B 0119 r APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OP CUPERTINO BUILDING-VI EC'1'NICAI, PERMIT NO.'90119 0
IIUILDINO DIVISIDN APPLICATION/PERMIT PLUMBINGRODE HCHANICAI.
9UILDING PROdt:LT IIXENTIFICATIUN
NUILDINGADDR SANI'T'ARY NO. APPLICA'rIDN SUnMITTAI,DAR
(V
9�
XWN 'SNAME: PHONE: CONTRA 'S NAME: LIC NO'.
I � � 9 NIC ONTR LM
IITECf : GINEEIt: / LIC NO'. -- ADDREti1; f ❑ D
CONTACT: PHONE: - BUILDING PERMIT INFO_
❑ Consultant Fees Paid by Applicant(Initial) RL ELECT PI-UM/B MECH
'f/5 / S� R [+a' L✓J
LIC SED CONTNACfOR'S DECLARATION QTY RICEE HLECTPERNIFF F
1 ncrchy afersoma 1 am licensed under pmvitimm err elapmr 9lcommencing JOB DESCRIPTION
WQµ]aZ with Seelfo190011 .ON,romr3ofthe Uo,mI,,md1 Professions Code,and my license is I
n full aneffect. PERMIT ISSUANCE
ill fdff
Y]" SFDWL ❑KITCIIIiN RFbfOUIiL
aUZV License Class Conti APPLIANCES-RESIDENTIAL ❑AUDITION [I PLUMBING RFs-1'11'13
�dRDate Cmmmctor
'D. A CIIFECI"S LARATION PANELS ❑MULTI-IJNIT ❑STkUC'I'URAf.
ZOmZ lun r y assh Ibeuse, spuldwomords MODIFICATION
OZ=� UlIT02MAMPS [I INTERIOR C1 CHIMNEY REPAIR
Lice...d ZA o I✓ F.CLARATION 201-11"AMPS IMPROVI;MENT �SWIMMIN .POOLS
a4. ..I OWNER-RUILDER OVER lWUAMPS El BATH BEM ODEl/REPAIR CUENICIA PION
m
6 I her mon that I aexempt from he Contractor's License Law for the
X�6U follmving tc:
in.(Section 7031.5,business and Professions Code:Any city or county SIGNS ELECTRICAL [IOTHER
3 p. which requires a permit to consumer tdmo improve,demobsl,or repair any stmctim
F�Oe prinrro its l.usuance,also requitev me applicant for Imb genniuolile vsigncA ntamment SPECIAL CIRCUIT/MISC.
�ythrheislicenselpyyrsuam nr the mmviainns ofthe Commcmts LicenseLwlChupter9
w1'Qn0 (commencing with lection 7")of Division 3 ofthe business and Professions Cade)or TEMP.METER OR POLE:INST COMMERCIAL:
A.yy thin lie is exempt therefrom and the basis for the alleged exemption.Any violation of Cl NEW BI,DGIEMOLD'ION
Section 9031.5 by any applicant for a permit suhjects lheappliennt 1o.civil penalty mf POWER DEVICES —�-
u1"^n OTENA ❑F '(VICE
�.zp, nounore than rive hundred dollars(S500). _ IMP ..EME
p^�Q 0I,as ownernfthe progeny.or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC
Sp will dothe work,and the structure is not intended or offered furmle(Sm.9DU,Business
W en and Profeadons Cade:The Commetor's License Law does no apply rot an owner of OITI'LETS-SWITCHES-FIXTURES
prolrotty who hands or Improves thereon,and who dies such work httrtelf or[Enough i '
his own employees,provided that such improvements are not intended nr oRemd for NEW RESIDENTIAL ELECTR SQ Fr.
sale lL however,the building or improvement is xnlJ within one year of contgletion,the .FL /SBE 10S
ownef-huilder will have the burden of proving that he did not build m improve for par- l/'�
'ase vitiate.).
1,as owner of the progeny,am exclusively contracting with licensed contractors m TOTAL:
summer the projmt(Sec.7044,business end Professions Cai The Li-
xeLawdoesnotapplytornownerofpropertywhobuildsorimprovesthemr.anJ QTY, 'PI,I1M91NGP MIT PEE ,
who commms or such projects with a oomnamr(O licensed pursuant w the Contractor's
n
License Law. ., PERMIT ISSUANCE
lam exempt under Sec. ,R&PCfor this reason
- ALTER-DRAIN&VE '-WATER DIA7 VALUATION.
Date
WORKER'S COMPENSATION DECLARATION RACK FLOW PN .DEVICE D coo
1 hereby affirm under penalty of perjury one of the following declarations: Cl
lhuvennd will meront aCerircac ofConsennn self-insure for Works/t Compen- DRAINS-FL00 ,ROOP,ARG,C(1ND.
,.tion,as provided for by Section 3900 of the Labor Code.but the perfnrnance of the STORIES TYPE CONSTRIIC'i'ION
work for which this permit is issued. FIXTURES- NTRAP
1 have and will maintain Workers Compensation Insurance,as required by Section
3700 ofthe Labor Code,forthe performance ofthe work for which this permit is issued. GAS-EA YSTEM-I INC.4 OUTLIUS t C.GROUT' N'N
My Worker's Cnmprool o t Inaumnce curler and Policy number ore:
Carries put icy N., GAS- A.SYS'IEM-OVER4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GN ASMNDUSTRL WATIT INTERCEPTOR
(TMs,ammo need nm heriondral ifthe penial is for.,,.hundred dollar,($I W) A91JILDING QIV ISION PP.E9
or less.) IEASETRAP PI NCHECK FEE
I muify that in the Performanceofrhe work for which this permit is issued.l shall SEWER-SANI'T'ARY-S'FORM EA.2W FT. p
not employ any petters in any manner so as to become subject to the Workers'Cmmpen. (ENERGY 193E l
z satin.Laws &CAlfomia.Dam WATER HHA'1'ER W/VENT/FLF.CTR py�G F.P
Applicant - GRAF#'
Tr, NOTICE TO AI'I'LICANP.If,after making Nis Ccnifcate of Exemption,you xhoulJ WATER SYSTEMITRI&TING
f" become subject m the Workse,Compensation provisions of the Labor Cafe,you mu SOILS FEE
fedQ forthwith comply with suchpro,bionsorthispemitshallheJecmedrevoked. WATER SERVICE Nis au
�L CONSTRUCTION LENDING AGENCY NEW RESIDfENTIAL PLMIL SQ.Fr l'r
U Ihereby union,that there is a construction lending agency for the perfect ncof Dam a tptp
the work for which this peratil is found(Sri.3097,Civ.C.) Cil Vn
Lt•tF LONarly Name `
s' nrlrn T'O'TAL:
V Lender's Address TOTAL: y
'>• W4 1 verify that I have read this,,firairlia..yy
hat the alms information is - -- BUILDING FEE 0
.�. Z) comer l agree m comply w an all city and coues andit mwarclaingm QTY. MECHANICALPERMIT' FEE
U��.. building cnnsvnainn,and ofthisytoenmrupunnc. SI3ISMIC PEE
above-mentioned property for inspection PropoPERMIT ISSUANCEie y mf C.,vmno.,mn ELECTRIC Flit:liabilines,judgmems.emsand expenses which y acro,against said Cityg1a'lik OR ADD TO MGCII.in...sequenccur te gmalit n his pcnnir PLUMBING PETEAPPLICANT UNDERST ND AND WILL WI'f11 ALL NUN-POINT AIR HANDLING UNIT('1'0 Ir"CFM)
M1i[NSTRUCAI.FEF.
SOURCE k' I.ATIONS.
AIR HANDLING UNIT(OVER In,(XXI CFM) CONSTRUCTION TAX
Signor lieu IC at c r - Date EXIIAUS'F 11000(W/DUCT) HOUSING MITIGATION ITS
DE US MATP IALS DISCLOSURE
r rhe app cauturfaurelmildl mcupantnomorhandleha ousmatedal 1117ATING UNIT(TO BOOK TIED
as def d by the puminu Municipal alq Clapton 9.12,and the Hmhh and Safety
ODiarml
ala, ration 25532(1)9 1 IHAI'ING ONE I'(OVER 100,050 In U)
C]Yea ❑No PAID
VENTILATION FAN SINGLE RESID) Dare Receipt#
W d the applicant or fuer building by the B use equipment or device which BO[I CIt COMP(3FIPOK I00,MO IFI'U1
it laznrdbtu air cmnami as dclinnl by the 13ay Area Air Quality Management T(YI'A �r (�
❑Yes FIN. BOILER-COMP(OVER I(0,0(1I1 RTE/)
have ruin the aaNnlsrwtanr
++(tt¢mirenx antler Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DAT
Forms Health&Sa Code SectJi6m 2. 05,25533 and 25534.I undersurd that if Ne
humid, If sum nIy have ..I
at it is my responsibility to notify the mecupant NCW RFSIDENTIALMECII. SQ.EL
IF
there rem, s hkh mostbe or to issuance of.Certificate of Occupancy. �
Owner 1!7 age i Daf�e TOTAL: ISSUED BY: Al
OFFICE
Inspection Query fooppecfic Permit 81250
JOW-tv
PERMIMIS,�TJUVST-S�ITVS_:ST -INSDE&C .I R
B0119 1 RESULTS T-BAR 6/18198 6/18/98 CC 2P P
80119- --T---kE--S-ULTS—&G-5----6/22/98--6/22/98CC�-1p
ABV GRID/ELECT
80 1191 RESULTS 5 ABV GRID/MECH —6/22/98 6/22/98CC 3P P
B01_19 1 RESULTS CEILJFRAME 6/22/98 6/22/98 CC 3P P
B0119 _1 RESULTS —T-BAR/ELECT 6125/98 6/25/98 DS 2P
80119 I—RE—SULTS T-BAR MECH 6/25/98 6/25/98 DS
80119 _1 ME—SULTS —FRAMING/WALL 6/25198 6/25/98 DS- 1p
80119 1_RESULTS ELECT-R
6/25/98 6/25/98 DS —2 P
B0119 1 RESULTS SHEETRK SCRW 6/29/98 6/29/98 JS —20
130119—1—RESULTS —FRAME/BLDG 5 —717/98—7R/98 DS- 2P
B0119 1 RESULTS SHEETRKJBLDG5 717/98 7/7/98 DS 1F
60119 1—RESULTS T-BAR ELECT/PARTIA —7/7/98—7/7/98 DS_—1 P
1301 19 1——RESULTS T-BAR MJE_CH/PARTIA 7-17/98 DS —
7/7/98 2P P
60119 1—RESULTS DRYWALL 7113/98 7/13/98 JB 2P
B0119 1 RESULTS CEILING GRID 7/15/98 7/15/98 DS 3 P_P
B 0 1 T9_1—RESULTS —CEILING 7/22/98 7/22/98 CC 1F
80119 1—RESULTS —FRAME 8/17/98—AD i P___
BO 1 T9 1—RESULTS —ELECT 8/17/98 8/17/98 AD 1p
B0119 1 RESULTS——PLBG 8/17/98 8/17/98 AD
60119 1—RESULTS _lVIECH 8/17/98� 8/17/98AD _FP
60119 1 RESULTS DRYWALL—SCREW 8/19/981 8/19/98 DS 2 P_
60119 1_RESULTS SCREW 8124/981 8/24/98 DS —2
Page 1
r
• Inspection Query fops pecfic Permit 2/24/99
S:� Sin&T igATEDESiRE at Dad U il N
B0119 1 RESULTS T-BAR 6/18/981 6/18198 CC I 2P P
80119 1 RESULTS BG5 ABV GRID/ELECT 6/22/98 6/22198 CC 1
80119 1 RESULTS 5 ABV GRID/MECH 6/22/98 6/22/98 CC 3P P
80119 1 RESULTS---CEIL1FRAME 6/22/98 6/22/98 CC 3P P
80119 1 RESULTS T-BARIELECT 6/25/98 6/25/98 DS 2P
80119 1 RESULTS T-BAR MECH 6/25198 6/25/98 DS
B01119-1 RESULTS FRAMING/WALL 6/25/98 6125/98 DS 1 P
B0119 1 RESULTS ELECT-R 6/25/98 6/25/98 DS 2 P
B0119 1 RESULTS SHEETRK SCRW 6/29/98 6129/98 JS 2 P
B0119 1 RESULTS FRAME/BLDG 5 7/7/98 717/98 DS 2 P
80119 1 RESULTS SHEETRK/BLDG5 7/7/98 717/98 DS 1 F
80119 I RESULTS T-BAR ELECT/PARTIA 7/7/98 7M7/98 DS 1 P
r
/9
--WESULTS T-BAR MECH/PARTIA 7/7/98 1/78 DS 12 P P
B10119 1
E—1 RESULTS DRYWALL 7/13/98 7/13/98 JB 2P
30119
80119 1 RESULTS CEILING GRID 7115/98 7/15/98 DS 3P P
80119 1 RESULTS CEILING 7/22/98 7/22/98 CC 1 F
B0119 1 RESULTS FRAME
8/17/98 AD 1 P
B0119 1 RESULTS ELECT 8/17/98 8/17/98 AD 1
80119 1 RESULTS PLBG 8/17/98 8117/98 AD 1 P
B0119 I RESULTS MECH 8/17/98 8/17198 AD 1 P
B0119 1 RESULTS DRYWALL SCREW . 8/19/98 8/19198 DS 21P
B0119 1 RESULTS SCREW 8/24/981 8/24/98 DS 2P
B0119 1—MESULTS ELECTRICAL, BLDG 5 10120/981 10/20/98 DS 21P
Pagel