24324 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Pro'ed Identification PERMIT N2 4324
Budding Address:
l �uc6 L-i�o IPL,
CVlSoda 255 3Q use: CITY OF CUPERTINO-BUILDING'DIVISION
,_ con ad swme: LIc.No: APPLICATION /PERMIT
BUILDINr—MM RICAL.-PLUMBING-MECHANICAL CATEGORY L O
Architect/Engineer. LIc No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO '
Address: �4 -
PFRFITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
Iherebyafflrm lhatlamiic..dunderpravlelonsof Chapter9(commenc APPLIANCES-RESIDENTIAL4 JOB DISCIRMON
Ingwith Sec n700D)of Dlvision3oftheBmimuandPmfemionsCode,and my
Iianse le in full force and died. PANELS
License Class Lt.M
Date ContndorUP TO 2DO AMS
ARCHITECT'S DECLARATION 701-1000 AMPS
9OZ I understand my plana shall be used as public record& OVER1000AMPS SQ.Fr.FLOOR AREA $/5Q.F1'.
Ed� Licensed Professional SIGNS ELECTRICAL
<<�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MI5C
Z Iherebyaffirm that Iamexempt from the Contractor's Limnse Law for the '
following reason.(Section 70315,Businem and Professions Code:Any city or
r19i cmntywhichmquiresapermlttommtmd,alter,Impmwde=lBh,ormpair TEMP'METERORPOLEINST. -
q''� any stmdure prior to its Issuance,also requires the applium for such permit to POWER DEVICES
L5 (Ile a signed statement that he is licensed pursuant to the provisions of the -
3µ,�i Contractor's Licerue Law(Chapter9(commencing with Section 70(D)of Divi- SWIMMING POOL ELECTRIC O�
SOS e1on3ofthe Bua errand ProteasiomCode)orthathebexempttherefmmand VALUATION
Q the basis for the alleged exemption. Any violation of Section 70315 by any UTLETSSW37CI IESFLXTURES / a �i .
applicant fora permit aubjedsthe applicant to a civil penalty M not more than L� `�T/�
5.] five 1,as o nerdolof he pm Sw r, STORIES TYPE CONSTRUCTION
A f+, NEW RESIDENTIAL ELECTR
�n ❑Las owner of the property,or my employees with wages as thele door
compensation,0K will Ra.dothe es and rendthe,Codersbnot Intended or offered for
O dale(Sec. pply Benineseandf property Code:The Contrailds or improves
hemon U.
$ dos not apply to akh owner orth property y who empl ye p,p idedth n,and OCC.-GROUP RES.UNITS
whodo=nts moat msededorough hbowne.If,hovepr,thebuilding
ildisuch
ImpmvementsarenMintendedoroffered fcompfor eale.theo nver,theerwillhave O
Improvementissold wlthinoneyearo(comple[lorylheowner-bu0derwillhave
t en of Proving that he did not build or Improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
cont ors to cortatmct the project(Sec.7044,Businessand Pro(eabsu Code: IL
The C dor's Llanse Law does not apply to an owner M property who
buALTER-DRAIN&VENT WATER(EA) -
Wilds or mproves thereon,and who mab ntrafor such pG - -
ojects with a FEE SUMMARY
'c,2plpdm(dI licensed pursuant to the Contradori License Law. ' - B PLOW PR T.DEVICE
I_I I am exempt under Sec. B k P C for this reasonOUTSIDE FEES
(Tuner Data DRARITT50II,ROOF,AREA,COND, SANITARY Y_ N_
RECEIPT R
WORKMAN COMPENSATION DECLARATION
❑L hereby affirm that I have a certificate of consent to sell-Insure,or a FIXTURES PER TRA(' SCHOOL TAX Y_ NRECEITT Y
adRiateofWorkers'Comperuatlon Laurance or a certified copy thereof(Sec. 1 GAS EA.SY5172i-11NC.40UTLE15 PARK FFS Y N
P -
olic N CJ l RECD.p
Policy M GAS EA.SYSTEM.OVER 4(FA)
Com any -BUILDING DIVISION FEES `
Certified ropy is hereby filedwtumbhed. CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE a
F-1 cz,Certified copy,Is(Iles with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP, PAID
COMPENSATION INSURANCE. s �s
(Thlasection need not be completed if the permit b forces hundred dollars SEWER-SANITARY-STORM F.A.200FF. Date Recei
($100)mless') WATER HEATER W/VENT/ELECTR ENERGY FEE Y_ N_
I certifythat In the pedormanceof the work forwhich this permit Is(saved,
I shall not employ any person In any manner w as to become subject to the � O
WATER SYSTEM/TREATING
01
Workera'Compen p�'i�. Ee � PAID -
O Z APPucar, NEW RESIDENTIAL PLMB. SQFf.' Date Recei ton
Z NOTICE TO APDL er Yin t m6 tent Exemption,you
should become sub dto the Workere'Compevallon pmvbba o(the Labor - TOTAL:
fn Code,you must forthwith th sump mnyerthis parmitdnall be _ BUILDING
W,> deemed revoked.'
CL :DNS RUC(( I SEISMIC FEE O
Iherebyafflrm tlut there lsaconatmd lendings n he padorm- ELECTRIC FEE
Z sere of the work for which this permit is beacd(Sec.3097,CIv. .) TtWLt
V It L
O Lender.Name - PLUMBING FEE
LL F Lenders Address QTY.I MECHANICAL PERMIT FEE MECHANICAL FEE U /e
OW Icertilythatl havereadthls application and statethatlhe above information '
1 Is correctI agree to comply with all city and county ordinances and elate laws PERMTTISSUANCE FEES PAID: . .
} N relating to building cowtmdlon,and hereby authorize representatives of this
�... city to enter upon the above-mentioned property for Impection Purposes. ALTERORADDTOMECH.
? (We)agree to save,Indemnify an d keep harmless the City of Cu pertio, Dale R2CejJJ[iw
V against Bablllliee,Pdgmenis,mets and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,000 CPM) SUBTOTAL' .
aga Wt said City in consequence of the granting M this permit -
AIR HANDLING UNIT(OVER 10,000CIM) CONSTRUCTION TAX'
Sign reof Applicant/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Willtheappllcaslur f.Wmbullding occupantaloon or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Ree
material as defined by the Cupertim Municipal Code,Chapter 9.17,and the
ffli
Health and Safety Cade Section 25532(a)? HEATING UNIT(OVER 100,000 BTU) TO
❑Yes No
WBlthe$ppliant orfuture building ompant use equipment or devices VENTILATION FAN(SINGLE REBID) - ISSUANCE DATE ,
which cont harardous air contamlwnts as defined by the Bay Area Air ,
Iffy Management District? BOILER-COMP GHP OR 100,000 BTUs -
Yea C1�No
a Y.
read the hazardous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) R1 p r (/�
the Burris Health k Safety Code,Sections 25505,2'5533 and 25534.I 9� M Y y
understand that if the building does nM currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT
. . respomib0ity,to notify the occupant M the requirements which must be met /��,s•
' prier to issuance of a Certificate of Occupancy.
Owner or authorized agent Data - ISS /��0.
G UBD ki
OFFICE COPY
I
6
;1119195 PERMIT, INSPECTION ACTIVITY FOR PERMIT A 24324
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a : ,11446, LINBY PL °
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a DATE BONE TYPE OF INSPECTION Inspector Code PASS/FAIL COMMENT
--- ------ ------ ---- - ------- ----
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INSPECTION 101 "
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n INSPECTION CATEGORY 202
12 7/15/93 PLAG U/FLR LH P
13 31,13/93 g;,, ,1.,PLBG.UIFLR LN F
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u INSPECTION" ,
� CAT,.,EGORY 205
m 7/1,7•193 FRAME.0/FLR LH F
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is INSPECTION CATEGORY 301
ig Y2/13/9„3 MECHANICAL JA P
2a 12/10/93 PUG-R J.B
zi 17113I0 , - PCUMBIN6' ..,.. . JB ,. .. P
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m INSPECTION CATEGORY 304
2412!10193 ELEC-R JB F
n 12ZI3/93 ,;. ELECT � ., !B ? -
n INSPECTION CATEGORY 395 V4
m 12/10i93 FRAME JB F
w 12/13/93 FRAME JB P
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31 INSPECTION CATEGORY, 306 ..
12t,17993 < ,4 INSULATION JB 16v '
> INSPECTION CATEGORY 309
B 8116/93 EXT SHEAR JB P
37 INSP,EC;TION,CATE60RY: .311 -
0 12r119 . ,. P
; PARTIAL
m INSPECTION CATEGORY 312
41 6/31/93 EXT LATH JB P'
42
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-INSPECTION,CATEGORY,, 313 -
-121211:9Z,d,,, SHOVER LATH .. JR P
4e INSPECTION CATEGORY 314
0 9,02/93 SCRATCH COAT JJ P
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49 INSPECTION CATEGORYa-316,,
so 8/16// ROOF,OOF, SHEATHIN6 P
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