23346 (2) APPII_CANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
-'Building Project Identification 7 PERMIT NO.
Building Addnm: 23346
`3 1101P_ s oa &vC
1-f-d ojkw-�s va 77 3-mai 0
CITY OF CUPERTINO-BUILDING DIVISION
C°^trador'.N,me: Lu. rs ' APPLICATION /PERMIT Z-"L
Lk.No: AL•
BU(LDING-ELECTRICPLUMBING•MECHANICAL CATEGORY CONTROL 0
Architect/Engineer. +.
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address I'ERMITISSUANCE �� ��I' ❑
LICENSED CONTRACTOR'S DECLARATION �I
I
hereby
ectionaffirm that l ivscemxd under provWosof Chapter
ssions9da,and c- AI'I'I.IANCESRESIDENfIAL JOB DESCRIPTION
It...himfdlim )of Dlviefon3o(the Bustnesand Profemlon.Code,and my ' ` —
license la in fuI(once and effect. PANELS
Liana Clam LIs.Y
Date Contractor UP TO 200AMPS
ARCHITECPS DECLARATION 201-1000 AMPS
flO I understand my plans.hal be used as public retards. OVER 1000 AMPS SQ.
.FLOOR AREA 1 $/SQ.FT.
Licensed Professional - SIGNS ELECTRICAL S
OWNER-RUILDER DECLARATION D
J', E7 SPECIALCIiCUIT/MLSC .. i '1
p, Contractor's
�-6 Ihereby afRrrnthal l amaem
ept from the License Law fathe J i
7. fallowing reason.(Section 70315,Business and Professions Code:Any city or
O Z I:
�� mntywhkh requbesapermltroeonserucL ilter,Inprme,demmWh,orrepair TEMP.METER OR POLE INST.
any structure prior to its Issuance,also requires the applicant far such permit to POWER DEVICES IJ/
file a signed statement that he Is licensed pursuant to the provisions of the 171 1
3 Contractor's License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC VA---+Laal7fffJMMM++ N
don3ofthe Business and Prof Cede)o,that heis exempt therefromand
Q the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHESTDTURES
applicant fora permit subject the applicant toa civll penalty of net morethan
five hundred a sr owner arshepr. _SOFT. STORIES TYPE CONSTRUCTION
R NEW RESIDENTIAL ELECIR
�n ❑Lasow,will oche work,and
he emture Is with wage as their sole
C compensation,Business wakandions,cdure Isnot Intended License
ed for
Law
xk(Sm does or 7094,Busbies and f property
who
buildsTim Commove.thceve Law
(?js$
who does
apply torn owner orpropertysolacenemorlmpmvothercoM1and OCC.GROUP RFS.UNITS
0. whod°erentsam work hlmmnded or through edowne.If,ho seer,the provided building or improvements sold intenomyearofc=aeLo.the mer-, flder WI have TOT /r
Improvementtsoldwlthlnomyearofcomplctlon,[heawner-Wllderwll have
thRJ2urden of proving that he did nor build or Improve for purpose ofiale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
u L as owner of the pmperty,am exclusively contracting with licensed PERMIT ISSUANCE
contractee to construct the project(Sec.7044,Bu Ines ami Protcsslos Code:
The Contractor's License law dace not apply to an owner of property-who
Wilds or Improved thereon,and who centrads for such pW*u with a ALTER-DRAM&VENT-WATER(E/a).
ga4a.dor(s)hemsei pursuant to the Contractor's License Law. FEE SUMMARY
LJ am exempt under Sec. B &P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDEFEES
Owner Date
DRAINS FLOOR,ROOF,AREA,SND. SANITARY Y 'N_
WORKMAN COMPENSATION DECLARATION RECEITNFD(URES PER TRAP SCHOOLTAX Y N
[:)I hereby affirm that I have a certificate of consent roself-Inwre,a a - � RECFJPT A
certi(late ofWorkers'Compensatlonlnsuranamaartified copythereo!(Sec. GAS F.A.SYSTEM-1 ING4 OUTLETS PARK FEE Y
3800,Lab _ N
RECEIPT
Policy Y - GAS EA.SYSTEM-OVER 4(FFA)
Co, any BUILDING DIVISION FEES
ffCertNed copy Is hereby furnished. GREABE/INDUSTRL WASEINTERCEPTOR PLANCHECK FEE
OCertlRed copy Is filed with the city Inspection diAdon.
CERTIFICATE OF O(EMPFION FROM WOR KERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER SAMTARY SCORM G.200FT. Dale RC0.'1 t#
(This section need not be completed tithe permit Is forons hundred dollars
($100)or tem•) WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_
I certify that in the performance of the work for which thle permit Is Issued,
I shag not employ any person In any manner so s to become subject to the WATER SYSTEM/TREATING
Worker Compensationlawsof Califomla.Date PAID
O Z Applllant NEW RESIDENTIAL PLMB. SOFT. Date Revel t#
Z O NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
F— should become subject to the Workers'Compensation provisions of the Labor TOTAL:
it N Code,you=at forthwith complywlthsuch provisions ortht permit shall be -BUILDING
FEE
W j deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
O. a Ihereby affirm that there Is a construction lending agency forthe perform- ELECTRIC FEE �•
Z arm of the work for which this permit Is usued(Sec.3097,Cl,Q TOTAL:
02 lender's Name PLUMBING FEE
LL I– Lender's Add nes QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W Iartify that have read this application and state that the above lnfomvtf°n
6 correct.I agree to comply with all city and county ordinances and state laws PIRMITISSUANCE FEES PAID:
} N relating to Wilding construction,and hereby author(re representatives ofthis
F 2 city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. Date Revel I#
V. (We)agree to ssve,Indemnity an d keep harmless the City of Cupertino
against liabilities,judgments,coaand expenses which my In anyway acme AIR HANDLING UNIT R010,0(10CFM) SUBTOTAL'
a against did City In consequence q the granting of this pemdt.
AIR IiANDWNC UNIT(OVER 10,000 CPM) CONSTRUCTION TAX
Signature.(Applont/ trader I Date IXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
m
HAZA OUS MATERIALS DISCLOS RE
Will the applicant orfuturc building ompant Store or ha rad to havrd°us HEATING UNIT UO lal BTU) Date Recel t#
material as delned by the Cupertino Municipal Code,Chapter 9.1 2,and the
Health and Safety Code Section 25532(a)I HEATING UNIT(OVER 100,000 BTU) TOTA �—
qYs f]No
lil the applicant orfutum building occupant use equipment or devices VENIILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit harardous air contaminants as delrud by the Bay Area Air B
Ia city Management District? BOILER-COMP OHP OR 100,000 BTU).
Yes N No
TThhaYesread the Mazy ous materials requirements under Chapter 8.95 of BOLER-COMP(OVFR 100,000 BTU),
the California Health&Safety Code,Sections 25505,25533 and 25534.1 FEB 2 7 ]99
understand that if the Wces
building dnor currently have.tenant,that it Is my NEWRISIDENTIALMECH. SQ.FT. 2
responsibility to notify the occupant of the requirements which moat be met =CITY
prior to Issuance of a Certificate of Om
pa racy. Q� �UU.t-rn 111115
Owner or authorluTOTAL: �' .l(td agent Date ISSUED BY: 7 'r 1m
OFFICE COPY
q
a
y :rn% rsrnn%nnnoninnnnfinic�:::
-
7
.....:A'...:..�..�.....:. Yom/
y •\
V
1
a
F > <>
bd
:; ro
h
.'iiiiiii:
CD
:iiia:::i•iiii•
t�7
:ii:ii+ii:•i�•i�ki:•�iiiiiiiiiiii:S<iii>E3F.•i:•ii:iiiiiiSi:
lii•:... \"
c�
:•iso;iiiiiiiiii�;iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
ti N
r;;,;• axs:;ss;::is
ti
0
:::•. c
............................................................................
...
,n
m
ro
iiia
.............................................................................
•iiiiiiiiii:�n;v:&:;n;:v::v&:&;;•;•;n:�ti�ti�ti�::�8.......................: . .::::::::.::::.
ii'''??iY .:.:...:..:.:::.......................
b r-iCOD
r-F
(D
nirsrsiini'iiiiorslroEsirsi :' an' inn ':>.�?:...:� :i;:ni;.
:nni Q`
:.!''!!.}>{< :!>.•,'..:jti(j.:j.:j. :.:j.:j.:j. . r ills?i?is iiii iiiiiiAiiiliiii:_......
W
/!��
^S N
�b
N
m F
N m
9 G
m
N
� G
Q
0
R
W
r3
� m o
6
O O
Z
3 -
o
O
O 8
C
04 _.
N1 9
a.
m
l
0
a I UN
6
m
GCU A v
ti
p
d
O
� d
A
5.
� ~ K
Q
� m
f
m �}
o.
!^�
bs
. v -
.� G9 N
a = m
• O
d
N
� O
3 m
b
04
r
N
N
'3 CJ
m
W
0
v
N
m = ^
6
5i b
3
3 d _
m
o'
o
9
Q
m u
Z 6
R� .- N
N
6� —
Q
. 7 �
O
....
W
n
:...... . ... 3 Q
q e� 2� ✓`
�iiii::�i;
C• i'r
^ O
G
O�
m
i
W
S
v
P'
':....: CD
O _^
77
Z
\1
y
�.
rn
L�
.
Cb
L
:.
`V
s
^\
/V
W
AA,IY.Y:::J
V
y
0
I ~3
1 \
fi
r
NOTICE . .
When calling for FINAL INSPECTIONS, the following occurs prior to the release of utilities:
The Building Department coordinates the request for final inspection with the following City
departments, as required, to assure that the site/building complies with the requirements of
these departments.
1. BUILDING: Complies with all building code requirements.
2. ENGINEERING: a. New driveways, sidewalks, curbs, gutters completed.
b. Lot fine grading to drain or bond posted.
c. New water system in operation.
d. New sewer system in operation (Sanitary District). .
e. New streets paved, with sewer manhole and valve boxes raised to
grade. Sewer cleanout at property line to grade.
f. New subdivision lot corners set.
3. FIRE: a. Fire hydrants properly installed and operating.
b. Fire sprinkler system properly installed and tested.
c. Fire alarm systems completed and tested.
d. Fire extinguishers installed, dated and tagged.
e. No parking signs in required fire lanes.
f. Restaurants, hood fire extinguishing systems operating and tested.
4. PLANNING a. Required landscaping and irrigation system installed.
b. Paved parking, trash enclosures, exterior light fixtures, etc.
c. Documents (CC & Rs, easements, etc.)
5. HEALTH All food handling facilities must meet the requirements of the Santa Clara
County Health Department.
Upon receipt of approvals in the Inspection Division from all the above departments, gas and electric
utilities will be released, and you may then occupy your building.
If new owners are attempting to occupy the building for the first time and the utility release has been
delayed, check with the contractor who is responsible for meeting all the above requirements of the
various departments.
BUILDING INSPECTION DIVISION
CITY OF CUPERTINO
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
L'Oulkung Project Identification PERMIT NO.
Building Add.:
23346
APPLICA IION SUH9l`l7XE=
Y,.,.lkp TCITY OF CUPERTINOBUILDING DIVISION
ContradoYe Name: Lic APPLICATION /PERMIT
noao.rct/hugi.moLic.No: OLnDING-0,F.CTMCAL-PLUMHING-MMHAMCAL CATEGORY CONTROL#
0
Address: IL�.. oth,lf
PERMITISSUANCE
Thereby LICENSED CONTRACTOR'S DECLARATION si D
affhouthad I sen Bernard under provisions ofChapbn�9(camemetu, APPLIANCES-RESIDENTIAL
ingwithS�ion7OOD)oMm3oftheBusi�andPmfnsionsCod�and my— JOB D�RJTTION
license is In full force and effect. PANELS
License Class Lk.#
Date Contractor_� —12 TO 2DO ANTS �3
ARCHITEC17S DECLARATION 201-10DO AMPS
00 1 understand my plans shall be used as public records. —OVER 1000 AMPS S I Q.FT.FLOOR AREA $/9Fr.
Licensed_Pmfemi..1 SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION
lhl.byaffi�thtI..e...ptf.theC..t.de.LI...Law for the SPECIAL CIRCUIT/MISC
82- following reason.(Section 7031.5,
0 H� Business and Professions Code:Any city or
0 courtywhich requousa permit toconstrud,alter,improve,deenclish,orrepair TEMP.METER OR POLE INST.
any atm mmpdorm its issuance,also mquimthe apphuntfor such permit to POWER DEVICES
file a signed statement that he is,licensed pursuant to the provisions of the
� Co.tractor'.License Law(Chapter 9(camerancing with Section 7000)of Dlvi-
sion3oftheBu�fts..dProfl.i..C�.).rthatheisexemp"hemfmmand SWIMMING POOL ELECTRIC ;f 1. 'L,� VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any ourLETs_smTcHE&ptxTuRFq HT
applicant for a permit subiachath..pplicot too dvil posoflty of nor more than
• Ove hundred dollars($1011,
M 1,as owner of the property,or my employees with wages as their sole NEW RESIDENTIAL ELECTR_SQ.Fr. STORIES TYPE CONSTRUCTION
compensation,will do the work,and the structure is not intended or offered for
O sale(Sec 70K Business and Predesoo.Code:The Contractor.Lim.Law
does not apply to an owner of property who build.or improves theme,and
who doessuch work himself orthengh his own employees,provided that such OCC.GROUP RE.UMTS
Improvements are not Intended or offered for sale.](however,the building or TOT as,
iproveroart iaa.ld within one yearoicompletion,the owner-builderwill have
lFcl.e.n of proving that he did net build or Improve for purpose of sate.). D zDNE
ourbactureow.er of the property,am exclusively=trading with licensed F�--jcfrN—
t.ca ne trurt the project(Sec.7044,Business and Professors Code: PERMIT ISSUANCE
The Ccotmenn'.License Law does not apply to an owner of property who
builds or improves thereon,and who centrads for such p(plecte with a ALTER-DRAIN&VENT-WATER(EM
contmetor(s)licensed pursuant to the Contractor's License Law. FEE''SUMMARY '
[:]I am exempt under See. B &P C for this masum 3ACKFWWPROTDCT.DMCE
O_
UI M UE FEES
Owner ate DRAINS-FLOOR,ROOF,AREA,COND. SANITARY Y_ N_
RECEIPT 0
WORKMAN COMPENSATION DECLARATION
C]f hereby affirm that I have a cortificate,of consent to self-hosom,ora FD(TURES-PER TRAP SCHOOL TAX Y_ N_
�eftifimtoofWor�m'Cmpemati=I�mnm�amAlfLdmpythemof(S�. RECE1171'If
380D,Lab C.) GAS.F.A.SYSTEM-1 INCA OUTLETS PARKFEE Y N_
Policy N RECEIPT#
Com any
copy as hereby fured.hed. GASRA SYSIEM-OVEM,I(EM BUILDING DIVISION FEES
C.rtIficd copy 6 filed with the efty inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
CERTIFICATE OF EKEMPTION FROM WORKERS' GREASE TRAP
COMPENSATION INSURANCE PAID
(Th$.x.c1kmneed out becompletedifthe pernot Ls(Drone hundred dollars SEWER-SANITARY-STORM EA.2WFr. Date Receipt#
($100)or less.) 6
I enol in the performance ofthe work an as this permit Is boucti, WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N
I shall not employ any person In any manner an as to become subject to the
0 Workers'Compensation Laws of California.Date WATER SYSTEM/TREATING PAID
Z Applicant
L5 NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you NEW RESIDENTIAL PLMB._SQYT. ate Rewipti
Z
should become subject to the Workors'Compemation provisions of the Labor TOTAL
Code,you=at forthwith comply with such provisions orthis permit shall he
W > decreed revoked. :RUILDINQ FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
ance of the work for which this permit is Issued(Sec.3M,CIv.C.) ELECTRIC FEE
Z I hereby affirmthat them is a comeneedion lending agency forthe pmforn� TOTAL:
2 Lender's Name PLUMBING FEE
UPERM T, V>�
LL Lendres Add.. ,,":
0 ImAifythatlh�rndth�applimtionandgatethattheaboveinfo� mtiMECHANICAL FEE
0 LU
isommuct.lagrectocomplywithalleftyand centroyordinancesand slatelaws PERMIT ISSUANCE FEES PAID:
relatingtobuilding construction,and hereby authorize representatives ofthis—
city to enter upon the above_mustioned property for inspection Purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify an d keep harmless the City of Cupertino — —Date Receipt#
• against liabilities,jdScresta,costs.rd ezper.which may ie.eyw.y..c MR HANDLING UNIT CIO 10,000 CFV[) SUBTOTAL:
against said City in consequence of the granting of this permit.
f, f'XA MR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX
Sigrature of Applicart/�oatmctor Data EXHAUST HOOD(W/DLJCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,ODD BTU) t —
Date Recelotif
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the —
Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER Ifsitill BTU) TOTAB.
M yes M No
Will the applicant or future building occupant use equipment or devices VENTILATION FAN(SINGLE REBID) ISSUANCE DATE
which orrit lo.zzolmaa.Ir contaminants a,defined by the Bay A.At, —
Quality Management District? BORER-COMP OHP OR 100,DDO BTU)
N
q�hlyo'mad the hxzs�g us materials requ der Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU
lee b"ou're"'n P A I D
the iforria Health&Safety Code,Sections 25505,2503 and 25534.1 —
understa ed that if the building does net currently have a tenant,that it I,my NEW RESIDENTIAL MECH._SQ.FT.
responsibility to notify the occupant of the requirements which most be mot —
prior to housece a.arlificam forup.rcy. FEB 2
7199(,};
Owner or authorized agent CIT4
Data ISSUEDBY-.-
P I
APPLICANT'S COPY