGY emptuy any Kmn in any mancerar, as to becccrhesubject m the WoRcrs' CnntAnsudon Lawt< ofCa:ifamla. Date 502 - FINAL PLUMBING ENERGY Applicant NOTICE TO APPLICAW. If. rifIc tmaktnp this Ccnilicnmo fFssnpdian, you afaotd 503 - FINAL MECHANICAL ENERGY w:,>n a i,hicut in the Wurrtftt Crx7i rindott pt tsians or Lb:.LAtfr Ca>r, you m,-., 504 - FINAL BUILDING ENERGY Corttw•hh Comply with such limvi;iunsar Ibis permRsholl IL• r:ccmcd revfftd. i 505 - FINAL ELECTRICAL CO,TI- RUCTION LEWI)NO AGrKCY 3 ItxaCby ffitat that tRcte ist Cdasw. ^,tibn lcndinSagCrx7'Inrsha rfnnnancur 506 - GAS TESTtT�i Lb- work rut which tict.permU is uual s(sx. 3M7, Ci, C.) 507 - FINAL PLUMBING Lender's Nemr. Lend rs nddacss 508 - FINAL ME CHAN I CAL I Certify that 1 Cavc r.:Q du am- limim find stet that rho e'bove infurmotion e CvrreG. 1 a$me to c,imply with all city anal rnunty nrdlnaut- t"state taws tlaling to Sallding. cowiiucCin, and hereby aull'wrim r:ptcwx,4Dises of us city to catar t.,'�'m the r� 509 9 5 - FINAL GRADE -�nT F 1 avAL a.tC1t.Y L� T NC ohove- mantiomed piopeny for L:.tpowioo purlmses. } (We) atrce, uasotc- icAmiVy end keep Wrm1m Lhe City e7fupCtti.r 1 4 _ T FIN F3L1 C W RK ggtinst lib hilMiti ,judpiienLi,Mtsandcspenscs whkb rmiy.in any why aucrin: q2bsi Said City ' in eanscgmriceef the grnnfing of this rormit. ' APPLICANT' UNDERSTANDS AND WILL COMPLY WITH ALL NON.Powr Issued by: Date RC ' RECiULATt NS. �� 0 2t Re -roofs Signatu7C p{slJcnnUCr>•_•ractpt D:x HAZARDOUS MATMALS pLSCLOSURH Type of Roof Will ft applierni or Ioturcfiailune Cc!•aptLht stiuC or htrAle hsa4atkm mnicdal h>S ddla:d by the Curonizoo Municipal Code, Chapter 9.12, and the HCaILS and Safety CkiC, ato125531(a)3 All roofs shall be inspected prior to any roofing rnawrial being installed. J If roof is installed without first obtaining an inspection, Iagree to remove A�Jlthcapp )ita�tMfutorCh+�ildinp. tics »;tlolac:Cyuiperoslwdcr(ucswhieh emit hamrdnus edir Ctx•1LTiha:.0 as definM by di: Bay Amt Air Ouaf.ly Manayrrrat all new materials for inspection • rJ•: strict? r] Y;3 No I have rcad the harerJnuSnta='W 3 requirements under CP,uptcr 6.95 orthc carifor- na Health dY Safety Cat, Strtiowt 25505, 25$33 and 25534.1 CW;riaaad tot if Vic buiLira duel pat cununtly how a tthlnt [bar it is my respx6lrility to molly ts: occult= of ifc rrq °-h:mclits which be atµ Itihit to ISSti n A�of a l;tttifa al Q nptnry. Signature of Applicant Date �I All roof coverings to be Class "B" or better t ltct txnuLhariraia t We M ui ji 9 cn al % I Z 7:[ Q P- a 1,11 I 10 C) p t� `a 3 �3 0 CN F co .i E 0 0 w --- - --I I - - - 4-7- f to - LAY _ �` 03 CD 0 0 cu L) co Cf) E 0 0 z --J) I 0 .�N 1-0, 0 O 0 ccv U) co E 0 0 w a) c r"a 0 ro 0 z k e it s-31 B i t U5 H lit- t A I I's lit f- 3 H JIM; U1 it! 9 Z ZT on� gg� 2 H.Hv. 0:i ISO I 'D at i it Its T E HE a -tu E.I.H.M. M LI F 1 t -1 1 tit 'g! S T 9 WE SEE ji U Is F- Elk zn U s EH 11. IF -t A 4 L; At ZT on� gg� 2 H.Hv. 0:i ISO I 'D at i it Its T E HE a -tu E.I.H.M. M LI F 1 t -1 1 tit 'g! S T 9 WE SEE ji U Is F- Elk zn U s 4 L; At 30 ZT on� gg� 2 H.Hv. 0:i ISO I 'D at i it Its T E HE a -tu E.I.H.M. M LI F 1 t -1 1 tit 'g! S T 9 WE SEE ji U Is F- Elk zn U s an nN� F 2 > Uxi r5 39 it' , S I as E Z s n° y ui is y. zft as - rz i-a 4 L; an nN� F 2 > Uxi r5 39 it' , S I as E Z s n° y ui is y. zft as - rz i-a