S0808 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING-ELECTRICAL PF IF NO:.
BUILDING DIVISION APPLICATIONIPERMITPLUMBING-MECHANICAL OHO 8
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: 1-1 Lcs� \ � SANITARY NO. APPL I�N�TI'AI.DAIS
1�klIIONE:�� C NIRA NAM[: �� LIC ): NIC CON
Cf/ENC] EER' IC NO: ADDBMS: ❑
ALT: PHONE: BUILDING
CO PERMIT INFO
Elonsultenl Fees PniJY Applicant(Initia) BLDG EI.IiCf PLUMB MECN
LICENSED CONURACT(IWSDECLARATION QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
I lxseby,Raju tow I am licensed unuler provision,of Chapter 9(corm mg
„Os=O with Sativn]00(11 oflT,isicn 3&me Bosuns and ,vim,Cods.vd my license is R S11F
err infb SWieevtdellbet. IT:RMR ISSUANCE \VI, ❑KRCHEIS REMODEL
�F.UU License Cl. Lich APPLIANCES-RESIDENTIAL A Di DON ❑PLUMBING RIiPIPE
H Z E! Date Cawztm
ARCHffECTS DECLARATION ❑h1U1.TFUNIT STRUCTURAL
1" TPON
v Z I undcmaM my Mans shall Na Uses]as puhlic recnN, PANELS C14IMNL REPAIR
OZ- UI"f021X1AM15 ❑INTERIOR ❑SWIMMINGP O1,
O�Z A IMPROVEMENT' DENMINGI'OOIS
{+] Licrnxcd Prufettiowl 2111-IIIOI)AMPS ❑'
f-�
OWNER-BUILDER [I BATH REMODEI/ItFJ'AIR ❑DEMOLITION
OV"II]IXIAMPS
C�G 1 herthy,Diem Nat I am exsropt from rPr Canuu'rxs Licenc Lew for the ❑t7fIIEJt
aO a U which rc reason,ISmon 1 7031.1,9 thin, aril Pmfcadons Ctalc:Any city�.county SIGNS ELECTRICAL
c m4 which Myuirta a pcnnil ju csnvwcl,aloe improve dsnwli,h or mpuir any uamOuru .
�J prurta it,iasuvcc alwrhmr,'ha applicant fmsuch permit wile a signed,ounent SPECIAL CIRCUITIMISC.
f�Y thu be is licrn,ad po,om,juts,proves ions of the Conwhm's License Us.(Chapter 9 OMM R .IA
Wcep�O (mnsnnencinBwith Sectio]0001 of DiviuonlnftM Busineaxh)Pronession,Cndc1« TRAP.METER OR POLE.INST.
my a that he is exciON berefmm mal the ft for the all iwil excmprum.Any vin"iion of El NEW BLDG/ADDTf10N ❑DEMOLITION
X�W
Stalin.7031.5 by my vpplicant Into nor xuM1jchx th,npPlkonuouulvll Penvhy of Iv)WIiR DEVICES ❑TENANT ❑FOOD SERVICE
FZ y rat more than five franchised dollen(S500). IMPROVEM�f I D
�=QQI,mm,aer of de prsgety,mmyeMplrrycawiN xvgca,s deiewk amprnvatin. SWIMMING POOL ELECTRIC ❑OTHER
Wit �
will
now! offia Santis.and TMCnlmcmr'sn1�i Lwd cmtor kG+ply.il .owncrcuf OUrl,EIC-SWITCHES-1TXTURES
pmr ,r,who buikd err imprnc,m O un,amt who dux such work himself Sar moral NEW RESIDE TIAL ELECl'R SQ ET. FE
his own employ,INovWM tMt malt impmvemema are dx intesta l m ORaN for S�.R.00R AREA VSQ.FT
u1c.If,M1mve,er,the building Safi Uniform.,in sdd within ors year a compilation.me
sol aikler will love the Norden of pmMU,,her he did Int build m iUn,m-for pun- • (ifINO
"0,of Sale.). rl A .
❑ I,u axner of the property.am exclusively convecting with lian¢d cmuactas to LV
,mvruct We project(Sec.]MJ,Swire„arta Profcrasamr loaf Ile Camractar,- Ace.law Gen ma apply m im.wont Of pmpcuy who huild,or improves darmn and QTY. PLUMBING PERMIT FEE
who commas for vUch projects with u contmcmrrcl licenm
nd puuvnl to tic Contrac ,'s
Berns,law. PERMIT ISSUANCE
o I sur exempt umkr Sea. B&P C for this mews
ALTIiR-DRAINd VEM- 'A (f\) VALUATION
Prrcr Thu
•
WORKERuncle, COMOf rj.I on DfB ARATION HACK lI,OW PROItiCI'.IIT F,
I hertbyatbrmorderpenaltyofperjury oneof if IldlmfV Wak&ionv.
❑Ihe,e and will maintain aCmifiche ofCaueuwself-insure fa Workers Compen- DRAINS-ILIXIR RODE AREA.CONU. SrpRlfS TYPE CONSTRUCTION
shorn,u provided for by Section 1700 a the Iabm Cute.fa the Pmfmmoe Of de
work for which this permit i,iuncd. MIXTURES-I'I;R TRAY
1 hits,and will maintain Wurkcr',CvYnparromo n Ineurwcc,Sax oNUind by Sminn
37Mathe labor Codt,far Ne performwre,filo wart for which Nis permit is iuunl. GAS-EA.SYSTtki-I INC.J OOTLFI:S (CC.GROUT' APN
My
WmtCs C. 1 "�kitrry int_ ( Sec,yaicrPaM YNiry nutMmert: GAS-EA.SYSTEM OVER a(HA)
Com V101MIAF OWYM
CIiRTIFlCAT ERESBED" ROM WORKERS' GRHASUINDUNTRL WAS I[!INTERCEPI OR
C(1MPFNSA'rION INSURANCE BUI LSION EELS
jbusechunm ince be compind E mo mnit i,fir vrehmxbesl tldlan(SI IXII GREASETRAP
PLANCHECK Ji
or naJ
Loy anythmin Ne myUmvrr,of Ncw icrom whiaci to permit mr,'ed.Is1w11 SEWER-SANITAR\'-STORM FA.3IXIIT
nm Mnploy any permm nnyn Sero ram MmmauijcenutM WNcR Compcm ENIiRGY Il:
Z Saturn Law,of CWltamia.Date wn WATER HEATER WNENT/I:LECTR GRADING TEE"
z Applicant I
h
NOTICE TO APPLICANT:IL after making this Csnifi,au of F emprise.yw antwld WATER SYyUTbv fRFATING SOILS EIML
F htmnmemhjmty the Workers,proGions u,tionpmvisinn,ofthe laboe(v sle okinI You Muhl
GsnM1with comply with mcM1 pmvininm or thin pamdt slat((hu dmmal mvnkcJ. WA'T'ER SERVICE
W �
=.z CONSTRUCTIONre isasst LENULNGAGENCY NEN'RF_SIOIiY1lAL prat((. SQ.FT. PAID
IM1aebY affirm Nuthcrt i,arnnNructionlrnding agcocy for lle pcefanwxc nt UYe 'pts
U 0 the work for is this permit is lswcd(Sac.11199.Civ.C.) 'I OTAL.
W I--' IsndsFS Nene
U Lender.Addrtv T( aaaaa
1 I certify that I have real Nis application troll Saar dot tis above inm
foratisn is BUILDING FEE
V) a 1.1agrcctocomplywith NllciiyadnentyadinurccsaWs claws Mlhingto QTg MECHANICAL PERMIT FEE SEISMIC IT
U Z holding eonnmetion.and hereby arlb Tic Mprcscmhives orhis city In emcr uprml he
'-' ,hoe-mens:red prupcny mr inspection Eutp .v ITRMIT ISSUANCE ELECTRIC E
(We)agree to..iMemnify aril kap harmless Ne City of Copcnio ti'mmt
lia,lihi,judgments,cot,rowl exp,m,a xhich may in any way acame.gaimt saW City ALTER OR ADD TO MUCH. PLUMBING FEE �t
In em"muce of IS, rentin,of His permit.
APPLICANT 0 DERSr N AND VILL COMPLY WITH ALI.NON-POINT AIR HANDLING UNI'I'GO 10,000 CPM) MECHANICAI TH
SOUR G O
(r
I� c S AIR HANDLING UNIT(OVER 10.0CFM) CONSTRUCT[ NTA%
Sighlor A U HAUST HOOD(WMUC1X1) HOUSING MITI TIONFEE
H S MATERIALS DISCLOSURE
Wit Neipplluw¢buikling EXOccWantaue rc Needle hvurdoua mzmriil I lHATING U N IT(TO I MAC BTU)
as defined by th Cranio Municipal Cads.Chapter 9.12.anal the Hea1N earl Safety IIIiATING UNIT(OVER ItpJl(p BTU)
Cock.Smism 25512(a)]
[_1Yc, [:1 No VINTILAIION TT (SINGIJ:RIISAM PAID Dnte N¢c' ipN
Will De applicant Or rotor,WiWing occupant Use cyuipmear or tlaiaa which BOILER-COMP PHP OR 100.(100 BTU)
v
emit hardotn air contaminator u defirri by dose Bay Aro Air Quality hfao,gerrcm TOTAL
Distdn] BOILER-COME(OVER 100.000 BTU[
[:]Ye, No
AIR CONDITIONER IS UA DATE
1 save mad de Iwmdaas nuunalx n,goirmnrnu ural,Chapterh.95 0(Ne GdF
Toms Health S Salary y hl Satim,255(15.25my aril 255111 uNw, ❑w if Ile NEw RESIUIMIAL MECH. SQ.FT.
huibe die.,nacvrnmdyhiren .pduna u Orrarynxiruhf Mea Ofyton,Papsy t
4tne r.;,.imm.m wnim mn,l he jun pnaw�rtw,e,era c� raw rr�al'nar.
Ower,m uuhnnxd,gem Dae ISSUED BY:
OFFICE
POST THIS CARD NEAR FRONT OF BUILDING '
CITY OF CUPERTINO J NO. 8 8
6UB,DING DNLSION
•. eu1LOL�c:el [ sxlme.AnoN
e .��, s.Nrrn •rrLlc•I ,N L .N w D.,rz
9Ne'
_ crnvGtj+41`k73S. ...( ( .� •� :�� r >'6...- G' d .fly r'A[ Gc`} � /Si'^.[j
Pd
6uILDING PERMIT INTO
INSPECTIONS DATE INSPEC.,. CDC.A d n[Fm P�iE by ADDlic:n[(Initial) e L -Lj
(OUND.NnON/PTERS/H.D.S. AL JOB DESC'RIPT'ION '[`]
INSPECTION RECORD
UFER GROUND _ NOTE: ALL GRADING AND DRAINAGE .LgfnRMrl.
PADISET BACK-CERT SHALL BE INSTALLED TO COMPLY WITH S4tDWL i;xrTcII NReMwm.
THE APPROVED PLANS AND CITY OF ❑ADDrr1UN ^PLUMtINUeE•vu'F
GARAGESLABS/PREGUNITECUPERTINO STANDARDS. OMuln-uNrr I;,STRULItiR•I,
MODIFICATION
POUR NO CONCRETEUNTILABOVBfHAS. FENS
ENE TOARRANGF.INSPECCION ❑INTRRIOR UCIIIMmlNc;l AIK
IMI9lO\'lf-TENT SW LNMINC I'OiM.9
IINDF.RORUUNUrSL.AB _ CALL AFTERNOONS (1:00 PM - 4:30 PM) U fNfIIREMuuEukFy.UR LI DEMO WN
PLUMBING 777.7228 MONDAY TO FRIDAY 24 11OUR S BE- !7crrnER _
ELECTRICAL AND
REQUIRED INSPEC110N. JOB ADDRESS _
AND PERMIT M ARE NEEDED WHEN PHONING.
DO NOT POUR FLOOR UNTIL ABOVE HA'BEEN SIGNED CO MER IAl
PLUMBING - _ ATTENTION CONTRACTORS: ❑NgWRI.MADDITION ❑PtNOLMON
NO PERSON(S)SHALL PERFORM WORK ON ❑TtN•Nr Cl KKO SERVICE
MECHANICAL THIS JOB SITE WITHOUT BEING IN COM llia wENr
ELECTRICAL PLIANCF.WITH WORKERS'COMPENSATION OuIRER
FRAMING VENT'S '• / Cj INSURANCE REQUIREMENTS.
INSULATION D1sPCCTION SPECIAL INPECTION REQUIRED DATE INsr.
PLACE NO SUBFLOOR.UNTIL,Alil HA"EE'N.S19
ROOF SHEATH/DIAPIR.AM - -
PLUMBING — .
TUBS$SHOWER PAN tea,
MECHANICAL ro
ECTRICALMOOi,BOND
FRAMING/STAIRW...EGRESS _
INSUI.ATION/VENTILATION •� Al
COVER NO WORK.UNTILAB:OVE HASEFl+ IGNED.. "
FXTERIAL SHE.AR/HOLD DOWN
INTERIOR SHC•AR/HOLD DOWN L•/ry,
SHFFTW ROCK/SIIEETROCK SHEAR Cry l Jltu
EXTERIOR LATH/W-SCREED
SHOWER LATH • -
NO TAPS-OP PLKS_TER YEBEEN SIGNBD
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS,.".
OCCUPANCY
ELECTRICAL
1
GAS
:i:',�1.•''E'f.,`.'-.L".:...>i=:ti:sis_..:.irn2:t'.,M�a�'
GASTCST I
GRADE -
FIRE
HANDICAP I _
ELBCnUCAL �,-. .... .
PLUMBINGAmk �( -
MF.CHANICAL
_.NERGY PrWrIFICATE OF UCCUPANC
C VISIJA1.FINAL ONLY SS1;Rn�t On
BUILDING iMPOR].ANT:
OCCUPANCni
Y OP BUIL�INIG� NOTPE ITT 13`;" PLEASE KEAD REVERSE SIDt RFFORI>
UNTIL BUILDING FINAL IS SIGNB BY BUi�LDIlSG: CALLING FOR FINAL INSPECTION!!
INSPECTOR:
• A�11\n\ITI/\I\!\ • P !\llll\I
zd wdzs:90 6661 60 1pw r 'ON 3NOHd : W063