02110081_- �f #TY(D1FC-U?ERTEN'
CITY OF lC 1L'd11�11V RT AP L1L�1.�1 ilTEG IF RM�v
����JAp
APN #P"
. 61-1"6
s
Fee Group
Date:
Building Address:
A7 7 -
BBLDGFEE
Owner's Name: 7-'
�� l�
BBOILER1
Phone #: �'� O? O
Contractor:
BBOILER2
Boiler > 100K to 500K Btu
License #:
Contact:
Boiler > 5OOK to lM Btu
MECHANICAL
Cupertino Business License#:
Bu' Permit Info: Dom. C4 -t
,/Bldg_Elect ❑ Plur§ib
❑ Mech ❑
Job ption:
Resid tial ❑ PJ�A
Boiler > 1.75M Btu
°�WdoVerci
1 ❑
t. Floor Area:
BUILDING
BCONSTAX
$/Sq.Ft.:
Cost of Project:
BCONSTAXBQ
Con. Tax for BQ Zone
Occupancy roup:
Type of Construction:
Hotel and Motel
BUILDING
BCONSTAXR
Quantity Fee ED
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILER1
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 5OOK to lM Btu
MECHANICAL
BBOILER4
Boiler > 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC 1000
Elec 600V <=1000A
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B EN ERGY
Ener
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
TY OF CUEERTRN®
CU��� IlN® PIEII�IIT AI�FLECCA'I RON ]FORM
Quantity Fee RD
Fee Description
]Fee Group
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BMNEWSF&2F
New Sf&2F Res Bldgs
MECHANICAL
BNEWMULTI
Multifamily Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BNUMULTI
New Multifamily Res
PLUMBING
BNUSFD
New Single Family Res
BUILDING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BP ERMFIEIE
Bldg Permit ]Fees
BUI LDRNG
W]FI XTURIE
?blg Fixture
PILUMBING
BPGAS
Gas Piping System Fee
PLUMBING
BPINTERCEP
Ind Waste Interceptor
PLUIVIBING
BP LAN CIQHK
Plan Check ]Fee
BUILDING
BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Repeat Fee
BUILDING
BPREPIPE
Re i e Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
. PLUMBING
BPSPRINK
Lawn SprinklerBackflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water HeaterNent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 cfm
MECHANICAL
BREMAIRHAN
A/C Units <=10,000 cfin
MECHANICAL
BRENAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BRENFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BRENUVR P
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
2 of 3
aIM
LICIJ.L T O `SUPER 1L 11ITOF PERMIT APPLICATION FORM
CUPEkTBN®
Quantity Fee ID
Fee Description
Fee Group
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Lighting Fix
ELECTRICAL
BREMVENFAN
Vent Fan Single Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECHANICAL
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BSEISMICRE
Seismic Fee Ices
BUILDING
BSPECIAL
Special Insection
BUILDING
BSWDA
Swimming Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
BUILDING
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot
ELECTRICAL
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MP)ERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Change
BUILDING
3 of 3
C
� .. CITY OF CCUIFER' ENG
CITY OF
CUPEkTNO
APN #
Date: j C2,
Building Address:
Owner's Name:
Phone #:
yob 9 ��d
Contractor:
License #:
Contact:
Phone M
Applicant/Contractor:
Fax M
Building Permit Info:
Bl Elect Plumb Mech
—1615 Description:
Residential: Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation:
�e
Type of Construction:
Occupancy Group:
Quantity Fee RD
Fee Description
Fee Groan
BAPPLOTHER
Other Appliances
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <=1000A
ELECTRICAL
BELEC 1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B EN ERGIYY
Energy
-BUM DENG
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BNEWMULTI
New Multi -family Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
(., I/
1 of 3
cin of
tCUPEkTIINO
•
•
CITY OF CUPERTINO
PERMIT APPLICATION FORINT
Quantity Fee ID
Fee Description
Fee Group
BNUIVIULTI
New Multi -family Res
PLUMBING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFIXTURE
Pblg Fixture
PLUMBING
BPGAS
Gas Piping System Fee
PLUMBING
BPINTERCEP
Ind Waste Interceptor
PLUMBING
BPLANCHK
Plan Check Fee
BUILDING
BPLANCKADD
Plan Check Add Multi
BUILDING
BPLANCKREP
Plan Check Re eat Fee
BUILDING
BPREPIPE
Repipe Of Fixtures
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSPRINK
Lawn S rinklerBackflo
PLUMBING
BPSTORM
StomVRain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water Heater/Vent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 cfrn
MECHANICAL
BREMAIRHAN
A/C Units <=10,000 cfin
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMF-URNOV
Relo Furnace > l OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
BREMRESAPP
Remodel Res Appliance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Signs, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Lighting Fix
ELECTRICAL
2of3
Still
CITYOF PERMIT APPLICATRON FORM.
CUPEkTINO
Quantity Fee ID
Fee Description
Fee Group
BREMVENFAN
Vent Fan Single Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECHANICAL
BSCBLVD
Scb Specific Plan
BUILDING
1BS]EISMICOM
Seismic Commercial
]BUILDING
BSlEISMICRE
Seismic Fee Res
]BUILDING
BSF&2FAM
Single & 2 Family
BUILDING
BSFNA
Single amil New Add
BUILDING
BSPECIAL
Special Insection
BUILDING
BSWIM
Swimmin Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
. BUILDING
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot-
ELECTRICAL
>EPIERMITF>ElE
lElec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MPFRMITF1ElE
Mech Permit Issuance
MECHANICAL
PPIERMITFIE>E
Plumbing Permit Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
BBOILERI
Boiler <=100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler > 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75 M Btu
MECHANICAL
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CITY OF CU PERTINO
°a
BUILDING DIVISION P]rRMI �lYlr
AJ4��1
1u1vJ�LL ..
BU11D1N2 &6RE T CREST DR
CHAM KIT M
AND NG SAU L
PERMIT t0-2110 0 81
Gw@KftMMEKI T M AND NG SAU L
APPLICAT10 k1"2 0 0 2
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECr/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
hereby I licensed Chapter 9
Job Description
p
I affirm that am under provisions of (commencing
DECK
with Section 7000) of Division 3 of rhe Business and Professions Code, and my license is
in full force and effect.
ORIG
PERMIT 99080181 EXPIRED 11/13/02.
License Lie.
Date Contractor
D
NEW PERMIT
ISSUED 1/2 ORIG FEES CHARGED.
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such pemhit to (ilea signed statement
that he is licensed pursuant to the provisions of the Conuactors License Law (Chapter 9
Sq. Ft.
Floor Area
$ 2 0 M10ation
(commencing with Section 7000) ofDivision3 of lheBusiness and Professions Code) or
that he is exempt therefrom and tre.basis for the alleged exemption. Any violation of
19 Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Professions Code: The Contractor's License Law does to
(—A ed Inspections
and not apply an owner of10
2 —
PIERS
property who builds or improves thereon, and who does such work himself or through his
'
own employees, provided thatsuchimprovements are notimendedmofferedforsale.If.
103 —
UFE'R
however, the building or improvement is sold within one year of completion, the owner-
104 —
RE BAR
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
105 -
ANCHOR BOLTS
❑ 1, as owner of the property, am exclusively contracting with licensed convectors to
106 —
SEWER & WATER
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and,
202 —
UNDERFLOOR PLUMBING
who conuacts forsuch projects with a contractorts) licensed pursuant to the Contractor's
License Law.
203 —
UNDERFLOOR MECHANICAL
❑1amexemptunder _'B PC tsre on
204 -
UNDERFLOOR FRAME'-'
"Sec.
own hN�,?14 1- Datel� 12 D
205 -
UNDERFLOOR INSULATION
ORKE COMPENSAIIIONDECL.ARA
VVVV
301 —
ROUGH PLUMBING
1 hereby affirm underpenalty of perjury one of the following declarations:
302 —
TUB & OR SHOWER
❑ I have and will maintain aCertificate of Consent to self-insum for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this per -mit is issued.
304 —
ROUGH ELECTRICAL
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
305 —
FRAME
3700 of the Labor Code, for the performanceof the work forwhich this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
306 —
HOLDOWNS
Cartier. Policy No.:
307 —
INSULATION
CERTIFICATE
COMPENSATION INSURANCE mimoN OORKERS'
C
3 0 8 —
SHEETROCK
(Thissection need notbccompleted ifthepemitisforonehundred dollars($100)
309 -
EXTERIOR LATH
or less.)
310 —
INTERIOR LATH
I certify that in the pVfpmance of the work f r whiph this permit is issued, I shall not
311 -
SCRATCH COAT
employ any person y manncrso as to b'et'l to the Workers Compensation
Laws of Califo . Da
313 —
ROOF NAIL
Applicant
N,orllf TO APPLICANT: 1f, ter making this Certificate of Exemption, you should
501
F I NAL ELECTRICAL ENERGY
be e subject to the Workers Compensation provisions of the Labor Code, you must
_
5 0 2
FINAL PLUMBING ENERGY
thwith comply with such provisions or this permit shall be deemed revoked.
503 -
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
504 -
F I NAL BUILDING ENERGY
the work for which this permit is issued (Sec. 3097, Civ. C.)
Landers Name
SOS 5 —
506 —
FINAL ELECTRICAL
GAS TEST
Lander's Address
1 certify that I have read this application and state that the above information is
5 0 7 —
F I NAL PLUMBING
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
5 —
FINAL MECHANICAL
above-mentioned property for inspection purposes.
5 O 9 —
FIN GRADE
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities,judgments, costs and expenses which may in any way accrue against said City
5
F N G
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by5 1
c /
T WORKS Date 1.0�
SOURCE REGP9AZS.
/t
4
Re -roofs
Type of Roof
ignalure Applicant/on or ate
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
El Yes ONNo
All roofs shall be
inspected prior to an roofing material beim
p p y g g installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials
for inspection.
District?
❑Yes Nu
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Scctons 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my resporuibility to notify the occ pant of the
equiXrh4nustbemetpriortoissuanceofaCertificateof�cup
Signature of Applicant Date
y
All roof coverings to be Class "B" or better
Owtierorauzc gent p C
BUILDING DIVISION PERMIT
1122af'R' CREST DR
CHAM KIT M AND NG SAU L 1"
"".
03040068
OTMN"KI T M AND NG SAU L �T yuE711/2003
4
l PHONE: I I SANITARY N0. CONTROL NO.
1 O p LICENSED CONTRACTOR'S DECLARATION
U 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
yd with Section 7000) of DivisionSoftheBusimmandProfessionsCode,andmylicenseis
a h in full force and effect.
j z License Class Ile. d
't- Date — Contractor
ARCHITECTS DECLARA71ON
g u I understand my plans shall be used as public records
c t; Licensed Professional
y g OWNER -BUILDER DECLARATION
< I hereby affirm that 1 am exempt from the Contrectoes License Law for the
Z00 following reason. (Section 70313, Business and Professions Code: Any city or county
S.09 which requires a permit to construct, alter, improve, demolish, or repair any structure
Z N,' prior to its issuance, also mquires the applicant for such permit to file a signed statement
G that he Is licensed pursuant to the provisions of the Contractues License Law (Chapter 9
$ (commencing with Section 7000) of Division 3 or the Business and Professions Code)or
y .. that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars (SSW).
❑ I. as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractoes License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements ate not Intended or offered for sale. If,
however, the building or improvement is sold within one year of completion. the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[ 1, as owner of the property, am exclusively contracting with licensed contractors to
contWct the project (See. 7044, Business and Professions Code:) The Contractor's Ll -
cense Law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Convector's
License Law.
tI,1 am exempt under sec , B R P C for this reason
Owner n Date ��
CE S OM ENSA7'IONDECLARA ��((J///
�ereby der penalty of perjury one of the toll declarmions:
❑ I have and w ltl maintain a Certificate of Consent to self -insure for WorkeesCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Worker's Compensation Insurance carrier and Polity number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA71ONINSURANCE
(This section need not be completed lithe permit is forore hundred dollars ($100)
or lass.)
1 certify that In c perfolm�q of the work for which this permit Ia issued. I shall not
employ enyperso manbdrcomcsubject tothe Workers'Compensation
Lawn of CWifomi �a YJY'1 f
Ati
N TO APPLICANT: Ir, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
® forthwith comply with such provisions or this permit shall be deemed rooked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them Is a construction )ending agency for the perfortnantc or
6Ye v> the work for which this permit is issued (Sec. 3097, Civ. C.)
WGL Lenders Name
Lcnder s Address
U ® 1 certify that I have read this application and state that the above Information Is
(3n correct. I agree to comply with all city and county ordinances and state laws relating to
0 buildingeonswction, and hereby authorize mpresentatives of This city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
b liabilities, judgments, costs and expenses which may in any way accrue against said City
t� in consequence of the granting of this permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL,NObi-POINT
btknatum of Applicant/Contractor t Bate
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(x)?
(]Yes _'No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dclined by the Bay Area Air Quality Management
District??
0'�ns )` Nu
I have mad the hazar�tbusmatenals requirements underChapter 6.95 of the Califon
nia Health & Safety Code, SEmions 25505, 25533 and 25534.1 understand that lithe, building
does not currently have a tenant, that it is my responsibility to notify the occurt of e
mqulre c whi u m prior to issuance ofaCe'ricate Occ
Owner or authorvcd aeem I
Job Description
REVISION --IN HOUSE USE ONLY
NO.NEW PERMIT, ORIG. #02110081
Sq. Ft.
35626016.00
101
102
103
104
105
106
202
203
204
205
301
302
303
304
305
306
307
308
309
310
311
313
501
502
503
504
505
506
E1i
5
Issued by:5
Re -roofs J y
Type of Roof
BUILDING PERMIT INFO
Required Inspections
- FOUNDATION
- PIERS
- UFER
- REBAR
- ANCHOR BOLTS
- SEWER & WATER
- UNDERFLOOR PLUMBING
- UNDERFLOOR MECHANICAL
- UNDERFLOOR FRAME
- UNDERFLOOR INSULATION
- ROUGH PLUMBING
- TUB & OR SHOWER
- ROUGH MECHANICAL
- ROUGH ELECTRICAL
- FRAME
- HOLDOWNS
- INSULATION
- SHEETROCK
- EXTERIOR LATH
- INTERIOR LATH
- SCRATCH COAT
- ROOF NAIL
- FINAL ELECTRICA
- FINAL PLUMBING
- FINAL MECHANICA
- FINAL BUILDING
- FINAL ELECTRICA
- GAS TEST
FIN PLUMBI G
FI T.
hype
PUBLIC
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better