28483 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
C]TY OF CUPERTINO BUILDING-ELECTRICAL PERMIT'NO.
B ILDING DIVISION • APPLICATION/PRRMITPLUMBING.MF.CHANICA]. -
BUILDINO PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
NERSPf711L F .. - CON CTD MF D:
• NIC CONTROL#
si,
RCHITECTIENGINEER: LIC NO: D p �`/t ❑ ^^
COM'ACE PHONE: - (v_l BUILDING PERMIT INFO
�tz Oa 4_/y/-�L ❑ Consultant Fees Paid by Applicant(Initial) Its& F PLU i EC
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
1 hereby affirm thin I can licensed under provision of Chapter 9(commencing JOE DES IPTION
{Q{yyaZ with Section 70syb of Division J ofthe Business and Prideav'on.Cablindmyllconsoi' -RESIDENTIAL:
FUB in PERMIT ISSUANCE O�S,i WL D KITCHEN full fora and elfeal. �
�UUFU LsenseC Llc'# APPLIANCES-RT:SIDENTIAL ` DDRION ❑PLUMBING RE-PIPE
W Date Cnnlruc or
ARCHITECT'S UECLlicrec ON UCI9ANIT ❑STRUCTURAL
F04 � A PANELS
Z O 1 understand my plans shall be used as public records 1' �. MODIFICATION
OZ UP T02W AMPS DIM'ERLOR ❑CHIMNEY REPAIR
oq Licensed Professional 201,1(M10AMPS IMPROVEMENT
RgY J.1 OWNER-BUILDERexam , DECe Conte ON OVER IWOAMPS - ❑BATH REMODEUREPAIR ElDEMOLI'TION
IC a 1 heathy arbitration 1 um exempt lion the Contractor's License Law for the
LL0,U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS IiLECTRICAL DOTHER
C l- which requires a permit to co..man.alter,improve,demolish,a mPat,..,s,.cmre
prior to its issuance,also requires Ne applicant for such pernduo file a signed'mtemem' SP AI,CIRCIJI9'IMISC.
y✓�
that he is licensed Pnreuaann the provision of the Contractors License Law(Chapter 9
CC,, (commencing win Section 700X,of Division 3 of the Business and Professions Cnle).r I COMMERG[AI: '
C,. e m Nat he is exempt therclmm and me basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION D DEMOLITION
#.IZ is Section 7011.5 by onyrda,icam fora pennitsubjects the opplicanI to a civil penalty of POWERDEVICES CTENANT OFOOD SERVICElatt '
i not more than five hundred dollars($5M),
El "
CO I,ns owner of the property m,my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC IMPROVEMENT
will Jent,work,and the smatme sent itnendedorofferW forsale(Site 70,14,BusinessDOTHER
W acrd Profession Code:The Cmarensrs Licence,Law doe'not apply to sonowner of LETS-SWITCHES-FIXTURES
pmpmy who builds or improves thereon,and who docs such work himself or Ihangh
his awn employees,Provided that such improvement,are not intended'.,ordered fee NEW RESIDENTIAL.ELECT R SQ PT.• '
aide If.however.the building or improvement is old within one year of completion,the SQ.FT.FLOOARCA� ASQ IT.
owner-builder will havethe burden ofproving thnt he did nashuild nr improve for par- {N O�
pear ofsale.). - - ((�J( P
I,its owner of'the property,um exclusively contracting with licensed ecnhreant m I
cnnsa.anhe project(Sts.7114,Business and Professions Cod]The Com......s Li- //Vta�S/�.�I
cense,Lew does not apply to..ownerof property who builds ar improves thereon,and QTY, EDRAIN&
PERMIT FEE �w
who contracts for such projects with a conaocmrts)licensed pursuant the Commm.rs _
License Law. PERM -
El 1 um exempt under Sec. ,Li&P C fur thieare:nnn
A TE -WATER(EA7 ATncr Dam WORKE•R'S COMPENSATION DECLARATION, BACKEVICC
( I hereby affirm under pcmdty of perjury one of lire following deductions:
'❑ [have and will maintain.Certificate of Cnnsem ni sal Ginsure for Workers Compete DRAINS-hLOOR,ROOP.A0.EA.GGND. T
satins,os p a .. for by Section we of the Labor Cale,for the perfommncr ofan.
STORIES TYPE.CONSTRUCTION
work far which Ihis percent Ie,issued. FIXTURES-PER
❑ I have and will num n do Worker's Compensatinn Insurance,as required by Section.
37fM1 of'ire Labor Cale,tbnhe perfmn area work for which this pemdt is issued. GAS-EA.. '�M- INV.4 OUTLETS OCC.GROUP APN
y Policy number are:
icy Nm.: GAS-HA.SYST. :O 4
CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE GRP.A, ' NDUSTR I,WA IN
ILDINGD ON FIRES
(Thissation need not becompleted irthe permit is fnrone hundred dollars(S I(q) GREASETRAP 4�,
or less.) A. '\ PLAN
I cenifylhel inure performance of the work far which Ihis permit is issued,Ixhall SEWER-SAN YljR .2 RI'.
not employ any person in any manner so as to become xubject I.the Workers'Compen-
E
O2 satin Laws of California.Date
O Applicant WATER I ' 'R x� GR
uJ NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYS hL?R,A
f"t "'� beton¢suhjecnn Obc Workcr'x Qtmpe...ion mo tame,of the la:hur Code,you nmst 'VrSOILS FEE
ti fonhwithcorray with such provisions or this permit shill be deemelrevaked. WATER SERVICE -
CONSTRUCTION LENDING AGENCY NEW RESIDE 1'LMB. .Ff. PAID
U o hereby which thi hanhmeiss issued
lending agency for the performance of Dine dplN
w F the work for which this pemtit is Issued(gee.9097,Civ.CJ -
O� Lender's Name .S TOTAL:
Lcmdces Address T
1 certify that I have read this application mad scala that the shove information is BUILDING FTG AL �+
lA correct.i agree m comply with nn city and county ordion nces and store laws relining 1. QTY. MECHAWM PERMilf FEE
V building communion.and hereby authorize representatives ofthis city to enter upas the SEISMIC FEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
YJ
(We)agme to save,indemnify and keep hmmlcss the City of Cape,in..,ain't CLECTRIC PEE
liabllities,judgme.s.costs and expenses which may in any wayaccrtm against snit CiOy ALTER OR ADD" iCH.
in nsian eme.r he pardin,of this permit. PLUMBING FEE ��
ss�
APPLICANT UN ERSTANDS AND WILLC hY WIT ALL ION-POLI f AlR 1 )LI UNIT(TO Im(KKI CFM)
g UR MECHANICAL FEC
VA i LIN IT(OVER IIk000CFM)
CONSTRUCTION TAX
Sig re of Ap UCmiad,a Ute t HAUST D(W/DUCO
HOUSING MRIGA'1'ION FEE
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO IIlgW0 HT1] -
as deBnod by Ne Cupertino Municipal Code,Chapter 9.12,and the I leach and Safety
Cade,Section 25592(.)" HPATING l IT O P
❑Yes ❑Nn PAID
VENTILATION FAN(SINGLE RES] Date Receipt#
Will the air contaminants
or ntsaulum building by the
use equipmentordeviceswhich
BOILER-COMP GHP OR 100,000 BTU)
Demit hazardous air mmamiooms ns defined by the Bay Arca Air Quality Management TOTAL:
istrict? - -
D
Yes ON. BOILER-COMP(OVER 100,000 BTU)
I have read the hazardous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
humin Health&Safety Cade,Sections 25505,25533 and 255}1.I understand that if the NEW RGSIIlENT1A1.MECH. SQ.FT.
building does not currently have a tenant,Nat it is my responsibility to easily the occupant
of the ret ireameafs which mint he met pd.,I.issuance or,,Ccnific.l.of Occupancy.
Owner m inahmi,ed."at - Date ISSUED I3 .
OFFICE
• Inspection Query for a Specfic Permit Print 8/15/96
• PERMIT# SITUS ST SITUS STREET AVE,CT,ST,RD .Lot# INSDESCRIPT In.T e
28483 10387 AMISTAD FOUNDATION PIE
28483 10387 AMISTAD FOUNDATION
28483 10387 AMISTAD U/F FRAME
28483 10387 AMISTAD U/F INSULATION
2848310387 AISTAD UNDERFLOOR ME
28483 10387 AM
MMISTAD UNDERFLOOR PL
28483 10367 AMISTAD ROOF SHEAR
28483 10387 AMISTAD SHEAR WALL,EXT
28483 10387 AMISTAD PIER HOLES
28483 10367 AMISTAD ELEC
2848310387 AM STAID FRAME
28483 10387 AMISTAD HOLDDOWNS
28483 10387 AMISTAD IN SHEAR
28483 10387 AMISTAD MECH UNDRFLR
28483 10387 AMISTAD PLMBG
28483 10387 AMISTAD INSULATION
28483 10387 AMISTAD SHEETRK NAIL
28483 10387 AMISTAD SHWR PAN/LATH
28483 10387 AMISTAID EXT LATH
28483 10387 AMISTAD SCR COAT
28483 10387 AMISTAD SCRATCH COAT
•
'I
•
Page 1
• Inspection Query for a Specfic Permit Print 8/15/96
• DATEDESIRED DateDone I Inspector Units Pass/Fail
11/2/95 11/2/95 CC 2P
11/8/95 11/8/95 AD 3 P
11/20/95 11/20/95 J6 2P
11/20/96 11/20/95 JB 2 P
11/20/95 11/20/95 CC 2 P
11/20/95 11/20/95 CC 2 P
12/7/95 12/7/95 CC 2 P
12/19/95 12/19/95 AD 3 P
1/3/96 1/3/96 AD ' 2 P
2/1/96 2/1/96 AD 1 P
2/1/96 2/1/96 AD 1 P
2/1/96 2/1/96 AD 1 P
2/1/96 2/1/96 AD 1 P
2/1/96 2/1/96 AD 1 F
2/1/96 2/1/96 AD - 1 P
2/2/96 2/2/96 AD 2 P
2/6/96 2/6/96 AD 21P
2/28/96 2/28/96 AD 3 P
4/16/96 4/16/96 CC 2 P
4/23/96 4/23/96 JB 2
4/26/96 4/26/96 JB 2 P
•
•
Page 2
Inspection Query for a Specfic Permit 1/13/00
PER►I9CLIEDESIEiE 7 ---
19
28483 10387 AMISTAD FOUNDATION PIERS 11/2/95 11/2/95 CC P
28483 10387 AMISTAD FOUNDATION 11/8/95 11/8/95AD P
28483 10387 AMISTAD U/F FRAME 11/20/95 11/20/95 JB P28483 10387 AMISTAD U/F INSULATION 11/20/95 11/20/95 JB 28483 10387 AMISTAD UNDERFLOOR MECH 11/20/95 11/20/95 CC P
28483 10387 AMISTAD UNDERFLOOR PLMB 11/20/95 110/95 CC P
28483 10387 JAMISTAD ROOF SHEAR 12/7/95 1217/95 CC 2 P
28483 10387 JAMISTAD SHEAR WALL,EXT 12/19/95 12/19/95 AD 3 P
28483 10387 JAMISTAD PIER HOLES 1/3/96 1/3/96 AD 2 P
28483 10387 JAMISTAD ELEC 2/1/96 2/1/96 AD 1 P
28483 10387 JAMISTAD FRAME 2/1/96 2/1/96 AD 1 P
28483 10387 JAMISTAD HOLDDOWNS 2/1/96 2/1/96 AD 1 P
28483 10387 JAMISTAD IN SHEAR 2/1/96 2/1/96 AD 1P
28483 10387 JAMISTAD MECH UNDRFLR 2/1/96 2/1/96 AD 1 F
28483 10387 JAMISTAD PLMBG 2/1/96 2/1/96 AD 1 P
28483 10387 JAMISTAD INSULATION 2/2/96 2/2/96 AD 2P
28483 10387 AMISTAD SHEETRK NAIL 2/6/96 2/6/96 AD 2 P
28483 10387 AMISTAD SHWR PAN/LATH 2/28/96 2/28/96 AD 3 P
28483 10387 AMISTAD EXT LATH 4/16/96 4/16/96 CC 2 P
28483 10387 AMISTAD SCR COAT 4/23/96 4/23/96 JB 2 N
28483 10387 AMISTAD SCRATCH COAT 4/26/96 4/26/96 JB 2 P
or 1 •