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23595 APPLIUANI IU PILL IPJ IW i'Uluruwlwl: Ya1111IIJ I itLk, LI I a LU — UJGUPILL i 1'I:IU+11 INO. 1lulldln Pm u,Idend(lodownfA /I - 23595 Uullding Add rest: /OI SI M LtA- C-r- ( CU/-Ep-�-'7ry0 A }rmr a(amc: r-•�� ✓•' 441-9983: CITY OF CUPERTINO-BUILDING DIVISION ^ C T. /2e E SEs c.ntr.d.r.Name: 'Ig.N.. APPLICATION 1 PERMIT (' BUILDING-ELI:CTRTCALPLIJMOING-MECIMNICAL CA RY COMROLN (�'�f i,•,Archltect/G Lk.No ;b' BUI4DINO;P6RMiT."INF0 l .4 �WIS 38 *.,.,3I�;CTRIe+akPtF , 4tti-,+ 5'< /✓ /a'l L•F 0 µms_ �iy a°Ua� ELECTRICPE IVIT " F Address: zN4ol �dp,ea•Rk DR. S_o �' .•� �A�118R_.[ pg PO2h9TIS5UATICE a-LICEE EDCONTRA O`R'''SS DR—CLA^RATIO APPLIANCMEE ENTIAL )OB DCSCRB'f10 a I hereby affirm that I am beenaed under provl,lona.(Cha Pte'9(commenc- log wllhSectl.n]000).(gvlelonJ.fthcllminessandPmlc,aloms Codgandmy PANELS 1 keno lain full lone and effect. Lkense Clam_ Comm �_ Date Contractor 1 � ARshall ousel aCLAlie re, f� ERI .SQ.FT.FLOOR AI{Ti� f/SQ.Ff. q�7 Iundersmnd myplansehall be used upublkrecorda. (VIES\,YY\/) 'Ij_l/L./1'•) �La �p qWp!wus O SIGNS C L •ate Licensed Proles+lanai G<� OWNER-BUILDER DECLARATION — �j Ihereby affirm that l am exempt from the Contractor's License Law for the SPECIA UIT/MISE followingreason.(SMIon7¢11.5,Businessand Professions Code:Any city or TEMP,METER OR POLE INST. O ccantywhichrepoler.xin rit to construct,alter,Improve,demolish,orespatr enydrodom prior to it,I...sea,also requires the applicant for such permit,- POWER DEVICES S file a signed antenna ot that he V licensed pursuant to the provisions of the d a °O 1� CcNncorb License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING IDOL ELECTRIC A T� 'd%OJ s1on3o(theausinen.nd ProfesslomCode)orlhathebexempithemlmmand i rf9 Qs37 the basis for the alleged exemption. Any violation of Section 7MLS by y E F .577 dryp appUontforaperMts.bjectstheapplicanttoadvilpenalty.I of SIDW- TYI R five undreddollan(S50B. P E SQ.FI. 'ECONSIRUCTION .. 1,as owner of the Properly,or my employees with wages as elr I s. compensaRon,wllldothe workandthestructure b not inlendedor o d g O ale(Sec.704L Business and Pmfemlow Code:The Contractors tic e does not apply to an owner o(properly,who builds or eprovrather an OCC.CROUP' RES.UNITS F: who doeseuch workhlmself orlhragh FlaownemPl-yeea,provldedth.ttL x improverrcntaare notlnlendcd oroffemd forsal�If, cvep(hrWIldln r( A : •/.411 Improvem rot w1dwithlooneyearofc.mpietlogthgowner-bullderwill have �; T}ry,1 o,Gl,\lIc"lFEE y1�' PLOOD TONG PN 11�u rdenofpmving thathedld natbielmlerprovekupuri ilse.fsal..). QW.,�s",�U71E• L�L as owner of the property,am exclusively exnlrae log with licensed — PERMIT 1. UANc contractorstocenot theprokct(Sec.7074,Business and Professions Code: The Contncioe's loan Lw does not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA) Wilds or Improves thereon, and who contracts for such p(-Iectn with a ,y"'' j aa.rts)Ilcensed pursuant to the Contractor's License Law. 1%t"NW`1SYcl 4" �E}SV AIkVAI4"`-�4a nI qW� Pu BACK FLOW PROTECT.DEVICE cgaj(I am exempt under Sec. B k P C for this mason U DRAINS-FLOOR ROOF,AREA,COND. SANITARY Y_ N_ qv DC OSZ RELEB'TN �. WOR ANCOMPENSATIDNDECLARATION SCI IDOL TAX Y_ N_ FIXTURES PER(INP []I hereby affirm that I have a certificate./consent,o self-Innurq or RECEIPT N ceniflcam ofWorkers Com,..tL.niruurance ora cad pled copy thereof(Ser. GAS EA.SYSTEM-I INC.(OUTLETS PARK FEE Y N 3BtD,Ub C.) RECEIPT N Policy N GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES Com any [rcz(fledcopyvherebyfurnished. GREASWINDUSTRLWASTE,INTERCEPFOR PL NCHECKFEE �� MCenuted copy b filed with the city inspection division. .��yy'v CERTIFICATE:OF EXEMPT ION FROM WORKERS' GREASE TRAP PAID 6�I 101 COMPENSATION INSURANCE SEWER-SANTTARY-STORM EA,700FT. ate Remi tH (fhl,,rethoneed on,be completed It the permit Is foronn hundred dollars ENERGY FEE Y N ($100)or leu.) WATER HEATER W/VENT/ELECTR — I o dlfy that In the performance of the work for which this Pump Is Issued, I shall not employ any person In any manner as,as to become subject to the WATIM SYSTEM/TREA'DNG PAID W.rkeri Compensation Lawn.f Calibumia.Data 0 Z Applicant NEWRIISIDENHALPLMB. FT Dale Remi tN Z O NOIICETOAITLICANLILafterm.kingthb Cedlflaigof Excmpti.n,y.0 TO AL: should become eubka to the Workers'Compensation provlelone of the Labor V) Codgy.umw,f.nhwlth comply with such provisions orlhls permiUhallbe -Il_VILDING >_ deemed revoked. SEISMIC FEE ILP CONSTRUCTION LENDING AGENCY CL Ihereby a(Orm that there is.construction lending agency for the perform, TOTAL: ELECTRIC FEE M Zance of the work for which this permit Is Issued(Sec..3097,Civ.C.) ��q PLUMBING FEE LLO Looder'e N.me Q.1.1,, +1 1x s F La.dersAdder.s W'rI.i1v1EC/ANiCA' ,''',P8 `T; } le h MECHANICAL FEE 0 W Lmdt.Iagrehave replyw irailcityndmuntahatinances and PERMIT ISSUANCE FEES P 1 R Lcornt building construction, alndtyandcouhorixe repre.aand datelnws '2 } eeyunetobuilding c.nslmctlonaoned property yor inspection purposes. ALTENORADDTOMECII. Z city toenter ee to the above-ropy and properlyf.rinepe Cit pfCoaea. Date Receiplft V _ Me)agree to ave,Indemnify and keep harmimthe City of Cupedlno AIR I LANDLING UNIT UO 10,0DOCI'M) egalnel Ilahllltles,}udgmenta,codaand expenses wM1kh may In eny way accrue SUBTOTAL: agatrutnlddCCity;Inycg��(sequrece of the granting of this permiitN AIRHANDLINGUND(OVER10,000CIM) CONSTRUCTION TAX �LC CONSTRUCTION TAX PAID: $Ignalur Appllcun'1%Contracmr nate at NUS'T 1100D(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE YIFATING UMT('1'O IIXI,fgO BTU) Will the applicant or future building occupant store or handle hazardous _ Dale Reeel tB material as deflned by the Cupertino Municipal Code,Chapter 9.17,and the Ideallh and Safety Code Section 75537(,)) HEATING UNIT(OVER MOOD BTU) TOTAL: ❑ Ycs No !N, 10rNnALh4I:CIL_SQ.ry !FAN(SIESID) ISSUANCE DATE WIIl the xpplkam or arum bullding.ccvpantux equipment or devices which emithavardoustlr contaminants.,deflned by the Bay Area Air Nl BT U)Quality Management Distrn7 P A I D BTU) the California Wealth k SafetyCode,Sections 25505,75533 and 75534. 1 � {} 1('('2 . JUN d 'DODO neponaiblllly to natty the occupant of the requirements which most be.met poor to Issuance at a Certificate of Occupancy. CITY L Ownermaulh.eized agent Data ISSIIF,U BY:_ a1 U� _ TOTAL: OFFICE COPY POST THIS CA" 'NEAR FRONT OF BUILDING Pig TNO. 23595 CITY'OF CUPERTINO A . INSPECTION DIVISION- JOB INSPECTION RECORD WR'— r-, -- JOB ADDRESS � n d UNIT#_ LOT# cA RY CONTROL _ ��` p ., tBU1NC.PERMIT.,INFOeFc,?s; OWNER S CONTRACTOR INSPECI'IONr ... `ftk "y' � ' ¢ED 44i INSPECTOR INSPECTION RECORD ❑ FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE UFERGROUND SHALL BE INSTALLED IlICOMPLY WITH JQIIDF 1411.110N PAD/SETBACK-CERT THE APPROVED PLANS AND CITYOF CUPERTINO STANDARDS. .. GARAGE SLABS PREGUNITE - ©� L7-0 1 POURWO CONC--RETE,UNPIL4AB0V�1HdSABEENfSIGNED,2" UNDERGROUND/SLAB INSPECTION DATE INSPECTOR PLUMBING ELECTRICAL MECHANICAL >DOSNOTd'P.OURSFLOOROUNTIL""''ABOVE.tHASzBEENiSIGNElYe WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL FRAMING VENTS CLEAR INSULATION TLA EEiNO;SUBFGOOR IL ABOVExHAS,1BEENISIGNED' ROUGH PLUMBING TUBS&SHOWER PAN MECHANICAL ELECTRICAL/JACUZZI BOND FRAMING STAIRS INSULATION/VENTILATION EMERG.EGRESS SEWER WATER ( =EOVER;7U0£WORIf•UNBI ABOV69HA8 BEEN.'SIGNED EXTERIOR SHEAR HOLD DOWN INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREEN SHOWER LATH SCRATCH COAT 700 T PE OR GiSTE A OVE#HA'S E N SIG DI NOTE.INOF.I1V�,G QN U THETONSTRUCTIOPW54000 ,- �' FINALS DATE INSPECTOR SAN.# ELECT.ENERGY PLUMBING ENERGY MECH,ENERGY BUILDING ENERGY ELECT.FINAL TEST PLUMBING GAS TEST MECHANICAL HEATING ELECTRICAL RELEASE ¢. FIRE DEPT. GRADE OCCUPANCY TEMPORARY APPROVALS ELECTRIC GAS BUILDING 64, ISSUANCE DATE OCCUPANCYof, {>(c;z grrrr { BIl/LDING<tFIN'A) GIVEDI�IILfISGTNS TCTO P • ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN 12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS JUN _ �9y� BEFORE REQUIRED INSPECTION. JOB ADDRESS AND �yP�ERMIT# ARE NEEDED WHEN PHONING. CI it vl- W ru�1 ury miry'V` 11K .. eN_sY PLEASHdREAD ISSUEDBY4 NQAP 1 Z APPLICANT'S POSTING COPY �L