31013`—o,---TAPPLIZANTTO FILL IN INFORMATION WITHIN RED LINES=USE SALT,POINT PEN ONLY "
CITY OF CUPF,RTINO BUILDING•ELECTRICAL. I 1.17RNIII N°. 31013
EUILDING DIVISION APPLICATION/PERMIT PLUMBING•MECHANICAL.
1=s^OiR�SWs"%BVILDINO PROJECT IDPXtIPICATION:"!41ny •'fl'�
BUIlAINO ADDREt3; SANITARY Nn. APPLICATION S1111AtlTh\I.OA[
PBONE iihf c ! 1 A Y)R'p F5CGVSTiQ GD ICN -
!Y N/f CONIHOLN
4. \RCHIILCr/ENOINEER: " I LICN D S:
CONTACT: Ke f�l� AiK a cer 964,19 BUILDING PERMIT INFO i,
/1,\p AyJ.y-•.�g ��,.:,� av �/�y���O/� ❑ Consultant Fees Paid by Applicant(Initial) I BLnO. EL PLUMB Nil(.9
' l%TVLf T'f-ZLICENSED JgC'07MR�A3CID�0.'S DECLARATION/ 1 e' Ran " F'?;
fit.R~W i s MMIRFX I v -
I hemhy elfirm tM,I am liteaned'omtn pmvi.lana of Cheplei V lrommenving Y,1t%.41 :•..l••ex.xr,rnr>M.; Fe ,woo,� )OE UIiSCRIPTION
aZ whh Salton]OII01of Dmvidnn lof the Pudnera d alau C'de,enJ mylkenae is
k 0p I PERMIT ISSUANCE R
{µt11 i ILme Cie. eRed �I�j�j�j ❑. WI. ❑KITCHEN REMODEL
p team Claa r I APPLIANCES-RESIDENTIAL WliON ❑PLUNIHING REPIPH
me Comraemr
ne,r A CIIrIF.CT$UECLA A ION UMU1, IT i]SIRU('IVRAI.
PANELS
IZ Iunderatmd mypinn.,hell bewmIen public.cords MODIFICATION
App UPT0200AMIrS ❑INICRIOR ❑CI ITMNEY REPAIR
Lieemed Profe.mo..I 201-1000AMPS I IMPROVHMHNI'
rig OWNER BUILDER DECLARATION OVER IpX1AMi'S ❑HATII REMODEUf(I[PAIR (]DCAIOhIIIf1N
I hemhy.(flan that I em exempt from the CoxmI Lice.,Lnw for the
following rtemn.ISation]011 5,fludxaand Profadnn CSde:Any oily.rmmlY SIGNS ELECTRICAL DOPIER
a WO{: which requiree a permit to construct,alter,Improve,demolish,.repair any nsuaum
.J7 prior to in iuueme,.I.teyui.theepplicant(.such permit to file.mgmdnammcm SPECIAL CIRCUIT/MISC.
that he IN Bernard Mom ent no the provision.of the Commerce.Llmve law(chapter 9
( GC (aommenrin,with Section 70001 of DiOur.3 aOhe n.,ine. juxt prorendons Code)., I TEMP METER OR POLE INST I COMMERCIAL;
f �C that he Is exrmpr therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDI'rION ❑DEMUTH ION
Yee.• Salion70315 by any applicant for a Permit aubjeeu the applicant to a civil penalty of POWER DHVICHS
�. ram some than flve hundred dolla.(I50e). ❑IMPROV ❑P(N)O SFRVICG
GOI,an owner of the property,or my emptoyn,s with wage..,their note comproundon, SWIMMING POOL,HLECOUC I IMPROVEMENT
wllldnlhe work,old the etsudum 1.ram 6nendeA.offered fur tole(Sec.IMd,OUSbrt,s ❑OTIIHR
end Profaduns Cork:IM Contractor'.Liters,Law dose our ePly.....war,of OUTLETS-SWI rCHUS-FIXTURES
pmryeny who builds or improve.thereon,and who doer such work himself or through
his own employees,provide)that such Improvements are nor intended or offered for I NEW RESIDENTIAL ELECfR SQ Fr
.elalLhnweverJM buildingorimpmvemembmldwithinure put.
poposer SQ Fit I'I(N)R AREA VSO 19,
nerbuildrr,will havethe.)�ortenof proving that he did mrt build m improve for pun I ,t s�
se of use.).
\ ❑mn. epolct(SecpertY•am einessan!c.niraming ash.)The Ceonuarto"mI
reous La the project apply][N4, osor of sod Property who s or i The Canner oi. ltd ,y t9 7�, �.�.{���,1 J - ;5 NAP
ream law J.anmx apply to an owns rat ptvpeny ahn Wilds.rimprn e.Ihnenn,.m:d ij7y,;�r�+^r� 'i�pL 914 PP.PERMITg%� J" :1011- tl
who mnlrxuferr nuc h prolau whh ecomraemrte111an seJ pumuem ro the('mm�anr'n 'r^%tl' )'+-'v v^.+'ouzo-,en;vy ,•d
cme law. PERMIT IS. AN nV I UN' 11[VD
tam exempt under Sec. ,Bk PC Poe this meson ,_
r )caner vnm ALIER-lZ\m `f-WATER(EA) I�'IL�r—�'yT���-ww]]�Uh1�(f�l
_ WOR KER'S COMPENSATION DECLARniION BACK FLAW PiRulUTUHVICE I �`PR, �G1 j�-(N�_ Iw
.\ I hemhy iffirmumler penalty of perjury one of the following declomlion-
` love enJ will maimaln•Cenllkne nlGmunuo mlM1innurefor Worker's Compere I DRAINS-MOOR,ROOF.AREA,COND. I SIORUS TYPHCONSIRUCIION
.ao u Provided for by SaOrn 3)11(1 of the lake Cade,fm the perfimvree of the
work for which ths perms is ixmW I FIXTURES-PEI{1RAP I
❑i have and will maintain Workers Compenv0on Inomen e:n required by Section 1
Pound III LAW,Cook.Pulse padormorm of the work for wIncb permit lhis peit inissued. I GAS-F.A.SYSIRM�I INC.4 OUTLETS �/ 1 IK'C.GR(IIII' 1 AI'N
My Worker,Compmrntinn Inannce ramie,end Pal icy number art: II� •
Curler. Points No I GAS-EA.SYS rFM.oVER 4(EA) C
CERI'IFICA'IB UP EXf:MPTION FRQAI W'ORKIiRS' GREASI%INDI15fBi.WASTE INTERCEPTOR X '
t COMPENSA'I ION INSURANCP. I I•#Y,Lp�+' 4& f,�,i IjU11,D1 3 IEE9 j{:ki`G e^i{i:{'r
(Thin.ecninn need n.be completed If Um permit la f.(me hundred dollars II RAT)
c ln.J GREASEtRAP fr
Icenlfy that In the performance of the work for which thin I PLANCHE('K rl'E
{ flneW "Corm roll SEWER-SANITARY-SIDRM EA.2011 Pr.
`
net employ any permn in ymannn.nuta hernme suhjecnntk Warkni Cnmprn. I IENERGY THE V _/I
Z u0ri law,of ifmmi
f y O Applicant Wnir:R NEA71iR w/vENr/ELECfR RMINO ITE
[dry— NOTICE A! LI A ,are rag Ihi.Certificate of Exemption,you skald WATER S STP.M/I R PAT I N 0 I c00 51TH
becmrc subject to me Workers Comp onatimm pervi.ionc of the labor C.Iq yea um,.
I forthwith comply withsuchpolders or this emit shall M domed revoked WATER SERVICE I
O
Uz CONSTRUCDON LENDING pOENCY NEW RESIDENTIAL PLMR. SQ Fr.I IPAID Dam ¢ nth
L1 O I
W icfrm that there last ec lending ngercy fnr the perrnrmnm n(
the work for which Ns permit n 6.uM(sac.3 a], 1
Civ C.) I I
Lemlee.Add 'IOIAh
IsixlarI Addmr• 1 —
I empe,that 1 have read thin apAM county and arena that arc starve lot%mmalmirr rs _ "UIIAIN(1 FE r�
fGn\'1 • 41!`.ICAL
Vl mrmcn.l ejme no comply with all dry amt canmy ordlnencn and mel<Irws.loons. >•�t(y�ECHANICALI I' IiMf{'j{ IhYP.EA I O
I' C.J F77 building comnmcdon,slW hembY auth.lie reprtremeliva or nhncinY tocnmrurym the ;•�r-.`,n. •-'sr:rr.aa.mA:P ( i,u:x tl rSEISMIC ? 1
abovememinrmW pmapeny for inspection purlmiea I l PERMIT ISSUANCE I— �'1� I
(We)agres to uve.indemnify,.)keep hemde.s the City of Cuprninoegeinst EI.FCIRIG F: JJJJI��••aarr��//wJJJ-
I..artiermudgmen",ernmind expensumit.. may in any way ea.e eRninn.ad City p1.1T:R OR ADD DO MFCH' II'LDkIflING FT,T�
Incrmaenurnceofine 1.ting.lthisp whit
APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NnN-POINT AIR HANDLING UNII'11010,IMaCFMI
SOU CEE UTATIU IMECI1ANIfAI/l'HH
2—q� AIR HANDLING ICONSTRII(71NLAX
ignumem.f App teen onmmlor, .• Dnm I EXHAUST'I LfWDIW/DUCr) I TIDIISINOM11RIATIO 'F.EI
HAZARIA)t1S MATERIAIS UISCIASURU
Willlhe epplIcmtofmnrc hulldingmeupemmare err hnnJlr hmnnlnw material IIHAiIN(1 UNII'(I(1 Npk(x.)BTU)
deft...)by the Cupertino Munlelpel C.le,('hepmr 9 12.and she Ilenith and Rxlay I
e,Section 215121.)1 DEAL INC)UNIT I(IVHR ITN AXX)BTU) I I
C]We ❑Nn I I IPAID Uae Receipt
VENT ILA[ION I'r\N(SINGLE 0.ESID1
Will the applicant err fuium building occupant um equfprlent m drvire,which t
emit ha"me air ccmenineml a1 defined by the Be,Arta Air Qunlily Mannpmmrnl I BOILER-COMP(IIIP OR I(pLtl 0 BTU)
TOTN.I
1i.tM,
I C]No BOILER-COMP(OVER 100INpIRfU) /
dead she hnerdou niniedel. AIRCONUITIONER ISSUANCE.DATE
requimmam,under CTnpn fins.(the C.li I
�.' :r< noiA Sefay CMe,Stttinn.255111,21A1 em1255t4.I umkmtmxl tbm If Jar NEW RESITHNI IAL MECH. SQ.r•L
j' nntrmmnlly'h:nenlrnme,Ihet lnivny tt,rymaihilitym...ts,tine mranpunt
1 men"whirhmr,bernel prim tninmmae ore Ceni(tmenftk'u:p:mnry. �p�//�g■!�/��4/
- Nmoed npem _- _Unl_ _ _ _ TUT A r ISSUED fly------- �
Z OFFICF
Inspection Query for a Specfic Permit 1/7/99
PERMIT#:SITUS°STISITUS;STREET Lot#>::=`tNSDES6RIPT= In'sTyp DA_TE_DESIRECDateDone.InspectovUnits,P,as's/_Fait�g6`de
31013 10196 ADRIANA FOUNDATION _ _ 613/97 _ 6/3/97 JB 2 N
31013 10196 ADRIANA _ FOUNDATION,_AM_ PL 6/4197 JB 2 F
31013 10196 ADRIANA U/F FRAME 6112/97 6/12/97 TO 2 P
31013 10196 ADRIANA U/F PLBG 6/12/97_ _6/12/97 TO _ 2 P
31013 _ 10196 _ ADRIANA _UNDFLR INSUL _ _ 6/16197 6/16/97 TO 2 P
31013 10196 ADRIANA _ _ _ GASTEST 6/12/97 6/12/97 TO 2 P
31013 10196 ADRIANA UNDFLR FRAME 6/24/97 6/24/97 TO 2 P
31013 10196 ADRIANA INSUL 6/24/97 _6/24/97 TO 2 P
31013 10196 ADRIANA ELEC_RELEASE 7/14/97 7/14/97 TO 2P
31013 10196 ADRIANA PLYWOOD NAIL 8/11/97 8/11/97 TO 2P
31013 10196 ADRIANA SHEAR NAIL 8/11/97 8/11/97 TO 2 P
31013 10196 ADRIANA ELECT-R 9_/18/97 9/18/97 CC N
31013 10196 ADRIANA PLBG-R 9/18/97 9/18/97 CC N
31013 10196 ADRIANA MECH-R 9/18/97 9/18/97 CC _ _ N
31013 10196 ADRIANA FRAME _ _ _ _ _ _ 9/18/97 9/18/97 CC N
31013 10196 ADRIANA FRAME-R 9/19/97 9/18/97 AD 2 F
31013 10196 ADRIANA ELECT-R 9/19/97 9/18/97 AD 2 F
3_1013_ _ 10196 ADRIANA HEATING- R _ _ 9/19/97 9/18197 AD 2 F
3_1013 10196 ADRIANA MECH-R _ _ 9/19/97 9/18/97 AD 21P
31013 10196 ADRIANA PLBG-R 9/19/97 9/18/97 AD 2 F
31013 10196 ADRIANA PLBG-R 9/23/97 9/23197 AD 3 F
3_1013_ _ 10196 ADRIANA _ _ BLDG-R 9/23/97 9/23/97 AD 3 F
31013 10196 ADRIANA MECH-R 9/23/97 9123/97 AD 3 F
31013 10196 ADRIANA ELECT-R 9/23/97 9/23/97 AD 3F
3_1013 10196 ADRIANA FRAME 9/24/97 9/24/97 AD 3F
31013 10196 ADRIANA ELECT-R 9/24/97 9/24/97 AD 3F
3_1013 10196 ADRIANA_ PLBG-R _ 9/24/97 9/24/97 AD 3 F /
31013 10196 ADRIANA FRAME-R 10/2/97 10/2/97 CANCEL 9
31013 10196 ADRIANA ELECT-R 10/2/97 10/2/97 CANCEL
31013 10196 ADRIANA PLBG-R 10/2/97 10/2/97 CANCEL
31013 10196 ADRIANA ELECT-R "ROLLED 10/6/97 10/6/97 JS 3P
31013 10196 ADRIANA PLBG-R"ROLLED" 10/6/97 10/6/97 JS 3 P
31013 10196 ADRIANA FRAME-R "ROLLED" _ _ 10/6/97 10/6/97 JS 3 P
31013 10196 _ ADRIANA INSULATION 10/14/97 10/14/97 AD 2P
31013 10196 ADRIANA SHEAR WALL 10/14/97 10/14/97 AD 2 P
® •page 1 • -
Inspection Query for a Specfic Permit 1/7/99
PERMIT#.SITUS;ST SITU&S,TREET Lot#�" INSDESCRIPT L— InsTyp DATEDESIREV4DateDone Inspecfo-4Units p- /Fiji ;Code
31013 10196 ADRIANA DRYWALL NAIL 10/22/97 10/22/97 JS 2 P
31013 10196 _ ADRIANA STUCCO LATH 11/13/97 11113/97 JS 2 P
31013 10196 ADRIANA FIRE PLACE HEART 4/1/98 4/1/98 AD 2 P P
31013 10196 ADRIANA FIRE PLACE HEART 4/8/98 4/8/98 AD 2 F
31013 10196 ADRIANA ELECT-F 6/17/98 6/17/98 AD 1 F
31013 10196 ADRIANA_ PLBG-F 6/17/98 6/17/98 AD 1 F
31013 10196 ADRIANA MECH-F 6/17/98 6/17/98 AD 1 F
31013 10196 ADRIANA_ BLDG FINAL 6/17/98 6/17/98 AD 1 F
31013 10196 ADRIANA BLDG ENERGY FINAL 6/17/98 6/17/98 AD 1 F
31013 10196 ADRIANA BLDG-F 7/1/98 7/1/98 CC 1 P
31013 10196 ADRIANA_ _MECH-F 7/1/98 7/1/98 CC 1 P
31013 10196 ADRIANA PLBG-F 7/1/98 7/1/98 CC 1 P
31013 10196 ADRIANA ELECT-F 7/1/98 7/1198 CC 1 P X
31013 10196 ADRIANA
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® •°age 2 •