29142 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
w'CITY OF CUPERTINO BUILDINGELECTRICALPERMITNO.
APPLICATION/PE T PLUMBING-MECHANICAL. 29142
BUILDING DIVISION �1 BUILDING PROJECT IDENTIFICATION
BUILDTNGADDRESS:' ✓ — I SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER'S NAME: PHONE: CONTRACTORIS NAME: LIC NO:
JIM
NIC - CONTROL♦
RCHITECPENGINFSR: LIC NO: ADDRESS: ❑ O A�
CONTACT:' PHONE: - BUILDING PERMIT INFO
❑ Consultant Fees Paid by Appfi a t(Initlal) BI.DG ELECT PLUMB MITCH
LICENSED CONTRACTORSDECLARATION ❑ ❑ ❑ ❑
I hereby"ffmt hour 1 em ficensW undccptovinionx of Chapter 9(commencing QTY ELECTRIC PERMIT . FEE JOB DESCRIPTION
up�00 mmSwim 7")of Divialm 3 office Buds and Pmfessiona Code,and my licensee RESIDENTIAL:
FOO ufull force imro eBaL PFJLMITISSUANCE -
r�..U�j Lccna Clam Lica ❑SFDWL D KITCHEN REFIODEL
to z Dale Cmmesor APPLIANCES-REilDE PHAL �DDTUON �❑PLUMBINGRH-PIPHARCHITE .
Z O�Z I umlcnund my plaru shall h uTuW as public R resccomis ULTI-UNIT. D MODIFICATION
ION
ATION PANELS
OZ— UP TO 2N)AMPS DINTERIOR . DCHIMNCY REPAIR
-rr .F. I.icrnrcd Pnlfcssitrwl 201-1000 AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION
yy C Q I hereby affirm that 1 rm exempt from the Contractor x Licen,e Wan fa the OVER lipbl AMPS r ❑HATH REMODEI/RFPAIR ❑DI:MOI.ITION
X<3 a V following..(Sevum 7031.3,Husircv anal Pmresxims Calc:Any city or cumaYSIGNS ELECTRICAL
D OTHER
LLu11 u.O which regvirn a pemul to crostrucl,alter.impmve,demoEsh,Or rtpe'v eery"mc urt
prior to iu lvmance,alw m4uires the applicant for xah pctmil m 5lc v signed swmmat
,� SPECIAL CIRCUIT/MISC.
�} rhmarra emM ptusien mthe fvovivimsol.f Cmtrnn«,Liame Ww(Clupter9
(m"""om'"a wins Savor 700(]of Divisinn3o[OS Buainm vat Profaiwns Cndgnr TEMP.h1ISTER OR POLE INST, COMMERCIAL:
d e C the he k e.cmpt Perrelman aN the basis for me allegW e.cm more,Any vidviw of ❑NEW BLDG/ADDMON 'D DEMOLITION
Ic SasTiam 70313 byeny a,,ii.fits.pomil subjms me.,licerm roe civil penalty of POWP.R DEVICES
ern ❑TENANT ❑FOODSERVICE
tZ i+ fur nwxe Own hv<huMmd dtllea(S310).
=O ❑I,uhe ncroflhe Propene amYcmpbym withwupe,asdcu Weco,L Bmi m, SWIMMING POOL ELECTRIC IMPROVEMENT
F willroo Jwwmk.aNe.The fOrtale nor.Scc.7Bf4, .neror El OTHER
and I'mfessions Cottle.The Cmrmcr«x Licensee law duo era apply m on owner of OUTLETS—SWITCHES—FIXTURES
butpxvpw�y
own who build,a improves memItm aero who oras ra m wak himuB a mMfor
his o employees,providal mel such inilrznvcments um not i earref a n0'nad for NLNJ RESIDENTIAL ELIiCTR SV IeI'.
v .If, hroc lthe borer of pemcra is "nasYeanorcumplefonme SQ.FT MOOR AREA SSU.FT.
aw�fadlda will have the bvNcn of ptnvine rhm he did hot Wid or improve for pts- \n� ♦ � `��
of areal.
I.u owncc M me Property w exclusively examating wins licemml cuorfsrm m
eaWmn the Pomw(S .70W,Boone.and Profeasiims Cale:)The Co m iT U X^1
cerni dxranar anlymanowarofprop ywbo buildsaimpnrvn memnoand Q'ry, UIB GPERMIT FEE
wto anuacu for aach pmjev xvim a cmtrvcloK,)lianxd mnaannt ro tk Cunhncl«a
License Wan. PERMIT 1 A - JUL 'I 6 J�
❑ IanLmv. MerSec. ,B&PCfa this BeasonI/ ,J•{/
qg
ZALTER-DRAIN TEp n VALUATION
WORKERS COMPENSATION DECLARATION a BACK FLOW PROTECT.D wr Ur
I herthy affirm under Parpolyof perjury oteorhoe following rottlamtionv: a �U
DlMvc mdwiD muimvnvCmifuvs of Consent mself-eswe hr Wod:ds Cmnpco- DRAINS-FLOOR ROOF.AREA,CO STORIES TYPE CONSTRUCTION
udnm v Imnvi for by Smion 37W of tk Lehor Cndc,fa me pefrmna ne of the
rk lir which mi,perm,is i.sseed. FIXTURES-PER TRAP
❑I have and will maintain Wutr(s Conrpenattim I...n m9dmd by Section -
1100ofineLabor Caste*hr the pcHmmwmc of the wok for whish lhislt[mnirlx vocal. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN„
My Warier'.Cmycwuim Insurance curb nal PeBey number art:
Carrie: Policy No.: GAS-EA.SYSTEM-OVER 4IRA) •,
CER'URCATE OF EXEMP TION IIIOM WORKERS'
COMPENSATION INSURANCE. GREASEINDUS RL WASTE INTERCEPTOR
(TIT swim n dera)emmptclml frac peman is Orme hundrd vXp dolle (SI( BUILDING DIVISION FEES
m kv.) GREASE TRAP
PLANCHECK FEE
Imtify met inthe n myarmenttafat toh kfm w'hi to fbs mW ixiwrd,lshall SEWER-SANITARY-STQRM EA.21X1 ET -
na employ any person in any Danns,ut v In become suhjecr m us WoAurn'Compeer- ENERGY PEE 1
7r lWwaNCalifomia Date
A,i
O Applcam WATER IIGTCR WNFM/FlEC1R GRADING THE ,
NOTICE TO APPLICANT:If,after making mi,Certiticwe of Exempm,ym ahold WATER SYSTEMTREATING
a bttolx sub)ect to Ni Woci Compcwanim PrOVl,lm,of the labor Code,you most SOILS FEL
fmhwimcatm)ywimsuch provision,m this perpooshell be Jcemedrn loxia
WATERSERVICE
600
.`J,Z CONSTRUCTION LANDING AGENCY NEW RESIDENTIAL PLMH. SQ.IT PAID
O Ihachy ofhrm thm thertis'aemsweliun lmrofnQ eyen<y ra me pefannanreM Due Reaiplf
the work fee which mi,Permit i,ivuM(Sec.3007,Civ.C.)
C F-' boder,Nems r' TOTAL:
IeoroeYs ASlreas - A
6x 1.ify mm I have and ala applicmm em)state met the above infametim n BUILDING FEE
W conal. QTY.ngrtt to nrinplY wish 001 coy and L.,mly Winucu amt wa laws muting w QTY. MECHANICAL PERMIT FEE
t U Z Mdldin;cwavuc0an.and Mmby eulwrice rcprtscmvti.v of mics city menmupon Oc SEISMICFEE
ebovcm fimx 1 Pmpmy fm mi,ectim purporce.
(We)aFna to ave,indemnify end kap hunnleat are City of Cupenuw aaeinu PERMITISSUANCE ELECIRICFEE
IubiOtiajudgmenu.costa anal expenses which may in any way aaruc against aid City ALTER OR ADD TO MECH.
in mnseyuence of mc'mmmg of this Pemlil. PLUMBINO FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNT(TO 10.000 CFM)SOURCE REGULATIONS. MECHANICAL EER
AIR HANDLING UNIT(OVER)0.000 CFM) CONSTRUCTION TAX
SigrWurt o(ApplicnnvCmtimtor Dna EXHAUST HOOD(W/DUCD
HAZARDOUS MATERIALS DISCLOSURE NOOSING MITIGATION FEE
Will tk applieenr a furore building occulant store rr handle harpN mmcrial HEATING UNIT(TO I W,()(X)BTU)
ex dcfnml by to Cupenino Municipal Code.Chapter 9.12,coal the Health amt Sarny
Coc e.Swourn 255324)7 HEATING UNIT(OVER IM."BTU)
❑Yea QNo- VENTILATION FAN(SINGLE RESID) PAID
Dale Rawita a _
Will me nr comm m future WiLInF by He..,at use ca Air m m dcviax whicb BOILER-COMP(3HP OR 1 W,(XKI BTU) ^J
mit Iwwdms air comanunanu ns dchnN by me Bay Arra Ab Quality Muaegemem 1 /
Dsmn1nyest r7 NO BOILER-COMP(OVER I W,00(l HTU)
I hevc mad me monarchism materialsngairt�nu male, AIR CONDTIIDNER ISSUANCE DATE A
Chapter 6.93 optic Cdi-
hmia I Imlm 5 Sefgy Gore.Saiioris 233113,23311 wd'333a.I undcnvnxl dant If do NEW RESIDENTIAL MECH. SQ.ET.
a Bea Joel Bal tmvdyhevea met' oi mynppfa ibi0l)'toa tifYItsaapatl
of the�u'verrcns wheh nam,ba mel pnamissuvrac WuCrnif urns of(kcupusy. -
Omcrm euthari]41 a(enr Dole - IT
ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 9/15/97
PERMIT#; ITUSFSTn SITUSTSTREET Lof# INSDESCRIPT IFiisT,;r DA,TEDESIREFDateDone
9142 IHOMESTEAD BDG FLOOR NAILING 7/25/96
9142 IHOMESTEAD BDG FLR NAIL 8/1/96 8/1/96
9142 20641 FORGE BD 1 ISHEAR WALL 8/8/96
9142 20641 FORGE BD 1 RGH ELEC 8/14/96 8/14/96
9142 20641 FORGE BD 1 ROOF NAIL 8/28/96
9142 2Q641 FORGE BD 1 TOP OUT 9/12/96 9/12196
9142 20641 FORGE BD 1 RGH MECH 9/12/96 9/12/96
29142 20641 FORGE BD 1 PLBG TOP OUT 9/13/96
9142 20641 FORGE BD 1 MECH-R 9/13/96
9142 20641 FORGE BD 1 PLBG-R 9/16/96 9/16/96
29142 2 641 FORGE BD 1 RGH ELEC 9/19/96 /19/96
142 20641 IFORGE BD 1 FRAMING 9/20/96 9/20/96
9142 20641 FORGE BD 1 FRAME 9/23/96 9/23/96
142 20641 FORGE BID 1 R C CHANNEL9/25/96 9/25/96
142 20641 FORGE BD 1 INSUL 9125/96 9/25/96
9142 20641 FORGE BD 1 INSUL 9/27/96 9/27/96
29142 2 641 FORGE BID 1 ELECTEL 12/9/96 12/9/96
9142 20641 FORGE BD 1 BLD -F /97 1/27/97
9142 20641 FORGE BD 1 BLDG ENRGY-F 1/27/97 1/27/97
29142 2 641 FORGE BD 1 PLBG-F 1/27/9 1/27/97
9142 20641R E BD 1 ELEC-F 1/27/97 1/27/ 7
9142 20641 FORGE BD 1 PLBG-F 1/27/97 1/27/97
9142
120641 FORGE BD 1 ME H-F 1/27/971 1/27/97
•
Page 1
Inspection Query for a Specfic Permit 9/15/97
rCF
Units P_asslFail6'o'de,
6P
12P
N
N
S 2P
J
S 8P
S 8P
J 4P
J5 2
S 6P X
S 2P
S 2P
S 2P
S 2P
S 2P
A
Page 2