29138 APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING.ELECTRICAL PERMITIN29138
BUILDING DIVISION PPLICATION/ ZIT PLUMBING.MECHAUCAI,
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAD
^(../�I�f
OWNERS NAME PHONE: CONTRACTORS NAME LIC NO: ' 1, v
NIC CONTROL Y
4RCHITECT/ENGINii- LIC NO: ADDRESS: '❑
CONTACT PHONE" BUILDING PERMIT INFO
❑ Consultant Fm Paid by Applicant(Initial) LI ELECT PLUMB MECfI..
LICENSED CONI'RACIORS DECLARATION QTY ELECTRIC PERMIT FEE
1 hR ereby. ma I'm licensed mder pmvisimns of Cbeper 9(commn¢ing JOB DESCRIPTION
y"y] Z aimSes ion]II00)of Division 3ofmc Btoirca.mul%ofndow Cods,endtoY license,,
FC0F. ndRE_
fullforceaeffect. PERMFFISSUARESIDENTIAL� -
aF�UF(.J Liemseaus _ Licg - ❑SFDWL� ❑KITCHEN REMODEL
y< Dom re
Comchm APPLIANCES-RESIUGN ❑ ❑ IN
'FIAL DDIIION PLUMBGRE-PIPE
F,>y _ ARCHITECTS DECLARATION PANS
ULD-UNIT ❑STRUCTURAL
ZO Z n Z I umdmsti d my plans hell he Used u public records MODIFICATION
F.C, Imnscd Pmfueimlal UP TO 200 AMPS ,❑INTERIOR ❑CHIMNEY REPAIR
201-1000AMPS IMPROVEMENT
�Y thereby door I am exemptER m the CoATIGN OVER 1000AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
C 1 ras .(Onn Thu 11m exempt form me Corms Co Liana Lew her me
ax 3 d U
following og eman.(Section 7031 d. t,sircv and professions Code:Any my w me SIGNS F,LECIRICAI. ❑OFFER
W AO whkh require a permit h .iroh e,pplic Improve,h Permitt, file
mpw any xVudure'
I:rh Pror ot he
Evad Thoom coo,he Mokwram for inchPermittoOrso salmon! ha,c,m S%:TIALCIRCUR/MISC.
00�. Out he neinnwiprmmuem7(me Pmwivi 3rte husiClara ticef i IChePlmv _
(`rmnwncine Wim Sectim]IMl(Ho[Divivon3Uf the Husilry cot Pmfrniom Codelm TEMP,MF.eI'ER OR POLE INST. COMMERCIAL
a y Nu he is exempt dreefmmand the ubeais fm me JRgM exemption.Any viaWilm of [I NEW BLDG/ADDITION [I DEMOLITION
LLX] Section 70315 by.ny awiwm for u permit nuhjcne l to applicant to n civil Nasally of POWER DEVICES ❑TENANT ❑FOODSERVICE
Z y res more men Ove hoard duelers($300)_
❑ I.uowry of me property,wmy emMoym wins wages umhcir Nae congers lion, SWIMMING POOL ELECTRIC IMPROVEMENT
'•LTJ` will do the wash,wJ the I.o.re iI of.olso,h1mobe1W for x5k(Sm.]044,11mineu ❑OTHER
a 3 W Pisteeions Code:The Commnmor,I-Io.Ia.don not apply In m Dore of OUTLETS-SWITCHES-FIXTURES
progeny wM Inmilds or improves maem.,and wh.ebn such work 1limse1f rex thmueh
his own cmploym,prnJd mal ruck improvements ore not me ded w o0'vd for NEW RESIDENTIAL ELECIR SQ FT,
anda.If.tmosm.the building or imsroverely is old wuhin one you o(mmpldan,the SQ.FT.FLOOR AREA sisQ FT.
owanbuiklcr will have the burden of prvving do,he did mol hold or impnrve for par-
pmcoLalcJ. (��.y,-4t_ 7
I,u owner ojtci Property.am exclusively mnmetieig wide,)Thm Contract...
m TT 74,m' ('y, • ,
ct de Pnejcd(Sa.JIW4,Bueiwu ata lYofusinns GdcJ'I11c Cnnlmamr'n Li-
emelawmum.pply loan Dauer of aopeny Wtu batiks or impovn morn,uW QTY. MBING PERMIT FEE JUL �� '
who eonmxa fm such *on wins.mnonctonO)Ikcmed purxuenl ma me Contraclerr s
Liccnra:law. PE ISSU 1996
❑ImucmpudvSee. ,Bh PCfhrihis mama
Yv . ..
ALTER V,N - 'R(EA)
VUrCfv. VALUATION
1....v
WORKER'S COMPENSATION DECLARATION BACK FLO ,CLD
Meby affirm under pe.I,y one nw
f p nor,aof the rullir, n,ig decluolioo
WI love and Will maroon•Ci,mr leofConsem to klf-Imwrt for Worl Conger- DRAINS-FLOOR, AR OND. STORIF_S TYPE CONSTHUCI'ION
ort.u provided!for by Sections 37M of the Lab Code,for the perfommnce of rte
work for which mis pcook is isucd. FIXTURES-PER
❑ I have ud will moment Worker'.Compem..dm Inwratice.u eequhd by Section -
37WofteLabor Code,for the pmformarwe of the work for which ihin permit is issued. GAS-G.SYSTEM-1 INCA OUTLETS
My W.xkcr s Cwnpcnwtlon Inwwee comm umb
era Policy nci ate:` OCC.GROUP "N
Cartier. Pdicy Na.: GAS-FA.SYSIPMdVER 4(EA)
CERTIFICATE PE EXEMPIiPRAM WOR KERS'
COMPENINSSATION INSURANCE GREASFJINDUSTRL WASTE INTERCEPTOR_ BUILDING DIVISION FEES
fl3d.ration red m be compMcd if Ile pmdm is for m1c hmdmldollers 151(X11
or llxsJ GREASCTRAP
PLANCHECK FEE
Ioyany morin the tiermannerof the bac fmwhichmu me wars EssuN,n'.- SEWER-SANITARY-STORM EA.3f0 FT.
rM emPRry my person in any mennerw¢e In become whlaltn me Wmken'ComPen- ENERGY FEE,
rZ ralionlowsaf Cdifumi¢Dac
O WATER HEATER W/VF.YI'/ELECfR
Z O NOTICE
GRADING FEE
W NOTICEch i to the APPLICANT:IL afar making min Cisiom,of
P imor Cool
yew ehwlJ WATER SYSfEhVTREATING
� l>" forth inuhjcwloth Wwtcrs'inmpenwiweermitsmsof mclahorvoked. mot SOILS FEE
CQ femhwim comply wins web prmviamm.aoris perndt Dullddccnui revoked. WATER SERVICE
7z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLNIIL SQ,PT. PAID - r
V V thereby affiml that mere is a con.Vnclim luting agency for the performumce of Due Receipt0
LL the work for which mperm
it it ec laued(,See iv.310)7,CC.)
oIrotcra Name
W Looters Acd. O TOTAL:
1 cenJy can 1 have mad thin epplicuilw and stat mu the above informa.i. BUILDING PER �.
Z) cmmca I.eree m.,Iy Wim Wciry and county ordin.nca and shut lewa relane to QTY, MECHANICAL PERMIT FEE
U ,Za building enmtrniom,enJ earthy wlMxirempnvnmtivn of,hie citymrnmr upon Ore SEISMICFER 1pas
above-mentioned pmpeny for im eonmpmprsev. PERMITISSUANCE
(We)egmc ma ave,irdmmnifY shed keep hormin.de City of Culrnim ogoinn III FCTRIC IJ E O
in
a cow vd of
may in my stay acme neainn wiJ City ALTER OR ADD TOMECIL
in coouqucae Mlhe BreminB of thio Frwt. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000IO, 0 CFM)
SOUR CE REGULATIONS. - MECHANICAL FTE
AIR HANDLING UNIT(OVER 10,000 CF M) CONSTIUJCI'IONTAX
SiBwwreof APpI.d Conuacwr Dale EXHAUSTHOOD(W/DUC1) HOUSING MITIGATION FEF.
HAZARDOUS MATERIALS DISCLOSURE
Will mcu,knoloefuturc builJineacaPmll Amxc or MNle mucadou.—fto.l HEATING UNIT JO 100.00 BTU)
u defined by doe Cupcnim Municipal Cute.Cluply 9.11,ed the Beelm ata Safely
Code,Socnmi 853$.)7 HEATING UNIT(OVER,T4(100 BTU)
[3 Y. ❑No VENH-VUON FAN(SINGLE REID) PAID
Dole RccigN
WIIme an oomnlmfurore building by temB useen Air emit Mahawhich BOILER-COW CMP OR IOO.DO BTU)
or huuJws.'v motnmivnla¢,defrN by 0e Bay Arta Air Qwlily hlvwgamcm
lsacrt BOILER-COMP(OVER 100,(X0 HTU) IOTA
❑YnpNc. -
I have read the hsa rt s lealeriib CTmopter AIR CONDITIONER ISSUANCE DATE
r5. i 533 sex uZ5 M1.95 of the Coli
ramie Hmlm&camo Codc,Scutum.than issis my rmp 8534.1 to notshad d1u if dee NEW RESIDENTIAL MECH. SQ.FT.
of the ledaumtts m(,h most lb cnt,nor.kmy rcofmCilimymmdfyme.mmpad '
M me rtyuimrcna which most he can prieswie.womec nfe Cmif maf0.upon y.
Owvmeru aumoriuM.gcm
One O ISSUED
OFFICE
Inspection Query for a Specfic Permit 9/15/97
® PERMIT#' ITUSf_ST IS ITU SISTREET Loot#I=INSDESCRIPT ns "'
ITDATEDESIRE ateDone
9138 20657 IFORGE BD 7 FLOOR NAIL 8/7/96 8/7/96
9138 20657 IFORGE BD 72ND /7/96 8/7/9
9138 20657 IFORGE BD 7 ROOF NAIL 9/16/96 9/16/96
9138 20657 IFORGE BD 7 ELEC 10/2196
9138 20657 FORGE BD 7 TOP OUT 10/3/9
29138 20657 IFORGE BD 7 FRAMING 10/4/96
9138 20657 iFORGE BD 7 FRAMING 10/7/96
9138 20657 FORGE BD 7 R C CHANNEL N UL 10/8/96
9138 20657 FORGE BD 7 RC CHANNEL 10/9/96
9138 20657 FORGE BD 7 ELEC SERV PANEL 2/3/97
9138 20657 FORGE BD 7 BLDG-F 2/3/97 2/3/97
9138 20657 FORGE BD 7 ELEC-F 2/3/97 2/3/97
9138 20657 FORGE BD 7 PLBG=F 2/3/97 213/97
N138 20657 FORGE BD 7 ELECT=F 2/3/97 213/97
13 2 57 FORGE BD 7 BLDG ENERGY FINAL 2/3/97 2/3/97
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Inspection Query for a Specfic Permit 9/15/97
rns ecto units Pass/175H IC60e
J
18P
C 6P P
S 2P
J 8P
S lop
S 1 N
s 2P
S 2P
is 2P X
is 2P
S 2P
S 2P
S
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