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19640hy W > W C a 0O U_ LL ~ O lis >M F N 2 U— APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY aa Bulldhi Paled Identification "°°d"z0676 PERMIT NO. 0 d 19640 ner A s arse: Phone: S L(� V 24.,f_ No�'�}SZO CITY OF CUPERTTNO-BUILDING DIVISION APPLICATION / PERMIT BUfLDINGELECTRICALML BINGMECHAMCAL A A — — 4 m na" a '.nm:rug. Ng: "# f V✓ nso.� ✓0 ® CATEGORY CONTROL# ArcMtect/Engineers Lle. e C 3 IC PERMIT FEE QTYEA11 BUILDING PERMIT INFO Address 14--11 �/00 ITOO I ILICENSED CONTRACTOR'S DECLARATIONI hereby affirm that l am licensed under provisions ofChapter9(rommeac. ion7ODO)ofDiAsion3oftheBusinessandProfesa(omCode, and mylicense is In full and effoo. ps, LicenseCl — Cmdr�7�IJ6�Date�.q_ 4 (�ContnctARCHITECTS ENIALJOB DESCRIPTIONingwithSe DECLARATION I understand my plats shall be used as public records 5Q. Fr. FLOOR $/SQ.FT. SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION I herebyafOrenthat I am exempt fromthe Contractor's License Law for the SI'ECIALCIRCUIT/M15C 'rGMP.MLTER OR POLE INST. POWER DEVICES following maion.(Section 7031.5, Business and Professions Cade: Any city or county which requires a permit to commid, alter, Improve, demolish, or repair any structure prior to its Luca ace, also requires the applicant fgrsuch permit to file a signed statement that he is licensed pursuant yr the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Dwi- sloa3 of the Businessand PrrftesioruCode) orthat he b exempt therefromand the basis for the alleged exemption. Any violation of Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty d nd merethan Ove hundred dollars ($500). E]1, as owner of the property, or my employees with wages as that, sole compensation, will do the work, and the structure in not intended or offered for sole (Sec. 7044, Business and Profogxma Code: The Contractor's Llcenae law SWIMMING POOL ELECTRIC VALUATION 3 OUTLETSSWITCFIFSEXTURFS NEW RESIDENTIAL ELLCTR—e'A2�7STORIES - TYPE CONSTRUCTION does not apply to an owner of property who W ilds or improves thereon, and who doessuchworkhimselforthmugh Msownemployees, provided that such Improvements am not intended oroffered for sale. If, howevegthebullding or imprevementls sold within oneyearofoompletion, the owner-bu0der will have tl�Lutden of proving that h, did not build or improve for purpose ofsale.). LJ L as owner of the property, am exclusively contracting with licensed contractors to mnstred the project (Sec. 7054, Business and Professions Code: The Contractors License raw does not apply to as owner of property who Wilds or Improves thereon, and who mntram for such Etojeas with a m,l!lRt�ractor(s) licensed pursuant to the Contractors License Law. LJ I am exempt under Sec. B Ne P C for this region OCC.GROUP RES.UNI'r5 TOTAL: 3.90 QTY. PLUMBING PERMIT FEE PERMIT ISSUANCE Z bQ ALTER -DRAIN & VENT -WATER (EA) FLODDZANE APN, BACK FLAW PROTECT. DEVICE FEE SUMMARY Owner Datc S DRAINS FLOOR ROOF, AREA,COND. 16 ' O b FIXTURES PER TRAP ( D ��'Y ie GAS EA. SYSTEM -I INC.40ULLEIS q SAMIARY Y N RECERT N WORKMAN COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to seB-insure, or a rtlficate ofWorkeri Compensation Insurance or a certified copy thereof (Sec. CJ.. / TO .y W SCHOOL TAX Y_ N_ RECER'TN ARK FEE Y N_ lvi, Ifb D G RECENT N Com any e • EN + y t LG e ✓ s (� �CerUOd copy b hercbyth the �CertlBed ropy b filed with (he city inspection division. GAS EA. SYSrENI-0VER 4 (EA) GREASE/WDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES PLANCHECK FEE GREASE TRAP CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crhisserrion need not beomptated ifthepermit Morons hundred dollars ($100)gr less.) I certify that In the performance.fthe work forwhich this pemdn is laved, 1 shall not employ any person In any manner so as to become subject to the Workers Compensators Uwa of California. Date Applicant PAID Date Rcoei [# SEWER -SANITARY -STORM EA. 20017. WATER HEATER W/VENT/ELECTR r ENERGY FEE Y_ N_ PAID WATER SYEfEM/'TREATING NEN' RESIDENTIAL PLMB,__SQF. NOTICETOAPPLICANT.If, after making this Certificate of Exemption, you should become subpet to the Workers' Compensation provkioro olthe Labor Code, you must forthwith comply with such erosion orlhls perm t shall be deemed revoked. CONSTRUCTION LENDING AGENCY lending agency Cjv. ,Che perform- I hereby orkfowlffirm that iherelaacoretro tionIssued Lace,!the work for which this permit V Lswed (Sec. 3097, Clv. C.I lender's Name Lcnd,rs Address Irect. Iaareto c ready hbapplletlonandunty ordinncesadgateaaws laroingt building complywcs,ii.l hereby authom opmessand gate laws relatingtororutrocttoq andhereby authorize Inspection CtyWenter upon ave,he Indemifyaud property harm) Wee Cloy purposes. (We) to save,indemnifyiodkeepes whihthe City of Cupertino agar' la Attics, pdgmenb, costs and expenses which may in anywayaccrue aga tsar' Cltylncti ence t granite this permit. - Date Revel t# TOTAL: BUTWING FEE TOTA SEISMIC FEE ELECTRIC FEE Z QTY. MECHANICAL PERMIT FEE PERMIT ISSUANCE lel./D ALTER ORADD TO MECH. Q'C AIR IiANUENC UNIT (TO 10,000 CFM) PLUMBING FEE MECHANICAL FEE FEES PAID: �=p Gb _ESL i( O Date ReC21Pf# SUBTOTAL: _ AIR HANDLING UNIT (OVER I OMOCFM) CONSTRUCTION TAX Signa rcof pelican Contra o Rate HAZARDOUSMAT IALSDISCLOSURE Willtheapplicam or futumbuildi occupant store orhandle hacardous by the Cuperun funicipal Code, Chapter 9.12, and the E lralt Yea Safety Co Nion 3Xa)7 Yes No Wi0thea pplicant tore Wilding occupant use equipment or devices which emitham rdmaair cont ntura ata as defined by the Bay Area Air Quality Management etl 4Yes No D(ELAUS'r HOOD(W/DUCT) CONSTRUCTION TAX PA ID: Date RCCeI t# HEATING UNIT (TO 100,006BTLD Tin _ HEATING UNIT(OVER 100,000 BTU) - TOTAL: 33- 0 VENTILATION FAN(SINGLE RESID) ® f ISSLIANTOTA IPA BORE-COMPOERPOR1D0,000EITU) have read the h=a Tisa materials mgWrcm,ntsunder Chapter 6.95 of the Cilifomla Health h SifetyCedq SeCbrs 25505, 75533 and 25534. I undcrs a,tithe building does not mrmatly have a tenant that it is my resp An onotify the occupant,! the requirements wMch;'Q be met pr: t ua ceofa Ctrtlf(citeof panty. FEB 091990 City Pf (:1—Tti60 BOILER -COMP 6t NE'✓RE%DENTIAL MECH. SQd7. _ L- b �TOLLUC(� Owner authorised agent Date TOTAL: 6. SD ISSUEDBY:�' OFFICE COPY MA POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO INSPECTION DIVISION yJJOB INSPECTION RECORD JOB ADDRESS a� 6 7 AoSS Pl r tiQl UNIT # LOT # OWNER S S UVLC(r W- CONTRACTOR P[R.wT NO. 19640 A A A CA BY CONTROL N BUILDING PERMIT INFO INSPECTION I MITE IINSPECTOR INSPECTION RECORD NOTE ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CLI'ERTINO STANDARDS. LILT 11=0 N [A Ix FOUNDATION/PIERS UFERGROUND JOB DESCRIPTION PAD/SETBACK-CERT GARAGE SLABS PREGUNITE POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB INSPECTION DATE' INSPECTO PLUMBING - ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED ' WOOD FLOOR PLUMBING ' MECHANICAL ELECTRICAL FRAMING VENTS CLEAR INSULATION ' PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ROUGH PLUMBING • . TU13S & SHOWER PAN MECHANICAL ELECTRICALIJACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION EMERG. EGRESS SEWER WATER COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN - SHEETROCK/SHEETROCKSHEAR EXTERIOR LATH-/W-SCREEN - SI LOWER LATH SCRATCH COAT NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED NOTE: NO FINAL INSPECTION SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID FINALS DATE INSPECTOR SAN.# ELECT. ENERGY - PLUMBING ENERGY MECH.ENERGY - 13UILDING ENERGY ELECT. FINAL TEST PLUMBING CAS TEST MECHANICAL HEATING ELECTRICAL RELEASE FIRE DEPT. cannE OCCUPANCY TEMPORARY APPROVALS - - ELECTRIC GAS BUILDING OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL ISSUANCE DATE BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR phom ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY, 24 HOURS FED U 9 290 BEFORE REQUIRED INSPECTION. JOB ADDRESS AND PERMIT # ARE NEEDED WHEN PHONING. Cltl ^s Fa^^rfint� IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION 4SSUeDBY: Lt . T; U Oc r r OFFICE COPY `4/