29797 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL .., 2.9797'
(((ALBINO PROJECT'IDENTIFICATION
BUILDINGADDRESS: � SANITARY IS APPLICATION SUBMITTAL DATE
OWNERIS ryyn1id
O� �$ PHONL: CONTRAr�R' � NIC CONTROLp
ARCHITKI'MNIGINER; LIC NO: ADDRESS:(•' - `1�1V1 ❑
CONTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) B ELat _ EcyT PLUMB MECH
LICENSED CONTRACTOR'S ECLARATION - QTY ELECTRIC PERMIT FEE "�`�,
I hemby offiro an 1 am licensed under an ions of Chepmr 9(commencing LOB DESCRIPTION
O=Z with Section'/001ryofDivisiot3oftheliminssandp, loo.sCode.andm Iiccawis
{�00 y PERMIT ISSUANCE RESIDENTIAL: -
F ly in full e a and effect.
fk-.UV License Class Lica P ❑SFDWL - [I KITCHEN REMODEL
fnZW Date Cadmiumr APPLIANCES-Rf•_SIDENTIAL ❑ADDITION ❑PLUMBING R&PIPE
ARCHITECTS DECLARATION PANELS
p.,pm ❑MULTI-UNIT ,�$TRQGTGRAL
ZOEE24 - I understand myplum,mill be tried ns public records � MODIFICATION
O Z s^^QJ16UPTO 211BAMPS ❑INTERIOR ❑CHIMNEY REPAIR
Licensed Professional 2o1-IfIf111AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER IfXq AMPB
C Q 1 hereby uffirtn that],an exempt from the Commcmao,License t ❑BATH REMODBUREPAIR. ❑DEMOLITION
3 06 U following reason,(Section]1131.5,Business and Professions Code:Any cit n y SIGNS ELECTRICAL ❑OTHER
O yQ which requires a permit to construct,alter,improve,demolish,or repair any t
F.LL.O.i prior mils issuance.also requires the applicant for such Permit o file a signed st mem SPECIAL CIRCUIT/MISC.
} Ila,he is licensed punoanuo the providers of the Comment"License Law(Cho r
Q leamntenoing with Section]011lnof Them 13 of the Bosinessand Professions Csde n TEMP.METER OR POLE INST.. - OMM R IA
d y M e+ that he is exempt therefrom hand,m and the bs fur Nem
c alleged exemption.Any violmion ❑NEW BLDG/ADDITION ❑DEMOLITION
Y%1 Y• Section 7031.5 by any applicant for ape.it subjedsthcapplicantm a civil penaltyo UR DEVICES NANT FOOD SERVICE
t mole than rive hundred dollen(g5 W).
6 I^Its owner at the - IMPROVEMGN'I'
t 0 ❑ progeny,ormywith wages I Istria cam, nations W LNG POOL ELECTk1C
Microform ork,and Care, he Contractor's
not intended.,offered for sale(Sec.I so Business OTHER
W m and property
who
Code:The Contmcrreo License Ivo docs not apply tO so owner of T S-SWITCHES-FIXTURES
a 3^ his own who builds or improves thereon,and who dos such work himself or,hrough
his own employees,provided that such im nt iv mid w nm not intended of offireadtion,t a W 1`'SIDENTIAI.ELECTk SQ FT.
sale.ll'.however,r will have tdingmitnpdwemcnt ithat he ithinon ui aof completiumtbe SQ.FT;Fl.On�dksAREA LSQ.FT.
owner-builder will have the burden of proving that he did not build ur improve for fur- P ✓I iLi/
pose of sale.). -
❑I,as owner of the progeny,nm exclusively cantmeting with licensed contractors m TOTAU
construct theproject(Sec.]W4,nosiness Ind Profcasinns Code:)The Convector's Li- I APR 24
cense Law dues not apply to an owner of property who builds or improves thereon,and B PERMIT FEE 1996
who contracts for such projects with a contmrsm m N
etor(s)licensed gouae Conucto
oo -
License low. I - U ,
❑ lton csemptunder Sea ,B&1'Cfor III.so17 n cl rvfil ' Ul'. "i"CIyIINU
NIRE R(EOwner Date ' - VALUATION
WORKERS COMPENSATION DIiC1.ARAq'ION "tC. I0p
1 hereby affirm under petnay of frailty one of the following declaration I have and will maintain a Cmificate ol'Cnroent m sell�insum forWorkers Cooper- O, ^"` J (:ampsminn,as provide)fur by Section 1]00 of the Labor Caste,for the pedormancc of the STORIES TYPE CONSTRUCTION
work for which this pradt is issued.. TRAP❑I have and willmaintain Worker',Compensation Insurance,as required by Section3]IX)nf the LYMlr Gds,fur the crformnnee nfthe work fin which this omit i,issued. EMIN_C4p p OCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy tumherare:Carrier: Policy No.: pCERTIFICATE OP EXEMPTION FROM WORKERS' TRI.WA. '�.1 IGZ1yCOMPENSATION INSURANCIiBUILDING DIVISION FEES
Merrectionneednothecompletedifthepemtit is aDmi,lammeldollen($I EA-IR-97"RAC 6
or les.) , PLANCHECK EF.
Icenify that inthe performance of the work fnrwhi<h thispermit isissor .l Shull SEWEk-SAN -S
a not employ any person in any manner so as as become subjecnothe Workers'Cmrpe ENERGY FEE
zZ satio,Laws of Callfmnio.Date p I�
O Applicant Ig m•ME ' s EC GRADING FEE
fq NOTICE TO APPLICANT:If,after making this Cenifteam of Excmmtion,you shn Id WATER SY TEM/fREATING
become subject to the Worker's Ci mpcnsatinn provisions of the LoMtr GMq yon st 'OILS PIil3'
kWQ Iny forthwith romply with such provhinns orthls permit shall he deem,]revnke� ay �
Q6.
CONSTRUCTION LENDING AGENCY I NEW RESIDENTIAL PLMB. SQ.IT. WAID
U O l hereby afftmvhatthem is a convection lending agency for the performance of - Data Receipt
I-y the work for which this femur is issurd(S..3097,Civ.C.)
O E'I Lender',Name TOTAL
WLenders Address TOTAL:
y Icodify that l have read thisapplicmiunand sate that heoMveinfomminn is LDING EEE
N correct.I agree to comply with all city and county ordinances and state laws taking to QTY. MECHANICAL PERMIT FEE
U� building construction,and hereby authorize representatives of this city to enter upon the SEIS IC PEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree ro save,indemnify end keep harmless the City Of Cuper inn against ELECTR FEE
liabilities,judgments.costs and expenses which may in any way damoragaind said City ALTER Oil ADD TO MECIL `
I in moen
egce of the groamin,of this permit. PLUMBING E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITfr010.0(X)CFM)
SOURC. EGULATIONS. MECHANICAL "
AIR HANDLING UNIT(OVER I(kgX)CFM) CONSTRUCHON TA r
es" ignaarca Applicam/Contactor Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION EE
ItHAZARDOUS MATERIALS DISCLOSURE
Will theapplicanlrefnumbuildingsscoperm mnmorhandle h...ukkusmemrial HEATING UNIT OD 100,000 TOO)
es defined thyme Cuprino Municipal Code,Ch mm,9.12,dad the Health end Safety
Code,Section 25532m)? HEATING UNIT(OVER 100,000 HTU) _
El yes ❑No PAID
VENTILATIONF.\N(SINGLE RESID) Date Recciya
em
Will the applicant or lama building occupant equipment or device,which BOILER COMP(31411 OR 100000 RTU)
it ius air tomi
conn+mts as defined by the Bay
Areu Air Quality Manvgem - ,
cnt 'TOTAL
District?
ct] y
❑Y<s C]No BOILER-COMP(OVER 100,(Xp PTU)
I have read the mtzarelmonanerials requumarms under Choptcr 695 of the Cali- AIRCONDITIONER ISSUANCE DATE
foroia Health&Safety Cade,Sections 25505,25533 and 25514.1 understand that if the NEW RESIDENTIAL MLCH. SQ.FT.
building doe,not cturendy have cannot.that it is my responsibility to notify the occupant ,
of the nNuirements which must be met prior issuance of a Candidate ate of Occupancy. +
Owner m moth ar"d agent bate TOTAL: ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 4/7/97
9797 20605 LAZANEO PLBG 4/25/96 4/25/96 1 P
9797 20605 LAZANEO REBAR 4/25/96 4/25/96AD 3P
9797 20605 LAZANEO TBAR 4/26/96 4/26/96AD 30
9797 20605 LAZANEO TBAR ELEC 4/26/96 4/26/96 MD 3 F
9797 20605 LAZANEO ELECT-R/CEIL 5/1/96 5/1/96 AD 1 P
9797 20605 LAZANEO T BAR 5/1/96 5/1/96 AD 1 P
9797 20605 LAZANEO BLDG FINAL 6/13/96 6/13/96
9797 20605 LAZANEO ELECT-F 6/13/96 6/13/96
9797 20605 LAZANEO PLBG-F 6/13/96 6/13/96
9797 20605 LAZANEO MECH-F 6/13/96 6/13/96
9797 20605 LAZANEO BLDG ENERGY FIN 6/13/96 6/13/96
9797 20605 LAZANEO BLDG FINAL 6/17/96 6/17/96CC 2F
9797 20605 LAZANEO ELEC FINAL 6/17/96 6/17/96 CC 2P
9797 20605 LAZANEO BLDG ENERGY F 6/17/96 6/17/96 CC 2 P
9797 20605 LAZANEO MECH FINAL 6/17/96 6/17/96 CC 2P
9797 20605 LAZANEO PLMBG FINAL 6/17/96 6/17/96 CC 2P