30789APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL,
- PERMITNO. O
789
BUILDING PROJECT' IDENT'IF'ICATION
BUILDINOADDRESS; -
SANITARY NO.
APPLICATION SUBMITTAL DATE
OWNS�'S AME: - PHONE:
''`�
CONT :TORTS NAME: LIC NO:
x Byl�p
NIC
❑
CONTROL
J,
RCiAJECDENIENEEHU LIC NO:
ADDRESS: - -
CONTACT: PHONE:
'I {� H I S 3� ZaO
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
g G ELECT PLUMB MECf
LICENSED CONTItACI'OR'S DECRATION
1 hereby affirm that 1 ant uansed under provision. (Chapter 9 (commencing
QTY. ELECTRIC PERMIT FEE
JOB DESCRIPTION
with Sedion0000)of Division3 of the Business and Professio Code, end my license is
rm1 farce and effeel3 5
j License Class Lic.p-it
-0 Date Comrvcmr
PERMIT ISSUANCE
RESIDENTIAL'm
❑SFDWL [I KITCHEN REMODEL.
❑AUDITION El PLUMBING RE -PIPE
❑MULTI -UNIT El STRUCTURAL
MODIFICATION
APPLIANCES—RESIDENTIAL
j ARCHITECTS DECLARATIONPANE
' 1 undcrsmnJ my plans shell be used ver public records.1
S
1
UPT02110 AMPS .
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEUREPA1R EI DEMOLITION
OTHER
Licensed Professional
j OWNER -BUILDER exempt from CLARATION
C 1 hereby affirm rhes 1 em exempt from the Contractor's License Law fa the
following reason. (Section 90.313, Business and Professions Code: Any city m cuu❑
j which requires a pern l to commuet. alcor, improve, demolish, m repair any streamSIGNS
201-10010 AMPS
OVER 1000 AMPS
ELECTRICAL.
prior to its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7")of Division 3 of the Business and Professions Cale) or
SPECIAL CIRCUIT/M ISC.
TEMP. MITER OR POLE INST.
_
COMMERCIAL,
that he is exempt therefrom and the hasis for tee alleged exemption, Any vialmion of
Section 7031.5 by any applicant for a permit subjcas the applicant a civil penehy o!
not more than five btndred unit... (65118).
❑ I, as owner of property. or my employees with wages as aheirsole rompensnt1.:,
will do the work, and the thera e, is not intended or offered fivsme(Sec.]044, Business
i and Professions Cale: The Contractor's License Low does not apply m an owner of
NPW BLDG/ADDITION Q DEMOLITION
'NANT ❑ FOOD SERVICE:
PROVEMIiNT
eMOTVE.R '
1'�
WG r Permit
S IMING POOL ELECTRIC
OUTL S k lag- f" '"Ik
properly who builds or improves thereon, and who does such work himself or through
his own employee, provided that such improvements are at intended ar offered far
Nit R K.a T iii J I rI S FCi ei
IV a I JIM
IDnSw FT. FLOORAREA
1.
jaij 16 RfC�B
S/SQ. FT.
sale. If, the building or improvement issold within one yearnfcompletionJhe
ownu-builder wi 11 have the burden proving that he did not build or improve for pur-
paaen(aale.)
71. as owner of the properly, mai exclusively contracting with licensed contractors m
• t,', ,d 11
r2S onSl I I. 1S%� ' Li
»n
OfniS on, tjf lsr' h. 1\')t`kL •�
-
construct the project (Ser. IOW, Business and Professions Code:) The Contrdemrs Li-
cnseLawdoesnof apply to an owner ofproperywho huilo, orimproves iherear,and
who contracts for such pmjects with a comarecoms) licensed pursuant the Comucmrs
♦/s r-
CITY Ur ��rtlillNO
m
QTY, C 16F
Licemc Law. -.
C]1 an esentpt under Sec. B & P C for this reason
PERMIT IS UANCE
ALTERgmft V NEE—NkR�EfP
BACK FLOW PROTECT. DEVICIi
Owner -' - Uma
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty if perjury, one of the following declarations
VALUATION
DRAINS RED, CO
I have and will maintain a Certificate o(Coneeut to self -insure for Worker's Comped-
stairs, a, provided bar by Section 3900 of the Labor Code. Paco the Parounalree ol'the
S TYPE CONSTRUCTION
FIXTURES —PER TRAP
work far which this permit is issued,
I have and will maintain Worker's Compensation Insurance; m required by Section
37M of the Labor CMe, far the performance of the walk (a, which this permit is issued.
My Worker's Crntpamction Insurance carrier and Policy mother am.
UP APN
a� _ `a,.
GAS—Rost
Caricc Policy No.:
GAS — EA. SYSTEM -((VER 4( A)ik
CERTIFICATE OF EXEMPTION FROM WORKERS'
• COMPENSATION INSURANCE
(This section need not hecompleted lfthe pennit is forone hundred dollars f$ On
or less.)
1 codify matin me performance of the work for which this permit is issued, ],hall
employ any person in any manner so as to became subject mthe Worker.: Coanpen-
GRI?ASIUINUUSTRLWASTEIN'I'ERCII.MR
'
BUILDING DIVISION FLIES
TRAP
PLANCHECK FEE
SEWER-
SEWER—SANITARY—STO0.M EA.200 FT.
ENERGY FEE
WATER HEATER WNENI'/ELECTR
Laws of California. Dam -
nationApplicant
Applicant
GRADING FEE '
NOTICE TO APP LICANT:If, atommaking this provisions of of Labor odyoushould
become subject m the Worker's Crmpensution provisions n( tho Labor Code, you nmst
WATER SYSTEM?REATING
OILS FEE -
IonhwiNcomplywithsuchpmvisionsonhispermilshallbedcemedrevoked.
WATER SERVICE
CONSTRUCTION LENDING AGENCY
I hereby affirm that hem is a construction lending agency for the performance of
PAI
Date - Receipt»
NEW RESIDENTIAL PLMB. SQ. IT.
He work for which duk Darton is issued (Sec. 3097, Civ. C.)
TOTAL:
Lender's Name
benders Address
_
'TOTAL:
1 cenify that 1 have mad this application and state that the above information isL_DING
H
correct. l agree to comply with ml city wd counrynolounces and sutc law, mmmlngm
building construction, and hduchyauthorize represclutives o(thiscitytoemcrupunthe
QTY, MECHANICAL PERMIT FEL?
MICNE
ohnve-mentioned property for inspection purposes.
(We)agree to save. indemnifyinl keep harmless Ne City of Calvin r against
'
PERMIT ISSUANCE
ELL F
liabilities,judgments, casts and expenseswhichtoy in any wry occrucagainst said City
' onsequenceufthegmntingofthi.% a it. '
APPLICANTUNDERSTANDS AND WIL ;O P WITH ALL NON -POINT
SOURCE REGULAT INS,
AILERORADDTOMECH.
PLUMBIN I:
AIR HANDLING UNIT(TO 14000 CFM)
MECHANICAL TEE -
AIR HANDLING UNIT (OVER 10,000 CFM)
/
CONSTRUCTIONTA%
EXHAUST HOOD(W/DUCq
5 nutum of YM cam/ radar Gibe
LARDOUS MATERIALS DISCLOSURE
HOUSING MITIGATION FEF.
HEATING UNIT (TO 100.000 BTU)
Willtgicip am or future huilding occupant sate arbitrage luminaries n ial
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Heahh and Safety
Cost, Section'_5532(a)?
HEATING UNIT (OVER II0,f00 BTU)
❑Yes No
VENTILATION PAN (SINGLE RP_SID)
Willies air cote manta as building occupantuseAir ntordwicagemem
mit hazardom air contaminants as d(nned by the Bay Area Air Qualiry, Management
District? I
PAID
Date Receipt»
BOILER— COMP(3HP OR 10i BI U)
TOTAL:
BOILER— COME (OVER 100,000 BTU)
❑Yu No
„
AIR CONDITIONER
I have read the hanWoua mmeriali 6950(the ifmie
tresis gdoHeales ne Safcry Cade, Sections 25505, is my and 25534.1 undersand that if Ne
t5. 2553 ad 25534,
i(ythe000upant
building dcesmentset whichemly have a tenant,matitisionam
ISSUANCE DATE
NEW RF.SIDCNTIAI. MECH. SQ. FT.
-
o(Ne requirements which must bo mm prior a issuance of a Certificate of Occupancy.
mo Ceritficate
ISSUED BY:
Owner or authonzed agent Date
TOTAL:
OFFICE
•
•
is
Inspection Query for a Specfic Permit 2/19/97
P,eRMIT#i
Wro-W INSDESGRIP,j-5I _ a7
a D/1TE ESIREo D lyd , rie
30789
20525
IMARIANI
ELECT -R
1/17/97
1/17/97
30789
20525
IMARIANI
UNDG PLBG
1/17/97
1/17/97
30789
20525
MARIANI
DRYWALL FRA
1/17/97
1/17/97
30789
20525
MARIANI
DRYWALL SCR
1/17/97
1/17/97
30789
20525
MARIANI
SHEETMTL DU
1/17/97
1/17/97
30789
20525
MARIANI
DRYWALL NAIL
1/21/97
1/21/97
30789
20525
MARIANI
ELECT-R(2ND)
1/17/97
1/17/97
30789
20525
MARIANI
UNDG PLBG 2N
1/17/97
1/17/97
30789
20525
MARIANI
DRYWALL 2ND
1/17/97
1/17/97
30789
20525
MARIANI
SHEETRK NAIL
1/17/97
1/17/97
30789
20525
MARIANI
ELEC-R
1/22197
1/22/97
30789
20525
MARIANI
SHTRK
1/22/97
1/22/97
30789
20525
MARIANI
FRAME -R
1/22/97
1/22/97
30789
20525
MARIANI
PLBG
1/23/97
1/23/97
30789
20525
MARIANI
FRAME DRYWL
1123/97
1/23/97
30789
20525
MARIANI
REBAR A UT -r
1/23/97
1/23/97
30789
20525
MARIANI
FRAME
1/23197
1/23197
30789
20525
MARIANI
FRAME
1/23197
1/23197
30789
20525
MARIANI
ELECT -R(2 FLO
1/28/97
1/28/97
30789
20525
MARIANI
MECH 2 FLRS
1/28/97
1128/97
30789
20525
MARIANI
PROCESS PIPI
1/28/97
1/28/97
30789
20525
MARIANI
HVAC
1/29/97
30789
20525
MARIANI
MECH-R
1/29/97
30789
20525
MARIANI
ELEC-R
1/29197
30789
20525
MARIANI
DRYWALL
1129/97
30789
20525
MARIANI
ELEC
1/30/97
30789
20525
MARIANI
TOPOUT BTHR
2/3/97
30789
20525
MARIANI
DRYWALL SCR
2/3/97
30789
20525
MARIANI
PARTIAL FRME
2/3/97
30789
20525
MARIANI
ELECT -R
2/3/97
30789
20525
MARIANI
ELECT-R/3RD&
2/4/97
2/4/97
30789
20525
MARIANI
PROCESS PIPI
2/4/97
2/4/97
30789
120525
MARIANI
FRAME/WALL
2/4197
2/4/97
30789
20525
MARIANI
ELECT-R/WALL
2/5197
30789
20525
MARIANI
TOP OUT
2/5/97
30789
20525
MARIANI
HVAC/PIPING
2/5/97
30789
20525
MARIANI
WALL FRAME
2/7/97
2/7/97
30789
20525
MARIANI
PROC PIPING
2/10197
30789
20525
MARIANI
ELEC-R
2/10/97
30789
20525
MARIANI
PLBG
2/11/97
2111/97
30789
20525
MARIANI
SHTRK SCREW
2/11/97
2/11197
30789
20525
MARIANI
ELEC-R - 1ST F
2111/97
2/11/97
30789
20525
MARIANI
ELECT -R, 1ST F
2/12197
2/12/97
30789
20525
MARIANI
PLBG-R/WEST
2/12197
2/12/97
30789
20525
MARIANI
ELECT -R
2/13/97
2/13/97
30789
20525
MARIANI
PLBG-R
2119/97
30789
20525
MARIANI
ELECT -R
2/16/97
30789
20525
MARIANI
CEIL FRAME
2/19/97
Page 1
•
r 1
U
•
Inspection Query for a Speck Permit 2/19/97
Ins
scto .ffl Pa: sIFail od .
cc
1P
cc
1P
cc
1P
cc
1P
cc
1P
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8P
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2P
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2P
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2P
JS
2 P
JS
2 P
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2P
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2P
JS
2 N
JS
2P
JB
2P
O
2P
JS
3P
JS
3F
JS
3 F
JS
3 P
JS
21P
JS
3 P
JS
3 P
JS
3 P
JS
3 P
JS
2P
JS
4 P
JS
4P
JS
3 P
JS
3 P
JS
3 P
JS
3 P
JS
3P
S
3P
Page 2