31206- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL,POINT PEN ONLY-
CITY OF CUPERTINO BUILDING-ELECTRICAL. ' PERMIT NO ^ 1^0 6
BUILDING,DIVISION APPLICATION/PERMIT PLUMBING'-MECHANICAL. - JK L Vh
BOB DING PROJECT IDENTIFICATION
RUILDINGADDRESS: ' SANITARY NO. APPLICATION SUBMITTAL DATE
C CL l a.I 52� 10x5 Qz AV
D NF.R'S NAME: - PHONE: CUNTRACfOR'S NAME: -LIC NO: NIC ' CONTROL It
1., E ow5 OKpX tJ(NZ C u
RCHITECT/ENGINEER: LIC NO: ADDRESS: ❑
k . M ASSoc '-T 9 c.ASTs rwoocgae9C S'• ? ..
'oNTACT. - a PHONE: - BUILDING PERMIT INFO
❑'Consultant Fees Paid by Applicant(Initial) ELECT PLUMB MECH
LICENSEDCONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm goal am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
�a'Z with Section 9fNNq o[Divisien3oflheBusbmesand Professinn,a Gdn.and my licweais RRSI--DENIIAL
Op PERMIT ISSUANCE '
C F in full force and feet 2 6 S`�' ❑S• WL ❑KITCHEN REMODEL
Q U License Clas Lic.N _ e-4-1-16S-7
� APPLIANCES-RESIDENTIAL D (TION El PLUMBING RE-PIPE
yDate Carol,, nr' hL 7eN� .
N ARCHITECT'S DECLARATION. FANIdS MULTI-UNIT El STRUCTURAL
ZO O I inclinational, handrail hecasedoe public records MODIFICATION
_ UPT021K)AMPS ❑ PE
IN ❑CHIMNEY REPAIR
f-'(y Licensed Professional y 201-IOOOAMPS IMPROVEMENT -
OWNER BUILDERDEC!ARATION OVER 10(10AMP5 El BATH REMODELIREPAIR 0DEMOLITION
5(iy�
W, 1 h by. ff m that I am exempt fir theContractor's License' L 'f the
0 4 U follow g reason (Section]031 5,Business and Professions Code:Any crily umy SIGNS ELECTRICAL ❑OTHER
which req .. permit w c rwa co,after, p d 1:h p m dare - _
pnorl t' e 1maladies'he ,Iplcvtf hpe tt 11 I1 int _ SPECIAL CIRCUIT%MISC
2y thath ......
1pursuant to p (if the Contractor Lcen (Ch iler9 '
COMMERCIAL:
O O (coma g 'th 5 'I' 9(100) f Division i f the D fie C de)or. TEMP.METER OR POLE INSIST. IN
O,y m y' mal h pt th fmm and the basis for thalleged �l, t A y P f m of ❑NEW BLDG/ADDITION� []DEMOLITION
lWf Yom. Sect.. 91UI56y y pphcem faro petmusuhlet the ppilc nt "Ipe by of POWER DEVICES
atm than 1 hundred dollars is 00). ❑TENANT ❑FOODSERVICE
7�i' IMPROVEMENT A '
Q Z
owner of the properly,or my employees a gesoetheir able compensation SWIMMING POOLE29j {'+
wJe work.and property or iaycorm orafPered forsela(Sec 9(004,Business OTHER
anessions Code.The Cbnvmmr's enee Lawdoes nil apply m an owner ofOUTLETS-S TCH -FIXTiIprwho builds or improves Iher ,antl wondocssuch work himselfhismnployees,provided thn ch improvements arcnm imendetloroffered for NEW RESID(NTIAI.E SQ Pf.salowevecthebuilding avomwemom is sold within oneyear afcompletibn.the .PLOORAR $/SQ.owuilder will have In union of proving that he did not build or improve for pun - Qcale.).Oowner aft Prop rty m situ.' ly t i g ih hoensW«n0auo toO the p em(See ]044 B aft.:and Pr f.. C dw)TTe Contractor:Li-
w snot applyt fp pe ty h h Id. nmprzwes thorecr d Q'j'g PLUMBING FERMI FEEwhasfnrsuch pr ject.wuhacbmrat rOIieenseJ pursuenna theCanimu r'v LtIxwPERMITISSUANCE
❑ empt under Sec. B&P C for this nnon-
Owner Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
Wm under p COMPENSATION DECLARATION , BACK PLOW PkOfELT.DEVICE
1 Smithy will
tion a penally of Perjury one of the Following declarations: -
1 n, a pmdwill malnminuction acme of he La llaCoadenfar the enformWalker'e Compen- DRAINS-FLOOR.ROOF,ARP,A,COND. STORIES TYPE CONSTRUC'fiON
as provides for by Semina 3]00 of the Lobar Cale,for the performance of(he-
-
irkfarwhichthispumilisixsuW. FIXTURES-PER'MAP
❑ I have and will maintain Worker's Compensation Insurance,os requlrcd by Section ^
3]00 of the Libor Cada,for the performanceof the work for which lois permit is issued. GAS-EA.SYSTEM-I INC.40UTLE'f5 -OCC.OROUP APN
My W..ker'.v Compensation Inaurunco came,and Policy number sm:. -
Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA) -
CERTIFICATEOFEXEMPTIONFROMWORKERS'COMPENSATION INSURANCE GRF:ASF'IINDUSTRL WASTE INTERCEI'1'OR + -
(Tn Ion need oat hewmplmWiRhm pbnnlu norb h Dred J611urs($100) - - - - x BUIi.DINO DIVISION FENS_-. '
or les ) GREASETRAP PLANCHHOK FEE
1corrif,that in the perfortnan ewnrkinrwhich rht.pe 1 is"sued,lshall SEWER-SAN D'ARY-STORM EA.200 FT
not employ any person in� as to becourn subject to the Workers'Compen- ENERGY FEE -
cation taws of Calif 7�7 ,Done WATER[SEAT SIR WNENT/ELECfR� Applicant GRADING FEE
a y 'NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WAS HR SYSTEMITREATING
E" [t become subject m the Worker's Compensation provisions of the i.ahor Code,you nor, SOILS FF.F. r ,
fonhwlth comply with such provisions or this ddrail vhall ho deemed revoked. .WATER SERVICE. (T�
a' CONSTRUCTION LENDING AGENCY NEW RESIUGNTIAL PLMB. I SQ.FT. PAID'
w,�z Iherchy affirm that them isaconshudion lending agency for the performance of DateReceipt#
the work for which this permit is issued(Sec.3099,Civ.C.)
CD?I*
Little Name,
TOT L:
W Lender's Addo., -
lcertify that I have read this unification and state Ihal the above information is BUILDING FEE
7n cored I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
U , building conatruc0or and henehy nuthem,c reprecentativesof this city to carer upon the SEISMIC HE �`7r
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEB �!
luddliies.judgmenn,costsand expenses which may i nanywaymerardgainstarm City AUfERORADDTOMECH.
in consequence of the granting of this permit. PLUMBING FEE.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IE000 CPM)
SOURCE REGULATIONS. MECHANICALFEE
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUCTION TAX
Signature a pnlicanUCommmor Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION PEE
HAZARDOUS MATERIALS DISCLOSURE
' Will the applicant or future building dccopam store or handle hamrdous material HEATING UNIT(TO 100,000 BTU) ^
as defined by the Cuperrimo Municipal Cos e,Chapter 9,12,and the Health and Safer)
Code,Section]5532(a)1 / HEATING UNIT(OVER 100,000 BTU) - -
(]Yea SY19, VENTILATION FAN(SINGLE RESID) PAID
Will the aliplic nal of future building bccupanl use cquipmenl or devices which Date kcceipt M
ith...olmetiou,aminantsasdefmedby the Bay Area Air Qmality Management ' BOILER-COMP(3HP OR IIXI,OIH)BTII) -
�// T01'AI:
'i sMctq LN - BOILER-COMP(OVER IOg000BTU)
❑Yes .. .. � ..)
I have lead the hazardous materials requirements undo Chapter 6.95 of the Cali- AIR CONDI'fiONER - ISSUANCP.DATE
forma Health&Safety Cade,Sections 25505,25533 and 25534,I understand that if the NEW RESIDENTIAL MECH. SQ.PI'. �
building not currently havbalenam.mm 1. y Imnsihii tyl notify the occupant L• .,
of Ihe requirements
quirem to Winch oust bemet pilon o of u Cert f I f 0.uPanry'.., _ t
ori a—�— -___ �c1aam
Owe authbrzed agent - me j ISSUED BY
a
OFFICE
• Inspection Quel for a Specfic Permit 10/98
PERMIT# 10 C1S ST-saw ST,REEF Lot#_ 1NSDESCRIPT ns3yp _ATEDESIRE _ ateUone nspefo,Ums 005StEait mCode
31206 1341 JASTER ITEMP POWER 6/26/97 6/26/97 0 1 2 P
31206 1341 ASTER FOUNDATION 6/30/97 6/30/97JS 1 N
31206 1341 ASTER FOUNDATION 7/1/97 7/1/97AD 2F
31206 1341 JASTER FOUNDATION 7/3/97 7/3/97 AD 2P
31206 1341 JASTER UFER 7/3/97 7/3/97 AD 1 P
31206 1341 ASTER PAD CERT. 7/3/97 7/3/97 AD 1 P
31206 1341 ASTER UNDF/FRAME 7/17/97 7/17/97 AD 3F
31206 1341 ASTER U/F FRAME 7/22/97, 7/22/97 TO 2 N
31206 1341 ASTER UNDFPLBG 7/25/97 7/25/97JS 2F
31206 1341 ASTER UNDF.FRAME 7/25/97 7/25/97JS 3F
31206 1341 ASTER FRAME 7/29/97 7/28/97AD 3P
31206 1341 ASTER INSUL 7/29/97 7/28/97AD 2P
31206 1341 ASTER U/F PLBG 7/25/97 7/25/97JB 2P
31206 1341 ASTER PLBG 7/29/97 7/29/97 AD 3P
31206 1341 ASTER SHEETING 10/14/97 10/14/97CC 2F
31206 1341 ASTER SHEAR WALL NAIL 10/14/97 10/14/97CC 2 F
31206 1341 ASTER ROOF SHEATING 10/15/97 TO 2N
31206 1341 ASTER SHEAR WALL 10/15/971 TO 2N
31206 1341 JASTER ROOF SHEATING 10/16/97 10/16/97TO 2P
31206 1341 ASTER EXT. SHEAR HOLDDO 10/16/97 10/16/97T0 2P
31206 1341 ASTER LATH(CROSS ST RAI 11/6/97 11/6/971AD 2P
31206 1341 ASTER FRAME 11/6/97 11/6/97AD 2F
31206 1341 ASTER ELECT-R 11/10/97 11/10/97AD 2F
31206 1341 ASTER PLBG-R 11/10/97 11/10/97AD 2P
31206 1341 ASTER MECH-R 11/10/97 11/10/97AD 2P
31206 1341 ASTER FRAME 11/10/97 11/10/97AD 2F
31206 1341 ASTER ELECT-R 11/12/97 11/12/97JS 3P
31206 1341 ASTER FRAME 11/12/97 11/12/97JS 3P
31206 1341 ASTER TUB/SHWRS 11/12/97 11/12/97JS 3P
31206 1341 ASTER INSUL 11/14/97 11/14/97
31206 1341 ASTER SHEETRK 11/19/971 11119/97AD 2 N
31206 1341 ASTER SHEETRK NAIL 11/20/97 11/20/97AD
31206 1341 ASTER SCRATCH COAT 11/26/97 11/26/97JB 2P
31206 1341 ASTER DUR ROCK 11/26/97 11/26/97JB 2P
31206 1341 ASTER ITEMP. METER SET 12/18/97 12/18/97AD 3P
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• Inspection Quer a Specfic Permit 10/98
PERMIT# ITUS''.ST SITUS;ST:REET Lot#: ;INSDESCRIPT .. IrisTyp DATEDESIRE DateDOne Inspector UnitsPass/Fail ;Code.
31206 1341 ASTER GAS TEST 12/19/97 12/19/97 TO 2 P
31206 1341 ASTER SHOWER LATH 12/30/97 12/30/97 AD 2 F
31206 1341 ASTER SHWR LATH 12/31/97 12/31/97 AD 2P
1206 1341 ASTER ELECT-F 4/13/98 4/13/98JB 2F
31206 1341 ASTER PLBG-F 4/13/98 4/13/98JB 1 F
31206 1341 ASTER MECH-F 4/13/98 4/13/98JB 1 F
31206 1341 ASTER BLDG ENERGY FINAL 4/13/98 4/13/98JB 2F
31206 1341 ASTERBLDG FINAL 4/13/98 4/13/98 JB 1 F
31206 1341 ASTER ELECT-F 4/14/98 4/14/98JB 1 F
31206 1341 ASTER PLBG-F 4/14/98 4/14/98 JB 1 F
31206 1341 ASTER MECH-F 4/14/98 4/14/98JB 1 F
31206 1341 ASTER BLDG FINAL 4/14/98 4/14/98 JB 1 F
31206 1341 ASTER BLDG ENERGY FINAL 4/14/98 4/14/98 JB 1 F
31206 1341 ASTER BLDG-F 4/20/98 4/20/98 AD 4F
31206 1341 ASTER ELECT-F 4/23/98 4/23/98 JB 1P
31206-134-1 ASTER PLBG-F 4/23/98 4/23/98JB 1 P
M-2061341 ASTER MECH-F 4/23/98 4/23/98JB 1 P
31206 1341 ASTER BLDG FINAL 4/23/98 4/23/98JB 2 N
31206 1341 ASTER BLDG ENERGY FINAL 4/23/98 4/23/98 JB 1 N
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