S 4305 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY ••
CITY OF GUPF.RTINO BUILDING-ELECTRICAL PERMI O.
an
BUILDING DIVISION APPLICATIONTERMIT PLUMBING-MECHANICALewe
BUILDINGPROJECl1tDENTIFICATION 'r '
BUILDING ADDRESS. SANITARY NO. APPLICATION SUBMI'fTAL DATE
0i l "Dig Z 1 (, -2/-9
NER'S NAME: I' ONEe CO RACI'O 'S ME: LIC NO:
S S ��ti ST✓m S3sl N/C CONTROL#
wRCHITECUTINGINEER: LIC NO: ADDRESS S� 7 y� 3 ❑
/ M'ACT: O ozHM E: + 11 r B DING PERMIT[NFO
/y ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT/ PLUMB MECH
LJ El 1:1LICT.NSED coNTRACTo1xs DECLARATION QTY ELECTRIC PERMIT' f FI E,
1 hereby affirm that 1 m licensed nde pr v ' f Chapter 9(Sommer g _ JOB DESCRIPTION
�aZ with Seu'nn]000)nfDivision J(if the Noris andlr ressi.ns Cndc nd ny liee ac rs
W O O PERMIT ISSUANCE 3 S S RESIDENTIAL:
h W E in full fora and effes
a U V License C i is x 6 f 3 ❑SFDWL ❑KITCHEN REMODEL
FFi<L Dare Contract APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION
F� PANELS 0MUUrFUNIT ❑STRUCTURAL
Ov� 1 understood my plan.shall he nscd ns puhlie records MODIFICATION
Z=J p uF DO NO AMPS ❑INTERIOR ❑CHIMNEY REPAIR
F�n2
F"tel Liceme l Professional (11-IfNO AMPS IMPROVEMENT
' ap Mf.4 OWNER-BUILDER DECLARATION ❑SWIMMING POOLS
w WW
I hereby affirm that I am exempt from the Contractor's License Law for the OVER HOPI AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
3 d V following reason.(Section 1031.5.Buxities,and Prum,,,i.nc Code:Any city or...ny SIGNS ELECTRICAL El OTHER
Cwhich requires a permit to consumer,alcor.improve,demolish,or repair any streiam
printroit,issouree.ulsn requiresrheupphram Fireman permit to filen aignedmaemed SPECIAL CIRCUIT/MISC.
fyly tharheislicensedpursuanttorhe provisinm.f me Conwdors Liccna law(ChapterY
LL1��0 (commencing with Section 7")ofDivision 3.frhe Business and ltofessions CWc)or TEMP.MET ER OR POLE INST. COMMERCIAL:
'L rhm be is exempt therefrom and the basis for the alleged exemption.Any violation of
w2 ❑NEW BLDG/ N DEMOLITION
^,w Section 7031.5 by any applicant for a permit subjens the appllcanl In m civil pwolry of POWER DEVICES
m more than five hundred dollars(85(10). ❑1BRADI FOODSERVICE
SpO 1,as owner ofthe property,or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC IMPROV ENT
will do the xericand rhe structure is not intended.r offered hostile(See.104/.Business DOME
a and Professions Code:The Connvaar'a License law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES d
property who builds or Imposes thereon,and who does such work himself or through
his own employees,provided that such improvements ere not intended or offered for NEW RESIDENTIAL ELECTR SQ FT.
sale.If,hawc%c,the building orimpro emem is sold within one yearifcompletit the SQ.FT ODR AREA Q.Fr.
owner builder will have the burden of proving mm he did not build or improve for pur-
pose of sale.).
❑L as owner of the property,am exclusively contracting%uh licensed amuvmars to AL'
construct lheprojecl(See,7l44,Business and Professions Cii The Cammam's L, - .- -
aseLaw does not apply toanowner ofpropeny who builds or improves themnn,and QTY: > PLUMBINGPERMIT
colicensed ' +'FI?EI '
who contracts for such projects with a ntractor(s) parmanno the Comracmri -
License Line, PERMIT ISSUA CE
❑I amxe
empe under Sec. ,B&P C frn chis reason
Alll'ER-DRAT & .NT-WA'I'ER(EA) VALUATION
r Date
n WORKER'S COMPENSATION DECLARATION BACK FLOW .DVI w 1 hereby affirm under penalty of perjury one of the following declarations: D(' O
I have and will maintain a Cenificam ofConsentto set Limure for Worker's Compen- DRAINS-FLOOR,' O D. STOR1 'TYPE CONSTRUCTION
tion,as provided for by Section 31(10 of the Labor Coda,for rhe pefrormonc.of the
ork far which this permit is issued. FIXTURES-PER TRAP
❑1 have and will nomm tin Worker's Compensmion Insurance.as required by Sector.
31014the Labor Code,for the pedmmacocrAhe work for which this peardeada.issued -EA.SYSTEM-I INC.4 OEM OCC.GROUP APN
My Wodels Compensation Insurance carrier and Policy number am: /fir 7
Carries Policy No.: 4p GA. . 'YSTEM-OVER 4(EA)
CERTI FICATE OF EXEMPTION FROM WORKERSSEIIN� "
COMPENSATION INSURANCE ASTE INTERCEPTOR ,
(This section need not be completed if Bre permit isforms madmd d.11ars(SIBB) BUILDING DIVISION PEES
or less.) ORE AP t^
PLANCHtiCK FEEI acidly that in the performance ofrha work for which this permit is issued.I shall J
not employ any pcoVao vnymamnerso us nee Eacomenuhjeet to the Workers Cmnpem ER-SA Y-$ RM EA.200 FI'' ENERGY HE
,z wrion La it Dare
z O A,phei m[�,�r WA EATER ENT/ELECTR GRADING FEE
Pti NOTICE.TO APPLICANT.If,A er making this Certificate of Exemption,you should T ?BEATING
become subject m the Worker's Compensation provisi.m of the Labor Code,you mon SOILS FEL
forhwimh comply with such provisions of this permit shall be dammed revoked. WAFTeSiUVIC17
0 0
7z CONSTRUCTION LLNDINGAGFNCY NEW R[SIDE IALPLM SQ,ET. PAID
V work
whaffimi rembere issued(Suaionlending agency for the performance of Dar Receipt
• the work for which this pormir is issued(Sea.)091,Civ.CJ �
C) Wfender's Nana Coo,
Lender's Address l.i'l�'
I certify Nat 1 have read this application and state that the above information is BUILDI G E
it to cancer.l agree to comply with all city and county ordinances andante laws relating to QTY. MECHANICAL PERM FEF
U Z building ennswctiun.and hereby mahmizc represenmtives.fthis city r.enter upon the SEISMIC E ^ �Q
tr ab.vomardmed progeny for inspection Pumnses. x
(We)agree It,meve,indemnify and keep bananas,the City or Caperton.gainnm PERMIT ISSUANCE Iss. ELECTJ(1 FEEqz
liabilities,judgentra,cmrsinl expenses which cony in any way accrac.lor id said CityALTER OR AUD'TO MECH. ` PLUMBIN FEE
in cumequrree of Ne grnming of this permit.
APPLICANT UNDERSI'6DS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITOD 10.00CFMI
CA
SOU EGO STIO MECHANIL FF.E
AIR HANDLING UNI'f(OVER 10,0010CFM) CONSTRUCI'IONTAX
name nfwpplicanlContmcmr Ii Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATI NO UNIT(TO 100,000 B'I'Of
as defined by the Capstan.Municipal Code,Chapter 9,12,and the Ilahh and Safe,y _
Code,Section 25532011 IIIIAIING UNIT(OVER r)Q000 BTU)
C]Yes ❑No VENTILATION FAN(SINGLE RFSID) PAID
Will the aMi...I or future building mcupant use equipment or devices which Date Receim x
l
.it huzuNoms air contaminants as defined by the Buy Area Air Quality Management BOILER-COMP(3HP OR 100.000 BTU) -
DlsmnmY Yes E]No BOILER-COME(OVER IOQOW BTU) TO L
mat
6.95
I base res Safety
h ode,Se tion25505,
2 5 requirements under .1 and rstand e,Calm AIR CONDITIONER r IS NCC�.jI^TE�
land Heahh&Safmy 6sda,Scalar.25505.25aty and 25534.1 understand the
rho if @c NEW RESIDENTIAL.MECH. SQ.PI'. 1,{{SS�Q''JJ[[))
building duce not currently hove a tervnt then it is my ret if a Cedifim nnllfy the'ree,
fs�f7N wh' t be m prior m ismwa of o CetlOcore of Occupancy.
Owner rvmhonzcd.gem Date TOTAL: ISSUED BY: n
OFFICE
Inspection Query for a Specfic Permit 7/18/00
SITU U MSU l"MWOWWOMIREE big"ib Iikz peck U, at, tsEle
S4305 10110 IDE ANZA UNDRSLAB STEEL 7/13/99 7113/99AD I i P I
S4305 10110 DE ANZA UNDSLB ELECT 7/13/99 7113/991AD 1 P
54305 10110 DE ANZA FRAMING-R 7/19/99 7/19199 JB 2 P
S4305 10110 DE ANZA ELECT-R 7119/99 7/19199 JB 2 P
S4305 10110 DE ANZA SHEARWALL NAIL 7/19199 7/19/99 JB 2 P
S4305 10110 DE ANZA INSULATION 7/20/99 7120/99 JS 2 P
S4305 10110 DE ANZA SHTRK NAIL 7/21/99 7/21/99 CC 2 P
S4305 10110 DE ANZA WATER HEATER 7/21/99 7/21/99 CC 2 P
S4305 10110 DE ANZA EXT LATH 7/20/99 7/20/99 JS 2 P
S4305 10110 DE ANZA BLDG-F 10/4/99 1014/99 JB 1 H
S4305 10110 DIE ANZA ELECT-F 10/4/99 10/4/99 JB 1 H
S4305 10110 DIE ANZA MECH-F 10/4/99 10/4/99 JB 1 IH
S4305 10110 DE ANZA PLBG-F 10/4/99 10/4/99 JB 1 IH
S4305 10110 DE ANZA ELECT-F 1014/99 10/4/99 JB 2 F
S4305 10110 DE ANZA IPLBG-F 1014/99 10/4199 JB 2 F
S4305 10110 DE ANZA BLDG-F 10/4/99 10/4/99 JB 4 F
E�4305 10110 DE ANZA MECH-F 1014/99 1014199 JB 2 F
S4305 10110 DE ANZA HANDICAP 1014/99 10/4/99 JB 3 F
§4305 10110 IDE ANZA FIRE FINAL 10/4/99 10/4/99 WESV P
S4305 10110 IDE ANZA FIRE FINAL 10/4/99 10/4/99 WES P
ge 1