S0946 CLOSED/
EXPIRED
TEMPORARY
PERMITS
AP,+LICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
4BUILDING
Y OF CUPERTINO RI111.DING F,LIECTRICAL I'ERMI"f NO
ILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0946
BUILDING PROJECT IIIEN'1'IFICATIONi
ADDRESS: SANITARY NO, API'LICAI I�/O�N SIIBMI'PIALDAFE
vRz
BS ��i�. IIONF. C IA T HS NAME: LICN / `^�G f L ��� N/C CONTROL#
ITECTINEER: LICN ADDRESS"MUNE: - BUILDING I'1: IT INFO
❑ Consultant Fees Paid by Applicant(Initial) LOU ELEC PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT PEE
I trreby.Tara that 1 at Banned nndm powalu a,'If chapter 9(arminendntg L 70 ESCRIPTION
{Coe p S r 7BX))of Division 3 ofthe nosiness and Professions Cole,and my liccraeis
F I08� in full green and. PERMIT ISSUANCE H S1�E T
�UV License Clas, Lic.of Itl TI� ❑SFDWL ❑KITCHEN REMODFI.
vFi<Z'y Dale Conwcmr APPLIANCES-RESIDENTIAL ❑ADDITIO
ZO`t�Z 1 ad
a ARCHIT' SU[CLARATION ❑PLUMBING RIi-PII'li
W s public records PANELS ❑MULT Nff ❑STRUCTURAL
OZ-- UPTO 200 AMPS MODIFICATION
F+� W Lore .cel no
assumed Of ERIOR ❑CHIMNEYREPAIR
201-1(q(lAMPS PROVEMENT
,J OWNER-BUILDER CLARATION ❑DEMOLINGPOOLS
ry, Q I hereby maso .fern that 1 1. exempt from the lessors Co :License Law for the OVER 10(IB AMPS BATH kEMOI3EIlkEPAIk 11 DEMOLITION
x d U allowing reama. emit t Son m r Into.end improve,
de Professors Cale:Any city m cruor
W 3y,FF y SIGNS ELECTRICAL (1THEiR
O y¢ which requires a permit m di.thiL aper,improv.,demolish,or repair any swerve
mJ patterns imancaal.snm in
theapplic.ntfrr Cloorwrntirz.icensele Law aamment SPECIAL CIRCUIT/MISC. a
lz�} tam he i,licensed pursuemt.the pmvisimna of the CnnlmetoeY License lnw(Chapter 9
I 6S (commencing with Section AtlID)of Division 3nftho Raairre nd Profs..fact Ludy or
O O TEMP'.MITI It OR I'OLIi(NST. COMMERCIAL
a W M q (hat Section
is exempt therefrom and the hosts for the alleged applicant
to Any l violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
%�,m
out
than
hundreany d
dollars($500er for a mia xubjmts the vpplicammecivil penally of POWER DEVICES
p. } not more ah.n Bvc hundeW dollars[$5118). ❑TENANT 01700 SERVICE
❑ I.axervnel-ofmcfmpcny ermy employees with wages ax theirsolecompcnxation, SWIMMING POOL ELECTRIC IMPROVEMENT
W m will doth tr
work,and Neaucmrc is not intended orrffered Nr.xaE(See.704,1,Business 0OTH17R
Send Profession,Cade:The Contractor's License].me does not apply to an owner of OU'I"LETS-SWITCHhg-19XTI1RE5
property who builds or impmv.s thereon,and who does such work himself or through
his over employers,provided that.such improvements arc",'I
balanced or rwrd cfor NEW RESIDENTIAL ELECTR SQ P.
sale.If.however the building or improvement is cold within one yeerofromplelimt,the SQ.FT.FLOOR AREA US FT.
ewner,builder will have the burden of proving that he did not build or improve for pur- Q'
µtae of sale,. P p ' D
1,asowner ofthe pmpcny,amexclusively Pool contracting with licensed atoI i. TOTAL: N
returnconstruc,
maesnotapplytoan owner
and
dywhobuidsori pro GmBmmr'xand N�
mere Law dcesnntapplytoe,with
aofprtµny whesed paorimpmva Nereoµand QTY, PLUMBINGPER FEE V 6
whaatntraa¢for such pmjecn withucomranor(s)limnsed pursuamm do Cnnmmmdx - V
Pal
License Law. PERM IT ISSUANCE City Uf r
I am exempt under Sec. ,B&P C for this reason V
Owner UI
Date ALTER-DRAIN&VENT WATER(fes)' VALUWJBEEI
WORKER'S COMPENSA'T'ION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: HACK PLOW PRIME .DEVICIi
I have and will maintain a Certificate of Consent o self-insure for Workers Compen- DRAINS- 00 OOF,AREA.CONT.
on,m provided for by Section 3700 of the Lalcn Coe,lite the performance rf the M15 STORIES 'TYPE CONSTRUCTION
rk for which this permit is iss.ed. FIXTURE - _ e
1 have and will maintain Workers Compensation Insurance,as required by Section I
31W ofthe Labor Cale.for the rfurntan enf the work for which thi,+pemtit is basun,., GAS- U'LETS IG 110 OCC GROUP APN
MyWof�7c Can se.jeanxrle cPol¢yN romr GAS- r [EA C( CQm
Gari n
CER FICAIL OF EXEMPTION FROM WO ?HS'
COMPENSATION INSURANCE G AS F I: O "' Cie ac
(Thissmtion need nm hcrmplafrA if Nepemdt is far one hundW dollars($I W) dd r BIILDINO III VISION FEBS
or lass) REAS. . •-. ';^'(RfI GI �ra..�
'�Icalify than in 0uperformance nfthe work forwhet hmix permit lx isweJ,Ishe1l _ s, - a,npt�f:CK IgiE
not employ any rsan in my'an
c x o the Winders'Compen- SP.WI3N ST) .2 'eI•) 110 ENERGY FEF.
O Z union Lows C' i i Dane WATIiR - ' � /VEN'I'lli ' ! S.
0 Applicant
Z GRADING PEE
s-t y Nwman subject
j APo the W l 's ter making this Cemhcate the
Exemption n,you shoal Wq'fEH SVS'fEMRR A I It da
ai bceatme,abjectm the Worker's'Crmns or tis previsions nrthe lather Gale,you nt SOILS PEE
{tl fonhwiN comply with such provisions or this permit chant be decmeA revoke,. WgTp
Q
CONSTRUCTION LENDING AGENCY
r-)O l hereby union that them is a construction lending agency for the parte ce of NF.W RFSIDISNTIAL PLMI3. PAID Dam Rcmipt#
IL Fthe work for which nal,permit Is issued(See.3099,Civ.C.) ► natuf
U Landers Name TOTAL
W Lendre,Addree,
1 certify that 1 have read this application and state that the ah information i, t
w-th cancer l agme to comply with all city and county ordinances and if lawn relating to QTY .r
U huilding nmstnmhon,and herchy euthnrizercpresentabse,afdix ytocmcrupnnde SEISMIC FEE -
.1w,r-merfiemed property for inspection p.qw x. PERMIT ISSUANCE
(We)agree msave,marmot yand keep hmilos,the of Cupertino against ELECTRIC PEE
limilifies.judgments.costs endexpense,which may in any w accrueaguNsl sic City ALTERORADDTOMECIL
Inc pence nRhegmnting of Nis permit PLUMBING FEE
AI'P AN UNDERSTAN US ANTI WILL COMP L ITH ALL NON-POINT AIR HANDLING UNIT(100.000CFMI
SO I ATION - MECHANICALFEE
AIR HANDLING UNIT(OVER I0,0IDCFM) CONSTRUCTION'IAX
n A nwmor I m EXHAUSTHOOD(WMUCD
HAZARDOUS MATERIAL. RSCLOSURE, DOUSING MITIGATION PEE
Will the applicant or future Wilding we of store or handle losoudoes material HEATING UNIT CIO 1001 RI'U)
its defred by the Cupertino Municipal Code, apter 9.12,and the Health and Safety
Code,Scene.25532(a09 HEATING UNIT(OVER 1g1,g BTU)
❑Yes 0N 1
V ENTILATION PAN(SING LE RHSID) PAID
Will the IsPPlicam or helium buildg occupant use equipment or devices which Data Recciµof
I hmmdous air contaminants is def ed by the Buy Arca Air Quality Management BOILER-COMP 0HP OR 100,000 RTU)
I
I
❑Yes ON. BOILER-COMP(OVER 100,000 RTU) _
havereadthehmendeus .metals requiremcnN--ander Chapter 695 of the Cali- AIR CONTI,POKER
ia Health&Safely Cade.Section,25505,25533 and 25534.1 un hese n I that if the ISSUANCE DATE
building does not currently have a fenam.that it is my msponsibilinn,really the occupant NEW RESIDENT"IAL,MECH. SQ.Ff.
e r;uircments which must M met prior Ie.issuance of u Cera ficam of Occupancy.
er or awwrizel agentDate TOTAL:
ISSUED BY
OFFICE
_ Inspection QIO a pectic Permit
p,
PERMIT# StTl7SST_ _ITUS'8TREET Cot# 'INSDESCRIPTInsT p QTEUE5IRE ateDon Inspecto Units.PasslFail C66e
50946 10351 BUBB ROOF FRAME AND W 11/12/97 11/12/97 JB 3 P
S0946 10351 BUBB
S0946 10351 BUBB WALL FRAMING 11/13/97 11/13/97 JB
50946 10351 BUBB WALL FRAME 11/12/97 11/12/97 JB 2F
S0946 10351 BUBB WALL FRAMING 11/14/97 11/14/97 JB 2P
S0946 10351 BUBB
S0946 10351 BUBB ELECT/WALL 11/14/97 11/14/97 JB 2P
S0946 10351 BUBB SHETRK 11/14/97 11/14/97 JB 2P
S0946 10351 BUBB T=BAR CEIL 11/20/97 11/20/97 JS 4P
S0946 10351 BUBB I ABV T-BAR 11/6/971 JS
S0946 10351 BUBB PLBG-F 11/24/97 11/24/97 AD 2P
S0946 10351 BUBB GAS TEST 11/24/97 11/24/97 AD 2P
Pagel