29435 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELECTRICAL. PERMITNO. ^ ^`435
BUILDING DIVISION APPLICATION/PERNIT PLIIM1181NC-MF:CIIANICAI.
it, BUILDING PROJECT IDRNTIFICA'1'ION
BUILOINGADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE
k, OWNiI'SNAMBPHONE: CONTRAC'TORSNAMR: LIC NO:
L Q NIC C 'TROL#
97
AKCHITECT/ENGINbhK: LIC NO: ADDRESS: ❑
atS
CONTACT: PHONE: BUILDING PERMIT INFO
�� �' ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'SDECLARA'ON QTY. ELECTRIC PERM IT FEE - �
1 hereby affirm that 1 am licensed under proviame nl Is 9(commencing TOB DESCRIPTION
Op'7-'IwithSection)OOIp of DivisionJoflhe Business and ProfessionsC ,andmylicenseis
X 00 In PERMIT ISSUANCE RESIDENTIAL:
F full forte end effttt.
.ey j License Cl ss • Liap a ❑SFDWL - El KITCHEN REMODEL
�TaW'Dme Conma.u,r APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE.PIPE
I-,ay ARCHITECTS DCCCLARATION ❑MULTI-UNIT ❑STRUCTURAL
w,Z lundersmndm 1 hall be used s Public barred, PANELS
ZOan, o p MODIFICATION
024— UPT0 200AMPS
F4tq�s Licensed Professional DINTERIGR ❑CHIMNEY REPAIR
201-1000AMPS IMPROVEMENT
Oat I am-IexemptE rand the Contractor's
OVER 1000AMPS
1 hereby ul'Brm that I roes exempt fomes the Convoeor's License Law fort El BATH RIiM01313L/REI'AIR ❑DEMOLITION
�p5�06U following reason.(Section 7031.5.Business end Professions Cade:Anycityorcounty SIGNS ELECTRICAL ❑OTHER
W O f- which requires a Permit to construe,.alter,improve,demolish,or repair any souctur,
pooro its issuance,also requires the applicant for such Rermitto file a signedstatementSPECIAL CIRCUI"1'/M ISC.
<� that he is licensed pursuant to the provisions ofthe Contractor's[JeenseLow,(Chapter9
K� DO (commencing will,Section700(firf Division I of the Business and Professions Crde7 or N TEMP.METER OR POLE INST. COMMERCIAL'
6 cy that he is exempt therefrom and the basis for the alleged exemption.Any violation of
^,LL Section 7031.5 b ❑ W BLDG/ADDITION '❑DEMOLITION
y any applicant Permit t<applicannoacivil penalty of WER DEVICES .NANT ❑FOOD SERVICE
Z� not more than five hundred dollars($500). - -
60 ❑ I,ns owner of the propeny,mmy employee,with stage.,as their sole enmpwsmion, SW MINGPOOLELF.CTRIC ROVIiMENT
will do the work.and the,vacmu is not intended proffered for sale(Sec.]DM14,Business ❑OTHER
W 3 and Professions Cale:The Co me ts's License Law does not apply to an owner of OVTL S-SWITCHES-FIXTURES
properly who builds or improve,thereon,and who does such work himself or through
his on employees,powided that such improvements are not intended or offered for NEW NCS ENTIAI.ELECTR SQ fT. r� ..
sale.If,however,the building or improvement is sold within on eyeurofdampinion,the , SQ.fTIFLObRAIMAF $/SQ.F1
owner builder will have to burden of proving that he did not build or improve for pur-
pose of sale.).
❑ 1,as owner of the prnpeny,am csclusively contracting with licensed contractors to TOTAL: MAR-13 1996
construct theprejttt(Sec.7044,Business and Professions Code:)The Commends U.
came,low does not apply to an owner i,f property who builds or improves thereon,and Q]y.. P 0
rojmftftitFEE fx"},
Who contracts for such pts wit a contmctngs)licensed pursuant Ne pursuano Contmdoes
Uf
License low. PE IT ISSU NCE �UrC(yIINU
E]I am exempt under Sec. B&P C hands reason , iY1
Owner - Ilam AL - - A C D>p e - VALUATION
'S WORKER'S COMPENSATION DECLARATION BA Owneraccep c mplete
and
will ai under penabyof ofConeent neoftefNlre for declarations: 8a 10
�Olbavc andwill Iorby eCion 37mof the LabrCode,for
Worker's Cumpen- DR A .re a STORIES TYPECONSTRUCI'ION
tion.as provided fpr ro swum,37(X1 p[to Labor Code,for the perfornwrce of the ODS D
w fur which tis permit is issued. FI A eV
_ ❑7 1 have and will maintain he pall s Compensation Insurance,as requirtd by Section
My ache Labor Celeron the peon carrier
work for which tis permit isi sued. GA. 1 U OCC.GROUP . APN
My Wary�Is CCyy,, pp Pion ln9u nc carrierone,N..1,W�l,rwrr• e
CarricraLdlJ�i 4a(� IN�NrPnlicy Na.:-F]G(�oYao4 G Q� a ,
CERTIFICATE Of'EXEMPTION FROM WORKERS'
. COMPENSATION INSURANCE G SMNDUSTN TG INT
Glux seeinn nwd not be compleed iftc permit is Forane hundreddallnrs(8100) BUILDING DIVISION FIiPS
ft
or lcsW - G E .
PLANCHECK PEE
Ieenify thin in da,perl'onnuncc oflhe walk for which this permit is issued,lshnll SP Y-STD 3A
not employ any Retain many manner suits m become fall to the Workers'Compen- ENERGY FEE'
Oz cation laws of Califnroia.Date WATE H[ATL'R N
z O Applicant - EE
w+ y rNOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should 6TCMRRG 1
a "become subject I. he Worker a Compensation pnwisionx of the Labm Cale,you must " SOILS IEE
.W
forthwith comply with such provision,or this pem,il shall be deemed revoked. WATER SERVICE.
ate '
U CONSTRUCTION LENDING AGENCY
agency NEW RESIDENTIAL PLMB. SQ.FT. ID
UO I for which
termite isncnnswainnknding agency for the performance of Date Receipt#
U to work for which this permit is issued(Sec.91191,Civ,Cd
O l-t Lender',Name TOTAL:
U finders Address TOTAL:
I certify that I have read this application and state that the above informant,a is BUILDI FEE
trZcancer.1 agree m comply with all city ane county nedinnnces true stain Inwx relating m QTY. MECHANICAL PERMIT PEE
U ,4a. building construction,and hereby authorize representatives of this city m enter upon the SEISMICF
oMve-mentioned property for impection purpnsex.
(We).9.to save,indemnify and keep hamless the City of Caperton against PERM IT ISSUANCE ELECTRIC FE -"
lialditicx,judgmems,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MF.CH.
in eomainence of the granting(if this permit. PLUMBING iT.H _
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITITO Iq(XIO CPM)
SOURCE REJG I1p,ATIONS. MECHANICAL FEC
MO-/ L.. 9�3/O / AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCIONTAX
9ignu0nc of ApplicnnJComn,eor f ale b 'EXHAUSTHOOD(W/DUCT) HOUSING MITIGATION P.H
HAZARDOUS MATERIALS DISCLOSURE
Will to applicant or future building creation store orhandle hazardous material HEATING UNIT DO 100,000 BTU)
as def ned by to Cupertino Munici al Care'
Chapter 9.12,and the Health and Safety
Code.Section 25532(a)1 HEATING UNIT(OVER 100.000 B'T'U)
E:1 Vic,
Nn
VENTILATION PAN(SINGLE RHSID) PAID
Dam Receipt It
Will the applicant or furore building by the B use equipment Qu or devices which BOILER-COMP(3HP OR 100/IIID BTU
emit District?
us air conmminan efned by 0e Bay A.Air Quality Managcmem )
District, BOILER-COMER,(OVER 100,00011FID t TOTAL,
[I Yes Nn
I have read the haurdom macrialsAIR CONDITIONER ISSUAN
requiremma under Chapter 6.95 of the Cali- -
fomia Health&Safety Code,Section,25505,25533 and 25534.1 understand that ifthe NEW RESIDENTIAL MECH. SQ.ET.
building does frictionally have a tenant,that it is my responsibility m notify tc wcupant
f the bey bwhich must he incl primmisuonce ata Ce (Occupancy. , ..
z 1Ecm j_y
Owner or autpnuJ agent Date TOTAL: ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 4/7/97
PERM U$ t$STREE oT NS[ E P — SI 1 "1
9435 19310 PRUNERIDGE R MECH 3/14/96 3/14/96 CC 2 P
9435 19310 PRUNERIDGE FRAME 3/22/96
9435 19310 PRUNERIDGE SHEETRK SCREW 3/22/96
9435 19310 PRUNERIDGE FRAME 3/25/96 3/25/96 CC 2P
9435 19310 PRUNERIDGE SHEET SCREW 3/25/96 3/25/96CC 2 P
9435 19310 PRUNERIDGE SHT SCRWS 3/26/96 3/26/96 CC 2P
9435 19310 PRUNERIDGE FRAME 4/1/96 4/1/96 CC 2P
9435 19310 PRUNERIDGE UNDRSLB ELECT 4/1/96 4/1/96 CC 2P
9435 19310 PRUNERIDGE UNDRSLBPLBG 4/1/96 4/1/96 CC 2P
9435 19310 PRUNERIDGE SHEETRK SCREW 4/3/96 4/3/96 CC 2 P
9435 19310 PRUNERIDGE RGHPLMBG 4/8/96 4/8/96 CC 2P
9435 119310 iPRUNERIDGE FRAME 4/9/96 4/9/96 CC 2P