01070100 CITYOF GUPEliONNo
BUILDIN
PERMIT .'.-CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10582 SANTA LUCIA RD WATER HEATERS ONLY 01070100
OWNER'S NAME: APPLICATION SUB LVE
SHOBHANA ANAND 970 E. MAIN ST SUITE 200 07/23/2001
W
ONE SANITARY NO. CONTROL NO
725-8324 GRASS VALLEY CA 95945
ARCHI'I'EC'I1ENGIN[ER: PHONE# BUILDING PERMIT INFO
BLDG ELECT PLU.\IB ?TECH
REPLACE WATER HEATER. I I I I I I 1 I
µµp YZ
&oE INSPPCTTON'S DATE I,NSPEC. TO ARRANGE INSPECTION JOB DESCRIPTION
a i w CALL 7T7.3228 MONDAY-FRIDAY 24 HOURS RESIDRNTIAL'
��i FOUNDATION/PIERS/H.U.S. BEFORE REQUIRED INSPECTION.JOB ADDRESS D SFDWL D KITCHEN REMODt
O z=p AND PERMIT#ARE NEEDED WHEN PHONING. D ADDITION C PLUMBING RE-PIPE
UFFR GROUND [D MULTI-UNIT Cl STRUCTURAL
PAD/SETBACK-CERT RESIDENTIAL_COMMERCIAL_OTHER MODIFICATION
aGARAGE SLABS/PREGUNITF - D INTERIOR D CHIMNEY REPAIR
G HAZARDOUS EIRE AREA
o
—0" POUR NO CONL'RFTEUNIIILABOVE HAS BEEN SIGNED � IMPROVEME\'I' D SWIMMING POOL'
Z W m - - - - -'- D BATH REMODEVREPAIR D DEMOLITION_ _
a6pp UNDERGROUND/SLAB ❑ YES It ye.-I unJer.wnd tnuuCla.aA riwf asxmbly istvynired. DOTHFR
w?,.t -PLUMBING .__... _.. .._. .... Y.._— .__.. '
..._...... _.. .. ...._ _�.. �—__. _"__ _ ..... ... .. ... ......_. ................._..
t-tn r D NO Initial .C.H.O.
5-0 ELECTRICAL
"'=z DO NOT POUR FLOOR UNTILABOVE HAS BEEN SIGNED EXISTING ROOF COVERINGCOMMERCIAL:
D NEW BLDG/AUDITION D D14MOLITION
PLUMBING' '—
N'wnbcrnl'cxixtingcovcrings D TENANT ❑ FOOD SERVICE
MECHANICAL . . .IMPROVEMENT
ELECTRICAL To be removed To be relnined D OTHER,
FRAMING VENTS
INSULATION
It\ ''RACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED TYPE OF ROOF COVERING
n.n•
ROOF SHEATH/DIAPHRAM -- ESXISTING: - '_"" PROPOSED:-'
PLUMBING D Built-Up Roof D Built-Up Root -
TUBS&SHOWER PAN D Asphalt Shingle, D.Asphalt Shingles
MECHANICAL D Wood Shakes+:: D Wood Shakes „
-ELECTRICA VPOOL BOND - 0\�ood Shingle; \' D Ward Shingle,
1)
FRAMING/STAIRS/E.EGRESS .. Other(Speaity).- .. ❑ Other(Specity)
INSULATION/VENTILATION - FINALEOLC.B4O.Report No.
t OVER'NO W'ORKUNTIL ABOVE HAS BEEN SIGNED Provide Mfgr.Installation Specs,
SEP 1-2 2001
. .' ;.'• 'EXTERIAL'.SHEAR/HOLD.DOWN:... _... . �. ,,., ,.y. . ..� ' ,• r -
- INTERIOR'SHEAR/HOLD IJOWN ,
.SHEETROCK/SHEEiTROCK SHEARINSPECTION SPECIAL INSPECTION REQUIRED O DATE- INSP
INSP
.'EXTERIOR LATH/W-SCREED
BUILDING-
SHOWER LATH I• ...
. .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED -
..SCRATCfI COAT ...._.. .. .
SFWER/WATER
...TEMPORARYAPPROVALS
-OCCUPANCY -
..FINALS .
.'PLANNING 777.3308
ZQ GAS TEST .. _ .
;:17 -GRADEI IW.`777-33541
CL FIRE' . . ... . — ..
0.. .HANDICAP. .......:......... . ... :.. . .' i
ELECTRICAL'.
O.F .'.PLUMBING, . .
:MFCHANICAL '
t ..
FINAL ONLY'. . . ._ _ .. .. . _.
. BUILDING'
OCCUPANCy.OPBU83)INOIS\'Or PERMITTED -
- .EJ.NTI1IBUII.DING'FINALIS SIGNED.By BUILDING. 1
,ISSPECrOR. CERTIFICATE OF OCCUPANCY❑
'PRE-INSPECTION_: - - PLYWOOD. IN-PROGRESS,
INSP. DATE- INSP. { DATE MSP. DATE-
I.;
ATEI. - ;NEAR OFF INSPECTION: , BATTENS: - _ _ FINAL:
MSP. DATE INSP. + DATE iNSP. - DATE
NOTE: OSHA APPROVE® ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION ..
Ir. -.. I,,. it':•, " APPLICANTS POSTING COPY.,
I-CITY OF CUPERTINO .
nun,nwcmvlsioN
' CONTRACTOR,INFORMATION: '
_ PERMIT
., 'B 1 GA DRESS.. -'
__WATER...HEATERS_.ONLY _ .0107.0.s1pp00_._..: _ . __ . . __......
'. ctfffTMWKLIN 500^ AIRPORT BLV A57cr2 y�0�E1
PHONE: (415) 349-3747 SANITARY NO. CONTROL NO.
n- ARCHITEC(ENGINEER: BUILDING PERMIT INFO
w— - BLDG ELECT PLUMB MECH
o sH z LICENSED CONTRACTOR'S DECLARATION ]��p �
`-'e Ition7 (firm matin 3oeensadunder provisions ndPonfans Codrgndan,lcei,e REPLACE WATER HEAT `K�Iption
m s•w with Sllf.,,.nd of Division 3o(the Raciness and Prolev'cionsCWe,and my lkense
<-�5 iammnrareeandem,. (75 G GAS WATER HEATER)
-6,z a License Class Lic.N0
rJ Date Contractor
u F• ARCHITECT'S DECLARATION
u O to I undersmnd mY plans shall be used as public records
w z Licensed Professional
OWNER-BUILDERfrom
DECLARATION
a.��• E 1 m�so affirm ma 1 sin exempt from the Contractor's License Law for the
F < following requires
a lermit t TO3L5,Business and improve.
de o demolish.
Code Any city orcounry
F ❑ which requires a permit m mnstma,alter,improve,Demolish,or arepair"q any swdum
i3 prior,omsissuance.also q eh 'ppl tf ch pe tmfile seLowiias neat " -
thntheylemsedpmr<ua rta 'he finec tenet sL'aenaeLaw(enapter9 S, F[.,F11110ocArea- _ -_.Valuation -_
ued
(commemm�g wnh Snt ,]0001 of D' 3 f she B imess and Pro(ess,ons Cade) 1 t;,"y t;is s 9''; r .t e y - f 1,1�' ��•,
or the he is asempi therefrom and the hes s for the alleged at If
Any viola on l'_., •'
of Serino]031 5 by any applicant for a permiuubjcns the aPPbcum m a civil pea Ify
,of am mare them five hundred and
f35Wl.. - APN Number, " av: "id'Occupancy Type
_ :... -- '- - UMBZN -,ENERGY--
sale — ...... __..._. . ..
•p ❑I;as ownerof the prophny,or mycmploycs�.'tth Wa-, aamensore mmpcnsaifon, '502'- FINAL, PL _
ill do he wora.'aad the'avucture is no,intended'.,offered for
Tse,:. 5 0 6' '- GAS TE S'I$e uired•Ins ections
„�,• •Busineis and Professions Code:The Contractor's License Law does not apply to an q _p `• ""
• owner ofpmpcnyWho Wild,orimprove,thamn.and who dressuch work himself 507 - FINAL PLUMBING
or through his own employees.provided that such improvements are not intended or __-
�'-
gs barren
•Ycldo
mprove for the owner-Wilma will have she burden of proving that he did not Wild or
improve for pugroac of sale.).
15.1,as weer 0f the p(Secry,a Business
and
Pru«ing with Ilcenseh Contract to o .
- License
t the does
n (Sec,Toa.ownr and Professions CaloO The improves
Contractor's
License Law does not apply man owner of propcny what Wilds or imprrs a thto the
: : .._andwhor',License
projects,with.a.comrxmnxl.IicenuJ.pursmmwthe ._ __._..._..__ .___......... ........... ..... ........ .:.Contra . .....-
0I:.ama License Law. --
❑IamcncmDtunJ<rSec. .B&PCfonhis moron 1• s <'t •0
Owner Dale .
_ w RKER'S COMPENSA11ON DECLARA9'ION -
I hereby affirm under penalty of perjury one of the following dectarations: .
❑ 1 have'and'will maintaina Certificate of COnum to self-insure for Worker's t
Compensation, as provided for by Section 37W of the Labor Cods, for the
Perfom,ance of the work for which this permit is iaucal
,
01 have and'w ill mai nmin Wmkar'C.rmpeniution insane,as mjoireJ by Section
37W of the LhMsr Code:for the perfonnarice of the work for which'this permit is
-(. issued.My Workers Compensation lawrince<oriciana Policy number are: -
�1 'l r I,g nYr, tyS.,i
Poliay N ' '.. " . ,t t pp s- r''11�•..:.r: sDw9yE •, ,r's r. s .. s .•..._ t _..
(CERTIFICATION OF EXEMPTION FROhi P'ORKEI�s l,` h - r•'a •-
•• COMPENSATION,INSURANCE„ _ .__...
_,, 1F' -rat r • - i.::. ). 1+,....1.
ITh s sEnton'ncea not W completed if the Permit is for one hu WrcJ dollars
' III nfythatin the pef fth k! w,"
h hrh. pc 'i ued.l e,,, •:> t,.y�]s:'!i:t
stiall tot employ any p many !a us,m'beco ne st bjeu m the Workers
CompensaGno Laws of California;Daia p
_.
A,"'an
'NOTICE fO AI I LICANH if ft a"
g th.C r T f E e pi Yom
o should
Wco ne sublet w the Worker s Ca npensbu n pr s ''ani nl iIt Ltbor Coln pi,must ,
� Q forthwith comply said,our,
Provisions o.this permit shall be docrZ revoked.
hereby «DING Gagen Yf ole . _ _._ ......... ... .. . . . .. ...—._. __ ...__. ___ --
F!� 'J ' n CON Sem is a m,m LENDING it,r AOCNCY ' s
x,7 1 h fo Oum that them s s const perfommnie 1
W Q of the workforwhich his perms is is,ad lSec.JW].Civ.C.1
0.. -'Lentler's Name — -
c,z LenderF Address
U-0 I certify fl a l have read this application and state thin be above infomution is
V. F cmrect 1 agree 0 comply with all city and County ordinances and state laws relating
Q U tobuilding c nuucrp d hereby author m representatives of this city to ter upon
the h t d st p:.io r sped p rp.cs
F,y fwlg tos < JemofYsas which
yintheC iy fCpcnnoagaina
.h liabilities. cost. aM a genus h eh may n any y g incl said µ
U-z APPLICANT
consey croa NDERfthe mall.,AND t WILL
iM '
SOUkCEREOULERSTANDSAND WILL COMPLY WITH ASI.NON POINT Issued by: Dale
SOUhCE REGULATIONS: ' . y'
Signature of A,p1icoWCommr6r-. ,n;. Omc',„• Re-roofs
fid!%RDOUS MATERIALS DISCLOSURE
: worn ppi cm fm W Id ng we pat,t tore or handl hazvJw.m ten I -Type of Roof
as defined by he Nostrum Municipal Cole Chapter 9.12.and the Health and Safety __ „p�• `,,,, ,iy„
Cod SOcY n25532(1 I sONS. r .,Dt s - '.t•:' S 1 L� '., ' J ' ;
_ . . _All roofs.shall'be inspectedpriot to.any roofing material.being installed.-- .--, -.
W um pp(iw r rr� Wiiamg o<_<�pant�,�egap t u iba wnmht If a roof is installed''withodtfirst obtaining an'inspection;,l gfeerto remove
em t h d _ r«ter . t. J fined by rhe Bay Area A Quality Afanagemem
Di r; toy all new,materials for inspection Applicant,understands_and will comply'with y
.c I 0 N°. all non-point source regulations,, .. t , II,r• , '
I oriel read,he h rJ s-muler L .,y cempte
ents under Char 6.95 of she
C.:iforma Hcalth&Safety Code:Sutions 25505.25533 and 25534,1 understand that --
i(the building doci riot currently have 5¢nano ttiar it is my¢sponsibility m notify the
. . . .
. . .. .....
occupant of the requirements which muss M met prior to issuance of,a Cenificwe of
^' o"y„aney.; Signature of Applicant Date..
Owneroramhmi.dagant ' ; Da,e.. All roof coverings to be Class "B” or better
.. .. .
... ,. .:,,. t.. ,. ._ _- ,... .. �.. OFFICE .. . . . ..