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29493 APPyCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY " CITY OF CUPERTINO - BUILDING-ELECTRICAL PERMIT NO. //� /a�� Q BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL L 9 4 9 3 BUILDING PROJECT IDENTIFICATION BUILDINGADDRESS/� � ' � ^ ! � 1.1 L ./v o SANITARY NO. APPLICATION SUBMITTAL DATE OW AME: 'HO arta,,, V CONTRACTOR'S ME: LIC NO: 'q4 1, 1 `—y NIC CON'1'Hlll.p 5 Wp „ RCHITECT/ENGINEER: LIC NO: N ` ADDRESS ❑ CONTACT: PHONE: - BUILDING PERMIT INFO - ❑'Consultant Fees Paid by Applicant(Initial) RLDG_ ELE PLUMB MF,CH ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hereby affirm that 1 am barred under,ownhmf of chapter 9 obanarmcmg JOB,DESCRIPTION F�ccZ with Section'/000id'Dtvision 3 of he Rosinmsand Professions Care,andmyliomwis RESIDENTIAL: ob in full force and effect. PERMIT ISSUANCE m ❑S DWT. ❑KITCHEN REMODEL aVU License Cl.n LIC.H APPLIANCES-RESIDENTIAL DITION• . 4 a Dam Commmon, El PLUMBING RIiPIPE E,Dm ARCHITECTS DECLARATION PANELS h1ULT1-UNIT ❑STRUCTURAL. mZ l understand any pIcn,,hnll be used as pchfcove 1, MODIFICATION C Z UP TO 200 AMPS OZ—M El INTERIOR El CHIMNEY REPAIR F�Fw Licensed Professional 201-1000AMPS- IMPROVEMENT EI/RE ak�'gqa OWNER-BUILDER DECLARATION OVER IOM)AMPS El BATH RF,MODPAIR [I DEMOLITION d C�6 1 hereby afirin that I am exempt from the Contractor License Law for the z. D r W 3 E U fallowinreason .(Section re .(Section 9031.5,Business and Prufeuiity ons Code:Any cor county SIGNS ELECTRICAL ❑OTHER W ' ^ F` which¢q pc I t c t ct Imt P J ar fish n p any strucame 6, priori t sola also q th applic t hpermit t fl signedstatevent SPECIAL CIRCUIT/MISC. fw f'�} that h d pursuant the provisions f the Contractor's L e La (Chapter H _ f {til O;Oa�O (commennng 'NSecti 9f100) fDr nim 3 ftheB i ss dPrf sCode)br TEMP.METER OR POLE INST. COMM ' - 't W 6 q o W bar he is exempt therefrom and the basis for the alleged cxemptma Any violation of [INEW BLDG/ADDITION C3 DEMOLITION k u' Section 70315 by any ti,micamm,apermit able,,,Nee Haman v civil lly oP POWER DEVICES W—m I Pp p`na l ❑TLNANTt Jr vU+rlII O FOOD SERVICE not more than five hundred dollars(4500). FZ} r IMPROVEMENT < will Las er work, progeny.or is empmyeeswim wagonstic(Sere compensation. SWIMh11NG PoOL F.L . IC F� will do the land the s c Com is nal s Limem nr offered fa a.apply 9044, whereof ❑OTHER W"m and Pm(ediom Cale:The Conaacmis Lieenu law does not apply m an owner of OUTLETS-SWITCHES-P " 6 3^ property who builds or improves thereon,and who does such work hinneelf or through his awn employees,provided that such improvement,arc not intendd m o0'cred far NEW RESIDENTIAL ELECTR SQ aale.If,h th b Id g p nc t Id :th Y' f mpl t m.Ne SQ.IT.FLOOR AREA - $/SQ.FT. tr at 'IJ lib the b fide fpr v he raving tdid tb Id p for pur ,se ` 1 pof:I )e s L ❑ L n f ct(See property, m exclusively contracting with? d t secs to TOTAh ceme La d project(Sec.90M.Bus refs and 1 y who bui Code.)The e%daemon, L cense Law does not apply je an owner of t m tcny who builds or improves thereon,and QTY. PLUMBING PERMIT PF,E who contracts for each projects with acomracmrfv7licensed pursuant to Connector's License Law. PERMIT ISSUANCE ❑I art undo Sec. B&P C for this reason 1� Own+ , .Dae NdER-DRAIN&VENT RfEA) I'� VALUA'f10NCN WORKERSC . TION DECLARATION BACK FLOW PROTECT .VI (�© OOH /�'� I hereby affnounder pe aty of,equry one of the following edamtioms ❑Ihnvc vnd will maintvinu CcrtiOmm of Gmscm reacts-insure for WorkeLv Camlxm DRAINS-FLOOR,ROOF,AREA,CO STORIES TYPE CONSTRUCTION s mon,as provided for by Section 37W of the Lahr Code,for the performance of the _ - work for which this pe.,I k ismad. FIXTURF_S-PER TRAP EJ 1 have and will maintain Worker's Compensation Insurance,as required by Section 3900o1 the labor Code.fiomeperfa..ance id'um work for which mispermit i road, GAS-EA.SYSTHM-IINC4OUT r OCC.GROUT' N My Worker's Compensation Insurance carrier and Policy number arc: Carrier: Policy No.: GAS-EA.SYSTEAf-OVER 4(EA) cEffOFICA I'It OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASrANDUS'IRL WASTE INTERCEPTOR. BUILDING UIVISIO� q?FS (This section need not bmi e completed ifthe permit is formic bond"dollars(S[an) GREASE TRAP or lens.) � PLANCHECK FEE r^ I certify that in the performance of the work for which this permit is isued.I shall SEWER-SANITARY-STORM EA. FT. not employ any perm.in any manne...... became subject io the Worker'Co.,.- ENERGY FEE Oz ar satiun haws of California.Dam WATER HEATER WNEMRILECTR GRADING IT Z O Applicant .N.. NOTICE TO APPLICANT:If,afmr making this CertlGcme of Exemption.you should WATER SYSTEM/TREATING _ a , become subject m the Worker's Compensation provisions of the Lahr Care,you mica SOILS FEE forthwith comply with such pmvisiaie or this permit shall he Deemed revoked. ,WATER SERVICE aQ CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.FT. PAID '�f(/��\�f�� V C) l hereby affirm that there is a consnuction lending agency for performanceof �J"`l` Receipt# ' the work far which this peram is Issued(See.3(D].Civ.C.) W. U Lenders Name TOTAL: 0. Tender',Address r TOTAL: BUILDING FEE I certify thw 1 have rand rhos application and stem that the above Information is W correct l agree to comply with all city and county ordinances and.state laws relating to QTY. MECHANICAL PERMIT FEE V ,Z building construction,and hereby amhodze repre.wmatives of this city to enter upon the SEISMIC FGF. above-mentioned p,.,cy Ise inspection proposes. PERMIT ISSUANCE (We)agree m mve,indemnify and keep hannlens the City of Cupertino against ELECTRIC Fl/. Iiabilitics.judgmerns cons and expenses which may in any wav acerae against said City ALTER OR ADD TO MECH. in asequence of the granting of this permit PLUMBINGF.E APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING 11N13'(TO Il),001 CPM) SOURCE REGULATIONS. MECHANIC I.FEE AIR HANDLING UNIT(OVER 10W0 pest CONSTRUCTION X Signature mf ApplicunVCmnrucmr 'Date EXHAUST GOOD(WIDUCT) HOUSING MITIGATIO FEE HATARDOUS MATERIALS DISCLOSURE Will the.,he.rtorfumre Wildingmcupvntsnru or handle hazardous material HEATING UNIT(10100,070 BTU) as defined by the Cupedina Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532DD HEATING UNIT(OVER Hb.gID BTU) ❑Yes ❑No VENTILATION FAN(SINGLE RESI)) PAIDt [)—am Rcccip Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR 100,000 RTU) mit hvvdeaus air contaminants as defi . ned by the Bay Area Air Quality Management TO- L: District'? BOILER-COMP(OVER 100,000 B1'U) ❑Yes ❑Nu 1 have read the hvtds m znouacnequiremen als requirements maker Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE Sunni.Healdt&Safety Cade,Seetiune 25505.25533 mod 25534.1 underlined that if the NEW RESIDENT IAU MECH. SQ.FP , Wilding does not currently have a tenant.that it is no,responsibility to nodfy the occupant of the mar,mre memo which most be met to,tan issuance of v Certificate of Occupancy. Owner or authorized agent Dale TOTAL: ISSUED BY'. OFFICE POST THIS CARO NEAR FRONT OF BUILDING " F'CIPEF INO PER. TN°. I ^ r r BUILDING I\9 ION �.) BUILDING PROJECT IDENTIFICATION •+�' 1 B U ILDI NO tr., RES:. SANITARY. T APPLIGUIONSUBNII1TA1.DT OWNER S S - I PHONL - COYI'RALTOR'S NAM E: LIC NO: NIC CONTROL x e CHIIECT/INGINELR. LIC N01 ADDRESS: ❑ BUILDING PER INFO INSPECTIONS DATE INSPEC. ❑ Consultant Pecs Paid by Applicant(Initial) ul,DOELeJ-T. PLO/B MtOH FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION UFER GROUND NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL: PAD/SET BACK-CERTTHE BE INSTALLED TO COMPLY WITH LIS DWL El KITCHEN REMOOEI THE APPROVED PLANS AND CITY OF DITION ❑PLUMBI,NG RE-PIPE GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS ONIULTI-UNIT ❑STRUCTURAL ,MODIFICATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIG O ZARRNGE INSPECTION'd 'U3 ❑INTERIOR ❑CHI\THEY REPAIR IMPROVUNDERGROUND/SLAB CALL AFT' (12:30 PM - 4:011 PM) BATHREMENT ❑BATH REM1fODELBEPAIR ❑DE\IOLITION PLUMBING 777-3228MOFRIDAY 24 HOURS BE- ❑OTHERELECTRICAL FORE REQUECTION. JOB ADDRESSANDP . IEDED WHEN PHONING. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN S NED COMMERCIAL: PLUMBING ATTENTION CONTRACTORS: ❑NEW BLDG/ADDITION ❑DEMOLITION NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOODSERVICE MECHANICAL THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT' ELECTRICAL i PLIANCE WITH WORKERS'COMPENSATION OTHER FRAMING VENTS INSURANCE REQUIREMENTS. INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE 1•NSP PLACE NO SUBFLOOR UNTILABOVE HAS BEEN SIGNED ROOF SHEATH/DD\PHRAM PLUMBING TUBS 3 SHOWER PAN MECHANICAL ELECTRICAL/POOL BOND �.Zp FRAMING/STAIRS/E.EGRESS INSULATION/VENTILATION COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED EXTERIAL SHEARMOLD DOWN INTERIOR SHEARMOLD DOWN SHEEIWROCK/SHEETROCK SHEAR EXTERIOR LATH/W-SCREED SHOWER LATH NO TAPE OR PLASTER UNTILABOVE HAS BEEN SIGNED SCRATCH COAT �e SEWER/WATER TEMPORARY APPROVALS OCCUPANCY ELECTRICAL GAS FINALS - GAS TEST GRADE FIRE HANDICAP = ELECTRICAL - PLUMBING = MECHANICAL -_ ENERGY CERTIFICATE OF OCCUPANCY ❑ VISUAL FINAL ONLY BUILDING IMPORTANT: ISSUANCE DATE OCCUPANCY OF BUILDING IS NOT PERMITTED " PLEASE READ REVERSE SIDE BEFORE UNTIL BUILDING FINAL IS SIGNED BY BUILDING CALLING FOR FINAL INSPECTION!! INSPECTOR. ISSUED BY: APPLICANT'S POSTING COPY