29141 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING MECHANICAL 29141
BUILDING PROJECT IDPNTIFICATIO
BUIhDING ADDRP_SS: SANITARY NO. APPLICATON SUIIMI'PI'AL DATE
X06 �7 �- 13��d .�(/��/yy•lam`
OWNER'S NAME s PHONE.: CONTRACTOR'S NAME 'NO'.
WC CONTROLN
ARCHi LEMBINGINPER: LIC NO: ADDRESS: '
CONTACT. PHONE - BUILDING PERMIT INFO
❑ CH.Wfaml Fm Pald by Applicant(INlial) B_u7c PLUM H
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE �I£{''
I nertby.fflm mat 1 nm fxca ed ower vlovi.io�or chewer 9(eamn,eMWg JOB DESCRIPTION
QRZ with Sctim7(MMI)Of Divitim3offt Hu\ilmasrod Rofnsiau Cwc.vndin littuaei.
00 in full force wd effect. y PERMIT ISSUANCE S a RESIDENTLAL
�F-WZE L'rcrn¢Clt¢v Lic.N ❑SFDWL [I KITCHEN REMODEL
N6� Date Comrana APPLIANCES-RESIDENTIAL ❑A DURON C1 PLUMBING RE-PIPE
F.pv6i ARCHTIECTSDECIARATION PANFI9 kLTI-UNIT C1 STRUCTURAL
ZO�Z 1ulderv.nd my plain wll bc u,w as Public rtcomb, - MODIFICATION
OZ UPTO 2W AMPS E)INTERIOR ❑CHIMNEY REPAIR
F=t5 L'scenxel Plafc,ocral 201-100DAMPS TMPROVFMHNFF
OWNER BUILDER DECLARATION
C W V I hereby elfmt that I am exempt from the CosaboRims License law for the OVER USE AMPS ❑BATH REMOD111REPAIR O DEMOLITION
G. following leram.(Section 70315.Hu.ilta.nd Profeuinne Cak:Any city or county SIGNS ELECTRICAL ❑OTHER
OyQ
prior
its
issuance,
also re(ain,t the
,tic,it for such
Peorb!)1. file
a si anytaN[nIR '
F" rode pear l0 iucensedilsannryiteP,vikiliwn liu such permit mflc.s I'w melelelent SPEC W.CIRCUTf/A11SC. / ' /._ �^^^
00 (comm11bar N,encing 1Pumuanl mmc a Disiomafttr Colm.ctvr'snd Proelaw(Owwcf9 !tel
LL]apo (commencing with Section]Bou)dUiridnn J^f me Nu,inaa and Prnfrnions Cotle)a TEMP.MEIER OR POLE INSC - COMMERCIAL
6 a Y that he or nemr t thcrtWm ud the dtsi.,for the illegal escmwiw.Any vicWimt of ❑NEW BLDCJA66ff1ON ❑_DEMOLITION
�y $eetin]03L5 by any.,IkomSR.pemth u wbjecthe opplic.nuo.civil penilrynf Ib WLR DEVICES ❑TENANT ``(]FOOD SERVICfi
f-ZY ^0l none m:m five lbn dollars($500). IMPROVEMENT
FRm �Luowar of the pmpeny.nrmyemdoY=,with wegc,u their.rulc rompena.0on, - SWIMMING POOL ELECTRIC
Il do the wt, d me soRoo,k nes imcndal aroffrnd for sak(See.]OW,R..i- ❑OTHER _
T 3 wanrod Rof-'r nx Code:The Contmet«s License law dao Iwt apply to on owner of OUTLETS-SWH'CHES-FIXTURES ..
propel who build,on impmves Iherton,end who coves wch wort himself nr mraugh
hi,own employ.,pmvidcd that such impm"rec.rs roe MR intended OR offered for NEW RESIDENTIAL LLECTR SQ FL
sek.If.however,the buiWingorimpmvemem is soW within aeycarofmmpletinn,�- �� �� _y SO.FT.FLOOR AREA $/SQ.FT.
nerbuilder will have ON,huNrn of proving that be did not build or immoc for N
woof We.). x1 / 1�. • `�.
1,u OM, of c, See.7(y,tun exelu.tural Prot.ing with Iiaued mnimnoxx to
On me pruja't(.Sm.]Iwa,Hldlru and Pldesdaru CMeq The C^nlrmmr'a Li-
- wca,c Lawdoe\naeplO,to.n ownerofpmw'my who holds m imPravn lhclron road QTY. PLUMBING PE MIT FEE
meanmas.forschPodo,,ww.rn'.'.'rt0 licensed faunuram maecom.ano," .
License law' - PERMIT ISSUANCE
❑I am cxcmpl rour Sec. ,B&PC for this leasao _
O
ALTL'R-DRAIN& - (FA) VALUATION
i
WORKER'S COMPENSATION DECLARATION• BACK FLOW PROTECT DEVICE 2< 371
I heae(sy.Rirm under pc.byof Perjury tmeof the follawing dsclurolons: 1 Gr
❑IMve.rd will reambone CcnifenrenfQmmm w.alGluure for WMer'x Cancan- DRAIN$-[4. R.RWP,AR CO STORMS TYPE CONSTRUCTION
Winn,ax Provided for by Section J]W d the L rhvr Cafe,for the Pcrfnrma ce of dw
work for which this Permit i\issuad. PERTURBS RFS-PER TRAP•
Q 1 have and will rMinbon Woekdx Cnmpenswion Insurance.u reC+iled by Section
"I"the L ho'CIRe,G.meµrfamumec of wort for which this permit i,icobd. GAS-EA.SYSTEM-]INC J OITH.E OCC.GROUP AMMy Worter's Compcnmlion Inwnrec cart said Policy noodle,Our,
Cmncc Policy Na: GAS-FA.SYSTEIN-OVER J(PA)
CERTIFICATE OF EXEMI'1'ION FROM WORKERS' GRIASPIINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE. BUILDING DIVISION FEES
f11dx senlon Deed rd b nn'nPkRd Ifine permit ix fnrnrc holdout Ihdlroa($100)
. alcss.) GREASETRAP
PLANCHECKFEE
Iccnlfy that in l in Py marmerran0t work for wubjeen tto permit istut d,lxhall SEWER-SANITARY-STORM FA. FT.
MR employ.ny pcuan in anymwter anuto hccvlrc Subject to 0w WorAeli Contpcv- ENERGY FEE
O Z section Taw\of C.liflwie.Date WATER HEATER WNENf/E1EC1R � O
Z 0 Applicant - GRADING FEE
y NOTICE TO APPLICANT.[Tatter making mi.CMlfatecflhCmptlov.you sbaalJ WATER SYSILM/fRGT1NG
(•" ^^, necome subject roore Water's Con rlemoniem Provisions ofine labor Curie,you rare A $OILS FEE
Lat1 ` famx'im comdY with such pnwiooms rpt this Permit shell be dcevud rtvotM. WATER SERVICE -
Q
UZ CONS I ']ONLENDINGAGFN
CY
U O I t
hem is. S 'dingvgcvcy for de perfme of NEW RESIDENTIAL"R. SQ.FT _ PAID
Dmc RaclPl♦
depter,for whichPhi,Permit s io.ed Sec.3U97,Civ.CJOU -
I<wcMums TOTAL
1<rde,,' Addrtx.
OW I ttnify that I have rt:d this appleudon.nil stem that Ife.horc infanutinn iv � � BUILDING FEE '
h amect.l vglee mcanply with all city ud county adiwwex end aau luwe rtlningm QTY. MECHANICAL PERMIT FEE
UZ bwWiltg abruvuctiw,'arW teeny eutM'ie tejxesemvlivcs ofmis city lu enter upmt me SEISMICFEE'
Ig �' ab^vcmrntimal progeny for inspection Nrprscs.
PERMR ISSUANCE
(We).grcc mxave.anui e, ify rot which may
Or¢s lM City ofCuPioq agaiiLy, ELECTRIC FEE `
li.bililies,j Wgmcnn.c rancag aphis nmol. they in any way uerue eguia4 sild City ALTER OR ADD TO MUCH. t `�$
in corn¢R.csddee gr.aing ofmix perosit. PLUMPING FEE �C Ca
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(TO IOIpO CFM)
SOURCE REGULATIONS, MECHANICAL FEE �l Gil
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Si,ma.reuf ApplicvnUCatwcla Date EXHAUST HOOD(WMUCT) HOUSINGMITIGATION
FFE
H RDOUS MATHRIA1 S DISCLOSURE -
Willtealllicamwfulurcbuildingmoo,cont.rtoce orlwwle M1awoLms matenel HEATING UNIT TO IW.(W BTU)
as defined by the Cupeniar Municipal Code.Chnpler 9.12,.nil the Health and Safety
CWc,Station 25532(a)? - HEATING UNIT(OVER 100,"BTU)
C]Ye, C]No PAID
VENTILATION FAN(SINGLE RPSID)
WiDale RcaiwN
ll Ibe applinmt a fmum building ompenl use equipment M 4s ic'c.Wrich
e t haauolows air ronumilwu u dcfinul by 1e Bay Area Air Quality Mroragenela BOILER-COMP(THE OR loo. M1 RTU) -
T IIA
Urslruxf
Cl Yes Fl No BOILER-COMP(OVER Ig1,0W BTU)
' Ihave read tbo ha>mrbua metmielx ruNirtmcnu unk C AIRCONDI'HONER - ISSUANCE DATE
h.wef Me ddee,Cali
Fast Hewitt,no Saul Cede Sea acra 23505,255JJ and 2551(.1 to obly On mut if do NEW RESIDENTIAL MECH. SQ.Ff.
of th,dde,
does not cwendy have.ulen l or it a ce of
t,rufieaeof One orclµmnn
ofth uclreot which musthtan w
Iryu peaminwurcc nfe Canifr'^UfOavpury. ,
Oxmerwautkrrim agent U.Ie ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 9/15/97
'P-E-R-M—lT-#"FSlTUSST,SITUS?STREET Lrot#MINSDESCRIP�Tom IRT— D'AT;EDESIRE1 DateDM6
9141 20687 FORGE BG IROOF NAIL 12/3/96 12/3/96
29141 20687 FORGE G MECH 12/23/96 12/23/96
9141 20687 FORGE BG ELECT-R 12/23/96 12/23/96
9141 20687 FORGE BG PLBG-R 12/23/96 12/23/96
9141 20687 FORGE BG FRAME 12/23/96 12/23/96
29141 20687 FORGE BG MECH-R 12/30/96 12/30/96
9141 20687 FORGE BG ELEC-R 12/30/96 12/30/96
9141 20687 FORGE BG PLBG-R 12/30/96 12/30/96
9141 20687 FORGE BG FRAME 1/2/97 1/2/97
9141 20687 FORGE BG ELECT-R 1/2/97 1/2/97
9141 20687 FORGE BG MECH-R 1/2/97 1/2/97
9141 20687 FORGE BG PLB -R 1/2/97 1/2/97
9141 20687 FORGE BG FRAME 1/6/97
29141 20687 FORGE BG ELECT—R 116/97
9141 20687 FORGE BG PLB - 1/6/97
9141 20687 FORGE BG MECH-R 1/6/97
29141 20687G BG FRAME 117/97 1/019
29141 20687 FORGE BG EIECT-F 117/ 1/6/97
9141 20687 FORGE BG PLBG-R 1/7/97 1/6/97
141 20687 FORGE BG ME H- 1/7/97 /6/97
9141 20687 FORGE BG FRAME-R /10/97 1/ 0/97
9141 20687 IFORGE BG ELEC-R 1/10/97 1/10/97
9141 20687 IFORGE BG PBG- 1/10/9 1/1 /97
9141 20687 IFORGE BG MECH- 1/10/9 1/10/9
9141 20687 FORGE BG FRAME 1/14/97 1/14/97
141 20687 FORGE BG GAS RELEASE 3/11/97 3/11/97
® 29141 20687 FORGE BG BLDG FINAL 3/11/97 3/11/97
9141 20687 FORGE BG ELECT=F 3/11/97 3/11/97
9141 20687 FORGE BG IBLDG ENERGY FINAL 3/11/97 3/11/97
9141 20687 FORGE BG P FINAL 3/11/97 3/11/97
9141 20687 FORGE BG MECH-F 3/11/97 3/11/97
•
Page 1
Inspection Query for a Specfic Permit 9/15/97
ns ect"oUnits RiWFU jCOde
S 2P
cc 1P
C 1P
CC 1P
CC 1P
is 2 N
S 2 N
S 2 N
S 2 N
S 2 N
S 2 N
S 2
S 6F
S 3P
is 41F
S 4P
S 4P
S 3P
S 3P
is 2P
S 4F
S 2P
S 4F
HS F
S P
S 3P
® S 2P X
is 2P
2P
2P
S 2P
•
Page 2