19526 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
'Building Pro'ert Identification - I'(12h11'C NO.
arming Aadres,,: Z 19526 ,
wnera PhoneATIP�ICA[ION
SUBMITTALA
CITY OF CUPERTINO-BUILDING DIVISION /
Co actor'aName: /1 / LI No APPLICATION / PERMIT 1 —� D'
I'p �NS �10I�d BUILDING-ELECTRICALPLIMBINGMFLHAMCAL CATEGORY CONTROL Mme{',( C�
Arc^I'rn £mine!': LIr.No:
Iv -/I•�/� 1 ' ��-a� tYy+• ti h ELECTRIC.PERMIT „I1.FEET! t � •I`IBUILDING''PERMIT INFO
Address IZ5, V [j}"✓� .. . ., F� ..
PIRhRTISSUANCE •Zpo �Q ! 2 -I-VI
LIC NSCthat Ia CONTR under rDECLARATION Vim•
I Mh afflund fthdBuprovisionsof Chapter9(leand a APPEANCESRFSIDENTIAL TOB DFSCRP'HON
Ingwlth Sect1on70W)-iteldn3o(tee Buslnessand Pro/essioneCode,and my - - „
license is In(u and Ale(eR. -•7 1 PANELS
' 'T,Icen CJapa,�Q Llc N •4 ` ` q � .
Date 11S` "l Cantragor ��„ - �-
ARCHITECPS DECLARATION 201-IOW AMPS ��,"` 2
�Z I understand my plans shall be used u publo records OVER IODO AMPS- SQ.FT.FLOOR AREA $/SQ.FT.
µQ Op
o(� Licensed Professional - SIGNS ELECTRICAL
1�-< -OWNER-BUILDER DECLARATION SI'ECIALCRtCNT/MLSC
I hereby affirm that am exempt fromthe Contractors License Law for the _
p following reason. 7mlS,Business and Professions Code:Any city or
O Z F TEMP.METER OR POLE IN9f.
F rountywhich regrto it Issuanmmmtrucgalter,lmpmvgdemolbh'prdiftto '.(
�'Y� any slmcWrepriorta its issuance,also requlrestheappBcantfonuch pe:Mno ' Ii7N'ER DEVICES -(/
FpC e. file a signed statement that he is licensed pursuant to the provisions of the
WOEContractors License Law(Chapter 9(commencing with Section 7AY)of Divi-
El -
sion3ofthe Busincasand Profemlom Code)orthathebexemptthenfmmand 5WRvIMINC IY)0 FCTRI VALUATION
11'
O the basis for the alleged exemption. Any violation of Section 7WI.S by any Q
uppllcautforapermitaubjeRstheappllcanttoa civil penalty ofnat morethan A S.OUTLETS H 6
.,D ,OD 0
five hundred dallan(&500). NEW RPSID A ORl 7YPECONSTRUCTION
�n ❑I,as owner of the property,or my employees with wages as their sole III,I
compeenatlon,w81 dothe work and the simmers isnot intended or offered for
5 O sale(Sec.7044,Business and Professions Cade:The Contractors License law •'
.� does not apply to an owner ofproperty who Wilds orimroveatherconand - -
FS^ whodoeasuchworkhimselforthr gh Msownemployee!PrwldedthkAuch AOCC.GROUP - RES.UNITS
improvements am n&intended oroffered forsale.If,however,thebullding or TOTAL: -QD ..
improvement]3wtd within oneyearofcomplever,theowner-buederwlll nave - -
t1jurden of pmving that he did not build or Improve for purpose of sale.). QTy, • 1 i L Gi ERMIT,s��1r ;', FEE' I FLOOD TONE - APN
u L as owner of the property,am exclusively contracting with licensed P A
contractors to conatmct the project(Sec.7614 Business and Professions Code: V
The Conmdur'a Llemse Law does out apply to an owner of property who asDI &VENTWATER IFA)
Wilds or Improves thereon,and who contracts fee such p4ojemb with a 1. •)t FEE SUMMARY
ro,ra1tt.[ut (a)licensed pursuant to the Contractor's License Law. BAIX PIAWIa1tOTECT.DEVICE t
LI7 am exempt under Sec. B k P C for this reason
DRAINS-FLOOR,ROOF,AREA,CONE. SANITARY V N
Owner Date a RECEIPf p .
WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAPSCI;OOL FAX O� Y_ N
71 hereby affirm that I have a rdficah,of consent to sel4lnsursor a, RGCE T k
certifloteofWorker'Compevtimlmunnceoramrtifiedropythenrof(Sec. CAS EA.SYSTEM-1 INC4007TET5 PARR FEE Y N
38 W,Lab C.)
Paltry a CAS EA.SYSTEM1 OVER 4(EA) RECEIPT a
Cam any BUILDING DI VISION FEES
[�
Certmed copy 6 herebyfamished.thcity
GREASE/NDUSTRL WASTE INTERCEPTOR PLANCHECK FEE 11a 65
Codified ropy is filed hereby fM1 the ctty lvpxlian division. / SC
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP 'PAID 6
COMPENSATION INSURANCE SEWER-SANARYSTOREA X 11. - Date ReceI tN
(Thissection need not be completed if lI' M
ho permit isforone hundred dollars
($1 W)or less.) WATER HEATER w/vENT/E,ECTR ENERGYFEE Y N'
I mdify that to the performance of the work for which this permit is issued, _
1 shall not a toy any enon to an ma ner so as- xgRe wtb1q6the WATEt SYS'T'EM/TREATING PAID
Workers Co t o .11 Date_ \—\ 11 U
0 Z Applicant_ NEW RESIDENTIAL PLMR. SQRF. Date Recei tilt '
.z Z2 NOTICE be..
OAPPLICt to
after makingthis
erationCertificate provisions
Exemption,Labor
should become subject to the Workeri Campensatlon proWlouu of the Labor � '. TOTAL:
1C N Code,you resist forthwith comply with such pmvislov orthb permit shall W
LU 9 deemed revoked. _ BUIL N •FE a(7
IL a CONSTRUCTION LENDING AGENCY SEISMIC FEE
!1 Thereby affirm that there is a construction Lending agency forthe perform- r�
M Z ance of the work for which this permit is isaued(Sec.3097,Civ.C.) TOTAL: f6 00 ELECTRIC FEE
U O 1,Anders Name PLUMBING FEE'
_ly F I,Anders Addrcea QTY. MECHANICA'LPERMIT FEE.'' MECHANICALFEB D
O W isIwdifythat l have read thisappilationand atatethat theabove Information - 6'
rorrect.I agresto complywith all cityand county ordinances and gate laws PERMIT ISSUANCE UrD FEES PAID:
T In relating to building construction,add hereby authodae representatives ofthis
H W city to enter upon the above-mentioned property for inspection purposes. ALTFRORADDTOMECH. Date - ReeCl tN
V — (WB)agree to save,Indemnify an d keep harmless the City of Cupertino - P
against liabilities,judgments,mks and expenses which may In anywayamroe AIR HANDLING UNIT(TO 10,000 CPM) SUBTOTAL:
against said City In conaequmen of the granting of this permit. -
MR.HANDLINGUNIT(OVER 10,000CIM) CONSTRUCCIONTAX
Sigr.dmof Applicant/Contractor Date E%IIAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
' HAZARDOUSMATERIALSDISCLOSURE
Will the applicant or lower building occupant store or handle ha>ardous HEATING UNIT(TO IW,ODO BTU) Date ReCel t# '
material as defined by the Cupertino Municipal Code,Chapter 9.1$and the - -s
Hcalthand Safety Ccdr. Ion MiN(a)7 HEATING UNIT(OVER 100,00 BTU) TOTAL: Y
11 Yca Rhine
_ .
Rlthe hamrdsnt Lurenomantgas defieuse
ythe By Area devlma I VIiN'DLATION FAN(SINGLE RGSID) LI ISSUANCE DATE
which mot
anagement air citaMnanro as defined by the Bay Arca Air r pR�
@+ Illy Management Dist ict7, BOILER--COMP OHPOR l00,OW BTU) • PARD
4 Yes 1}r,No
California
Health
ar Safety
mode, echos 25505, 5533 and 255 4. 1 of eOILLR-COMP(OVFR 100,000 B111)the //�� ,tf1
.nde.t.ed thatlfth 65afety Code, mcud,mtlyhAvA a3and,that I ;IHIV b'}� JU
understand that notify the nu loss not erequir have which
that bItisurymet NEW RESIDENTIAL MECFI. SQ.IT.
'
responsibility to notify the ocmypant of the requirements which must be met .• •
'or is anco (a teofOcmvpanry: 0,Cnoprtina - +'
�ft a-
Ownerorautnorindagent Date - ISSUED BY_�
IDrnL: b'-S-
OFFICE COPY
O.
* /
POST.THISCARDNEARFRONT OFBUILDING ' PERMITN195Z6
CITY OF:CUPERTINO " A A
INSPECTION DIVISION-:JOB INSPECTION.RECORD-'
OB ADDRESS - t7 CATEGORY '. . CONTROL#
I�o(L - •� UNIT# LOT# - - .
OWNER, I �. 1 I l 'e�VL. CONTRACCOR`" C ��BUILDINC PERMITINFO
ANSPECTION'- '``' " •r DATE INSPECTOR INSPECTION RECORD
FOUNDATION/PIER$. NOTEALLGRADINGAND DRAINAGE ' - �' T �•
UFER GROUND. . • - SHALVIIE INSTALLED TO COMPLY WITH 4 109 DESCRIPRON
PAD/SETBACK-CERT - ' T9EAPPROVEDPLANSANDCITYOP- - - _
GARAGE SLABS PREGUNITE _ '; cupERnno srANDARDs. -
'POUR NO CONCRETE UNTIL'ABOVE HAS BEEN.SIGNED - - ,
UNDERGROUND/SLAB INSPECTION: DATE, .BVSPECTOR '• ,
.PLUMBING ' -
ELECTRICAL • 1 - ..
MECHANICAL.
: DO'NOT POUR FLOORAINTIL ABOVE•HAS,BEEN SIGNED -
WOOD FLOOR
PLUMBING -
MECHANICAL - '
ELECTRICAL. .` - .a I
FRAMING/VENTS/CLEAR _
INSULATION'
I - .PLACEWO SUBFLOOR UNTIGABOVE HAS"BEEN:STGNED. '.w '� 1 • ';
ROUGH' ' - -
'PLUMBING -
' .TU13S&SHOWER PAN
MECHANIC
AL �
:• ELECTRICAL ACUZZI 13OND "
''FRAMING STAIRS
INSULATION/VENTILATION
EMERG.EGRESS
SEWER WATER - ,
COVER NO WORK UNTIL ABOVE HAS'BEEN.SIGNED '
EXTERIOR SHEAR HOLD DOWN -
INTERIORSHEAR/HOLD DOWN - '!•
51-1EETROCK/SHEETROCKSI-IEAR -
EXTERIORLATI-I/W-SCREFN - -
SHOWERLATH -
SCRATCH COAT
NOITAPE OR PLASTF.R41NTIL 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
BUILDING ENERGY
ELECT.FINAL TEST - - -
PLUMBING
GAS TEST
MECHANICAL-
HEATING
ELECTRICAL RELEASE
FIRE DEPT.
*,
GRADE,
r .00CUPANCY
TEMPORARY APPROVALS
.ELECTRIC
,GAS - ..
` BUILDING .
OCCUPANCY OF BUILDING,IS NOT PERMITTED UNTIL - IS�CJf4�'ICDATE`
BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR ` '
ARRANGE FOR INSPECTION BY PHONING 252-4505 BETWEEN, ,JAN f"8 199U
;
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY,24 HOURS
BEFORE REQUIRED INSPECTION: JOB ADDRESS AND ",;' - Ciff'of ellmirtlp0.
PERMIT# ARE NEEDED WHEN PHONING.
IMPORTANT! ,
-PLEASE READ REVERSE SIDE BEFORE CALLING`FOR FINAL INSPECTION Isso:;DBy.' + `' �1`I C`,tom i
rr" .
OFFICE COPY .