31124 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. 31124
BuDIVISION APPLICATIONIPF.RMIT PLUMBING-MECHANICAI.
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS a4v, SANITARY NO. APPLICATION SUBMITTAL DATE
PHO 2','(I �Gc CO R'S NAME: ( � LIC NO:
O .�
aV(x+ �KL B 41IJ� NIC CONfROLn
HITECDENGINEE LIC NO: ADD S: # ❑
✓ ✓C55i✓ jrIrl Ela✓ d p yv(po2 a✓ 2 !2
c NTA . / PHONE: - _ BUILDING PERMIT INFO
Seo I`Q II `(DS 14 ❑ Consultant Fees Paid by Applicant(InitlW) � ELECT PLUMB MECx
LICENSED CO RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby e(fnn Out 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
�aZ with Section70(surdDivision 3 ofthe Business and Professions Code,and my license is
00 I - PERMIT ISSUANCE
WC in full force and effect. 1. ❑KITCHEN REMODEL
�UtI License Cleu Lica
DatAPPLIANCES-RESIDENTIAL 'OADDITION OPLUMBING RE-PIPE
tW e Contractor
((--��'/ m shbe
'ARCHITECTS heO
DECLARATION MULT6 ❑
UNIT STRUCTURAL
Z p7� 1 understand my Ala
shall heused as public records PANELSsPh MODIFICATION02.. UPT02WAMPS i-�
Licensed Professional - _ ,D INTERIOR ❑CHIMNEY REPAIR
W 2014000AMPS IMPROVEMENT '
3 'OWNER-BUILDER DECLARATION OVER I000AMPS O BATH REMODEL/REPAIR Cl DEMOLITION
G 1 hereby affrm'Nm 1 um exempt from the Contractors License Law for the
3 M U following reason(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRI O OTHER
Cwhich requires a permit to concoct,alter,improve,demolish,or repair any swcturt 'I
promo its issuance,Rlsorequiresrheapplicant fmsuchpermit no filetio,nedsratc, I SPECIAL CIRCUIT/ �VN
Tthat he is licensed pursuant to me previsions ofthe Contmctofs Licence Law(Chapter9
GAO (commencing with Section 7")of Division J ofthe Business and Professions Code)or TEMP METER OR POLE INST. �� COMMERCIAL:
S`a C�' that he is exempt therefrom and me basis for the alleged exemption.Any violation of O NEW BLDGIADDITION. DEMOLITION
^,m Section 7031.5 by any applicant for a pemdt subjects me applicant to a civil penalty of POWER DEVICES
2, nos more than f ve hundred d.11aa 6500). ❑TENANT ❑FOOD SERVICE
f C ❑1,mowner.l'the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
will dw
o me ork,and the rtmmuad
m is rot intend ...ffered fortune(Sec.7044.Business GOTH ER
L m and Profcasions Cade:The Convectors License Low does nut apply to an mom of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements am not intended or offered for NEW RESIDENTIAL ELECB SQ FT.
sale.If,however,the building or improvement is sold within one year ofc.mpletion,the SQ.FT.FLOOR AREA S/SQ.PT.
owner-builder will have the burden of proving that he did not build or improve for pur-
pau of sale.). _
I,ns owner of the property,an exclusively contracting with licensed contractors to -2,1 G 2 re,- SC
contract the project(Sec.7044.Business and Professions Code:)The Conuuctor's Li- re O
cense Law does not apply..an owner of property who builds or improves thereon,and QTY, PLUMBING PE IT FEE
who contracts for such pmjmts with a communist licensed pursuant to the Contractor's '
License Law. PERMIT ISSUANCE _ v�
O I um exempt under Sec. ,B&P C for this reason
Owner Date ALTER-DRAIN&VENT-WA E VALUATION
f WORKER'SCOMPENSATIONDECLARATION BACK FLOW PROTECT DEVICE .141 �7 t y �.
1 hereby amrm under penalty of perjury one cities following declarations:
I have and will maintain a Certificate of Consent to selNioure,for Worker's Compen- DRAINS-FLOOR,ROOF,AREA OND. STORIES TYPECONSTRUCION
/ motion,as Provided for by Section 37M of the Labur Code,for the performance of the
ml,for which this permit is issued. FIXTURES-PER TRAP
O 1 haveand will maintain Worker's Compensation Insurance,as required by Seetion
37M of the labor Code,for me performance of the work for which this permit is issued. GAS-FiA.SYSTEM.I INC.4 OUTLC S OCC.GROUP APN
My Workers Compensation Insurance carrier and Policy number am:
Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4 GIA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASF/INDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE, B .DI ISION RES
(Thissemim need a .be completed if he permit is for one hundred dollars 6100) GREASETRAP
or less.) PLANCHECK
LO tol—
I certify that in me performance of the work for whichdin permit is issued,ishall SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any manner so as to become subject o the Worker.Compen- ENERGY Ml�R
Z talion Laws of California.Dani WATER HEATER WNENT/ELECIR
y� O Applicant GRADING FEE
❑ y NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should WATER SYSTEM/IREATING
abecome subject to the Worker's Compensation provisions of the Later Code,you must SOILS FEE
{27 forthwith comply with such provisions mthis permit shell he deemed revoked. WATER SERVICE
0.
CONSTRUCTION LENDINGAGENCY NEW RESIDENTIAL PLMB. SQ,FE PAID
U 0 l hereby which thi that there issued(Sucti.n[ending agency for the Performance of Date ytN
W f-R me work for which this pemut is laved(Sec.3W7,Civ.CJ
1--� Limiter.Nome _ TOTAL:
� � Lenders Address TOTAL:
I really that 1 have mad this application and state that the above information is BUILDIN
Z) correct.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE '
haildingcnnsvumion,and hereby sum.dm repmumatives.fthis city to enter upon the SEISM
ry above-mentioned property for inspection purposes. PERM IT ISSUANCE ELE I
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilifn,jodgtnems,costs and expenses which may in anyway accrue against said Cny ALTER OR ADD TO MECH.
in co
nsequence of the granting of this permit. YYY��� PLUMBIN
APPLICANT UNDERSTANDS AND WILL COA VITH ALL NON-PO T AIR HANDLING UNIT IB,WO CFM) MECHA CAL FEE
SOURCE. \TIONS. //
AIR HANDLING UNIT(OVERIO,IXOCPM) CONS AX
Signew ¢anUConttacmr Dat EXHAUST HOOD(W/DUCD
HAZARDOUS MATERIALS DISCLO RE HOUSING MITIGA NFEE
Ore applicant or future building occupant store or andlehvudommaterial HEATING UNIT GM 100,000 BTU) -
as efined by me Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532on? HEATING UNIT(OVER 100,000 BTU)
OYu" ONo VENTILATION FAN(SINGLE RESID) PAID
Date Receipt M
Will me applicant or future building occupant use equipment or devices which
mit hazallous air momentums as defined by me Bay Arca Air Quality Management BOILER-COMP(JHP OR 100,000 BTU)
TOTAL:
)outer?
❑Yes ON. BOILER-COMP(OVER 100.000 BTU)
'
o AIR CONDITIONER
1 have revel the haarl Se trans 255 5.2553 ems under Chapter atur.f me Cali- ISSUANCE DATE
Foods Health&Scurry Code,Setons 25505,25533 es, 25534.1 uodersratd that if One NEW RESIDENTIAL MECH. SQ.El
building Jae not currency hu must
a tenant,mato is sea resminsCend roenotify the necupant ,
ofthe requirements which must be and poor missa.nec ole Ceailicate of Occupancy.
Owner or uumorimd agent Dare - - TOTAL: - ISSUED BY:
OFFICE
FROM PHONE NO. Dec. 03 1997 05:25PM P2
POST THIS CARD NEAR FRONT OF BUILDING
FGITVUFCUPERTINb
BUUDMIG DIVISION 31 LT
aNi.DBiG PROJR 7TTIFICATION
tlVLLU1NGADD0.D55: '.,' SZ4WARYNO. APPLIE''
\PA'S NLM K WNTMCTDRSNAMk: : LIC NOI •�
': '- r �J♦ HI is_.. L .J. N : 'NI'KUI.d
rtPA1TTJ:GW � I N ADD0.E55: ❑ -r.`> /� .
'. INSPECTIONS DAIS INSPECT ❑ Gmtuluar Fas PxIE n Bmx1Txttlnt j."::g';';BUII:DPIFj •IN SC
. M rr ( ) BLDG B; N.uMx tmcv'.
POUNDATION/P(ERMI D,S, INSPECTION RECORD �J 1�
ALL GRADIN JOB DESCR�'1'ION
UFF-R GROUND
NOTE: G AND DRAINAGE
PAWSETRACK-CERTSHALL BE INSTALLED TO COMPLY WITH FnwL (3mr.wWREmom
'00GARAGE SLABS/PREGUNITE HE .APPROVED PLANS AND CITY OF UMnnrrta+ ORumiNoRs-rut
CUPERTINO STANDARDS. 0 an-(n+rr [I STRUCTURAL
,
POjTRNOCONCRE?¢llN;D.'pBO�+E'YHwSB SIGNED 6' MODIRCAnQN.
TOARRANGE INSPECTION OtIfatwR nCTnMNrtrRRPA4
UNDERGROUND/SLAB CALL AFTERNOONS (12:30 PM • 4:00 PM) plmmuvmwmNT g ODxete EUREPAm ODRMrnyto
PLUMBING _ 777.3228 MONDAY TO FRIDAY 24 HOURS BE- OOnIER S
ELECTRICAL FORE RRQUIRED INSPECTION.JOB ADDRESS
DO NOT POURFLOOR.UN'CILABOv¢HASI'M
SIG AND PERMIT 0ARP NEEDED WHEN PHONING.
COMMRRCLLL
PLUMBING � .;. ATTENTIONCONTRAC'rORS: ❑NEWBUCADDRtON ODMOLMON
MECIL4NICAL _ NO PERSON(S)S HALL PERFORM WORK ON ❑TENANT 13 FWD SERVICE "'
THIS JOB SITE WITHOUT BEING [N COM- TMMOVEMEN!
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION 0nTRRR K
FRAMING VENTS INSURANCE REQUIREMENTS,
INSULATIUN INSPECTON SPECIAL.INSPECTION REQUIRED ❑ DAT¢ INSP.
PEACE NOSUBFI.00R UNTILABOVE , SIGNED,
ROOF SHF,ATH/DIAPHRAM
PLUMBING
TUBS B SHOWER PAN
ICN.
BLECTRICA1,TOOL BO
FRAMWrj/STARtS/E,EGRESS '
INSULAI7UNIVENTILATION '-""—
COVER:NOWORKUN,Tj[::ABOVE', •$HBN„ GNBq':"'
E%TERIAL SHEAR/HOLD DOWN
DITEMORSkih. HOLD DOWN
SW E IWROCKISHBSIROCK SHEAR
BXTBRIOR LATHAV-SCRERD i
SHOWER LATH
'NOTAP OR PLASTER'UNTIL,ABQvE HaSB
SCRATCH COAT
SEWER/WATER AftI D
TEMPORARY.APPROYALS '.� C
OCCUPANCY
ELEMICAL U('
GAS
,•
OAS TEST O
GRADE O I
FIRE
HANDICAP
JELECTRICAL �f
UMBING _
•6C^HANIC;N- �
VISUAL
FINwt ONLY
VCERTIFICATE OF OCCUPANCY ElVISUAL
BUILDING IMPORTANT: ISSUANCB Dara
��� "' PLEASE READ REVERSE SIDE BRFORS
:..OECIiRANL:Y DFB.:..'.&M-451'Iy i . ... ..
1JjiLl $'(JJLDINdJINAL4S;GNED;`BY;RitDING' CALLING FOR FINAL INSPECTION!!
S
FROM PHONE NO. Dec. 03 1997 05:25PM P3
BRIAN KELLY IVC.
KELLY CORDON DEVELOMMENT CORP.
Fax Yo.: (408)373-8819 (408) S73-3773
FACS=E COVER SHEET
Dau:
To: Ght'15
Company: G [1Q
F2.x:o.: 3333
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