31362 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO,
BUILDING DIVISION APPLICATION/PF,RMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS SANITARY NO. APPLICATION SUBMITTAL DATE
'2. L VESL� I o 15�L6
OW ER'SNAME: PHONE: CONytACTOR'SNAME: LIC NO:
t\v ` N/C CONTROLp
RCHITECD'ENGINEER: LIC NO ADDY SS:�'!ilit
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fecs Paid by Applicant(Initial) BLDG LF.LT PLUMB MF,CH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I /rCj l(
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing IDB DESCRIPTION
FODMZ with Section 7")of Division Sofia,Bminessvnd Professions Codeand my license is- -ffRESIDENTIAL:
O in full force and effect. PFRMITISSUANCE
�IFF, ❑SFDWL O KITCHEN REMODE1.
UU License Class Lie. a APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
F?jjvDam
Contractor
�y ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT []STRUCTURAL
Z O'^Z 1 understand my plain shall he used an public records - MODIFICATION
OZ�Q UP10200AMPS
F F-W Licensed Professional - ❑INTERIOR El CHIMNEY REPAIR
QYE— OWNER-BUILDER DECLARATION 20611%M)AMPS PROVEMENT
C C ( 1 hereby affirm that I am exempt from the Contmaars License taw for the OVER I000AMPS 6TH REMODEL/REPAIR 0 DEMOLITION
3 LLF following reason(Section]Ol l 5,Business and Professions Cnde:Any city or county SIGNS ELECfk ICAL OTHER,
m which requiresa p rrout to emixtract. II r, iniprove,demolish, p' y stroarthe
prim to I also requires the pplc tl suchPermit' fl signed cement SPECIAL CIRCUITAIISC.
f�} then he licensed pursuantt theprovisions flit C votrsL Use t(Chpter9 -
1 0 mm(coencing with Section 900(rid Division 3 of the Bu nes and Proax,mn.Cade)or MZ M EIER OR POLE INST. COMMERCIAL:
d a,.C thin he is exempt ibarefram entire hbasis lathe alleged exrnnioo.
pAny vimmirm of - ,. 0 NEW BLDG/ADDITION 0 DEMOLITION
X:2u. Section 70115 by any applicant for a permit subjects the applicant m a civil Penalty of POWER DEVICES
41—m ❑TENANT ❑FOOD SERVICE
F Z Y not marc Nan f ve humored dollars y em). IMPROVEMENT
SSC ❑ho the work,theand thiopeny,or myt intended or offend
ffewagesdf or their sole cram.Businesson. SWIMMING POOL ELECTRIC
F- will professions
andthe strecron,no
nots intended Iawddsno,apply to,
Businessilj� - ❑OTHER
A. opo anddcity who
Cut e:The Cestheeon Lind w Laws such
trk bun,unownerof W9'LF.TS-SWITCHES-it%TURBS
A. .. his own who builds or improves Thereon,and who dors inch work deed.,or Through
his own owe eyes,provided r m such mentis sold w aR not intended or uRcrd Por NEW RESIDENTIAL ELECT SQ FT.
sale.I(.however.the building or improvement is sold within ane ycarofcompl<tion,the SQ.FT.FLOOR AREA S/SQ.FT.
poowner-builder will have the buNcn of Loving that he did nut build or improve forpur
se of sate.)- PAID
❑1.as owner of the properly,aim exclusively contracting with licensed contractors to
construct the project ISec.7=.Rosiness and Pmfesvlons Code:)The Cotnmcmh Li-
Law does nor apply to an Owner ofpmpcmywho builds orimprovesthercmis ad QTY. PLUMBING PERMIT FEE OCT 25
who commets r,r melt Lu eer,with a varencimC)licensed nom nmtuo he Co ruccm;n 1996
License Law. PERMIT ISSUANCE JJ{Y
❑I sin exempt under Sec. ,B&P,C for this cman
Owner nine ALTER-DRAIN&VENT-WATER(EA) A
WOR KEE'S COMPENSATION DECLA RATION BACK FLOW PROTECT'.DEv1CR
1 hereby affirm under penalty of perjury one of the following declamnions: - '
I ❑I have aM will maintain aCerificate of Consent to self-insure for Workers Compen- DRAINS-FLOOR,RODE AREA,COND. is
STORIES TYPE CONSTRUCTION
cation,as provided for by Section 37M of the Labor Code,for the performance of the
work for which this Permit is issued. PI%TURES-PER TRAP Ir On
❑ 1 have and will mainmin Warkcd Cumpro-Inm In tminne,as rcgaimJ by Section
3900 of the futon Code,for the performance of the work for which this permit is issued. (3AS-EA.SYSTEM-I INCAOUTLETS
OCC.GROUP APN -
My Worked Compensation Insurance carrier and Policy number arc:
Cartier: Pali b.: GAS-EA,SYSTEM OVER q(EA)
CERTIFICATE Olt GXEMPTI OM W ORKERS'
COMPENSATION NS RANCE - GRIiASEINDUSI'NLWASTI;IWERCEPFOR .
BUILDING UI VISION FF.FS
(This,c on need nut compleAdifa rotii.crone undreJdollars18100) GREASETRAPor less.) PLANCHECK FEE
Icerlfyhmi epe nn a ehthi tonna is issued,l shall /SEWIiN-SANITARY-STURM F.A.2W IT.not enipiny porn t nnr}shjccn athc Wmkcry Compcn- \ t RGGHili
O ion haw ( niw� I / WATER HEATERWNEYf/ELF.CTR V GRAD[ F.FEE
Applicant
N ]CORDAPPLICAWT ill.atter ifakfing this Cerlificsfm of Exemption,you should WATER SYSTEMOREATING
l-^ become subject et the Wmkers Ci l,ro eon pmvtsicdi of the Labor Calc,you mum IscliLs IllE -
forb iib comply wiihsmch pre,iomeiii,diislw...m,iall is Jccmed revend. WATER SERVICE
a
CONSTRUCTION LENDING AGENCY - NEW RESIDENTIAL PIb1N. SQ.FT PAID
V P ' I for whi Rrm thin Nem isacaa(we 3097.nding agency for the perfomtanccof Date Rmeiptp
V. the work for which this permit is issued(Sec.)119].Civ.C.)
I-'' Lender's Name TOTAL_
U Landcr's Address TOTAL:
F4i I verify tM1a I have reed this aPPlicmion and cote the the above information is BUILDING FTE
LO correct.l agree to comply with all city and county ordinances and slate laws relating to QTY, MECHANICAL PERMIT FEE
U Z building construction.and hereby nilhoriae representatives of this city to enter upon the SEISMIC IgiE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)ago.to wve,indemmfy and keep h the City of Cupertino against ELECTRIC PEE
habiliticx.jud mems,coz¢ande roes whic essany way accrue against said City ALIT:RORADDTOMECH. PLUMBING FEE
onseque c of the lingo this permit
APPLICA, UNDP STA f 'AND W .C�f� W TH ALL NON-POINT AIR HANDLING UNIT('1'O 10,IHNI CFM) MECHANICAL FEE
SOURCE tGUL ION
AIR HANDLING UNIT(OVER 10,"CFM) CONSTRUCTION TAX
Signature Ap lean C tractor - Data EXHAUSTHWDIW/DUCT') HOUSING MITIGATION FEE
" HAZARDOUS N ATERIALS DISCLOSURE
am
Will NeapPlicar fumm building accupan)fpm or handle harerdoes material HEATING UNIT(LD 100,0011 BTU).
as defined by the Cupertino Municipal Code.Chapter 9.12 and the Health and Safety
Code,Section 25532(u)] HEATING UNIT(OVER 100.000 BTU)
❑Ycs El No - PAID
VIiNTILATION PAN(SINGLE kESID) Date Rvedp(#
Will the applicant or future building aeupant use equipment or devices which ,BOILER-COMP(3HP OR Ip),I%p BTU)
mit M1aurdous air cantaminams as defined by the Bay Arca Air Quality Management TOTAL:
District? BOILER-COMP(OVER 100,000 BTU) -
0yes 0N
I have read the havaNnu:enriched,fispiromene,under Chapte 695 of to Cali AIR CONDITIONER -ISSUANCE TE
forma Health&Safay Code Sections 3505 25533 mW 25531 I understand Thal if the NEW RESIDENTIAL MECH. SQ.FT.
building doe not somantly have tenant,thmt y responsibility to notify the exceptionof lite rcyummens which the nP,r. t fa Cenjifir.mofOc,aparry.,. �✓
Owner or authorized agent Data TOTAL: ISSUED BY:
OFFICE
POST THIS CARD NEAR FRONT OF BUILDING
CITY OF CUPERTINO PERM
BUILDING DIVISION ryUB,DING PROJECT IDENTIFICATION
BUIIIT
LDINGADURESS: ` Pd SANITARYNO. APPLICATION SUB] TAL Un
OWNER'SNAME: PHONE: I CONTE\CPOR'SNAME: LIC NO:
t l\ (�—' Ali y \,;\Se` .1�.• ,\ - Sq 9IC C(INTROL=
CHITECTIENGINEER: LIC NO;
ADDRESS: \\ ❑
BUILDING PERMIT INFO
INSPECTIONS DATE INSPEC. ❑ CunsWtant Fces Paid by Applicant(initial) BLDGLECT PLUMB MECH
FOUNDATION/PIERS/H.D.S.
INSPECTION RECORD
P � .z' o
JOB DESCRIPTION
UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL,
PAD/SETBACK-CERT SHALL BE INSTALLED TO COMPLY WITH CSFDWL ❑KITCHEN RE.MODE1
THE APPROVED PLANS AND CITY OF CADDITIUN El PLUMBING RE-PIPIT
GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI-UNIT ❑STRUCTURAL
MODIFICATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - RANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB ALM- AFTERN ) ONS (IZ O PM - 4:00 P3I) IMPROVEMENT
�4ATH REMODEIIREPdIR ❑DE\fOLIT10N
I PLUMBING 777-3228 MON AY TO FRIDAY 24 HOU RS BE- E)OTHER
ELECTRICAL FORE RF RED INSPECTION. JOB ADDRESS
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED T#ARE NEEDED WHEN PHONING.
COMMERCIAL:
PLUMBING ATTENTION CONTRACTORS: ❑NEW BLDG/ADDITION [I DEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOOD SERVICE
THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION OTHER
6.
FRAMING VENTS INSURANCE REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ I DATE I LISP.
PLACE NO SUBFLOOR UNTILABOVE HAS BEEN SIGNED
ROOF SHEATWDIAPHRAM r
PLUMBING
TUBS&SHOWER PAN t -
MECHANICAL
ELECTRICAL/POOL BOND �r
FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
EXTERIAL SHEARMOLD DOWN s
INTERIOR SHEARMOLD DOWN T 25 Orb
SHEETWROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREED CI I Y yr wr Lt I uyV
SHOWER LATH l
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/N'ATER
TEMPORARY APPROVALS
OCCUPANCY
ELECT
S
FINALS
4GAS TE
ADE
FIRE
HANDICAP
ELECTRICAL
PLUMBING AIA
• MECHANICAL
ENERGY CERTIFICATE OF OCCUPANCY
VISUAL FINAL 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,,
I&SPECTOR. - ISSUEDIO. '
APPLICANT'S POSTING COPY