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13028 POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO 13028 INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION • JOB ADDRESS ) ✓� �C ��Ll `7 'l�'L9 UNIT# _LOT# / PERMIT EXPIRES IF WORK OWNER (r LFG G �I["C'L CONTRACTOR j IZD/'Ve, IS NOT STARTED WITHIN 5xIIVAA^io: INSP15CTIOW ATE:, INSPECTOR INSPECTION RECORD`. 180 DAYS OF PERMIT ISSU- ANCE OR 180 DAYS FROM FOUNDATION LAST CALLED INSPECTION. LIFER PERMIT VALIDATION PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND /SLAB PLUMBING ELECTRICAL ISSUANCE DATE MECHANICAL R BLDG. ELECT. PLG MEC ., etre Ta-a- � E3 ❑ ❑ DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMITm. -.vFi;; INFORMATION":.-_.• WOOD FLOOR awnnoN $TFT PLUMBING MECHANICAL PERMIT TO ELECTRICAL FRAMING STORIES TYPE CONSTR. INSULATION .rill r v✓ 4 OCC GROUP RES.UNITS .PLACE NO SUBFLOOR UNTIL"ABOVE HAS BEEN SIGNED, ROOF SO.FT.FLOOR AREA TOTAL ACREAGE • DIAPHRAGM BUILDING USE RES IND CON PB CON, El 0 El 0 ='APPLY NO ROOFING UNTIL•ABOVE HAS BEEN SIGNED, EL ASSESSORS PARCEL NO ROUGH 1`I:. ., f) I�C•l PLUMBING GAS TESTCupertino TRACT rvo. PARCEL rvG. MECHANICAL ELECTRICAL ACC.DATE ACC.FILE NO S'A ti?FINALS a, ear: '� : DATE't:'" e',°INSPi�'. FRAMING SAN # ZONING ENG.SITE NO, INSULATION PLUMBING GAS FIRE SPRINK ENERGY T 2< MECHANICAL - v [:] N❑ v [j N� j*-'•,COVER NO WORKUNTIL-ABOVE HAS'BEEN SIGNEDFa-',z- HEATING FLOOD ZONE A.L.U.C. LATH—INTERIOR ELECTRICAL LATH—EXTERIOR FIRE DEPT. �❑ N� vl] N❑ SHEETROCK GRADE SHEAR INTERIOR BUILDINGBUILDING SHEAR EXTERIOR TEMPORARY APPROVALS FIREWALLS ELECTRIC PLAN CHECK FEE GAS NO,TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINALISSIGNEDBY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC S ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING O 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. CFFfCE COPY - APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO NUIIdMNG-ELECI RIC'Ah rERn1n'NQ.. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL, C BUILDING PROJECT IDENTIFICATION J 915 SKEFARY NO. APPLICATION SUBMI'1'1'AL DATE BUILDING ADDRESSI�� : 11 OWCP NAMBO `I PHONE: CONTRACTOR'S NAME LIC NO: RIC CONTROLX eS 7 2 'C T- A ❑ ARCHIIEC MNGINEER: LES IC NO: ADDRS: Z��M 3cAq CONTACT: PHONE. VM Aqq5 C BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ ❑ ❑ LICENSED CONTRACTOR S DECLARATION QTY ELECTRIC PERMIT FEE: JOB DESCRIPTION 1 heathy union thin 1 am licensed order provision, f Chapter)(continental, _ OCZ with Scnien 7axn ofU -enFonhaRs dPm[ass+o+ C le J ylicv wis RESIDENTIAL Woo PERMITISSUANCE C1= in bill fnacend cIf 1 I � -72-3375 ❑SF'OWE.. ❑KI'I CHEN RFMODF1. U license Cl:u^ La, AI'I'LIANCGS-RF,SIUENTIAI. ❑ADDITION [I PLUMBING R&1'll'li Foul Dare cnmmc-- ❑MULTI-un'rr ❑,CrNuc'nrnnl. LC ASCI II'PF,CTS DLCLARATION PANELS F i7AsZ lundemmod my plana shall he usrd as pantie mcoNs MODIIICA'1'ION OZ�- UPT0200AMPS f♦^ ❑INTERI R ❑Cl I IMN I:Y REPAIR y Licensed Pralbs.ione. 201-HOTAMPS IS1P F,MENT ❑SWIMMING IY)OLS OWNGR-BUILDER DECLARATION OVER IlNOAMPS ❑ HREMODEIJREPAIR ❑DHMOLITION O C Q I herchy affirm that 1 am exempt from the Contractor's License I.a.for the j�O EL U following tea®n,(Section 7031.5.Business and Profession.Cede:Ams cit)'or county SIGNS ELECTRICAL OTHER u:3 a y which requires a permit to cnnnnct.alcor.improve,demolish,or repair any strvnurc FLL0g prim to c is coq :the applicantfosuchpc ilt fl signed statement SPECIAL CIRCUIT/MISC. E �.' that he : 1pursuant they : fth C t ctor L Law(Chaptcr9 COMMERCIAL u2�C0 humnmenctngwm Section 7000)of Division J ofthe Business dProf :ions Code)or TEMP.METER OR POLE INST. 0.a c C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITII I e f01 X Section 7071.5 by any applicant for a peamil subjects me applicant to a civil penalty of POWER DEVICES ❑TENANT FOOD SERVICE not more than live hundred dollars 0510). IMPROVEMENT =Q ❑ ha.owner of the propenY or mY emPleyccswimwages us meinnlc anupcomion, SWIbIMINGPOOLELECTRIC ❑OTHER p. will Jo the work.and the structure is not intended connected for sele(Sec.9MJ,Business C 3 m and Protes.sion%Code:The Contractor's License law Joes not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who builds ar improves thereon,and who it,,,,such well:himself in Ibnmgh his own employees,provided that such Improvements are not intended or oflered Iia NEW RESIDENTIAL ELECTS SQ FI'. sole.IL howcvcr.the build....ofimprovemenGs sold within one year ur nnuplction,thu SQ.FT.FLOOR AREA SISQ.IT. cr-Mer Jldwill bass, rp the burden on ing tus hhe did oat build nr amp-11-fnrt" I pn I'out,) 'IUTAI.- ❑ 1 n r in the property,am exclu: ly cormitting vilh licensed conruiclo,to, ♦ co t t no E oto(S 7BJd 9 m d P I : 'n:Code)n C t t : }�'. Il- A I,aw does ral aptib to an ons net or prnpenY who builds proves ilocavoicand QTY. PLUM I RMIT who comm¢Is for such prujecs,wall a motmcmr(s)licensed pursuant,,the Contmnnr's OCTq License law. PERMIT ISSUAN d� ❑l am exempt under Sec. ,B&P C Introit,tenon VV 01) ALTER-DRAIN&VENT-WATE 117. VALUATION Owner Dale CITY OF LVERTINO • WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.1) C I I hereby affirm under penalty of perjury one of Ne following declamtinn: ❑I have and rill maintain a Certificate ofComem to self-inure for Workers Compcm DRAINS-FLOOR.RUDE.AREA. STORIES TYPECOYSTRUCTION .lion,as provided for by Section 3710 of the labor Code,for the performance of the work fm which this permit is Issued. FIX'1 V RFS-PER TRAP XI have and will maintain Worker's Compensation Insurance.as required by Section mofthe Labor Code,for the performance Of the work for which this pemtit is issued GAS-EA.SYSTFL1-I INC.i OUTL OCC.GROUP My Work pa,. an wmnce tamer and Policy number are: GAS CA SYSTEM.1. (E.1 Canner:YLCIrto�I t�If Policy Ntv:�1 CE EPIC E OF EXEMPTION FRO WORKF,RS' GRF,ASETNDUSTRLW'ASTF .TERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FL (This section need not be completedTme Permit is furtmc hundred dollars(Sllxt) GREASETRAP 1'LANCHECK FEE or less.) fUUOder'x IcerlillmIn thelrer(ormanceoflM1ework fnr wM1iehthiapenhis isxtsA,lahiJl yBWI1R-SANITAR STORM BA.9NIFELoyany pers tory m,tarsoasto,bewm c eobject m the Wmktr CmnpcnENERGY PEB nn in 'n l,uwsotCaillvnlaDwc WATER IIHATE IVF.NTIELI-C'I'R.nlGRAIJINGIIiE CH 10 APPLICANT:IC after making this Certificate of Esmnption,you should WATER SYS' .MoTREATINGSOILS PGH objmlmme Workers Compensation pmv@ionsofthe Lada Cala youmull m comply wilh,.ch prnvimer,or this permit shall be themed evoked. WATER S VICE CONS'IRUCDON LENDING AGENCY NEW , IDBNIIALPLMR. SQ,FT PAIDl herebyalHnn marine.iso locomcoon mndin Re<eiptgork far which This permit is isweJ Iger.3119).Cir.CJ � TOTALrs Name er's Address TOI'A h: 00.. 1 certify that I have read this application and ware that the above information is BUILDING PEE F h correct.l agree m comply with all city and county ordinances and slate laws relining to QTY. MECHANICAL PERMIT FEE SEISMIC FEE U Z building construction.and hereby amhonre representatives ofthis city us enter upon the above-memionNpropertproperty for inspection purpoxs. PERMIT ISSUANCE ELECTRIC FEE (We)agree m save,indemnify and keep nameless me City of Cupertino against liabilities,judgments,costs and expenses which may in any way Brame against said City ALTER OR ADD TO MECH. PLUMBING FEE in onaqucnee of he gaming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HAN HUNG ON IT(TO I0.000 CFM) MECHANICAL FEE S IRCE REGULATIONS. AIR HANDLING UNIT(OVER IO,IN)0C CONS'I'RUCTION'fAX Signature of Appliaml/Cnn¢ncarz Dam EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEB HAZARDOUS MATERIALS DISCLOSURE WdIdar,cham or Oulu baddingoccupa.tsmeorhande haauNouv norelial HEATING UNIT(TO IOTA( I'U) ns detinnl by the Cupcn.nn Municipal Code,Chapter 9.12,nod the Itrahb into Safety IiA'I'ING UNIT(OVE (X1.1100❑'I'W Code.Section 25532(.)! H ❑Yes ON. VHN'LILATIONF . (SINGLERESID) P ED 'D RccciptX Will the applicant ar furore building occupant use Important nr devices which BOILER- P OHP OR 1 Wditto HE otallou.a air ennaminams as defined by me Bay Area Air Quality Munagenrrin TOl',\L: mil h is District! BOIL F -COMP(OVER I odiciI B'ru) ❑Yes ❑No At CONDITIONER ISSUANCE ESTE I hmc read the h ode,So ni... is 5q 533 i u 5 Chapter h95 of the Cali forma gdoes&Scurry Code,Sections 25505.255JJ and 35Ji.I undersmnd that if Inc ,EW RESIUE:NfIAL MECH. SG.IT. Wilding Jars trot currently have a tenant,that it is my responaihlliry to notify the occupmn nl a reyuimttrcns which must be met prior to issuance of a Certificate Of Occupancy. Owner nr aumoriecd.gem Date TOTAL: ISSUED BY: OFFICE