29678APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OFFICE
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING MECHANICAL
BUILDING PROJECT IDENTIFICATION
PE"`TN0 2 9 ^ 7 8
`4J Vh 1/ �XJ
BUILDINGADDRESS: -
a
d[loOWNER'S
SANITARY NO.
APPLICATION SUBMITTAL DATE
o q
NAME: /J-, PHONR:
r9CTl�/—LT
ONTRA R'$N -R:. _ LIC NO:
NIC
❑
C'ONTROLp
R IT /ENGINEER: LIC NO:
DD:5k_ r
Si-
]Cy
O p
Y�F
QUU
A � til
7m
jvi'z
L1"0
3 u7
�yU
'j
L m
6�1,
L 3..
CONTACT: PHONE:
TA
❑ Consultant Fres Paid by Applicant (Initial)
BUILDING PERMIT INFO
BLDG PLUMB MECH
LICENSED CONN RACTOR'S DECLARATION
I hereby affirm mall am licensed under provisions Of Chapter 9 (commencing
with Section700(hof Division 3o[the Business and Professions Code, and my license isin full
Classme ellen.
Littnu Class - Lic.g
License
Dam Contractor -
QTY ELECTRIC PERMIT FEE
AB DESCRIPTION
RESIDENTIAL:
❑SFDWL O KITCHEN REMODEL
❑ADDITION El PLUMBING RE -PIPE
❑MULTLUNI'F [I STRUCTURAL
MODIFICATION
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT ,
❑BATH RCMODF.IJRF,PAIR (] DEMOLITION
[]OTHER
PERMIT ISSUANCE
APPLIANCES -RESIDEN'FIAT.
- ARCHITECTS DECLARATION
Iunderstand rayplium,hill Mused ox public re cords
PANELS
DP T021111AMPS
Licensed ProfessionalODECLARATION
1 hereby afftnn that I am exempt frothe ContractorLicense Law for the
am m
fOilowingnason, Section1031,5, Business and Professions Code: AnycilymcnunlySIGNS
which rectums. permit to construct, alter, namesc, demclUhrm repair any doiclu e
prior to ie issuance, also requires the applicant for such Permit to file. signed statement
thin he is licensed pursuant to the previsions ofthe Contractor's License Law (Chapter 9
mrmmencm9%ftb Scellon]INMI)olDivision 3 ofthe Business and Professions Code)or
that he is exempt Therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a pemai subjects the applicanuo a civil penalty Of
not more man five hundred dollars (S500),
as owner ofihe propeny, or my employees with wages as their sole compensation,
wlll do the work, and the mmcmre k rat uncoiled Oroffered fur sale (See. ](94, Busincxs
and, Prmfessi... Cash: The Contractor's License Lvw does not apply to an owner of
property who builds or improves merton, and who does such work himself Or Through
his own employees, provided That such improvements are not intended m olYered lits,
sale. lE however. the buildingof improvement is sold within nneyean I completion, the
owner -builder will have the burden of proving that he did not build or improve for par
Pass of sole ),
❑ has owner of The property, am exclusively convening with licensed,mil actors m
mmswct the project (Sec. ]044. Business anA Professions COde11'1'hc Contru<wrs..i-
cense Law does not apply to an owner of property who build or improves thereon.and
wno contracts for such projects with a commomdo licensed pursuanno the Cbmmnols
License Law.
I am exempt under Sec. ,H&P C immix recon
201-1000AMPS
OVER 1000 AMPS's
ELECTRICAL
SPFCIALCIRCUIT/MISC.
IEMP. METER OR POLE INST.
COMMERCIAL:
❑ NEW BLDG/ADDTTION ❑ DEMOLITION
❑TENANT ❑ FOOD SERVICE
IMPROVE
❑ OTHER
-
POWER DFVICES
SWIMMING POOL C1RIC �"!
OUTLETS -SW S -FIXTURES
NH4W RESI a llA '1. SQ FT.
SQ. IT FLOOR AREA
e ® A
/` �A
O
�h '996
L`r^ {l
S/SQ. IT.
7 - 1
QTY. PLUMBING PERMIT FEF
PERMIT ISSUANCE
AFTER - GRAIN & VENT - WAFER (HA)
Owner Date
VAIAATIOIF
WORKER'S COMPENSATION DF.CIARATIONV
1 hereby ammo under penalty of perjury one Of the insum for Jcda Workeis Co
❑shave and will maintain eCertificate700 ofine sent to Labor Cor forma immune Cn of er-the
action, as hick the for mi Section 3]W t(tbe Labor Code, forma performance of m<
k which this permit is issued.
wor have and will maintain Worker's Compensation mrequired by Section
3]00 ofthe Labor Code, for the perfnnnance ofthe work for for which which this permit is issued.
My Worker's CO ti Iaey,cW and Policy numM1y�ar� xS
Cartier: L�YL GOM/ PO,icYN..: L�`�T J-7-001.6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nil Mcompleted if the permit is human hundred dolls. ($1001)
or less) -
I certify thin in the performance ofthe work for which this permit is issued, l shell
not employ any Person in any manner so as m Income subject no the WOrkeri Compen-
canon Laws of California. Date
Applicant
BACK FLOW PROTECT DEVICE
z
O O
rj1
'l
y 0
J O
9r H
O (~
}
..(n
.�7,
DRAINS - FLOUR, ROOF.AREA, COND.
STORIES
OCC.GROUP
'
TYPE CONSTRUCTION
APN
FIXTURES -PF.R'fRAP
GAS - EA. gYSTEM-1 INC. 4OUTLETS
GAS - EA. SYSTEM -OVER 4(EA)
GREASFJINDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCHECK FEE
SEWER - SANITARY - STORM EA. 2011 FT.
IWERGY HE
WATER HEATER WNENT/ELECTR
GRADING FEE
..
NOTICE TO APPLICANT: IL after miring this Certiffecle of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code, you most
forthwith comply with such provisions Or this pevnil shall be deemed revoked.
CONSTRUCTION LENDINGAGENCY
iso ed( SectionlenCis. agency for the performance of
by which
then permit
wick
the Leaduek i'or which this permit is issued (Seo. 9119], Civ. CJ
Lenders, Name
WATER SYSTEMG REAPING
WATER SERVICE
-
SOILS FEE
PAID
NEW RESIDENTIAL PLMR. SQ.
Dam Rreeiplg
TOTAL:
.Lenders Address
TOTAL:
BUILDING FL'G
I certify that I have real this application coil stem thin the above information is
consist. I agree to comply with all city and county ordinances and state laws relating to
building conx0umitmand hereby amhnrim representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities. judgmems, costs and expenses which may in tiny way came against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WIL 0 NWITH ALL NON -POINT
SOURCF,REGU ATIhNS.
QTY, MFCHANICALPERMIT FEE
SEISMIC FEE
PERMIT ISSUANCE
ELECTRIC FEE
ALTER OR ADD TO MECH.
PLUMBING HE
AIR I ANDLING UNIT (TO IftnJO CPM)
MECHANICAL FEE
AIR HANDLING UNIT (OVER NO W CFM)
CONSTRUCTION TAX
Signore. VConveaor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous marerful
as defined by the Cupertino Municipal Code, Chapter 9.12, end the Health and Safety
Crile, Section 25532(a)]
[2 Yes ❑No
Will the app onto in nts a deflding by them ane ea Air Qu or Manan which
isthavrdous air contaminants as defined by the Bay Area Air Quality Manngemenl
District?
❑Yes 0 N -
I have read The haeardmu.s materials requircnmms under Chapter 6,95 of the Cali
fomia Health & Safety Cole, Sections 25505.25533 and 25534. 1 understand Nut if the
building does not currentant
currently have a me, that it is my responsibility to notify the Occupant
Of the repnirements which most M mel on, isnuamv Of a Cmifieute Of Occupancy.
EXHAUST HOOD(W/DUCD
HOUSING MITIGATION FEE
HEATING UNIT (TO UI BTU)
HEATING UNIT (OVER 100,000 BTU)
PAID
VENTILATION PAN (SINGLE RESID)
Dale Receipt is
BOILER - COMP (3HPr OR IOO,WU BTU)
TOTAL:
BOILER - COMP (OVER I(g.1ID013.1'U)
AIR CONDITIONER I
ISSUANCE DATE
ISSUED BY:
NEW RESIDF.NTIAh MECtI. $Q. FT.
Owner or amhorized agent I Dam
TOTAL
OFFICE
•
BoKx I0
BLOODHOUND ELECTRICAL SERVICES, INC.
255 SUNOL STREET . SAN JOSE, CA 95126 . OFFICE NO. (408) 271-9080 FAX NO. (408) 271-9087
February 20, 1996
City of Cupertino
Building Division
10300 Torre Avenue
Cupertino, CA 95014
Re: 21690 Rainbow Court
Cupertino, CA
To whom it may concern:
The following megger ground resistance test was performed and the results are as
follows:
• Meggered- #4/0 Subfeeds from the 400 amp main switch to the two -200 amp
subpanels. Results: From ground to each conductor read oo .
• Meggered- #8 Conductors for pool equipment all conductors to ground
read oo .
Results showed no shorts, open conductors, or broken down insulation.
Sincerely,
Frank Podesta